One of our physiotherapists, Ying, works with a patient to perform coupling actions with very simple task instructions. Especially with stroke rehab, Ying advises against letting the patient know that they are actually doing something more complex. It’s stressful enough to be in pain.

For this particular grandma, she is undergoing rehabilitation for a stroke causing left sided movement paralysis. Ying is getting her to grip her fingers while I encourage wrist extension. At the same time, Ying is holding her hand in a functional manner (a resting C shape curve of her hand). It makes it easier for the patient to activate muscles when the muscles are in mid-length tension. Starting position of muscle activation is a big deal in slow stream rehab.

As a society, we are transiting away from a mentality of quick fixes. We are starting to realise the beauty of preventive medicine rather than reactive medicine. Investments are flowing into digital health solutions on preventive care models. And a preventive care model should include movement medicine, away from a reliance on symptomatic medication.

One of our physiotherapist demonstrating a physiotherapy rehab exercise for the upper body, for early-mid stage Parkinson Disease.

This exercise is meant to improve upper body mobility and strength. Improving flexibility and postural strength can help reduce the deterioration of the condition, especially if the patient is able to have access to early intervention.

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Parkinsons Disease (PD) is a progressive disease of the brain but the symptoms can be managed with physiotherapy.

With parkinsons, the brain is hypergeared towards the flexor muscles. This causes the body to stoop and curl forwards. Without adequate postural strength, the condition progresses much faster.

Another symptom of PD is distal tremors of the limbs. The tremors exponentially makes it harder for the patient to engage in large movement patterns. This indirectly limits patient’s ability to move at the hips and core.

For parkinsons, the primary driver is from the brain. Especially for this neurological condition, the physical presentation and symptoms of PD further fatigues the neurological system of the body and brain.

In other words, especially for PD, the symptoms further exacerbate the presentation itself, exponentially worsening the entire condition.

Indeed the primary symptom management is medicine but complementing it with physiotherapy can better help to manage the progression of PD.

This sitted exercise is effective in teaching the patient to engage the core and glutes to initiate movements and weight transfer. To do it, attempt to keep the low back straight and lean forwards and backwards in a controlled manner. The idea is to encourage more movements at the hips while taking away movements at the legs. Specifically for PD, this exercise helps the patient to focus away from the tremors.

This exercise can be modified for every patient - the type of tactile guidance and the type of seating position etc.

If your loved ones have parkinsons, a personalised physiotherapy care can greatly optimise their quality of life.

An effective physiotherapy management for parkinsons will include:

- An assessment of the stage and type of parkinsons

- Strengthening of areas of weaknesses which should directly include functional movements

- Exercises that biases the postural muscles while encouraging large movement patterns

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Are you doing a lot stretching of the foot, ultrasounding it, massaging but nothing works?

Take a step back and look at the position of the foot. The resting position of the foot often reflects the tone of the muscles along with other implications.

The challenge that most physiotherapists face when dealing with big toe issues is that it’s hard to draw a logical link between the big toe and the muscular chain higher up.

For this particular patient, he was walking with the left leg crossing over into his right. When the left foot lands on the ground, the foot has trouble placing flat on the ground (walk in a straight line and you will find that you will end up putting more weight on the outer foot) and it will be in a more supinated position. This is indicated by the more inclined sloping angle as indicated in (B).

The body is smart. When it loses stability somewhere, it tries to create stability using some other methods. For my patient, the long flexors of the big toe kicked in so as to pull the big toe down just to compensate for the reduced contact of that inner foot onto the ground.

But it fails. This ends up creating more problems at the foot. When the big toe is pulled to the ground by the long flexors, the big toe loses its resting curve. There’s gonna be a jamming effect at the big toe, you lose stability at the arch, lots of irritation at the plantar fascia along with irritation of the inner ankle tendons (think shin splints, posterior tib tendinitis etc).

To correct this issue, there’s only one way. Limit your time on soft tissue work which includes ultrasound, massage, stretching, taping, infrared, theragun etc. These are great and has its place but there’s also so much work needed to be done for specific and active strengthening rehab. And it’s the strength that will eventually change your movement pattern and get you moving correctly.

Observe how the body compensates, because what you see is the compensation and not always the cause. Then confirm it with a gait analysis and muscle testing. Balance with the patient’s opinions and thoughts about his condition and lifestyle goals. Lastly, form a hypothesis, identify the logic and treat it.

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Do you have neck pain? Been following youtube videos that tell you to stretch it out? And then getting even more pain or worse, tingling sensations down your arm? It’s time to think about strengthening the shoulder blade muscles to better position the shoulder!

