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Sports Medicine

INJURY ASSESSMENT

The medical staff at The Sports Clinics are all MDs who have chosen to focus a large part of their practices in sports medicine. They work as a team to facilitate early expert opinion on patients with sport- or exercise-related injuries.

They work in concert with a group of therapists and use various methods including physiotherapy, osteopathic technique, chiropractic, massage therapy, athletic therapy, sports psychology and homeopathy. The collective effort of these doctors allows for better co-ordination of treatments and more efficient and reliable services for our patients.

IMAGING

Many injuries are more clearly understood by using some form of imaging. X-rays are common and used to detect bone injury or change. They do not see soft tissues.

Bone scans are highly sensitive to bone and some soft tissue changes. They may highlight stress fractures or other subtle changes in tissue or bone.

• CT or CAT (Computerized Tomography) scans provide minute detail of body parts, particularly in bone but also some soft tissues. These scans are high in radiation.

• MRI (Magnetic Resonance Imaging) scans are used to assess bone and soft tissue pathology when it is not clear on examination. No radiation is involved.

The above procedures are very expensive and used only when advanced diagnosis or surgery is required.

 

CONCUSSION MANAGEMENT

The medical community is often asked, "Have concussions become more common lately?" The answer is both yes and no...

In recent years, concussion awareness has increased dramatically. 

A "bigger, faster, stronger" trend has become commonplace across many sports and hence the risks of all injuries to athletes have increased.

We have noted a significant increase in the diagnosis and management of head injuries at TSC since early 2011. As a result, we have assembled a team of physicians and therapists to manage concussion using a standardized protocol derived from the latest concussion consensus. 

At TSC, we use the SCAT3 assessment tool (click here for PDF) to assess athletes and follow a graded protocol for full return to play. We encourage anyone at risk to obtain a pre-season "ImPACT" test as this makes our return to play decisions more accurate.

As a coach, trainer or parent, if you suspect an athlete of having suffered a head injury, he/she should be removed from play immediately. If symptoms persist, the athlete should be prohibited from participation in any sport and assessed by a physician. We recommend no physical or cognitive activity until all symptoms disappear. This may involve keeping the player out of school. Return to play should be a gradual process after all symptoms have disappeared and should never be rushed. The experience of a first concussion puts the individual at slightly higher risk of a second concussion - particularly if they return too soon.

 

VISCOSUPPLEMENTATION

A recent addition to our service offerings designed to manage osteoarthritis is viscosupplementation / hyaluronic acid preparations (e.g. Monovisc, Durolane, Synvisc, etc.). These fluids are injected into the affected joint, usually giving relief for 6 to 18 months.

These substances are natural to the body, acting largely as a lubricant to provide better mobility and pain reduction. They are non-toxic, and have no significant side effects. If you experience osteoarthritis, speak to one of our health care professionals to determine whether or not viscosupplementation is appropriate for you.

 

PLATELET RICH PLASMA (PRP)

Platelet Rich Plasma injections are a new approach to healing tissues using your body's own regeneration factors. No drugs are involved and it can be done directly or under ultrasound guidance.

 

What is PRP?

Platelet Rich Plasma is created by the centrifuging of blood taken from your own body. The fluid, which contains a very high concentration of many healing factors, is injected by a physician into the area of concern. The injection must be done without anesthetic and, hence, the procedure can be uncomfortable.

 

Are there any foreign substances or drugs used?

No. This is simply your own blood being injected into the area of concern. Spinning of the blood allows us to separate out the plasma, which has a very high concentration of growth factors.

 

What are these growth factors?

There are actually many factors as a result of centrifuging the blood. Growth factors work on damaged tissue to encourage or accelerate healing.

 

How much blood needs to be drawn?

Usually 15 to 30 cc of blood (about 2 to 3 tablespoons) is drawn. This is done using a butterfly kit to maximize the extraction process.

 

What conditions is PRP typically used for?

PRP has many applications. It may be used to encourage repair of torn tissues. For example, a partially torn Achilles tendon or rotator cuff muscle could benefit from PRP injections. PRP is also used to treat arthritis, arthrofibrosis and many other conditions.

