In Toe Walking

Now that it’s summer, I see a lot more kids and adolescents playing outdoors. I was amazed at the number of children I have seen walking with toes pointed in! Let’s understand more in details of what it is and how it affects children as they grow.

Firstly, what is a normal hip joint?

The Hip joint is one of the most important and strongest joint of the body which bears body weight and plays a major role in our daily activities. It is a ball and socket joint wherein the ball of femur (bone between hip and knee) moves within the pelvic socket called Acetabulum. It is a stable joint with supporting structures providing inert support and minimizing friction, making it pain free and without problems in majority of people through their lifetime.

Now let’s figure out what is Femoral Anteversion?

Femoral Anteversion is inward twisting of femur (thigh bone). In toddlers and children (younger than 7yrs), walking with feet slightly turned in, is normal part of their hip alignment. Their legs start to straighten once the baby learns to weight bear on their feet and walk (by around 9-12 months) and reach normal adult range by 7 years of age. Excessive inward twisting beyond this age causes your child’s knees and feet to turn in giving a pigeon toed appearance or in toeing gait (walking pattern).

What causes Femoral Anteversion?

Although the exact cause is unknown, it is believed to be a consequence of a child’s developmental habits. When the child is first learning to sit, it’s easier for a child to do so in “W” sitting as it is favoured by natural hip position, broad base and lesser use of core muscles.

What   signs and symptoms should you look out for?

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Child walks with knees and foot turned in (In toeing)

 

 

 

 

 

 

 

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Awkward running pattern where foot swings out during running

 

 

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Preferred W sitting as a child or uses it through adolescence

 

 

 

 

In addition, a child may complain of pain around his/her hip, knee or ankle; frequently lose balance or find it difficult to engage in outdoor sports like skating, hockey, soccer which put a demand on child’s dynamic balance.

 

How can Physiotherapy help?

 Although, it is commonly the parents and caregivers who notice these signs and symptoms in their child, I have also come across adolescents who would approach parents with these concerns. Parents, caregivers or adolescents are always encouraged to see a physician or physiotherapist regarding their symptoms and get a thorough assessment.

During examination, the child may commonly demonstrate decreased range in outward turning of hip (external rotation) and backwards (extension) with weakness of hip, knee and ankle muscles. Many may commonly exhibit lower strength in core abdominal and back extensors.

 

Even if Physiotherapy may not completely change the structure of hip joint specially if the child is post skeletal maturity age (varies from child to child, but on an average around mid-teens),  it definitely helps to control the progress of hip turning-in and brings about significant changes in child`s function.

 

Physiotherapy is generally aimed at:

  • Improving range at hip
  • Strengthening hip, knee, ankle muscles
  • Building up core strength of abdominals and back extensors
  • Improving or maintaining trunk and lower limb alignment through use of Specialized Orthotic Garment Systems

 

It`s always best to be alert and act promptly, than be late and sorry

 

Written by Shivangi Trivedi (Registered Physiotherapist, Specialized Pediatric Training)

Book an Appointment to have your Child evaluated with me at this Downtown Toronto Clinic

MATRIX PHYSIOTHERAPY TORONTO

 

 

 

 

 

 

Swaddling your Infant

Every new mother would have received advice from elders in the family, “Wrap the child tight, it will sleep well, grow stronger”. A lot has changed since the ancient times where new mothers would be taught how to wrap her child only by her mother! In the modern age, you have prenatal classes, Nurses teaching swaddling to new mothers in hospitals and to add on, lot of information on the internet for new parents which may sometimes be confusing or contradicting. Even so, I have come across numerous babies clothed too tight or in faulty positions which can be unsafe to the new baby. This got me thinking and encouraged me to write about this ancient art of ‘Swaddling’ and how it’s now modified after curious research on it.
Let’s look at the science behind Swaddling. The foetus in mother’s womb is in position of flexion with arms held close and hips curled up into flexion.

