shoulder physiotherapy

Shoulder Anatomy & Physiotherapy

The shoulder is an elegant piece of machinery. It has the greatest range of motion of any joint in the body. However, this large range of motion can lead to joint problems.

Understanding how the different layers of the shoulder are built and connected can help you understand how the shoulder works, how it can be injured, and how challenging recovery can be when the shoulder is injured. The deepest layer of the shoulder includes the bones and the joints. The next layer is made up of the ligaments of the joint capsule. The tendons and the muscles come next.

Burd PT Shoulder Anatomy

Important Structures

The important structures of the shoulder can be divided into several categories. These include:

  • bones and joints
  • ligaments and tendons
  • muscles
  • nerves
  • blood vessels
  • bursae

Bones and Joints

The bones of the shoulder are the humerus (the upper arm bone), the scapula (the shoulder blade), and the clavicle (the collar bone). The roof of the shoulder is formed by a part of the scapula called the acromion.

There are actually four joints that make up the shoulder. The main shoulder joint, called the glenohumeral joint, is formed where the ball of the humerus fits into a shallow socket on the scapula. This shallow socket is called the glenoid.

The acromioclavicular (AC) joint is where the clavicle meets the acromion. The sternoclavicular (SC) joint supports the connection of the arms and shoulders to the main skeleton on the front of the chest.

A false joint is formed where the shoulder blade glides against the thorax (the rib cage). This joint, called the scapulothoracic joint, is important because it requires that the muscles surrounding the shoulder blade work together to keep the socket lined up during shoulder movements.

Articular cartilage is the material that covers the ends of the bones of any joint. Articular cartilage is about one-quarter of an inch thick in most large, weight-bearing joints. It is a bit thinner in joints such as the shoulder, which don’t normally support weight. Articular cartilage is white and shiny and has a rubbery consistency. It is slippery, which allows the joint surfaces to slide against one another without causing any damage. The function of articular cartilage is to absorb shock and provide an extremely smooth surface to make motion easier. We have articular cartilage essentially everywhere that two bony surfaces move against one another, or articulate. In the shoulder, articular cartilage covers the end of the humerus and socket area of the glenoid on the scapula.

Burd PT Shoulder Ligaments

Ligaments and Tendons

There are several important ligaments in the shoulder. Ligaments are soft tissue structures that connect bones to bones. A joint capsule is a watertight sac that surrounds a joint. In the shoulder, the joint capsule is formed by a group of ligaments that connect the humerus to the glenoid. These ligaments are the main source of stability for the shoulder. They help hold the shoulder in place and keep it from dislocating.

Ligaments attach the clavicle to the acromion in the AC joint. Two ligaments connect the clavicle to the scapula by attaching to the coracoid process, a bony knob that sticks out of the scapula in the front of the shoulder.

A special type of ligament forms a unique structure inside the shoulder called the labrum. The labrum is attached almost completely around the edge of the glenoid. When viewed in cross section, the labrum is wedge-shaped. The shape and the way the labrum is attached create a deeper cup for the glenoid socket. This is important because the glenoid socket is so flat and shallow that the ball of the humerus does not fit tightly. The labrum creates a deeper cup for the ball of the humerus to fit into.

The labrum is also where the biceps tendon attaches to the glenoid. Tendons are much like ligaments, except that tendons attach muscles to bones. Muscles move the bones by pulling on the tendons. The biceps tendon runs from the biceps muscle, across the front of the shoulder, to the glenoid. At the very top of the glenoid, the biceps tendon attaches to the bone and actually becomes part of the labrum. This connection can be a source of problems when the biceps tendon is damaged and pulls away from its attachment to the glenoid.

The tendons of the rotator cuff are the next layer in the shoulder joint. Four rotator cuff tendons connect the deepest layer of muscles to the humerus.



The rotator cuff tendons attach to the deep rotator cuff muscles. This group of muscles lies just outside the shoulder joint. These muscles help raise the arm from the side and rotate the shoulder in the many directions. They are involved in many day-to-day activities. The rotator cuff muscles and tendons also help keep the shoulder joint stable by holding the humeral head in the glenoid socket.

The large deltoid muscle is the outer layer of shoulder muscle. The deltoid is the largest, strongest muscle of the shoulder. The deltoid muscle takes over lifting the arm once the arm is away from the side.


The main nerves that travel into the arm run through the axilla under the shoulder. Three main nerves begin together at the shoulder: the radial nerve, the ulnar nerve, and the median nerve. These nerves carry the signals from the brain to the muscles that move the arm. The nerves also carry signals back to the brain about sensations such as touch, pain, and temperature. There is also an important nerve that travels around the back of the shoulder joint to supply sensation to a small area of skin on the outside of the shoulder and motor signals to the deltoid muscle. This nerve is called the axillary nerve.


