Orthopaedic Physiotherapy

Orthopaedic Physiotherapy is the oldest branch and is orientated towards the treatment of muscle and skeletal conditions. It involves restoration of appropriate function of joints and their surrounding structures and the normalization of biomechanics following injury. It is important in the following:

  • restoration and improvement of joint mobility or range of motion
  • restoration and improvement of neuro-muscular function and performance
  • treatment of inflammation
  • treatment and repair of connective tissue
  • education and prevention of injuries
  • improvement of postural impairments/restriction


Persistent Pain

Persistent pain can be associated with many medical conditions seen by physiotherapists. In situations where appropriate time has elapsed to adequately heal the affected structures, persistent swelling, decreased mobility, and dysfunction remain.

As a result, pain persists with the severity and duration of this pain fluctuating and without any correlation to level of activity.  This pain can persist for many years following infections, trauma, stressful events, or emotional triggers from the past. Often clinical signs are minimal and tests are negative.

Some conditions that may result in persistent pain are complex regional syndromes, phantom limb pain, carpal tunnel, neuropathic pain, upper and lower extremity pain after injury and/or trauma, persistent pain following traumatic head injury.


Research in pain science states that our body is resilient and pain is an output—not always indicative of further harm or serious pathology. Explaining the nature of pain involves the brain and alternate approaches to therapy to effect outcome.


Concussion:  What is it Exactly?

A concussion is a brain injury that can affect how your brain works.  Concussions may happen because of a hit to the head, face, neck, or somewhere else on the body.  When a hit takes place, the brain moves back and forth inside the skull.  If it moves enough, the brain can become injured.  This can make your brain and body work and feel different.

How Can I Tell if I Have Had a Concussion?

Everyone’s concussion experience is different and not everyone reacts the same way.  For some people, concussions heal quickly, and for others, the road to recovery is longer.  Scans or images will show how a concussion impacts brain activity.  Physical tests can assist with determining which areas may be more effected.  It can be difficult to predict how long a concussion will last.

For additional information, visit www.hollandbloorview.ca/concussion

Orthopaedic Treatment Descriptions and Benefits

Orthopaedic Manual Therapy

Orthopaedic Manual Therapy is a specialised area of physiotherapy/physical therapy which deals with the assessment, diagnosis and management of neuro-musculoskeletal conditions using specific treatment approaches such manual techniques (including manipulation) and therapeutic exercises based on clinical reasoning. This knowledge and understanding in Orthopaedic Manual Therapy is informed by available scientific and clinical evidence and the psychosocial state of individual patients.

Extensive education and advanced clinical training and skills in the area of othropaedics and manual therapeutic treatment techniques following an entry-level physiotherapy program are needed to work as an orthopaedic manual therapist. The Orthopaedic Division, a sub-division of the Canadian Physiotherapy Association (CPA) as well as other post-secondary institutions, provide post-graduate courses and instruction in Orthopaedic manual therapy.


Individuals who have completed extensive post-graduate education and have attained internationally recognized qualifications in manipulative therapy may become Fellows of the Canadian Academy of Manipulative Physiotherapy (FCAMP). The International Federation of Orthopaedic Manipulative Physical Therapists (IFOMPT) represents groups of Manipulative Physical Therapists around the world who have completed stringent post-registration/post-graduation specialisation programs in the field of neuro-musculoskeletal disorders. This federation sets educational and clinical standards in this area of physical therapy.

manippt.org  noigroup.com  |  ifompt.org


General Acupuncture

Involves inserting thin needles into specific places on the body called acupuncture points. It is used for treatment of acute and chronic pain, muscle spasm, tenderness, and headaches. Acupuncture works by stimulating the body’s neuroendocrine system to produce its own natural pain relieving chemicals called endorphins, pain relieving neurochemicals.

Dry Needle Acupuncture

Dry Needling is performed by Western Medical Practitioners using acupuncture-type needles to treat the musculoskeletal and nervous systems based on modern neuroanatomy science.

How does this improve function and reduce pain:

  • Dry Needling of muscular trigger points causes relaxation through disruption of the motor endplate.
  • Tiny injuries created by the needle insertion causes a local healing response in the painful tissue, which restores normal function through the natural healing process.
  • Dry Needling stimulates neural pathways which block pain by disrupting pain messages being sent to the central nervous system.
  • Dry Needling causes a local chemically medicated response through the release of body proteins and neurotransmitters, which block the transmission of pain messages.
Electrical Stimulation

This is a technique where electrical stimulation is applied in a specific pattern to create an increase in pain modulation for larger areas and create more generalized pain control.


Cranial Sacral Therapy

Cranial Sacral Therapy is a form of alternative therapy using therapeutic touch to manipulate the synoarthrodial joints of the cranium. Practitioners believe that this manipulation regulates the flow of cerebrospinal fluid. This therapy was developed by John Upledger, D.O. in the 1970’s and this is used to achieve deep relaxation and increase endorphins brought on by the endocrannabinoid system.


Fascial Stretching/Muscle Release (Including Visceral Work)

Fascia is a band or sheet of connective tissue, primarily collagen, beneath the skin that surrounds your muscles and other internal organs.  Fascia is classified by layer-superficial, deep, and visceral fascia (organs). The fascial qualities return the body to the original position after being elongated. Excessive repetitive movements or trauma can increase the density of this connective tissue resulting in impairment to movement, circulation, and lymphatic flow. Mobilization of this tissue increases the biomechanical efficiency of the body.

Work Related Programs

  1. Ergonomic Assessment
  2. Return to Work Evaluation
  3. Functional Capacity Evaluations
  4. Conditioning Programs