Conditions

Understanding your condition

At Progression Muscle, Bone and Joint Clinic, our team can treat a wide variety of concerns you might have. On this page, we provide a list of 9 common conditions that we can help with:

Osteoarthritis (OA)

What is Osteoarthritis?

Osteoarthritis (OA) first shows itself as a change to the biological processes within a joint, followed by abnormal changes to the joint, such as the breakdown of cartilage, bone reshaping, bony lumps, joint inflammation and loss of joint function. This can result in pain, stiffness and loss of movement.

There are certain factors which make some people more vulnerable to developing osteoarthritis such as genetic factors, other joint disorders (such as rheumatoid arthritis), prior injury to the joint from accidents or surgery, being overweight or doing heavy physical activity in some sport or occupation. (Research User Group, Institute of Primary Care and Health Sciences, Keele University, UK)

OA is a result of the body’s failed attempt to repair damaged joint tissues. For most people this damage can occur when otherwise healthy joints are exposed to heavy workloads over a long period of time. However, for some individuals whose joints are formed differently or who have experienced a previous joint injury, even normal workloads can accelerate joint damage. Being overweight or obese is also a contributing risk factor.

There is currently no cure for OA. However, there are many ways to manage the symptoms and improve function. Management can include a combination of self-management strategies, strengthening and mobility exercises, medications, treatment by healthcare professionals such as Physiatrists, Physiotherapists and Kinesiologists who specialize in orthopedic care and for severe OA, possibly joint replacement surgery.

Prevalence

OA is the most common form of arthritis affecting nearly five million Canadians (one in six people). These numbers are increasing and an estimated one in four Canadians will have OA by 2035, with a new diagnosis every 60 seconds. OA affects more Canadians than all other forms of arthritis combined. Hip and knee osteoarthritis are among the most common types of Osteoarthritis.

The risk factors for knee and hip osteoarthritis are:

Systemic risk factors for knee/hip OA include increasing age, female gender, excess body weight, physical inactivity and family history.

Local risk factors for knee/hip OA include a previous joint injury, knee joint malalignment, abnormalities in gait biomechanics, and muscle weakness.

Natural history

Osteoarthritis (OA) usually progresses slowly over a period of months or years. Early on, osteoarthritis symptoms tend to come and go. However, over time as damage accumulates, symptoms can become more constant, occurring both at rest and disrupting sleep. The good news is that symptoms can improve with treatment, even if the disease process itself is unchanged.

The joints most commonly affected by osteoarthritis are the knees and hips, but it is also common in the big toes, hands and spine. OA affects everyone differently, but common symptoms include joint pain, aching, morning stiffness lasting less than 30 minutes, reduced range of movement in the affected joint(s) and possibly swelling or inflammation. The symptoms may come and go, but the intensity of pain can increase over time given that OA is a progressive disease.

Symptoms

Common osteoarthritis joint symptoms within the joint include:

Pain

Your joint may hurt during heavy use and improve with rest. As the disease progresses, the pain may be triggered by increasingly ordinary activities and may become unpredictable, occurring at rest and during sleep. The pain you feel may not necessarily match the degree of arthritis as seen on an x-ray. Pain is a complicated process affected by what is happening inside your joint as well as factors outside of your joint, such as surrounding muscle strength, genetics, physical activity, sleep and mood

Stiffness

The joint may become stiff after not moving it for a while, such as when you wake in the morning or sit for a longer period of time. This stiffness usually lasts 30 minutes or less. If you find it lasting significantly longer, check with your doctor.

Swelling

You may notice an increase in the size of the affected joints. This can be from an increase in fluid in the joint (inflammation), or from a bony outgrowth (often found in affected finger joints and big toes).

Crepitus/joint sound

You may feel a grinding sensation or notice a “clicking or popping” sound when the joint moves.

Instability

Joints like the knee or hip may feel like they are giving way or buckling.

Loss of function

The joint does not function as well as it should. This can be due to pain or reduced movement of the affected joints:

Hips – you may have difficulty with daily activities like walking, getting in or out of a car, or putting on your shoes.
Knees – you may have difficulty with activities like walking, getting up from a chair, squatting, kneeling or climbing stairs.

Common osteoarthritis joint symptoms outside the joint include:

Sleep disruption

OA symptoms may disrupt your sleep, which in turn can make your symptoms feel worse, and reduce your capacity to cope.

Altered mood

OA symptoms can have a negative effect on your mood. Mental health issues like depression and anxiety are significantly more common in people living with chronic pain and can in turn worsen pain and negatively impact your overall health.

Fatigue

It is common for people with severe pain from OA to experience high levels of fatigue (extreme tiredness, exhaustion).

Decreased quality of life

OA symptoms can make it harder for you to keep up with the activities and relationships that make your life enjoyable, affecting your overall quality of life and your ability to do things you want to do.

Pain sensitization

Some individuals with OA experience more severe symptoms from a process called pain sensitization, which comes from abnormal pain processing by the central nervous system. It’s as if the ‘volume knob’ on your pain system has been left turned up like a radio stuck on ’loud.’ As a result, you may feel exaggerated pain in response to a painful trigger, pain in response to a non-painful trigger e.g. light touch, or ongoing pain in the absence of any trigger.