 

How effective is PRP?

PRP is relatively new, particularly in its application to sport injuries. Studies show conflicting results and very few large double-blinded studies are available. That being said, PRP has been used effectively by many high profile athletes over the years with good results. At TSC, our experience and patient feedback regarding PRP has generally been very positive.

 

How will I know if PRP would be helpful for me?

Speak to one of our sport physicians and they will be able to advise you. Most conditions should receive a more standard treatment to start, as PRP is often used for unresponsive problems.

 

What does PRP cost?

The cost of PRP injections will vary depending on the size of the area of concern. Typically, two or more treatments will be necessary; these are approximately 4 to 6 weeks apart. The cost of PRP is not covered under your provincial health plan but there may be some coverage under your extended health benefits.

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Physiotherapy

ABOUT PHYSIOTHERAPY

As primary health care professionals, we combine our in-depth knowledge of anatomy and body function with specialized hands-on clinical skills to assess, diagnose and treat symptoms of illness, injury or disability. At TSC, The Sports Clinic, all of our physiotherapists are professionally certified and regularly participate in advanced courses in manual therapy to study the most current treatments and techniques being adopted in our industry. Our practitioners strive to provide you with the unique skill set and proven treatment methods needed to help successfully rehabilitate your injury.

With your optimal health and independence in mind, we take a holistic approach to treatment. Assessments performed at our clinic examine your entire body. Here's why: There exists an intricate connection between all parts of the human body. The body therefore should be viewed as a "whole", rather than in isolated sections. Since there is a correlation between all of the body's systems, the health of one system can ultimately affect the others. Health care providers need to acknowledge the complexity and interconnectedness of the human body in order to provide solutions that will truly heal our patients. At The Sports Clinic, our goal is to restore, maintain and maximize your strength, function, movement and overall well-being by treating the source of your pain rather than the symptoms.

When you make an appointment with one of our physiotherapists, we will spend the entire duration of your appointment with you. You will not sit with an assistant, a heat pack or a machine! We pride ourselves in our work and will spend the necessary one-on-one time with you while you are in our clinic.

Our physiotherapists promote a proactive, self-management approach to your rehabilitation. We prescribe personalized therapeutic exercises, and provide you with essential education about your body, what restricts your motion, how to restore your mobility and independence, and how to avoid or prevent bodily harm.

At TSC - The Sports Clinic, we are always happy to answer your questions. Contact the clinic with any questions you may have, or to book a session with one of our physiotherapists.

MANUAL THERAPY

Orthopaedic Manual Physical Therapy is a specialized area of physiotherapy for the management of neuro-musculo-skeletal conditions, based on clinical reasoning, using highly specific treatment approaches including gentle, hands-on techniques and therapeutic exercise. 

Manipulative Physiotherapy also encompasses, and is driven by, the available scientific and clinical evidence and the biopsychosocial framework of each individual patient. 

At the Sports Clinic all Physiotherapists have been trained in advanced manual therapy techniques which include the use of manipulation. Manipulation is a high frequency low amplitude mobilization technique used to restore Range of Motion, relieve soft tissue tension, and decrease pain. 

FCAMPT stands for Fellow of the Canadian Academy of Manipulative Physiotherapy. It is the designation given to Physiotherapists who have completed extensive post-graduate education in the area of orthopaedics and have achieved internationally-recognized qualifications in hands-on manual and manipulative therapy. 

The most common path to achieving this designation is through the Orthopaedic Division of the Canadian Physiotherapy Association. This program involves approximately 4-6 years of post-graduate study, including roughly 150 hours of mentorship with another FCAMPT Physiotherapist, 6 course-based written exams, one National written exam, and two National Practical exams

All Physiotherapist at the Sports Clinic have achieved or are working towards their FCAMPT status.

SHOCK WAVE THERAPY

What exactly is Shockwave Therapy (aka Extracorporeal Shockwave Therapy or ESWT)?

