Ankle sprains involve the stretching or tearing of the ligaments that hold together the ankle joint and can be classified as either mild, moderate, or severe.

Background: The most common ankle sprains are lateral ligament sprains (85% of all sprains) and occur from rolling of the foot and rotation of the lower leg. As the foot rotates, the 3 main ligaments supporting the ankle tear in succession, depending upon the severity of the sprain.

Risk Factors: Lateral ankle sprains occur most commonly in athletics, comprising 2-25% of all sports injuries. Up to 40% of ankle sprains become a long-term problem.

History and Symptoms: Following injury, swelling and bruising are observed. Pain, which is often worse with weight bearing; altered walking; and decreased range of motion are reported. Mild sprains typically heal within 12 days, moderate sprains heal within 2 weeks, and severe sprains heal after 4.5-26 weeks. Symptoms may worsen before starting to improve. Swelling may take months to completely resolve, and decreased range of motion and weakness may persist.

Physical Exam: Physical examination may reveal altered walking, tenderness near the injured ligaments, and swelling. Stability of the ligaments should be assessed, and a full assessment of movement should be performed in both the affected and unaffected ankles.

Diagnostic Process: X-rays, ultrasound, or magnetic resonance imaging (MRI) may be used to rule out fractures or to determine the severity of the sprain.

Rehab Management: Most ankle sprains warrant “PRICE” therapy, consisting of protection, relative rest, ice, compression, and elevation to reduce swelling, minimize pain, and restore range of motion. More conservative approaches may utilize a walking boot and rest in early care. Rehabilitation is intended to optimize function and strengthen the ankle, using appropriate exercises. Pain can be relieved with oral or topical medications and by reducing swelling. Using ankle supports, such as elastic bandages or tape, encourages a faster return to sports and work compared to complete immobilization of the ankle.

Other Resources for Patients and Families: Physicians work with patients and coaches or employers as well as with athletic trainers, physical therapists, and orthotists. Patients should be taught appropriate home exercises and balance training, and athletes should receive a sport-specific program.

Our physiotherapists work collaboratively with their patients and their doctors to design personalized treatment plans to meet your individual challenges, needs and goals. For more information, contact us at

Tel:      (416) 477-1101

E-mail: reception@priclinic.com

Web:   www.priclinic.com

For more than four decades, on telethons featuring celebrity performers and children in wheelchairs, Jerry Lewis has been raising money each Labor Day for the Muscular Dystrophy Association and the disease that helped make “poster child” part of the American idiom.

But for all the money collected toward a cure, Duchenne muscular dystrophy, the most common form of the disease that afflicts children, still confines thousands of boys in this country to wheelchairs in their early teens. Many do not live past their 20s.

It is a stark reminder of how Western Medicine with its focus on breakthrough treatments can sometimes fail a complex, rare and stubbornly uncurable disease. Single-minded in their pursuit of a cure, doctors and researchers for years all but ignored the necessary and unglamorous work of managing Duchenne as a chronic condition.

The approach is changing at a few medical centers, which are focused on making better use of available therapies to eke out higher quality lives for their patients. Rather than concentrate only on a cure, some researchers are now intent on developing drugs that may alleviate the effects of the disease.

One such option is an exoskeleton Keego^TM  device, that facilitates people with Duchennes with locomotion. Without the Keego^TM device, patients had a difficult time moving their legs, had to stop when taking stairs from exhaustion, had a difficult time picking up objects from the floor, exerted strenuous effort, when getting up from a chair to walk down the hall.

These same patients wearing a Keego^TM device were able to achieve much more fluid movement patterns during several clinical trials. These same patients were able to move quicker from one location to another, were able to promptly walk up or down the stairs, picked up objects from the floor with little effort, and were able to easily sit down, and get up from the seat without propping themselves up with their hands.

If you have been suffering from Muscular Dystrophy, please see a specialist at the PRI clinic. This multi-disciplinary team is specifically trained to properly introduce your body to the Keego^TM device, which will allow your body to achieve a remarkable improvement in your lifestyle. To book an appointment, please call or follow these links.

Tel:      (416) 477-1101

E-mail: reception@priclinic.com

Web:   www.priclinic.com

We look forward to helping you out!

Marathons are on the rise and people are striving to improve their marathon performance. If this is you or you know someone who is into extreme sports, you will love the book Born to Run by Christopher McDougall.

Flying through the book, we’ve come up with two things, that we  believe are the most important two things anyone training for a marathon, ultramarathon, iron man, etc. should consider; sleep and chiropractic care.