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A correct Swaddling technique is aimed to recreate this womb space especially in new born infants and neonates up to 2 months of age. Parents would commonly ask me this question, “ How should one swaddle a child?” I would always answer, “Swaddle – firstly, according to child’s comfort and secondly, catering to natural posture of the child”.

To make things simple, let me show you how we can swaddle a child at different months…

Newborn- 2 months

Swaddle a child maintaining Fetal position at this age.

1.Step One

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Place blanket on a flat surface in a diamond position in front of you Fold the top corner down about 6 inches, and place baby in the center of the blanket with top fold of blanket placed at angle of neck and shoulder

 

2.Step Two

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Starting on your left, bring the 1st corner over and tuck snugly behind baby. Ensure baby’s hips and knees are in a flexed froglike position inside the swaddle.
*Do not straighten or over extend your baby’s arms and legs.

 

3.Step Three

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The bottom corner goes up and over baby’s left shoulder and behind baby’s back. The weight of the baby will help to keep the swaddle secure.

 

 

4.Step Four

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Take the 3rd corner across and all the way around behind baby, tucking the tail of the blanket into the fold in the front.
*Avoid having the blanket touch baby’s cheek. This can stimulate baby’s rooting response and wake baby. Ensure face and neck areas are free of swaddle cloth.

 

 

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Swaddle according to comfort such that there is a 2 finger space between baby’s arms and the swaddle cloth
This allows for tiny arm movements during sleep while still giving a cozy environment to the child. The space also allows the child to breathe well in the swaddle without restriction

 

 

3-4months

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Hips start getting more extended from flexed foetal position due to kicking movements and tummy time as baby nears 4months. So swaddle with muslin cloth as shown in previous stage but at this stage allowing hips to stay naturally extended (straightened) without pulling them straight (as seen in above baby)
*Till 6 months of age, hips not completely straightened, so DO NOT pull the legs straight when swaddling

4months Onwards

Babies now roll from side to supine and are more active from 4th month of age. It’s best to keep a weighted blanket during sleep hours and wean swaddling from this stage to avoid risk of respiratory distress, which can be precipitated by increasing baby movements causing swaddle cloth to trap around neck or face.

Best cloth material for Swaddle?

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I would suggest using a thin muslin cloth for swaddling which gives room for baby`s skin to breathe.

Although there is an ongoing debate whether should Swaddling be done, I would like to say,
‘Swaddling when done correctly has various benefits’

  • Infants arouse less and sleep longer
  • Comforting flexed posture gained through swaddling helps to manage pain and distress in infants e.g. Colicky pain, GERD, flatulence, constipation
  • Provides baby’s growing nervous system with valuable information and feedback about this little body that they are just getting used to. The comforting tightness of swaddle is a type of deep pressure input (called Proprioceptive input or body awareness) to the body and limbs that help the brain learn about this new body of theirs, in a very calming, organizing way.
  • Improved Neuromuscular development, less physiologic distress, better motor organization and more self-regulatory ability through facilitation of midline orientation, gentle flexed posture and increased body awareness
  • Secondarily may also prevent other serious problems triggered by infant crying and parental exhaustion like postpartum depression, breastfeeding failure and child abuse.

Now that we went through steps to swaddle a baby and its benefits, it’s natural to ask oneself how long should a baby be swaddled? To answer that, I would tell, swaddle when you see the baby starting to get sleepy through the time the baby is asleep. Gently loosen the swaddle and open the baby if the baby has slept too long and it’s time for baby to feed.

* DO NOT swaddle when the baby is awake and active*

Remember, not everything is rosy about swaddling! There are a few precautions new parents have to take when baby is swaddled

SmallRedXNever put child in prone when swaddled
SmallRedXNever pull legs straight
SmallRedXLet the arms be softly in mid-line rather than pulling it straight down or across
SmallRedXNever wrap child too tight
Toronto Physiotherapy 11Observe for signs of increased body heat especially if one lives in warmer areas like redness of facial skin, sweating over scalp hair or forehead. Loosen your swaddle cloth or open it

Ola! Take care of them and you will see your cute ‘Baby Burrito’ stay calm, sleep peacefully and with all that, enjoy your time with your bundle of joy!