Every individual presents with a unique position of the neck & shoulder along with structural differences. As such, it is not ideal to follow general youtube exercises for neck issues.

What would work to effectively correct your neck, shoulder and back pain - is a proper identification of any muscular weakness alongside a static and dynamic postural assessment.

Neck issues are often a result of upper body postural issues. Many neck muscles have attachment points to our shoulder blade. When we slouch or round our shoulders, the tension on our neck increases as well. Overtime, the head shifts into a forward position, further putting greater stress on the neck muscles.

Contact our team today to understand how we can help you!

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An effective physiotherapy treatment plan for the elderly has to include a thorough assessment of the medical history and current lifestyle and social environment. In addition, the goals of the patient has to be taken into consideration given how this is such an important life stage for the senior.

Maison teaches the elderly how to perform functional daily tasks in the most effective manner based on their current condition and symptoms.

Exercises will include learning how to engage the core and postural muscles, dynamic balance exercises in seated and standing as well as range of motion exercises to maintain an optimal amount of flexibility.

For the elderly with medical condition, all Maison therapists will perform a thorough perusal and understanding of the medical history before proceeding with the treatment. This is because the side effects of any medication as well as recent medical treatments have to be taken into consideration as part of the curation of the treatment plan.

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Optimising one’s balance is especially important for the elderly. This minimises the senior’s fall risk which helps to prevent a lot of exponential complications such as fractures, leading to prolonged bed bound and a subsequent significant reduction in mobility.

Improving the elderly’s balance also requires a thorough examination of his/her current functional ability as well as pre-morbid functional status. Does the elderly have the potential to revert back to a pre-morbid state of mobility? What are some of his current medical issues / medications?

Understanding a complete picture would allow the physiotherapist to properly prioritise treatment goals and plans.

Our physiotherapists work with nursing homes and elderly day care centers as well to provide for private physiotherapy services as required by the seniors. Some of the more ambulatory seniors present with musculoskeletal discomfort which limits their mobility. In these cases, we provide for exercise equipments to teach these seniors specific rehab exercises that they can directly benefit from and resume their pain-free mobility.

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Our lead physiotherapist assisted with Tom (Name changed for privacy) for pain over his right calves. Tom leans excessively to the right when he walks. Our team analysed his walking pattern and nailed down what requires work on. 1 week later, Tom walks in a much better gait and pain free!

The problem with Tom’s previous walking style is that it loads the right leg excessively. Walking and running injuries primarily happen on the side of the body that you lean more towards. Also, this is Tom’s 3rd calf tear. By improving his weight bearing over both feet, he can avoid his 4th tear.

Effective rehab doesnt require expensive equipments. We just need time to understand the body, time to communicate and time to harness the strength already within you for recovery.

Let us bring this knowledge to you, at the comfort of your home.

Our senior physiotherapist, Ying, working with a grandpa post-stroke, which left him paralysed over his left side. He hasn't been able to stand for 1.5 years since his stroke due to a lack of follow up rehab care. In stroke recovery, early intervention is very necessary for optimal recovery. The earlier, the more focused (this means very speciifc and targeted work to his needs and impairments specific to his stroke) and the more consistent the better. Public healthcare system had great acute care, but the resources available weren't able to provide for sufficient early and consistent follow up care. Only recently that gramps had voiced out his interest to his son that he would like to try again and that he would like to stand and even try to walk again. And so his son had reached out to Maison for help.

In the 1.5 years after his stroke, grandpa succumbed to fatigue. Fatigue from the overpowering experience of this neurological condition, as Dr Jill had described the experience as “the inability to identify the boundaries of the body” “shocked to find myself inside of a silent mind”. Dr Jill bolte taylor (neuroanatomist and author of “stroke of insight”). In her TED talk ( https://www.youtube.com/watch?v=UyyjU8fzEYU) , she described her experience with stroke. While she was experiencing the stroke, she described how she was unable to feel her body. In her own words, her “consciousness shifted away from normal perception of reality”, “every step was rigid, deliberate without any fluidity in pace” and “there’s this constriction in my area of perception”.

In many parallels, grandpa wasn't able to control many aspects of his body. The stroke affected both the affected left side as well as the right side of his body. A lack of motion over his left side resulted in a general reduction of mobility over the right side. Paralysis over his left side affected grandpa's ability to stand. And since grandpa wasn't standing and walking, his right side eventually started deteriorating too with disuse. 