Blood Vessels

Traveling along with the nerves are the large vessels that supply the arm with blood. The large axillary artery travels through the axilla. If you place your hand in your armpit, you may be able to feel the pulsing of this large artery. The axillary artery has many smaller branches that supply blood to different parts of the shoulder. The shoulder has a very rich blood supply.



Sandwiched between the rotator cuff muscles and the outer layer of large bulky shoulder muscles are structures known as bursae. Bursae are everywhere in the body. They are found wherever two body parts move against one another and there is no joint to reduce the friction. A single bursa is simply a sac between two moving surfaces that contains a small amount of lubricating fluid.

Think of a bursa like this: If you press your hands together and slide them against one another, you produce some friction. In fact, when your hands are cold you may rub them together briskly to create heat from the friction. Now imagine that you hold in your hands a small plastic sack that contains a few drops of salad oil. This sack would let your hands glide freely against each other without a lot of friction.

Stretching and Physiotherapy

Stretching comes naturally to all of us. You might notice that if you have been sitting in a particular position for a long time, you stretch unconsciously. It feels good! In addition to that good feeling, a consistent stretching program will produce large gains in flexibility and joint movement.

What is Stretching?

The act of stretching is to extend or lengthen your body or limbs. Stretching helps you develop and maintain a healthy level of flexibility, which refers to the range of movement at any particular joint. Stretching is also referred to as flexibility training. Examples of stretches include: calf stretch, hamstring stretch, triceps stretch, and certain yoga poses and Pilates exercises. The Fitness Resource Center includes stretching routines, videos and stretching demonstrations.

Flexibility training is broadly accepted as a way to increase joint mobility. The goal of stretching is to optimize joint mobility while maintaining joint stability. Although research has shown that different stretching methods will improve joint flexibility, it should be noted that inappropriate stretching can cause injury. Recently, researchers have promoted the concept of a “functional range of motion.” This refers to developing just enough flexibility for a specific activity (or sport) without compromising joint stability.

Everyone should stretch, regardless of age, gender, or flexibility level. Stretching should be a part of your daily routine, whether you exercise or not. There are simple stretches you can do while watching TV, using the computer, or getting ready for bed.

What are the Benefits of Stretching?

Without regular stretching, your muscles will tighten and the range of motion in your joints will decrease as you age. This can put a damper on active lifestyles and even hinder day-to-day activities. Tasks that used to be simple, such as zipping up a dress or reaching for a can off of the top shelf, can become extremely difficult. A regular stretching program can help you to maintain your range of motion and make daily living activities easier.

Stretching does not demand a huge time commitment, but it can give you huge results! Here are some of the benefits you can expect from a regular stretching program:

  • Reduced muscle tension
  • Increased range of movement in the joints
  • Enhanced muscular coordination
  • Increased circulation to various parts of the body
  • Increased energy levels (resulting from increased circulation)
  • Delayed onset of muscle fatigue
  • Enhanced performance in daily life, sports, or other physical activity
  • Improved posture
  • Mental relaxation
  • Added variety, enjoyment, and satisfaction to your exercise program

Stretching is important for people of all ages! One of the greatest benefits of stretching is that you’re able to increase your range of motion, which means your limbs and joints can move further without discomfort or injury. Post-exercise stretching can also aid in workout recovery, decrease muscle soreness, and ensure that your muscles and tendons are in good working order. The more conditioned your muscles and tendons are, the better they can handle the rigors of sport and exercise, and the less likely that they’ll become injured.

What Influences Your Level of Flexibility?

There are four main factors that affect your flexibility level and ability to stretch:

Age. Younger people are naturally more flexible than older people. Why? Muscle connective tissues have a natural tendency to shorten and lose elasticity as you age, resulting in muscle tightness and stiffness.

Gender. Females on average tend to be more flexible than males.

Exercise history. Active people tend to be more flexible than inactive people.

Temperature. When your muscles are warm (whether from exercising or from a warmer environment), they will be more flexible than when they are cold. Why? Increase in muscle temperature decrease muscular resistance, which boosts your range of motion.


How Much Stretching Should You Do?

When considering the guidelines for aerobic exercise, keep the FITT principles in mind (Frequency, (Intensity, Time and Type).

Frequency: Number of stretching sessions per week

The more frequently you stretch, the more quickly you will gain flexibility. It is recommended to stretch all of the major muscle groups daily—or at the very least, each time you exercise (a minimum of 3-4 times per week).