 

Written by: Shivangi Trivedi (Registered Physiotherapist, Specialized Pediatric Training)

Book an appointment to have you Child evaluated with me at this Downtown Toronto Clinic

MATRIX PHYSIOTHERAPY TORONTO

Tummy Time

For long time I’ve been driving down the importance of Tummy Time to countless parents who have come to the clinic seeking help for conditions like gross motor delay(missed/late crawling, sitting, standing), torticollis (neck tilt) and light and shabby handwriting. This past March, I saw a child 8 months of age brought to clinic with parents citing concerns of sleeping for long hours, getting tired easily and not rolling yet. When I went through a detailed history, it was understood that the child A was born preterm at 34weeks with birth weight of 1.5kgs. Being low birth weight, parents didn’t put the child on tummy or play activities in his initial months with worry of causing harm. This concern can be faced by many parents and early intervention is the need of hour in these scenarios.
Let’s look back a little and discuss why Early intervention and Tummy time is so important for your child’s development. All through gestation (pregnancy time) foetus as it grows in mother’s womb curls up in flexion for want of space. As a result, babies are born in relative flexion and stay that way for 4 weeks, till gravity acts on them and all the random movements in first month of age, gets them to straighten gradually from 2nd month onwards. Tummy Time facilitates extension which helps the babies to come out of the flexed fetal position. Every newborn, when placed on her mother’s abdomen, soon after birth, has the ability to find her mother’s breast all on her own and to decide when to take the first breastfeed. This is called the ‘Breast Crawl’. It was first described in 1987 at the Karolinska Institute in Sweden (Widström et al, 1987).

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This is the best time to start introducing Tummy Time!

 

From my experience, a baby right from newborn does not tend to mind being face down while against mom or dad’s chest. Start with few seconds e.g. 15 seconds such that baby doesn’t cry and slowly increase to 30minutes as baby gets older. So lay back, and enjoy these cuddles with your baby, it’s the starting place for building your baby’s endurance in Tummy Time.

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As advancement, try placing your child on a soft blanket on the mat or over your knees.

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Cultivating the habit of Tummy Time is best when done as part of routine like after a shower, diaper change, active play time with baby. These frequent, short intervals of Tummy Time build endurance and strength without too much resistance from your baby and you’ll soon notice your baby is beginning to lift their head a little by 2 months of age to look around.
By 3 months of age, your baby will be a lot of active with more wakeful hours. This is a great time to get your baby a ‘Baby Gym’ as is popularly called. It has colourful patterns, textured soft surface and sensory toys hanging over and around them. Playing with your baby is best at baby’s eye level. So make it funny and get down on the floor to engage with your child. You will realise the baby is starting to sing to you in her own language. The Tummy Time will also do wonders for your sore back from work! Get eye to eye, sing a song, plant a few kisses, rattle a gentle toy, push /pull a toy. Essentially as per age of baby, anything that diverts them for few minutes off the hard work performed! And please, let them hassle a little before you pounce on your urge to move them. Ensure you ROLL them over, don’t pick them up. Let them learn that rolling will get them out of Tummy Time. Once settled, gradually as your baby gets comfortable you can roll them back to their tummy and do another few minutes.
Important tip is: Don’t carry your baby all the time when you are home. Let the baby play on mat and explore the environment around.
So back to why is Tummy Time so necessary?
It helps to:
• strengthen neck and back muscles thus preventing positional torticollis, plagiocephaly and delays in development
• strengthen shoulder and hand muscles aiding better grip and handwriting
• promote visual development
• promotes crawling which builds a very strong foundation for upper body strength, abdominal-gluteal strength and eye hand and eye foot coordination thus overall improving muscle tone
• promote digestion (helps babies to push out gas, making them less crankier)
Zoom forward to baby A, at discharge at 13 months of age, he was way more active, sleeping lesser hours than before, picked up on crucial milestones of crawling, pull to stand, standing independently and parents were ecstatic when he took those much awaited first steps.