Each rehab session and each step of the rehab process required the deliberate choosing of positivity over the more passive and natural negativity - giving in to pain, regret, frustration, fatigue. Grandpa described this recovery process as exhausting, as it took a lot of concentration to even try to figure out what aspect of the limb he was trying to move and in which direction the limb was moving. Some motions, such as movement through the full range of motion of his knee or his arm required assistance as when left alone, grandpa could only perform in jerky and fast motions, without the ability for precision in control. Grandpa didn't have the strength to perform motions in completion of the entire range, so Ying had to perform the movements with him in a very slow motion, without any jerkiness or speed, allowing grandpa's brain to match up to the motion. 

Because of the stroke, Grandpa also lost the ability to coordinate his mind and body, and of coordination within his body. The desire to move often didn't result in the expected motion. It was extremely exhausting and frustrating for grandpa. 

Throughout the entire rehab process, Ying worked with grandpa on relearning fundamental strategies of weight shifting of his body, increasing his range of motion at his upper body as well as his core and postural strength from the neck and his trunk. and 6 months later, we eventually managed to get him up into upright sitting and onto his feet. 

In the subsequent phase progressing to walking, Ying progressed with grandpa on weight shifting techniques in static standing. This involved guiding grandpa via shifting him from left to the right feet. Months later, we finally progressed to more advanced weight shifting techniques, allowing grandpa to advance towards a walking like motion. Ying would weight-shift grandpa from the hips towardsto the left, and help him lift his right leg up and vice versa, while grandpa manages support using his right arm onto a quad-stick (a type of walking stick with a 4 point end). Shifting grandpa’s body to the side imitates the way we shift our weight left and right while we walk and, grandpa’s brain was able to relearn this automatic ability to weight shift that so we take for granted.

6 months later, grandpa is now able to manage walking with a smoother gait and with greater endurance for exercise. The recovery continues and even though it may be long, but more than the outcome, it is in the process that we find hope and inspiration to live for another day.

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In this photo, you can see that Buttie's right leg appears longer than his left. However, when our therapist Ying held both feet in neutral, side by side, they showed up in equal lengths. Why is that? The resultant length difference is a result of tight muscles pulling the joints into different directions, giving a visual illusion of a leg length difference. In this case, Buttie's right outer shin muscles as well as the muscle in his knee (popliteus) were alot more overworked and tighter, pulling the shin and foot into a more externally rotated position. This gave him a sensation of a leg length difference. This would be dangerous if Buttie had followed internet advice and started wearing orthotics, which could result in a worsening of his compensated alignment.

Interested on what happened next? Read on to understand the backstory!

So, Ying first started seeing Buttie (our favorite patient's nickname! :-) ) for bilateral knee pain. The pain was located specifically over the inner part of both knees. Upon bending the knees, pain was felt just 3/4 into the bending motion. Direct palpation elicited vague responses of the pain.

Upon assessment, it was clear what was going on. When Buttie stood or walked, there was excessive horizontal front-back motion going through his knees while his pelvic slouched back. This meant that he was initiating alot of his propulsion forces from his knees while his limited mobility at his hips continued to encourage movement reliance upon his knees.

This excessive front-back motion at his knees placed alot of pressure over his knee cap. Buttie also had a tendency to create stability at his knees via excessively turning out his feet. Whereas, in an ideal situation, this turning out motion of his knees should be performed by his butt (hence, his nick!). His poor compensatory habits combined with weaknesses of certain key stabiliser muscles, were the root causes of his knee pains. His resultant motions in his daily living consistently create excessive strain over at the insertion of the surrounding muscles at his knee joint as well as the tiny muscle in his knee. When this particular tiny muscle overworks, it can block the knee joint from bending properly.

The resultant experience is painful and tight knees. Because the pain didn't simply go away on its own with rest, it was extremely frustrating for Buttie. I mean, doesn't rest treat all our issues? Often, rest treats covid, stomach flus or heartaches - But knee pains often don't go away on its own even with time!

Usually, pains at the hips and knees often remain because certain muscles are not strengthened and hence, movement patterns remain ineffective and even, injurious.

If you have knee pain, instead of simply popping in pills and hope for the best, reach out to our team for a proper movement analysis. We will work with you on your movement patterns, from the way you lift your dog, to the way you squat. We will then work with you on your walking and running gait.

We will be by your side from start to end. And even as you move onto completing your next milestone, we wish to continue to lend our support to you.

Our team believes that manual therapy alone is not sufficient by itself to successfully treat the neuromuscular system. We incorporate sensorimotor training in addition to manual work, in our treatment sessions. Sensorimotor training involves strengthening starting from the core and postural muscular systems. These systems contain a highly dense network of sensory and motor nerves, giving input back to the brain as to the body's spatial positioning.