Shockwave Therapy is a relatively new technology using high speed shock waves to treat chronic musculoskeletal problems. It is an intense short wave energy beam aimed at chronic problems, which are resistant to standard treatments. The original shock wave machines required local anesthesia to minimize the pain of the treatment, however this is no longer necessary. 

 

What is the origin of shockwave?

Shockwave was initially developed in the treatment of kidney stones (lithotripsy) in a hospital setting. The overwhelming effectiveness of this therapy in hospitals led to its introduction in clinics, where it has been beneficial for managing difficult musculoskeletal problems. Shockwave Therapy has proven to be very effective in our sport medicine practice.

 

How does shockwave work?

ESWT produces an inflammatory response at the site being treated. It induces microtrauma to the tissue affected. This treatment induces an inflammatory response, which in turn causes healing factors. Repeated treatments to the affected area will accelerate the formation of new blood vessels (neovascularisation), thus initiating the healing process.

 

How long are the treatments? How many treatments are needed?

Generally speaking, most treatment sessions last no longer than 3 to 4 minutes. Patients typically experience some minor pain but it is tolerable and does not continue after the treatment is completed. In most cases, 3 to 4 sessions are required. Occasionally, patients with chronic or very difficult conditions may require more treatments.

 

What conditions are shockwave used to treat?

Many conditions can be managed by more traditional therapies. More unyielding problems (such as those listed below) generally respond well to ESWT.

Plantar fasciitis (heel spur syndrome)

Achilles tendonopathy (tendonitis)

Rotator cuff problems

Shin splints

Bursitis

Trigger points

Jumper's knee

Tennis and golfer's elbow (epicondylitis)

 

Are there any conditions where Shockwave Therapy should not be used?

ESWT should not be used when any of the following conditions are present:

Cancers

Pregnancy

Open growth plates in children

Coagulation problems or treatment

Cortisone shots up to 6 weeks prior

Infected areas

Blood clots

Is shockwave covered by insurance?

Check with your extended health benefits provider. This treatment is administered by a registered therapist and may be fully or partially covered. It is not covered by OHIP (or other provincial health plans).

 

How do I know if shockwave would be effective for me?

Our physicians are able to help you better understand the process of Shockwave Therapy and to determine whether the treatment is appropriate for you. Please book an appointment with one of our sport physicians to enquire further.

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Osteopathy

LEARN ABOUT OSTEOPATHY

Osteopathy is the art and science of manual therapy treatment. The aim of osteopathy is to reposition the bones, muscles, organs, viscera and glands to give them the freedom to function better.

 

Dr. Andrew Taylor Still, the founder of osteopathy, once said that "structure governs function." Dr. Still was suggesting that the human body and all of its unique parts can function correctly whenever those parts of the body are free to move.

 

Who can benefit from osteopathic treatment?

Osteopathic treatment is for people of all ages, from infants and children to teens, adults and the elderly. Even athletes in good physical condition can benefit from osteopathy. For any aliment that the human body endures, osteopathy can assist in augmenting the body's own healing abilities.

 

Does osteopathy only treat bones?

No. Unfortunately, the name chosen by Dr. Andrew Taylor Still does not represent the full spectrum of treatment offered by osteopathy. A well trained osteopath looks at all of the systems that make up the body and treats each one accordingly, for the overall health of the patient. For example, a low back problem may be triggered by other (seemingly unrelated) issues with bones, muscles, connective tissue or discs. One of the most common problems assessed and treated by an osteopathic practitioner are the mobility restrictions of various body tissues resulting from abnormalities in the abdominal viscera (organs in the abdominal cavity).

 

What is cranial osteopathy?

The biomechanics of numerous cranial articulations are consistent and logical. These intrinsic movements of the cranial membranes and micro-movements of the cranial bones can be examined and influenced (through touch) by a well trained osteopath. Osteopaths are trained in the phenomenon known as PRM (primary respiratory mechanism), which is the intrinsic movement of bone, organ, viscera or gland. The movement occurs as a result of the histological movement of an organ's fluid. Treatment is focused on normalizing these fluidic movements so that the system "breathes correctly." This is a very important treatment for anyone who has suffered head trauma or concussion as a result of a motor vehicle or other accident.