 

Written by: Shivangi Trivedi, (Registered Physiotherapist, Specialized Pediatric Training)

Book an Appointment to have your child evaluated with me at this Downtown Toronto Clinic

MATRIX PHYSIOTHERAPY TORONTO

Part 1: Brief History of Canada’s Food Guide (Toronto Dietitian)

* Health Canada has provided a useful history of the food guides from 1942-1992 as well as the revisions made to the current 2007 guide, which I have briefly summarized here. If you are interested, I recommend reading the full articles, as they are very informative.
Canada’s Food Guide has always recognized the role nutrition has on the health of Canadians. From its inception during the war, when food rules were introduced to protect health in times of food scarcity and rations, to the modern day guidelines, where the shift has been to prevention of chronic disease due to excessive intake in our environment of food abundance. The food guide has undergone several revisions over time based on: new nutritional evidence, changes in the food supply, developments in food processing, consumer trends, and group consultations.

Canada’s Food Guide was first introduced during the war in July of 1942 when food rationing was the reality. Then known as “Canada’s Official Food Rules” these rules instructed Canadians on which “health-protective foods” to eat each day to promote the best possible health given the unstable times of war. Eventually times of scarcity led to a more consistent food supply and in 1961 the rules transitioned to guidelines. This change in language and food availability highlighted flexibility; Canadians were given choice in selecting foods to meet nutritional requirements rather than being told what to eat. The subsequent version included recommended number of servings for each food group building on this flexibility of choice. And, for the first time, food consumption patterns were available which were used, alongside a government report on health, to guide recommendations making the food guide more specific to the context of Canadians.

In 1982 there was shift in the messaging of the food guide resulting from an increased awareness of the association between diet and cardiovascular disease (CVD). To help Canadians make healthy choices, guiding statements were added. These statements included the importance of variety within each group, energy balance to prevent general overconsumption of calories compared to activity (leading to weight gain), and moderation to encourage limiting the consumption of sugar, salt, fat, and alcohol – foods known to increase risk of weight gain and CVD. The last update before our current food guide, completed in 1992, was informed by unprecedented research reviews, surveys, and various consultations. The result was Canada’s Food Guide to Healthy Eating. This guide introduced the visual representation of the rainbow illustrating appropriate proportions of intake from each food group (larger bands indicate to eat the most and the smaller bands to eat the least). This guide provided ranges of servings to account for differences in requirements based on age, body size, activity level, and whether the individual is male or female, pregnant or breast-feeding.

Finally, our current guide released in 2007 after 5 years of review using research, consumer trends, statistical mCanada' s Food Guide1odelling, average calorie recommendations, consultations, research regarding chronic disease prevention, and new nutritional guidelines. The 2007 guide was largely influenced by the newly released Dietary Reference Intakes (DRIs) from the Institute of Medicine completed in collaboration with Health Canada. The DRIs used the best evidencCanada' s Food Guide2e available to provide detailed information regarding the amount of each nutrient required to achieve ideal health and disease prevention amongst the statistical majority of healthy individuals. The DRIs also provide upper limits for some nutrients, to avoid the risk of harm associated with over consumption.