Your feelings of pain may extend beyond the boundaries of the joint and become widespread (such as up and down your affected leg). You may also experience nerve symptoms such as tingling and shock-like sensations. See your doctor to check if these symptoms are from your arthritis, or from another cause. It is very important to understand that you can ‘turn the volume down’ on your pain as you progress through self- management strategies such as regular exercise, optimal sleep and stress-reduction techniques, but it often takes effort and time. Medications that target the central nervous system may also be beneficial. Your healthcare provider can help to guide you in this process.

Concussion

We’ve all heard about them… and quite frankly, the word concussion can strike a lot of concern in people. This information is to help you understand what is going on, what will happen if the proper steps are taken, and how you can achieve a positive outcome despite how you currently feel. At PBJ, your rehabilitation team members (physiotherapist, occupational therapist, kinesiologist, and other medical team professionals) are here to help guide you and make sure you are on the right track!

Give Me Some Good News

The most recent guidelines from the Ontario Neurotrauma Foundation state that with proper early education and support, the likelihood of a resolution of concussion symptoms will occur within a few days to 1-3 months in the vast majority (80-85%) of people! Depending on the severity, you will be encouraged to get moving and get back to your normal day to day activities (as per the guidelines which will be outlined with you). The whole “stay in a dark room until you feel better” mentality has fallen out of favour and can be detrimental to your progress.

What is a Concussion?

A concussion is defined as “an acute neurophysiological event related to blunt impact or other mechanical energy applied to the head, neck, or body (with transmitting forces to the brain), such as from a sudden acceleration, deceleration, or rotational forces” (ON NTF Clinical Guidelines, 3rd version).

Typically, a concussion will exist without showing any evidence of intracranial injury on conventional imaging (i.e CT scan or MRI) or persistent neurological deficits. Despite lack of findings on imaging, you can still feel not quite yourself. Typical symptoms include physical, cognitive, emotional or sleep changes or disturbances that may evolve within minutes to hours after impact.

What Exactly Happened To My Brain?

With the injury there is typically an acceleration, deceleration or rotational force that occurs (or a combination), which causes trauma to the neurons. The trauma causes swelling and disruption of the axon (the information highway of the nerve) which then causes disruption to the metabolic and involuntary goings-on in the brain.

The end result is a change in the chemical signaling in the brain which causes decreased energy production in the brain and therefore a decrease in neuron signaling. No wonder you feel “off”.

What are the Typical Signs and Symptoms of a Concussion?

Physical:
Headache
Fuzzy/blurry vision
Dizziness
Fatigue
Drowsiness
Sensitivity to light or noise
Balance issues
Nausea/ vomiting

Cognitive:
Difficulty thinking clearly, concentrating, or remembering new information
Feeling slowed down

Emotional:
Irritability
Sadness
Feeling more emotional
Nervousness or anxiety

Sleep:
Sleeping longer or shorter than usual
Trouble falling asleep

What Will My Assessment Look Like?

Your physiotherapist will meet with you to see what is going on. The assessment will include a medical history and specific testing of your cranial nerves, eyes, neck and overall strength and mobility. Your kinesiologist will assess your balance and endurance. Your occupational therapist will assess your memory, mood, sleep and how you feel.

When Can I Get Back To School/Work? What About Sports?

But Why Can’t I Play Sports?

Second Impact Syndrome is a rare but potentially critical condition that can occur in those who have had one head injury, haven’t fully healed and then get a second head injury. Potential for disability is imminent (100%) and mortality is very high (50%) so the delay of return to sport is important. The good news is that there is a difference in return to exercise and return to sport, so you can get active while avoiding head injury.

What Do We Know About What to Expect?

The significant majority (approx 85%) of people will fully recover from a sports-related concussion within 3 months, with a large percentage within 7-14 days (McMroy P et al. 2016 & Hebert O et al., 2016)

Those with persistent symptoms at 1 month should be referred to an interdisciplinary concussion team for further assessment and treatment (Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms, 3rd ed.).

Younger kids/adolescents may take up to 1 month for full recovery (Weinstein et al., 2013)

How Do I Keep Track of How I’m Feeling/Doing? I Don’t Have a Baseline Measurement

Your concussion rehab team will give you certain “outcome measures” (tools to keep track of your symptoms and well-being) to keep track of your progress. Baseline measurements can be helpful (especially for athletes or those participating in sport) but not to worry, they are not a necessity and we can measure your improvements without a baseline.

Key Points to Remember

The majority of people (approx 85%) get better within the first few weeks after a concussion with the proper education and guidance.

You will get better and you have a team of professionals to help you understand what is going on and get you moving.

Follow the guidelines and forget about hiding out in a dark room. Gentle mobility, sunlight and light stimulation will help you get better, faster!

Other Conditions We Treat

Back Pain

Shoulder Pain

Hip and Knee Pain

Elbow, Wrist & Hand Pain

Neck Pain and Headaches

Foot and Ankle Pain

Pre & Post Surgical Rehab

To find out which specialist you should see, give us a call and select Option 1.

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