Intensity: How deeply to stretch

Each stretch should be done in a slow and controlled manner, without bouncing or forcing, which can cause your muscles to tighten, increasing your risk of injury. Stretch in a slow, steady motion to the point of “mild discomfort.” If you are stretching to the point of pain, you have stretched too far.

Time: How long you should stretch

Ideally, most experts recommend that people stretch for 10-15 minutes per day. Hold each stretch for 15-30 seconds, repeating one or two more times, depending on how you feel.

Type: Activities that count as stretching


There are several different types of stretching. The methods described below will help you safely improve your level of flexibility. The two most common and accepted techniques for improving flexibility are static and PNF stretching.

Static stretching is a low-force stretch where the muscle is held at the greatest possible length for up to 30 seconds. This is probably the most common type of stretch, mainly because it benefits from being both effective and safe. SparkPeople’s Stretching Demos are all examples of static stretches.

PNF is short for Proprioceptive Neuromuscular Facilitation. This involves maximally contracting a muscle (usually with a partner or trainer who is trained in this technique) and then immediately doing a static stretch for the muscle. This type of stretching may be performed without a partner, although it is usually more effective with a partner’s assistance. In all cases, it is important to note that the stretched muscle should be rested (and relaxed) for at least 20 seconds before performing another PNF technique. There are two types of PNF stretches, Contract-relax (an isometric contraction of the muscle, followed by relaxing, then stretching to the point of limitation) and Contract-relax-agonist-contract (an isometric contraction of the muscle, followed by relaxing, stretching to the point of limitation, then contracting the agonist/opposing muscle, followed by a stretch to the point of limitation).

Passive stretching increases the range of motion by using an external force (like a partner, a wall or the floor). These stretches can be very useful in the development of stretching but care must be taken to ensure the stretch is not forced; it should remain within the realms of comfort at all times.

Active stretching involves assuming a position (or stretch) and then holding it there with no assistance other than using the strength of your “helper” muscles. When you lie on your back with one leg extended up in the air, for example, and continue to hold it there without any assistance you are doing an active stretch. Active stretching increases active flexibility and strengthens the “helper” muscles too. Active stretches are usually quite difficult to hold and maintain for more than 10 seconds and rarely need to be held any longer than 15 seconds. These types of stretches are frequently used in yoga.

Dynamic stretching involves controlled, gentle leg and arm swings that take you to the limits of your range of motion. There are no bounces or “jerky” movements. An example of dynamic stretching would be slow, controlled leg swings, arm swings, or torso twists. Dynamic stretching improves dynamic flexibility and is quite useful as part of a warm-up for an active or aerobic workout (such as a dance or martial-arts class).



What is traction?

Traction is a manual technique designed to reduce pressure on affected vertebral discs that are causing pain. Traction is a manual ‘stretching’ of the spine which reduces pressure on the discs and therefore reduces the individual’s pain.

Therapist using a foam roller to increase the efficacy of applied traction


How does traction help?

A disc is a circular structure that sits between each vertebra in the spine. It has a tough outer layer surrounding soft inner tissue. When a disc is under pressure and damaged, the tough outer layer is damaged and the soft inside protrudes through the gap. This protrusion compresses nearby nerves causing pain. Traction pulls the vertebra away from the disc, releasing the pressure on the disc. This assists the soft part of the disc to return within the disc. This decompresses the nerve and reduces pain. This also helps to rehydrate the disc.

Specialist Therepist applying traction to relieve pain and stiffness by stretch connective tissues

Who benefits from traction?
Traction can be beneficial for problems such as:

  • Herniated or prolapsed disc
  • Sciatica
  • Neck pain
  • Spondylitis
  • Spinal stenosis
  • Degenerative disc disease

Spectrum Physiotherapy

Contact Spectrum Physiotherapy today to more on how Traction can help with your physiotherapy rehabilitation.

Physiotherapy for Osteoarthritis

“Arthritis” is a term used to describe inflammation of the joints. Osteoarthritis (OA) is the most common form of arthritis and usually is caused by the deterioration of a joint. Typically, the weight-bearing joints are affected, with the knee and the hip being the most common.

An estimated 29 million people in North America have some form of OA.  Until age 50, men and women are equally affected by OA; after age 50, women are affected more than men. Over their lifetimes, 21% of overweight and 31% of obese adults are diagnosed with arthritis.

OA affects daily activity and is the most common cause of disability in the US adult population. Although OA does not always require surgery, such as a joint replacement, it has been estimated that the use of total joint replacement in the US will increase 174% for hips and 673% for knees by the year 2030.

Physiotherapists help patients understand OA and its complications, provide treatments to lessen pain and improve movement, and offer education about obesity and healthy lifestyle choices. You can contact a physiotherapy directly for an evaluation.