To ensure that Canada’s Food Guide achieved the recommendations of the DRIs food modelling was used. First, food groups were modelled to determine optimal proportions of servings within each group to achieve acceptable DRI levels. This was done in the context of total calorie goals to ensure nutrient goals were met without exceeding healthy calorie ranges. Many of the guiding statements in the food guide are the result of this modelling. For example, by recommending ½ of grain product servings to be whole grain the nutritional quality improved without going overboard on calories. Next, using eating patterns of Canadians, 500 model meals were created using the proportions of servings determined by the food group modelling. This was to ensure that the flexibility of choice afforded to Canadians within each food group would still provide the distribution of nutrients and calories recommended by the DRIs. Pretty cool eh? Lastly, this was completed for various age groups recognizing that nutritional needs differ based on life stage.

A quote from the paper describing the revision made to the 2007 guide sums the purpose of Canada’s Food Guide best, “The purpose of the Food Guide is to assist the people of Canada in making food choices that promote health and reduce the risk of nutrition-related chronic disease”. Over all Canada’s Food Guide is about flexibility, while considering the quality of intake. Think of the food you eat as the fuel for your body; you want to optimize your performance with the best quality fuel. Canada’s Food Guide was designed and tested to ensure the optimal supply of nutrients. Understanding why the food groups, and the nutrients they contain, are recommended is important for appreciating the value of this tool. My next post will discuss why the nutrients recommended by Canada’s Food Guide are important for our bodies and overall health.
Written by: Laurie Wybenga, RD (Toronto Dietitian)

(First published on www.lauriewybenganutrition.com – Feb. 19, 2015).

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* This blog post is not a substitute for medical advice. Different medical conditions require specific dietary interventions; always follow the advice of your Physician and/or Registered Dietitian.
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References:
• Health Canada. (2007). Canada’s Food Guides from 1942 to 1992. Food and Nutrition. Available from: http://www.hc-sc.gc.ca/fn-an/food-guide-aliment/context/fg_history-histoire_ga-eng.php
• Otten, J.J., Pitzi Hellwig, J., & Meyers, L.D. (Eds.) (2006). Daily Recommended Intakes: The essential guide to nutrient requirements. Washington, DC: Institute of Medicine The National Academies Press. Available from: http://www.nap.edu/catalog/11537/dietary-reference-intakes-the-essential-guide-to-nutrient-requirements
• Katamay, S.W., Esslinger, K.A., Vigneault, M., Johnston, J.L., Junkins, B.A., Robbins L.G… Martineau, C. (2007). Eating Well with Canada’s Food Guide (2007): Development of the Food Intake Pattern. Nutrition Reviews; 65(4):155-166. Available from: http://www.hc-sc.gc.ca/fn-an/pubs/fd_int_pat-ela_mod_alim-eng.php

Canada’s Food Guide (Toronto Nutrition Counselling)

Let’s Talk about Canada’s Food Guide

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Welcome to my three part series on Eating Well with Canada’s Food Guide.
There has been debate questioning whether Canada’s Food Guide is out of date and out of touch with what Canadians eat, and the environment to which we live. Yet, Canada’s Food Guide remains the standard when discussing healthy eating; but do you know why? Perhaps you have heard wind of the debate and have wondered why the food guide remains so important.
To appreciate the importance of the food guide it is helpful to understand where it came from and why it was developed. Also, it is useful to know why there are 4 food groups and why each group has a role in helping us meet our nutritional needs. And lastly, to maximize the potential of the food guide, it is important to know what a serving actually is. * Here’s a hint – they aren’t as big as you think *
Over the next three posts I am going to break this topic down as follows:
1. The History of Canada’s Food Guide and its intended purpose for Canadians
2. The purpose of the 4 food groups and the key nutrients they contain
3. Clarifying the confusion about what a Canada’s Food Guide serving is
I hope you’ll join me as we discuss this important tool in promoting the nutritional health of Canadians.
Written by Laurie Wybenga, RD (Toronto)

(First published on www.lauriewybenganutrition.com – Feb. 18, 2015).  Toronto Nutrition Counselling

Meet your Health Goals for the New Year (Toronto Nutrition Counselling)

Staying the Course on our Goals for 2015

Nutrition Goals

January is a hopeful time; the numerous obligations of December have passed and the dawn of the New Year provides time to stop, breathe, and reflect on what we want for the future. Our talk is filled with resolutions and plans for the coming year. January is a new beginning, a fresh start. 2014 is closed. 2015 awaits.