What is Craniosacral therapy?

Craniosacral therapy is a gentle hands on manual therapy technique that assesses and treats the subtle fluidic movements of the cranial and sacral bones, the meningeal connective tissue and the Fluids of the brain. This approach is used in combination with soft tissue and articular manual  therapy techniques to restore the overall balance of the of the body. Effective for concussion, vestibular and headache management. 

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Athletic Therapy

WHAT IS A CERTIFIED ATHLETIC THERAPIST?

A Certified Athletic Therapist works within the guidelines and Code of Conduct set out by The Canadian Athletic Therapists Association (CATA). Athletic Therapists work cooperatively with other members of a health care team to maximize the performance and welfare of the individual. An Athletic Therapist promotes an environment conducive to optimal healing to prepare patients for the safe integration into an active lifestyle. AT TSC, our Athletic Therapists utilize a variety of techniques including therapeutic modalities, contemporary rehabilitative techniques, physical reconditioning, and supportive strapping procedures.

The Scope of Practice of a Certified Athletic Therapist includes the assessment, prevention, immediate care, and reconditioning of musculoskeletal injuries. Prevention includes musculoskeletal and postural evaluation, warm-ups, conditioning programs, prophylactic or supportive taping, and adaptation to activities and facilities.

The provision of on-field immediate care of athletic injuries by a Certified Athletic Therapist includes:

• Injury assessment.

• Basic emergency life support.

• Recognition and management of acute traumatic neurological dysfunction.

• Provision of first aid.

• Preparation for entrance into appropriate health care delivery systems.

• Utilization of techniques facilitating a safe return to participation.

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Acupuncture

ACUPUNCTURE THERAPY

Acupuncture involves the insertion of fine sterile needles into specific points on the body to achieve a therapeutic effect. These acupuncture points are found along meridians or channels in the body through which energy (or "qi", pronounced "chee") flows. The needles can be rotated manually or stimulated electrically. Acupuncture helps to control pain, reduce inflammation and swelling, increase range of motion, and normalize imbalances in the autonomic nervous system. Many conditions may be treated by acupuncture, including acute strains/sprains, chronic pain, nerve pain, and headaches.

All of our practitioners administering acupuncture have completed over 100 hours of training and education through the Acupuncture Foundation of Canada Institute or McMaster University Contemporary Medical Acupuncture Program.

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Massage Therapy

ABOUT MASSAGE THERAPY

Massage Therapy has become an increasingly acceptable treatment for reducing stress, decreasing muscle stiffness or pain, and injury rehabilitation. A variety of massage techniques work the superficial and deeper layers of muscle and other soft tissue to promote relaxation, improve function and assist in healing. Massage Therapy can improve circulation and help decrease swelling. The benefits of massage are not restricted to muscular issues such as insomnia, constipation and sinus pressure can all be treated with massage therapy. Prenatal massage is known to benefit pregnant women by alleviating pain and discomfort in all trimesters. 

Most extended health benefit plans offer coverage for massage services when provided by registered massage therapists. Contact us today to book an appointment at TSC - The Sports Clinic.

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Chiropractic

CHIROPRACTIC MEDICINE

Chiropractic is a non-invasive, hands-on health care discipline that focuses on the neuromusculoskeletal system providing diagnosis, treatment and preventive care for disorders related to the spine, pelvis, nervous system and joints. There are many reasons to seek chiropractic care including back pain, neck pain and headache.

CHIROPRACTIC/ART - ACTIVE RELEASE TECHNIQUES

ART is a form of soft tissue therapy that treats the entire neuromusculoskeletal system (muscles, ligaments, nerves, fascia). This hands-on technique involves movement of the particular area being treated while the practitioner releases any tension with specific direction of his/her contact. Active release brings oxygen/blood flow to the injured area to aid with healing mechanisms and breaks down and realigns haphazard scar tissue to improve function of the neuromusculoskeletal system and to decrease pain.

It can help with conditions such as shoulder impingement, nerve entrapment, tension/cervicogenic headaches, plantar fasciitis, to name a few.