Often, the patient undergoes a general strengthening and massage program without seeing much results in their pain and condition. This is often their postural and core muscles have not been included in the treatment plan. As such, the body segments can become stronger but this strength improvements do not show up in the movement of the body as a whole.

As such, both manual work and specific strengthening intervention are vital aspects of patient care. Rather than traditional strength training, a customised strength training specific to the patient's weakness and neuromuscular limitations is needed to promote whole-body neuromuscular activity. These include gently increasing proprioception from the posterior chain of muscles, from the pelvic region and to the deep core muscles, upwards towards the deep back and the neck musculature. These physical activities help activate/retrain the motor system, improving postural control and optimize gait.

Patients with autism experience pain and aches just like all of us. Unfortunately, they find it difficult to express these discomfort. To put it simply, their inner feelings are unlimited, but their minds only let them express extremes or nothing. This makes it difficult for them to effectively express their feelings effectively.

Patients along the autism spectrum demonstrate poor endurance and tone of their core and postural muscles. This is the primary reason for their disadvantaged ability to engage in sports and other prolonged physical activities such as walking, hiking, standing and etc. Because of their lack of endurance to hold up or maintain a good posture, they tend to develop a wide range of musculoskeletal problems. Unfortunately, many of them find it difficult to pinpoint their pains or even describe their discomfort as they have been dealing with these disturbances since young. Moreover, many autistic patients are not able to express themselves well and as such, often do not get access to early intervention.

Common issues that autistic patients present include excessive sensory stimulation across their bodies, fatigue and pain through their neck and back, excessive tightness through their front abdominal muscles as well as discomfort over their feet. To put it simply, due to their inability to hold an upright posture, they often slouch excessively at the pelvis and at their neck and back which then affects the loading through their weight bearing feet. This poor posture places their posterior chain of muscles in a lengthened position and their anterior chain of muscles in a shortened position, creating an imbalance that worsens overtime.
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The goal of treatment interventions for these patients present similarly to patients with no neurological issues, and that is to get their bodies to be less imbalanced, get rid of their symptoms, improve their mobility and their pain-free quality of life. However, the intervention method would differ. Treatment interventions would combine a mixture of exercises to calm their body and the anxiety through their body, in addition to specific strengthening and soft tissue manual work.

Working with autism requires a more patient way to communicate, as it requires us to reflect upon a perspective of the world that is different from what we are accustomed too. We believe that Autism is simply a different way in which the world is viewed. An effective treatment plan would begin from a more patient communication together with a customised intervention program.

Do I need orthotics?

That is one of our most commonly asked question! Patients often come in with foot pain, together with this very query on orthotics.

And our answer? No.
No, you do not need orthotics - at least for now.

The question about orthotics is often, but not always, backed by a misunderstanding that gait correction can be easily solved by a quick fix. This misunderstanding is also the reason why orthotics backfire, and proving injurious to the user instead. To give an example, an arch support is often recommended by people who overpronates. However, this same group of overpronators who overpronates during midstance often also excessively inverts their feet during pushoff. As such, these arch supports actually worsens the amount of inversion during push off, resulting in increased instability of the ankle, increasing the risk of ankle sprains among other issues.

Before addressing the need for orthotics, we need to start work on aspects that are not addressed and that needs work. Before you think about bringing in something external to support your body, we need to first work on aspects of your feet and your body's mechanisms to optimise the way you load.

Orthotics do not give you the strength you need. They do not erase any poor movement patterns of your foot. They do not correct the slouch from your head down - from the way you hold up your pelvis to the way you hold up your shoulders.

Let's work on improving the way you move and the way your body handles load and impact, before we think about bringing in orthotics - if there is even any need for one.

For foot conditions such as those with bunions or severe structural changes, there are still aspects of strength and mobility that require work upon. However for these conditions, treatment outcomes often improve with the complementary support provided by orthotics. In these cases, we do advise our patients to consult an orthotics or podiatrist for simultaneous assistance while continuing their physiotherapy rehabilitation work.
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The way we make changes upon the running and walking gait is primarily via muscle activation and strengthening. Orthotics can be recommended on a case by case basis, but it's often unnecessary as with strengthening, the arch, the foot and the body's mechanics can change to improve the way the body loads the ground, removing the need for any supplemental orthotics. Even with the recommendation of orthotics, there is a need for regular revisions and replacement of orthotics as the foot structure can change with the strengthening work incorporated. As such, the reliance and usage of orthotics should not be prioritised over corrective strengthening work.

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