The New Year is often associated with the resolve to be healthier – to exercise more, to eat less or, to eat ‘better’. You hear stories about previously comfortable gym classes now bursting at the seams, and talk of giving up eating this or that. But now, a few weeks later, reality appears to set in. Life catches us. Classes are missed, ‘treats’ are eaten, and guilt for missteps lead to feelings of failure in our ability to achieve success. We lose sight of the goals we set for the year – goals just weeks ago we were so committed to.

Does this sound familiar? I know it does to me. This appears to be the natural ebb and flow of January. But it doesn’t have to be! It is possible to change this pattern. What it needs is a reimagining of our goals, goals that set us up for long-term success. The missing piece is sustainability.

As a Registered Dietitian I’ll focus on what I know best – nutrition. I am sure many of you have read or heard about the rise in global obesity, a trend that increases the risk of developing chronic diseases such as high blood pressure, heart disease, and diabetes amongst others(1). It is not surprising then that a common health goal for the year is to lose weight. The benefits of losing additional pounds are clear, however it may come as a surprise to learn that even modest weight loss can result in health benefits. Research indicates that, amongst adults whom are overweight or obese, weight loss of 5-10% of one’s current body weight is often associated with improvements in health markers (such as blood pressure, blood glucose, and cholesterol levels)(2). Putting this into perspective, for an individual that weighs 200 pounds, 5-10% weight loss is 10-20 pounds. Setting an initial goal to lose 10 pounds is realistic and attainable!

The next step is making change happen. Research suggests that one of the greatest challenges with weight loss is not always losing weight itself, but keeping those pounds off year after year(2). There are a lot of diets available offering quick fixes, but the truth is weight loss takes time and commitment. Making drastic changes to your diet that you cannot sustain will not be helpful in the long run. Therefore it is essential to start with small changes you can live with, changes that can be sustained. Healthy weight loss is considered to be 1-2 pounds per week; one pound, in terms of calories, means removing 500 calories from your day, 7 days a week. Going back to the previous example, losing 1-2 pounds per week means, with perseverance, one can achieve 5% weight loss in approximately 10 weeks, or 10% weight loss in about 20 weeks. This means that in 3-6 months you may start to experience positive changes to your health!

Food Plate ProportionsBut, what does 500 calories of small change look like? Well, 1 cup of apple juice has 120 calories, whereas 1 cup of apple slices has only 60 calories – could you make the switch? Reducing the amount of pasta or rice on your plate from 2 cups to 1 saves 230 and 250 calories respectively. A can of cola (355mL) carries 140 calories and a commercial chocolate chip muffin can have between 260-490 calories depending on its size(3). As a general rule, vegetables have fewer calories compared to other food groups; substituting more vegetables for less meat, pasta, or rice will also cut calories. This doesn’t mean you should remove other food groups – simply change the proportions. In practice we use “Space on your plate” dividing your plate as follows: ½ a plate for vegetables, ¼ plate grains or starch, ¼ plate for meat, legumes, or fish.

 

As we approach the 3-week post-new-year threshold, take time to reassess your goals, think about what is feasible for you and your lifestyle. Can the changes you want to make be sustained for the long-term? Look to the past, did you resolve to address your health last year? What worked? What didn’t? We learn from the past to inform the future. Look also to the future, why is this change important to you? What motivates you to make and sustain this change?

Remember you have 365 days to work at and build upon your goals. As much as the New Year motivates us to consider change, we are not tied to the specific resolutions we make; there is nothing to stop you from frequently modifying your goal to ensure continued success. Here’s to 2015 and making this the year we achieve our goals.