Research has shown that light to moderate activities such as walking, biking, and swimming can provide more benefits than harm to your joints, and promote weight loss. One study showed that just an 11-pound weight loss reduced the risk of OA in the women studied.


What is Osteoarthritis?

Your bones are connected at joints such as the hip and knee. A rubbery substance called cartilage coats the bones at these joints and helps reduce friction when you move. A protective oily substance called synovial fluid is also contained within the joint, helping to ease movement. When these protective coverings break down, the bones begin to rub together during movement. This can cause pain, and the process itself can lead to more damage in the remaining cartilage and the bones themselves.

The cause of OA is unknown. Current research points to aging as the main cause. Factors that may increase your risk for OA include:

  • Age. Growing older increases your risk for developing OA because degeneration and aging of the cartilage and synovial fluid increases over time.
  • Genetics. Research indicates that some people’s bodies have difficulty forming cartilage. Individuals can pass this problem on to their children.
  • Past injury. Individuals with prior injury to a specific joint, especially a weight-bearing joint (such as the hip or knee), are at increased risk for developing OA.
  • Occupation. Jobs that require repetitive squatting, bending, and twisting (eg, construction, landscaping, childcare) are risk factors for OA. People who perform jobs that require prolonged kneeling (eg, miners, flooring specialists) also are at high risk.
  • Sports. Athletes who repeatedly use a specific joint in extreme ways (eg, pitchers, football linemen, ballet dancers, runners) and those who engage in high-impact joint loading done in a repetitive manner (eg, running, jumping, landing on hard surfaces) may increase their risk for developing OA later in life.
  • Obesity. Being overweight causes increased stress to the weight-bearing joints (such as knees), increasing the risk for development of OA.

How Does It Feel?

Typically, OA causes pain and stiffness in the affected joint. Common symptoms include:

Stiffness in the joint, especially in the morning, which eases in less than 30 minutes
Stiffness in the joint after sitting or lying down for long periods
Pain during activity that is relieved by rest
Cracking, creaking, crunching, or other types of joint noise
Pain when you press on the joint
Increased bone growth around the joint that you may be able to feel
Caution: Swelling and warmth around the joint is not usually seen with OA and may indicate a different condition or signs of inflammation. Please consult a doctor if you have swelling, redness, and warmth in or around a joint.


How Is It Diagnosed?

Osteoarthritis is typically diagnosed by your doctor using an X-ray, but there are signs that may lead your physical therapist to suspect you have OA. Joint stiffness; difficulty moving; joint cracking, creaking, or crunching; and pain that is relieved with rest are typical symptoms. physiotherapists often use the American Academy of Rheumatology criteria for diagnosing knee OA, which lists the presence of pain, plus at least 3 of the following 5 criteria:

  • Age >50 years
  • Stiffness <30 minutes
  • Crepitus (a grinding/crunching sound emitted from the joint with movement)
  • Bone tenderness
  • Bony enlargement

How Can a Physiotherapy Help?

physiotherapy treatment has proven to be an effective treatment for OA, and may help you avoid surgery and use of prescription painkillers. Although the symptoms and progression of OA are different for each person, starting an individualized exercise program and addressing risk factors can help relieve your symptoms and slow the condition’s advance.

Your physiotherapist may:

  • Perform a thorough examination to determine your symptoms.
  • Observe what activities are difficult for you.
  • Design an individualized exercise program to address your specific needs and improve your movement.
  • Use manual (hands-on) physical therapy to improve movement of the affected joint.
  • Offer suggestions for adjusting your work area to lessen the strain on your joints.
  • Teach you aerobic and strengthening exercises to improve your movement and overall health.
  • Design and teach you a home-exercise program to improve your strength and movement.
  • Teach you an exercise program for safe weight loss, if you need to lose weight to ease pressure on your joints.
  • Recommend simple lifestyle changes that will help keep the weight off.
  • In cases of severe OA that are not helped by physiotherapy alone, surgery, such as a knee or hip replacement, may be necessary. Your physiotherapy will refer you to an orthopedic surgeon to discuss the possibility of surgery.

Physiotherapy For Posture Correction

What is postural realignment?

Postural realignment involves a postural assessment, advice about your posture and exercises to help you improve your posture. At Spectrum Physiotherapy, all of the physiotherapists will look at your posture in the treatment session. If it appears that postural problems are causing or adding to your problems and pain, postural realignment will be included as part of your treatment.

postural-realignmentAbove: postural-realignment
Postural assessment: identifying any tight or weak muscles that may be causing you to maintain a poor posture and also any joint stiffness or hypermobility that may cause poor posture.