We all know sleep is important, whether we’re training hard or just doing our normal routine, but I think we fail to realize just how important sleep actually is for athletic performance. Studies have shown an increase in sprinting speed by 9% among basketball players who slept two extra hours each night. Their shooting accuracy also improved. Imagine carrying these benefits over to running and how your time will improve! It might be difficult to get an extra two hours of sleep every night while you’re training, but even increasing your sleep the week leading up to the event can boost your race-day performance.

A reduction of time spent sleeping reduces your reaction time, regardless of what sport you play or participate in. Just one night without sleep can reduce reaction times by up to 300%. If you’re training for a race and you’re also a student studying hard for finals, a CEO running a company, or a mom just trying to keep up with daily life, make sure you’re getting at least eight hours of sleep each night to keep your reaction times on point.

You might think the strongest predictor of sports injuries would be how many hours you practice, and you’d be in the majority. However, studies have shown that sleep is actually the biggest predictor of injuries. Without adequate sleep, your body doesn’t have enough time to regenerate cells needed to heal and protect your body. Without adequate sleep, your reaction times are slower, as previously discussed, so you can’t stop an injury as it’s about to occur. Make sure you’re getting enough sleep to keep you healthy and off the sidelines as you train.

Another benefit of getting enough sleep is improved growth hormone regulation. Growth hormone is vital to sustaining athletic performance as it aids in muscle repair, muscle building, and bone growth. Almost 75% of growth hormone is released during sleep. Getting a regular seven to nine hours of sleep each night guarantees the production of growth hormone and your ability to recover so you can keep up with your training schedule.

Sleep is something most people understand when it comes to athletic performance. Something that not many people understand is how chiropractic care can help athletic performance. Chiropractic adjustments balance the body while also enhancing the function of the nervous system, the master control system of the body. The nervous system controls everything; the thoughts we think, our hearts beating, digestion of our food, breathing and muscle contraction. Studies have shown that after a single adjustment, athletes had stronger muscle contractions measured by EMG technology. By maintaining a healthy nervous system as a part of a healthy lifestyle, your muscles will be bigger, faster and stronger. Imagine how having faster and stronger muscles will improve your athletic performance!

There you have it. If you’re looking to increase marathon performance, or any other athletic activity, adequate amounts of sleep and chiropractic care are two things you can implement immediately. To find a provider near you, click here. Good luck on your training endeavors!

If you’re like most people you were hoping to start the New Year by losing a few pounds. Now that we’re half way done through the year, hopefully, you were able to fully commit to your resolution.  Did you ever stop to wonder just where those pounds go when you lose them? Turns out most experts don’t know either, and the answer may surprise you.

Most people think that when we burn fat it creates heat and energy, but that’s not true. Instead, the majority of the fat we burn leaves through our lungs when we breathe – the more you breathe the more fat you can burn (providing of course you’re eating consciously). And what’s the best way to increase respiration? That’s right, exercise! So although exercise promotes weight loss by boosting metabolism and building muscle, simply increasing the number of breaths you take is going to help release those unwanted pounds from your body.

A recent Australian study was able to show exactly where our fat goes when we lose weight. For every 22 pounds of weight lost, more than 18 pounds are exhaled as carbon dioxide. The rest leaves as water through urine, sweat, tears, and other bodily fluid. The extra breathing you do when you exercise unlocks the carbon atoms found in fat, thus breaking the fat molecules down. The carbon then leaves through your lungs.

On average, people breathe about 12 times a minute when at rest, which takes with it 10 milligrams of carbon. If you’re completely sedentary and not going above that 12 breaths a minute it will put a cap on how much fat you can release.

And in case you’re wondering, losing weight is not contributing to climate change. It is simply returning carbon atoms that previously had been trapped in food to the atmosphere.

How you gain weight

We gain weight when we eat more food than we need. Those excess carbohydrates and proteins are converted into triglycerides (compounds made up of carbon, hydrogen and oxygen), which are stored in lipid droplets inside fat cells. Losing weight requires breaking down those triglycerides to access their carbon.

Making triglycerides is an energy demanding process. Do you ever feel sleepy after a high-carbohydrate meal, like a big plate of pasta, a bowl or rice, a large dessert, or maybe simply too much food? That tired feeling stems in part from the energy your body requires to make triglycerides that can be stored as fat.

Other weight loss tips

Naturally, you want to avoid that sleepy feeling, not only because naps are inappropriate at your work desk, but also because you’re making fat! Try reducing the amount of carbohydrates you eat and/or the amount of food to avoid that fat-promoting sleepy feeling. If you still feel sleepy after eating a healthy meal of moderate portion size and sensible carbohydrate content, you may need nutritional support to address insulin resistance.

Regular exercise not only helps you breathe away excess fat, but it also better sensitizes and regulates cell function to be fat burning rather than fat promoting.