Written by: Laurie Wybenga, RD ( Toronto Nutrition Counselling )

* This blog post is not a substitute for medical advice. Different medical conditions require specific dietary interventions; always follow the advice of your physician and/or Registered Dietitian.

References
1. Health Canada. (2006). Obesity – It’s your health. Available from: http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/life-vie/obes-eng.php
2. CMAJ. (2007). 2006 Clinical practice guidelines on the management and prevention of obesity in children and adults. 176(Suppl 8): Online 1-117. Available from: http://www.cmaj.ca/content/suppl/2007/09/04/176.8.S1.DC1/obesity-lau-onlineNEW.pdf
3. Nutrition information from Canadian Nutrient File (2012). Available from: http://webprod3.hc-sc.gc.ca/cnf-fce/index-eng.jsp

How to treat a Frozen Shoulder diagnosis? ( MATRIX Toronto Physiotherapy)

As a physiotherapist in practice in Toronto for over 12 years now at MATRIX Toronto Physiotherapy, I have seen patients suffer from all types of painful injuries and conditions. Many of these conditions are most painful in the early stages of occurrence (Acute Phase), and the pain associated with it diminishes over time through the rehab process. One of the conditions that break this typical pattern is a Frozen Shoulder or Adhesive Capsulitis. The joint capsule is a thin film or tissue that surrounds the entire shoulder joint that holds the structures together giving it increased stability.

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When the joint capsule becomes inflamed, the tissue can become thickened and shoulder movements become very stiff, painful, and restricted. Pain is the key word! There are many theories as to how this inflammation starts but the consensus is that it develops from a period of self-limiting behaviour due to pain or injury to the shoulder. Over a period of weeks to months, the capsule loses its ability to stretch and the shoulder becomes STUCK and very painful to move. I put it into perspective for my patients by explaining that if I put their unaffected “Normal” shoulder in a sling for two months, they would likely develop a frozen shoulder on that side even free of injury or pain to start with.

If a patient is given proper education to maintain full shoulder ROM through a series of rehab exercises early in their injury or pain episode, they would never develop a Frozen Shoulder. Much of the literature on Frozen shoulders describe various stages of recovery and extremely long expected recovery time-frames. I strongly believe these guidelines apply to those who are not actively and persistently working on their shoulder movements with a very aggressive physiotherapist. As long as all other pathologies have been ruled out such as tears, rips or fractures, the shoulder joint needs to be mobilized with a great deal of force in order to stretch out the ceased up joint capsule at ANY STAGE OF RECOVERY. The major issue is PAIN! Everyone’s tolerance to pain is different and the manual joint mobilization sessions are extremely painful, and many of the home exercises to promote more movement are extremely painful. The patient MUST understand and accept that the high degree of pain is a part of the recovery process and that no HARM is being done despite the agonizing pain. Over the years in my practice, the patients who have allowed me to deliver the high necessary force to stretch the capsule and who actively participate in their home-based exercises have all regained near full active shoulder range of motion in 2-4 months. This is not a judgement on those who just cannot tolerate the pain because pain is a very Primitive Response designed to help protect us.

I usually do not even begin to discuss strengthening exercises with my patients until they have regained at least 75% of their active ability to move their shoulder. I want my patients to focus their time and attention on getting more movement. Strengthening weakened muscles is an easy straight-forward process as long as they perform the prescribed strengthening exercises somewhat regularly.   The shoulder will get stronger as well just from increased ability to use it for daily activities once the functional range of motion has returned.

If you suspect you have a frozen shoulder or if you have been given such a diagnosis by your doctor, do not be discouraged. You should not scare yourself by the proposed extended recovery time-frame. You should actively seek an aggressive physiotherapist to work on the shoulder with you right away rather than believing that Frozen Shoulders get better on their own in 12-18 months as commonly stated in the literature.

Written by Aubrey So ( Matrix Toronto Physiotherapy )