Orthopaedic Conditions

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
Unique individual areas:

Elite Athletic Populations:  Sports injuries result from active trauma or continued stress associated with athletic activities. These injuries can affect bones and/or soft tissue. It is important to remember that many types of injuries affect not only high level athletes but also individuals who participate in recreational sports.

Tempero-mandibular Dysfunction:  This is a specific joint know as the “jaw” that requires a coordinated approach between dental and physiotherapy disciplines. An advanced level of orthopaedic knowledge is required to effectively treat this joint which often involves or has contributions from the head, face, and neck.


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

Ergonomic Assessment

This is a science that deals with designing and arranging physical work environments so that people can use and interact with them easily and safely. This allows individuals to work in environments that foster healthy movement patterns. Changes in ergonomic environments facilitates return to work and modifications to repetitive work places.

Return to Work Evaluation

A return to work evaluation is a tool for rehabilitation facilities to proactively help injured employees return to productive employment in a timely and safe manner. The priority is to return the employee to the position, normal routines, and work place he or she was in prior to absence. The treatment is intended to be transitional and has a fixed duration. Physiotherapists perform assessments and provide objective data and recommendations on the specific level of function of individuals and their return to work capabilities.

Functional Capacity Evaluations

This is a systematic method of measuring an individual’s ability to perform meaningful tasks in a safe and dependable basis. The purpose is to collect information about functional limitation of a person with medical impairments.

Conditioning Programs

Specific exercise programs tailored for individual patients to restore movement, flexibility, strength, and general overall function.  These programs permit individuals to return to activities of daily living or work with a level conditioning appropriate for the performance of these activities or work tasks.

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.

Lymphatic Massage Therapy

What is Lymphatic Massage, Lymphatic Drainage, and Manual Lymph Drainage?

This is a technique developed in Germany for treatment of lymphedema, which is an accumulation of fluid that can occur after lymph nodes are removed, damaged, or traumatized in certain types of surgery for melanoma, colon or prostate cancer for example. Other methods where lymph nodes can be damaged are by radiation treatment, infection, or trauma. Lymphedema can be present at birth or develop for unknown reasons at puberty or during adulthood; this type of lymphedema is called primary lymphedema.

The Lymph System

Most of us are familiar with the body’s vessel system that carries blood to the tissues, but there is another equally important system of vessels that remove cell waste, proteins, excessive fluid, and viruses and bacteria. The lymph system picks up fluids and waste products from the capillary vessels and then filters and cleans them. Lymph vessels are found throughout the body; most of them, about 70%, are found just below the skin. While this superficial system requires the need for gentle massage techniques or pressure applied by manual massage, the deep lymphatic system is drained by muscle contractions and/or exercise.

Additional Therapies that can Work in Conjunction with Lymphatic Massage

In addition to lymphatic massage, patients can be advised to do self massage following instructions from their therapist, as well as light exercises to encourage the flow of lymphatic fluid out of the affected limb. Some patients are also advised to wear compression garments such as sleeves or stockings designated to compress the arm or the leg and encourage lymphatic flow out of the limb. The combination of these therapies plus the lymphatic massage is called decongestant therapy (CDT).

Although a lymphatic massage is seen to be most beneficial after damage to the lymph system, there can be certain conditions with associated complications that benefit from lymphatic massage therapy. After a sports injury, surgery, lymph vessels can become overwhelmed with the demand placed on them, especially when activity is limited and the soft tissue is painful to deep tissue work. Lymphatic massage can also be a part of a care program for fibromyalgia, chronic fatigue syndrome, because of its gentle approach and being well tolerated by these patients. There is little evidence of any effects of manual lymph massage for conditions of insomnia, memory loss, obesity, or for antiaging effects.

Practitioners of Lymphatic Massage?

Lymphatic drainage and massage practitioners may be physicians, nurses, physical or occupational therapists, or massage therapists. In addition to their traditional course work, most require additional instruction in lymphedema therapy. Guidelines for training and qualified therapists have been established by the Lymphology Association of North America, American Academy of Lymphatic Studies, and the Lymphedema Association of Manitoba.



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