For practitioners to be certified to use this technique on all areas of the body, they must have completed at least three intensive 24-hour courses. 

For more information, please visit activerelease.com.

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Sports Nutrition

BETTER HEALTH THROUGH NUTRITION

The Sports Clinic provides a variety of services related to sports nutrition:

• Anthropometric/ Body Assessments/ Skin fold assessments

• Sport Specific Consultation (Individuals and Teams)

     - Endurance Sports

     - Team Sports

     - Bodybuilding/ Physique competitions

     - Power Sports

     - Much More!

• Nutritional Disease Management/ prevention

     - Diabetes Management

     - Cardiac Health Management

     - Osteoporosis

     - Wound Healing

     - Much More!

• Sporting Event planning and preparation (Individual and Team)

• Grocery Store Tours

• Nutrition Education Sessions (For groups, corporate groups and teams)

• Weight Gain/ Lean Mass Gain

• Weight Loss/ Toning

• Menu and Recipe Nutritional Analysis

• Body Transformations

• Healthy Aging

• Supplement Optimization

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Vestibular Rehabilitation Therapy

LEARN ABOUT VRT

Dizziness, vertigo, posture instability, poor balance, and nausea are all common chief complaints with vestibular(inner ear/balance) disorders.  Many times these symptoms are the consequence of disease, dysfunction, or maladaptation of the peripheral vestibular system. These changes can be assessed and treated to help restore symmetry, function or compensation in order to regain normal function. Our vestibular therapists have been certified through the world renowned intensive course at Emory University in Atlanta. Common conditions treated; Benign Paroxysmal  Positional Vertigo (BPPV), Vestibular Neuritis, Labyrinthitis, Meniere’s Disease, cervicogenic vertigo, central vertigo among many others.

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Pelvic Floor Rehabilitation

What is the Pelvic-Floor?

Many people suffer from pelvic floor dysfunction and yet it is hardly talked about. Most people don’t even know that there are muscles down there, let alone that these muscles have several incredibly important functions! They provide support to your pelvic organs against gravity and any increases in intra-abdominal pressure (ie. coughing, sneezing, laughing, lifting, transferring); prevent urinary and fecal leakage; assist in stabilizing the joints of your spine, pelvis, and hips; help with circulation; and, allow you to enjoy sex.

 

Pelvic-Floor Dysfunction & Therapy

Unfortunately, there are a lot of things that can happen throughout your lifetime that can cause dysfunction of these pelvic floor muscles. Perhaps, you have had a baby or two – which in itself is traumatic for the pelvic floor. Even more traumatic if there was tearing or an episiotomy, or if forceps or vacuum were used. Maybe you have suffered from chronic constipation or you strain constantly by heavy lifting in your job. Maybe you have chronic prostatitis/chronic pelvic pain syndrome, if you are a man. Perhaps you have had a bad fall in the past on your tailbone and still experience some tenderness with sitting. Or maybe you have already had some form of pelvic surgery. These are just some examples of risk factors that can contribute to pelvic floor dysfunction. We are often led to believe by our physicians and those lovely incontinence product commercials/ads that it is normal to leak after childbirth or as we age, or even that it is normal to have pain with sexual intercourse. Although these conditions are very common, it is a huge misconception to think that there is nothing you can do about them. 

Pelvic Floor Physiotherapy has been recommended time and time again in the literature as the first line of management for urinary incontinence and pelvic organ prolapse. It can also help people who suffer from pelvic pain and persistent low back and hip pain. Physiotherapists who have taken special post-graduate training in Pelvic Health can assess if your pelvic floor muscles are hypotonic (weak) or hypertonic (tight), and if they are contributing to your condition. This involves performing both an external and internal assessment. A hypotonic (weak) pelvic floor may contribute to stress or urge incontinence, and pelvic organ prolapse. A hypertonic (tight) pelvic floor may contribute to urinary and fecal urgency, urge incontinence, chronic pelvic pain, painful sexual intercourse, vaginismus, chronic prostatitis, interstitial cystitis, and pudendal neuralgia. Treatment is dependent on the assessment findings and may include external and internal soft tissue release, strength training, self-care education, and education on persistent pain mechanisms. It is important to understand that Kegels are not always helpful for pelvic floor dysfunction, and that they are often not done properly. When Kegels are indicated, internal palpation is the recommended technique for physiotherapists to understand, teach, and give feedback to patients.