Postural advice: this includes advice about correct sitting and standing positioning, moving and handling techniques that will help to improve your posture. The advice will be specific to you and therefore will consider your occupation, driving habits and other activities. This will allow you to implement our advice into your day. Exercises to improve posture: these are exercises that will help you to strengthen any weak muscles or stretch any tight muscles that are causing you to adopt a poor and maybe painful posture. Exercises are also given to loosen stiff joints, or provide more stability to those that are more mobile than they should do.

Our physiotherapists will teach you exercises to engage your postural muscles to help with alignment.Above: Our physiotherapists will teach you exercises to engage your postural muscles to help with alignment.

Who will benefit from postural realignment?

Anyone with a poor posture, muscle imbalance and pain will benefit from a full postural assessment and realignment. An optimum posture will help you to be more functional and reduce your pain levels.

There are different types of postural problems:

  • Kypholordosis: this is an exaggeration of the normal curves in the lower and upper back. This can cause weak neck, stomach, buttock and hamstring muscles. Your hip and back muscles may be tight and need stretching.
  • Flat Back: the natural curves of the back are lost causes the spine to be flat. This may result in weak hip and back muscles and tight hamstring muscles.
  • Sway Back: this is a forward tilting of your pelvis and may cause weak hip, back, stomach and neck muscles. Your hamstrings may also be tight.
  • Round Shoulders: this creates a hunched posture and causes the upper back muscle to be stretched and weak and your pectoral muscles to become tight.
  • Lordosis: an exaggerated inward curve of the spine causing some muscles to become tight and some to become weak depending on the location of the lordosis.
  • Kyphosis: this is an exaggeration of the outward curves in the spine which causes a muscle imbalance in the surrounding area.
  • Leg Length Discrepancies: this is a difference in the overall measurements between the two leg lengths. True leg length is a difference in the actual lengths due a discrepancy in bone lengths. Apparent leg length is due to soft tissue shortening around the pelvis, legs and ankle that makes the leg length appear different.
  • Scoliosis: a sideways curve of the spine that may be corrected by strengthening the back muscles that support the spine.
  • Poking Chin Posture: this posture can result in neck pain and headaches due to the muscle imbalance and stiffness around these areas.


Our therapists can advise you on effective techniques to improve your posture and prevent muscle tightness. Above: Our therapists can advise you on effective techniques to improve your posture and prevent muscle tightness.


What are the benefits of postural realignment?

Having a poor posture can cause a cycle of muscle imbalance and pain which is difficult to stop without intervention. Poor posture will cause you pain and this pain will make it difficult to regain an optimum posture without physiotherapy.

Having postural alignment as part of your treatment can produce many benefits including:

  • Reducing pain
  • Strengthening weak muscles
  • Stretching overused muscles
  • Loosening and strengthening stiff joints
  • Improving general posture
  • Improving function


At Spectrum Physiotherapy, the specialist physiotherapists will work with you to try and create the optimum posture and reduce your pain. They will carry out a full postural assessment and design a treatment program specifically for your needs.

heel spurs Newmarket

Physiotherapy for Heel Spurs

Heel pain is very common and often painful.  There are many heel conditions that arise from the wear and tear and stress on your heel bone. One of the conditions being heel spurs. A heel spur (or osteophyte) is a small bony growth or collection of bony growths on the back or underside of the heel. Fortunately, most of the time they are painless, and cause minimal discomfort and generally have no symptoms.

Heel spurs are often associated with plantar fasciitis, although similar, they are two completely different diagnoses. About 70% of patients with plantar fasciitis have a heel spur that can be seen with an X-ray. Usually, plantar fasciitis is followed by a heel spur.

Calcium deposits building on the underside of the heel bone is how a heel spur is formed.  This process take a long time to form. The cause of heel spurs are often caused by strains on foot muscles and ligaments, stretching of the plantar fascia, and repeated tearing of the membrane that covers the heel bone. Heel spurs are typically prevalent among athletes whose activities include large amounts of running and jumping.

The recommended treatment of heel spurs  is to rest from any physical activity, apply ice to heel area, and stretch the calf muscle and foot.  Stretches and exercise will help relax the tissues that surround the bone.  Going to a physiotherapist will help you take care of all heel spurs.  You may also take anti-inflammatory medication to help control the pain, and if pain worsen, an injection of cortisone. It is also important to be sure to wear well- fitting shoes.

Spectrum can treat your heel spurs, contact us today to learn more.