The key to promoting fat burning is to keep your blood sugar stable by not overdoing carbohydrates or portion sizes and by keeping your body active.

Ask our office for more advice on how to turn your body into a better fat burner.

Tel:      (416) 477-1101

E-mail: reception@priclinic.com

Web:   www.priclinic.com

Aquatic Therapy is often used in the treatment of patients with osteoarthritis, fibromyalgia, chronic pain, and post surgical movement and weight bearing restrictions. Aquatic Therapy utilizes the principles of buoyancy and viscosity of water to allow you to facilitate your rehabilitation.  Buoyancy allows for weight bearing activities while not allowing full body weight compression through your joints while performing exercise.  The viscosity of the water provides resistance to movements during exercise that helping to improve strength.

The physical benefits of aquatic therapy are astounding; however, our favorite aspect of aquatic therapy is the psychosocial benefits. Aquatic therapy can reduce stress and anxiety, increase one’s ability to concentrate, enhance a feeling of well-being and confidence, and allow a person in pain to find their center of calm. The pool atmosphere often seems less clinical than a P.T. gym, and most people equate the swimming pool with fun!

We love to see a well-worn wheelchair sitting empty by the side of the pool, while the wheelchair user walks in the pool with perhaps only minimal support from an aide or therapist. While observing a pool therapy session at our facility one day, we  noticed something unique. It was difficult to tell which person was the client (who was actually quite impaired) and which person was the therapist, as the two walked and joked side-by-side in the water. The pool atmosphere is very normalizing, especially if therapy sessions can be transitioned to a community pool. At the pool, it is easy for exercise and therapy to naturally evolve into games, recreation, and friendship.

One study showed how Aquatic physiotherapy is considered a safe and effective tool in the treatment of knee OA because immersion in hot water decreases the joint overload and pain symptoms and improves functional capacity and quality of life. On the basis of these assumptions, the following hypothesis was formulated: Aquatic physical therapy programs contribute to the increase in the pain threshold, improved functional capacity, and improved quality of life in older adults with knee OA.

PRI started offering Aquatherapy classes over 5 years ago. Join us in our 92-degree salt-water pool. This is the safest possible low-impact therapy with world-class fitness results. Includes cardiovascular strengthening, core work, and stretching. If appropriate for patients, there are also running and jumping exercises. Bring your own towel and lock. Spacious locker room and post therapy shower space are also available.

For more ideas on how to keep your body healthy, contact our office at

Tel:      (416) 477-1101

E-mail: reception@priclinic.com

Intramuscular stimulation (IMS) or Functional Dry Needling (FDN) involves inserting a tiny monofilament needle into a muscle in order to release shortened bands of muscles tissue and decrease trigger point activity. Dry needling is an effective treatment for acute and chronic pain, rehabilitation from injury, and even injury prevention. The definition of dry needling as per the American Academy of Orthopaedic Manual Physical therapists is described as the following:

“Dry needling is a neurophysiological evidence-based treatment technique that requires effective manual assessment of the neuromuscular system. Physical therapists are well trained to utilize dry needling in conjunction with manual physical therapy interventions. Research supports that dry needling improves pain control, reduces muscle tension, normalizes biochemical and electrical dysfunction of motor end plates, and facilitates an accelerated return to active rehabilitation”

Is Intramuscular Stimulation or dry needling the same as acupuncture?

This is not traditional Chinese Acupuncture, but is instead a Western medicine based type of treatment. IMS is primarily directed at myofascial trigger points located within taut bands of muscle tissue. Traditional acupuncture uses points located along meridians. Meridians are channels of energy flow that make up a conceptual network of pathways throughout the entire body.

What will I feel with IMS or FDN?

Most patients will not even feel the needle penetrate the skin, but once it has and is advanced into the muscle, the feeling of discomfort can vary drastically from patient to patient. Usually a healthy muscle feels very little discomfort from insertion of the needle; however if the muscle is sensitive, shortened or has active trigger points within it, the subject may feel a sensation much like a muscle cramp. This sensation is often referred to as a twitch response.

Is IMS or FDN an appropriate treatment technique for me?

IMS or FDN can be used to treat a large variety of musculoskeletal conditions but can also be used to treat neuromuscular conditions such as increased tone. To find out if IMS will be right for you, contact one of our physiotherapy locations to book an initial assessment.

How does it work:

Nerves allow muscles to fire and when there is an altered relationship between how the nerve fires the muscle, pain and weakness can result. The insertion of the needle allows muscles to work with less pain.

Treatments can be scheduled by contacting our office.

Phone: (416) 477-1101

E-mail: reception@priclinic.com

Web:   www.priclinic.com