 

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Concussion Management

MODERN CONCUSSION THERAPY

The medical community is often asked, "Have concussions become more common lately?" The answer is both yes and no...

In recent years, concussion awareness has increased dramatically. 

A "bigger, faster, stronger" trend has become commonplace across many sports and hence the risks of all injuries to athletes have increased.

We have noted a significant increase in the diagnosis and management of head injuries at TSC since early 2011. As a result, we have assembled a team of physicians and therapists to manage concussion using a standardized protocol derived from the latest concussion consensus. 

At TSC, we use the SCAT3 assessment tool (click here for PDF) to assess athletes and follow a graded protocol for full return to play. We encourage anyone at risk to obtain a pre-season "ImPACT" test as this makes our return to play decisions more accurate.

As a coach, trainer or parent, if you suspect an athlete of having suffered a head injury, he/she should be removed from play immediately. If symptoms persist, the athlete should be prohibited from participation in any sport and assessed by a physician. We recommend no physical or cognitive activity until all symptoms disappear. This may involve keeping the player out of school. Return to play should be a gradual process after all symptoms have disappeared and should never be rushed. The experience of a first concussion puts the individual at slightly higher risk of a second concussion - particularly if they return too soon.

 

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Shockwave therapy

LEARN ABOUT SHOCKWAVE THERAPY & BENEFITS

What exactly is Shockwave Therapy (aka Extracorporeal Shockwave Therapy or ESWT)?

Shockwave Therapy is a relatively new technology using high speed shock waves to treat chronic musculoskeletal problems. It is an intense short wave energy beam aimed at chronic problems, which are resistant to standard treatments. The original shock wave machines required local anesthesia to minimize the pain of the treatment, however this is no longer necessary. 

 

What is the origin of shockwave?

Shockwave was initially developed in the treatment of kidney stones (lithotripsy) in a hospital setting. The overwhelming effectiveness of this therapy in hospitals led to its introduction in clinics, where it has been beneficial for managing difficult musculoskeletal problems. Shockwave Therapy has proven to be very effective in our sport medicine practice.

 

How does shockwave work?

ESWT produces an inflammatory response at the site being treated. It induces microtrauma to the tissue affected. This treatment induces an inflammatory response, which in turn causes healing factors. Repeated treatments to the affected area will accelerate the formation of new blood vessels (neovascularisation), thus initiating the healing process.

 

How long are the treatments? How many treatments are needed?

Generally speaking, most treatment sessions last no longer than 3 to 4 minutes. Patients typically experience some minor pain but it is tolerable and does not continue after the treatment is completed. In most cases, 3 to 4 sessions are required. Occasionally, patients with chronic or very difficult conditions may require more treatments.

 

What conditions are shockwave used to treat?

Many conditions can be managed by more traditional therapies. More unyielding problems (such as those listed below) generally respond well to ESWT.

Plantar fasciitis (heel spur syndrome)

Achilles tendonopathy (tendonitis)

Rotator cuff problems

Shin splints

Bursitis

Trigger points

Jumper's knee

Tennis and golfer's elbow (epicondylitis)

 

Are there any conditions where Shockwave Therapy should not be used?

ESWT should not be used when any of the following conditions are present:

Cancers

Pregnancy

Open growth plates in children

Coagulation problems or treatment

Cortisone shots up to 6 weeks prior

Infected areas

Blood clots

Is shockwave covered by insurance?

Check with your extended health benefits provider. This treatment is administered by a registered therapist and may be fully or partially covered. It is not covered by OHIP (or other provincial health plans).

 

How do I know if shockwave would be effective for me?

Our physicians are able to help you better understand the process of Shockwave Therapy and to determine whether the treatment is appropriate for you. Please book an appointment with one of our sport physicians to enquire further.