Physiotherapy for bicep tears Newmarket Ontario

Physiotherapy For Bicep Tears

A biceps tendon rupture occurs when the biceps muscle is torn from the bone at the point of attachment (tendon) to the shoulder or elbow. Most commonly, the biceps tendon is torn at the shoulder. These tears occur in men more than women; most injuries occur at 40 to 60 years of age due to chronic wear of the biceps tendon. In younger individuals, the tear is usually the result of trauma (such as an auto accident or fall). Biceps tendon ruptures can also occur at any age in individuals who perform repetitive overhead lifting or work in occupations that require heavy lifting, and in athletes who lift weights or participate in aggressive contact sports.

A physiotherapist help individuals regain flexibility, strength, and function in their arms following biceps tendon ruptures.


The shoulder is a ball-and-socket joint made up of 3 bones: the upper-arm bone (humerus), the shoulder blade (scapula), and the collar bone (clavicle). The ball at the top of the upper-arm bone is called the head of the humerus. The socket on the shoulder blade is called the glenoid fossa. A tendon is a fibrous bundle that attaches a muscle to a bone. The muscles and tendons of the rotator cuff hold the ball into the socket of the shoulder. The biceps muscle has 2 tendons that attach it to the shoulder and travel the length of the upper arm and insert just below the elbow. The biceps muscle is responsible for bending (flexing) the elbow and rotating the forearm. One of the tendons is called the “long head” of the biceps muscle; it attaches to the upper-arm bone. The second area of attachment is called the “short head” of the biceps; it attaches the muscle to a bony bump on the shoulder blade called the coracoid process.

Most commonly, the biceps tendon will tear at the long head of the biceps at the upper-arm bone, leaving the second attachment at the shoulder blade intact. The arm can still be used after this type of rupture, yet weakness will be present in the shoulder and upper arm. A tear can either be partial, when part of the tendon remains intact and only a portion is torn away from the bone, or complete, where the entire tendon is torn away from the bone.


After sustaining a biceps tendon rupture, you may experience:

  • Sharp pain in the upper arm or elbow
  • Hearing a “pop” or snap at the shoulder or elbow
  • Bruising and swelling in the upper arm to elbow
  • Weakness in the arm when bending the elbow, rotating the forearm, or lifting the arm overhead
  • Tenderness in the shoulder or elbow
  • Muscle spasms in the shoulder and arm
  • A bulge or deformity in the lower part of the upper arm (a “Popeye arm”)


In most cases, a thorough history and physical examination of the involved arm can diagnose a biceps tendon rupture. Your physical therapist will ask you several questions regarding your medical history, your regular daily tasks at home and at work, and your recreational or sports activities. Your physical therapist will ask how the injury happened and where you are having pain and/or weakness.

Your physiotherapist will examine your entire upper arm for bruising or swelling, and gently touch it to determine if there is any tenderness over the biceps region at the shoulder, upper arm, or elbow. Your physiotherapist also will examine the amount of motion and strength present on the involved side in the shoulder, forearm, and elbow, compared to the noninvolved side. Functional testing may also be performed to determine what daily tasks are difficult for you to perform (eg, lifting an object, reaching overhead, reaching behind the body, or rotating the forearm to open a door).


A biceps tendon rupture often is treated without surgery. Your physiotherapist will design an individualized treatment program to help heal your injury in the safest and most efficient way possible. Treatment may include:

Rest. You will be instructed in ways that allows the limb to rest to promote healing.

Icing. Your physiotherapist will show you how to apply ice to the affected area to manage pain and swelling.

Range-of-Motion Activities. Your physical therapist will teach you gentle mobility exercises for the shoulder, elbow, and forearm, so your arm does not get stiff during the healing process.

Strengthening Exercises. As the pain and swelling ease, gentle strengthening exercises with resistant bands or light weights will be added.

Functional Activities. You will learn exercises to help you return to the activities you performed before the injury.

Education. Your physical therapist will teach you how to protect your joints from further injury. You will learn how to properly lift objects once the arm is healed, and how to avoid lifting objects that are simply too heavy.


To prevent a biceps tendon rupture, individuals should:

  • Maintain proper strength in the shoulder, elbow, and forearm.
  • Avoid repetitive overhead lifting and general overuse of the shoulder, such as performing forceful pushing or pulling activities, or lifting objects that are simply too heavy. Lifting more than 150 pounds can be dangerous for older adults.
  • Use special care when performing activities, such as lowering a heavy item to the ground.
  • Avoid smoking; it introduces carbon monoxide into the body and leaves less oxygen for the muscles to grow and heal.
  • Avoid steroid use, as it weakens muscles and tendons.
physio for shin splints Newmarket

Physiotherapy for Shin Splints

What are Shin Splints?

Shin Splints is the common name for generalized lower leg muscle pain that occurs below the knee, usually along the bottom 1/3 of the tibia. They can be either on the inside or outside of the leg. Though they’re most often associated with running, the pain and annoyance of Shin Splints can affect basketball players, tennis players, dancers, or anyone who spends long hours on their feet. In fact, anyone who changes their routine too quickly, adds too much, or doesn’t warm up properly can develop them.

What causes Shin Splints

The muscles on the front portion of our lower legs tend to be weak. And repetitive stress from running constantly aggravates them. If you’ve begun increasing your mileage, gone from a flat route to a hilly one, aren’t stretching enough, or are wearing shoes that don’t provide enough support, you can end up in pain.

Weaker muscles on the front legs, combined with the chronically tight calves so many runners have, creates an imbalance. This imbalance causes extra strain where the anterior shin muscles attach to the shin bone. The strain on the muscles is too much and they become inflamed. That inflammation is what we call Shin Splints.

How to avoid getting Shin Splints

  1. Keep your running shoes in good condition. Your foot mechanics may predispose you to Shin Splints, so be fitted by a professional and replace your shoes every 300 – 400 miles.
  2. Try not to run every day on hard surfaces like concrete or asphalt. Running on the grass reduces the impact and force transferred through your legs. This is particularly important early in your training.
  3. If you notice pain in your shins while you run, massage the area with ice for five to 10 minutes after every run. This will help calm the inflammation.
  4. Stretch often and stretch properly, particularly your calf muscles. Maintaining flexibility and staying loose there will help you avoid Shin Splints. The runner’s calf stretch at the wall is a great one you can do anywhere, anytime.

Treat shin splints sooner, not later

If you continue running (or whatever activity is causing them), you’re just creating more strain on your tibia. That can lead to more serious conditions, like stress fractures.

Shin Splints are not something you should ignore or one of those times when you “run through the pain.” In fact, experts suggest you stop running completely. Try a different workout like swimming or biking until the pain goes away.

How Results Physiotherapy treats Shin Splints

One of the things Physiotherapists are trained to do, especially those like us who specialize in manual or “hands on” therapy, is recognize muscle weakness that can lead to pain. So if the pain isn’t going away, it’s a good idea to contact us.

We start by analyzing every aspect of your running gait, look for joint or soft tissue restrictions around your foot and ankle, and examine the biomechanics of your foot. This can tell us what predisposes you to Shin Splints.

Then we work with you to create an individualized plan for treatment and recovery. Our goal is to get you back where you want to be – on the roads.  Contact Spectrum today to learn how to help treat your shin splints.


Physiotherapy for Patello-Femoral Syndrome

Patello-Femoral Syndrome (PFS) is an irritation under the knee cap (Patella) and the surrounding tissues due to increased compression. There can be pain around or under the kneecap and sometimes in the back of the knee. Painful activities may include:

  • Running or Jumping
  • Walking when it is flared up
  • Sitting
  • Going up or downstairs
  • Squatting or kneeling
  • Driving
  • Walking on hills orramps

What contributes to PFS?

  • Tight hip or kneemuscles
  • Weak hip or kneemuscles
  • Flatfeet
  • A knee that collapses inward whilestanding, walking or playing sports
  • Repetitive or excessive amounts ofactivity
  • Improper squattingmechanics
  • Poor jumpingmechanics

What can you do?

Use an ice pack: Put an ice pack on your knee for 10-15 minutes, 3-4 times per day. Make sure you ice after activity.

Wear supportive shoes: Good arch support and supportive shoes decrease pain with activities by achieving good alignment. Avoid non-supportive shoes like, flip flops, sandals and high heels.

Modify your activities:

  • Limit repetitive or excessive amountsof activities that increase
  • Compressive activities like squatting, stairs, running, and jumping put the most pressureon your
  • Replace these activities with lesscompressive activities such as biking, swimming, water aerobics and the elliptical
  • Use a pad under your knees when
  • Change your leg position often when
  • Take frequent


Stretch tight muscles. The best time to stretch is after you warm-up.

Quadriceps – Front of thigh stretch

Place your foot on a chair behind you. Gently

tighten your buttocks and feel the stretch on the front of the thigh. Hold 30-60 seconds, 3-4 times per day.


IT band stretch

Stand with the leg you want to stretch crossed behind the other. Hold onto a wall or chair

on the side you want to stretch. Lean your hips towards the chair or wall until you feel a stretch on the side of your hip. Hold 30- 60 seconds, repeat 3-4 times per day.


Strengthen muscles to improve alignment.

Quadriceps set: Place a small towel roll under your knee. Straighten your knee by tightening your thigh

muscles. Press the back of your knee into the towel and hold for 5-10 seconds. Repeat 10-20 times, 3-4 times per day. This may also be done sitting.

Straight leg raising: Lie on your back with your affected leg straight and your other leg bent. Tighten your thigh muscles then lift your leg no higher than the other knee. Keep your knee fully straight while you lift and lower your leg. Keep your thigh muscles tight while you lower your leg. Repeat 10-20 times, 3-4 times per day.



Lie on your back with knees bent and feet flat on the floor.

Gently tighten your stomach and buttock muscles. Lift your hips 3-5 inches from the floor without arching your back. Hold for 5-10 seconds, and then slowly lower your hips to the floor. Repeat 20-30 times.

Top leg lifts: Lie on your unaffected side with your top leg straight. Bend your bottom leg to help keep you balanced. Gently tighten your abdominals to protect your back. Slowly lift your top leg up towards the ceiling 6-8 inches. Keep your knee pointing forward and your ankle in line with your trunk. Do not roll your body or pelvis backwards. Repeat 20-30 times.

Clam: Lie on your side with both knees bent and positioned in front of you. Gently tighten your abdominal muscles to protect your back. Slowly raise your top knee up and outward like a clam opening while keeping your feet together. Keep your buttock muscles tight throughout the

exercise. Hold for 5 seconds then slowly lower your knee back to the starting position. Do not roll your body or pelvis backward. Repeat 20-30 times.

Wall squat: Stand with your back to the wall and your feet about 12 inches away.

Perform a small squat, making sure your knees stay over your ankles. Hold the position for

5-10 seconds. Return to standing and repeat 10-20 times.

arthritis physio in Newmarket

How Physiotherapy Can Help Arthritis

Sufferers of arthritis will be glad to know that physiotherapy is an ideal treatment to help relieve pain and regain mobility. Physiotherapists are experts when it comes to assessing movement and can help show how to take proper care of your joints. Since therapists are trained in diagnosing muscle and joint problems as well as treating them, many doctors refer their patients to physiotherapy treatment first rather than an orthopedic surgeon.

Your physiotherapist will examine the joints that are giving you trouble and ask questions about your general health history. The assessment will help them design a specific treatment plan that suits your individual needs.

Physiotherapy for arthritis

Treatment will typically consist of an exercise program as well as advice on how to gradually increase your mobility and activity as well as how to avoid any injuries related to exercise.

Depending on your unique condition, pain-relief and therapy treatments can also ice and/or heat packs, TENS (transcutaneous electrical nerve stimulation) machines, hydrotherapy pools, manipulation, taping, massage, medications and acupuncture. You may also be prescribed splints or walking aids to help keep you independent and mobile.

One of the main reasons arthritis sufferers visit physiotherapists is to help manage their pain. If you understand what exactly happens to your muscles and joints when you have to deal with arthritis you’ll be able to help manage the effects.

The pain may be centralized in one specific area of your body or it could effect several areas and be more widespread. You may be taking medication to help numb the pain but your therapist will be able to teach you about other pain-relief methods which may help.

For instance, ice packs may soothe your swollen, hot joints and heat packs often help relax tired and tense muscles. Splints can help painful, swollen joints when rheumatoid arthritis flares up. And as for TENS machines, they work by blocking messages that send pain to your brain. These machines are tiny electronic device which are designed to sends electronic pulses to the nerve endings and the result is a soothing, tingling sensation.

Your exercise and therapy program will come along gradually to make sure you’re not overdoing it as this could increase the pain. Your physiotherapist will let you know how to increasing your level of activity and find the right balance between activity and rest.

The exercises will begin slowly and then gradually increase. This method helps strengthen the joints and muscles and will also aid in your overall level of fitness, strength, mobility and stamina. As this gradually improves you’ll be able to increase your activity without an increase in pain. In addition, a regular exercise program helps stimulate your body to produce its own pain-relieving endorphins.

Other treatments for arthritis could include massage to help relax the muscles and acupuncture to help your brain produce endorphins. Electrotherapy techniques could also be helpful such as low-level laser treatment or ultrasound and manipulation may improve your joints’ range of motion.

If you have arthritis it’s important to try and stay active if possible. However, many people believe exercise may cause further joint damage or increase the pain. Joints are designed for movement though and the tissues and muscles which surround them will weaken when they’re not being used. If this happens the joints could become unstable and this may result in reduced range of motion.

About Spectrum Physiotherapy

Spectrum Physiotherapy is a physio clinic in Newmarket.  We specialize in treating chronic conditions such as arthritis.  Arthritis can definitely affect your daily activities due to weaker muscles, stiff joints and pain. If you’re suffering from arthritis and would like to relieve the pain while improving your mobility at the same time please feel free to contact our team at Spectrum Physiotherapy for more information.