Many of you have touched base, eager to learn, about the exciting news we mentioned in our previous newsletter. If you haven’t guessed it, here it is. We have moved!
Although, it was very emotional and difficult to leave our prior clinic space, which was exceptional, our team knows that the new facility offers additional benefits for wellness & rehabilitation.
We have the same Fit for Life team, same contact information and same eagerness to assist you with your health needs. Our new facility is focused on exclusively providing wellness and rehabilitation services including: physiotherapy, chiropractic, registered massage therapy and naturopathic to name a few. Of course, we will continue to collaborate with family physicians, pharmacists and medical specialists in order to be comprehensive and effective with our care plans.
Along with a clean, modern and functional feel, we have a larger rehabilitation area, additional treatment rooms and some new equipment to showcase. Our new location is located at 3865 Major Mackenzie Drive, Units 101 & 102, just a few minutes south of our prior location. We are one block west of Major Mackenzie and Weston Road at the corner of Jutland Street/Major Mackenzie. Parking can be found at the back of the building. Please look for the Fit for Life Wellness & Rehab sign.
We will be offering online booking & reminders emails/text messages. The online booking feature will be live once we open post COVID-19. You can access this feature from our website at fitforlifewellnessclinic.com or direct at fitforlifewellness@janeapp.com.
We cannot wait to open our doors again post COVID-19. Again, this opening date all depends on how successful our societal physical distancing is going, along with our regulated health college recommendations on when clinics can reopen as health providers.
As always, if you needs anything from me or any of our team members, please do not hesitate to contact us via phone or email. Take a look at the pictures of the new clinic and enjoy! We cannot wait to have you! Thank you for your loyalty and patience during this time.
Stay Fit for Life,
Dr. Luciano Di Loreto & Associates
Fit for Life Wellness Phone: 905.303.6223 or 647.873.4490
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By Luciano Di Loreto
26 Mar, 2013
Chiropractic, Knee
ACL, Chiropractic, Knee Locking, Knee Pain, PCL, Popliteus Strain, Popliteus Syndrome, Posterior Knee Pain, Woodbridge Chiropractic
Today, my chiropractic health assistant and I are writing about a rare and often misdiagnosed condition associated with the knee joint and tissue structure surrounding the knee. There are various knee conditions such as Anterior Cruciate Ligament Strain/Sprains/Tears (ACL), Posterior Cruciate Ligament Strain/Sprains/Tears (PCL), Meniscus irritation, and Patellofemoral Arthralgia that get diagnosed correctly. However, at times, a simple strain/sprain/tear injury to the muscles at the back of the knee goes undetected.
Knee Pain
Just the other day, a 30 year old runner came into the clinic complaining of posterior (back of the knee) pain. The knee pain started after he ran 5km over the weekend. The patient went to his medical doctor and his doctor indicated to rest and ice the knee. The medical doctor referred the patient to our chiropractic clinic for further physical investigation.
We tested the knee for any Anterior Cruciate Ligament (ACL), Posterior Cruciate Ligament (PCL), Medical/Lateral Collateral Ligament, and menisci damage. All the tests were negative. The patient explained that he felt the pain most when we touched the back area of the knee (mushy area) while in a flexed position. No baker cysts (small ball like structure that can be felt at the back of the knee) were felt. The patient also explained that he felt pain while we tested his knee flexion. We quickly understood the cause of his pain. This rare condition is called Popliteus Syndrome or Popliteus Strain.
The Popliteus knee muscle is responsible for internal rotation of the shin bone (tibia) as well as for unlocking the knee joint when bending the knee from a fully straightened position (extended position). The popliteus muscle originates from outside surface of the knee and goes on to attach to the back aspect of the inside area below the knee joint.
This muscle is often injured through acute injury (sport injuries, car accident or fall) or overuse.
Acute injuries to the popliteus occur after a significant force to the knee. They are common in road traffic accidents or falls where the knee is extended. Popliteus injuries may occur in association with other knee injuries occurring to the ACL, PCL, Meniscus and Collateral ligament. Thus, it is important to screen for this muscle injury at all times and especially in the presence of other knee injuries.
Overuse injuries to the popliteus muscle develop gradually and are most common in runners. They tend to be due to biomechanical issues (foot issues) and tight hamstring muscles, quadriceps and calf muscles. We explained this to our patient.
We went forward by treating the patients knee joint. We started with therapeutic ultrasound, laser therapy and electrotherapy to the posterior/back area of the knee. Following this, we proceeded with soft tissue therapy (15 minutes) to the popliteus and stretched the calfs, hamstrings and quadriceps. The patient returned the next day for a second treatment. After the second treatment, the patient explained that he was much better and did not experience any more locking/pain in the knee joint. The patient went back into training in a progressive fashion (1km added to each day without pain). We made sure that the patient followed proper warm up and stretching instructions in order to prevent the injury from reoccurring. Two weeks following the injury, the patient returned to explain that he ran 5km with no issues.
As one can see, it can be easy to ignore this muscle especially with the other knee areas/injuries/concerns that are often more common. It is critical to always evaluate all the soft tissues in the knee area (fascia, tendons, muscle, and ligament) in order to avoid missing this often under/misdiagnosed injury. If you have any feedback or comments, please write to us.
MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.
Dr. Luciano Di Loreto, HBSc., DC
Chiropractor in Woodbridge, Ontario
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Let’s first start with a few Case Studies:
1) 45 Year Old Female
Pain on the outside of the elbow due to twisting/closing jam jars over the weekend. Pain is localized to the outside of the elbow. Patient is complaining of progressive pain.
2) 50 Year Old Male
Pain on the inside of the elbow after playing a bocce (lawn bowling). Patient explains that extending the wrist is painful. Patient finds it difficult to use his wrist due to the progressive pain found along the inside of his elbow.
Answers found below.
Many patients have been presenting and asking me about these two conditions (tennis elbow and golfers elbow) and how they differ. Okay, so let us break them down into very simple terms.
1) Both conditions occur at the elbow.
2) Tennis Elbow occurs on the outside of the elbow.
3) Golfers Elbow occurs on the inside of the elbow.
Now that we have these simple concepts in place, let us explore the anatomy of the elbow joint and structures surrounding the joint.
Anatomy of the Elbow
The human elbow consists of 3 bones and 3 articulations. The three bones are the humerus (arm bone), ulna and radius (forearm bones – remember the radius is on the thumb side and the ulna is on the 5th finger side WHEN the hand is in a position where the palm is facing upwards). The humerus attaches to the ulna – the humeroulnar articulation and the humeroradial articulation (the articulation between the humerus and the radius). The third is a pivot-type joint with articulation between the head of the radius and the radial notch of the ulna (the two forearm bones). Surrounding these joints are a number of muscles, ligaments, fascia and arteries/nerves. The muscles of the forearm are responsible for turning the arm as if you are using a screw driver as well as flexing/extending the wrist.
Elbow Joint
What is Tennis Elbow?
Tennis elbow also known as lateral epicondylitis is a condition that affects the muscle on the outside of the elbow.
Tennis elbow is a painful condition of the elbow caused by overuse or repetitive strain (partial tearing of muscle fibers in the elbow) . Playing tennis or other racquet sports can cause this condition. However, it is also important to note that other sports like golf, or activities that involve moving your wrists/elbow joint can aggravate the elbow (Golfers, baseball players, bowlers, gardeners or landscapers, house or office cleaners (because of vacuuming, sweeping, and scrubbing), carpenters, mechanics, and assembly line workers).
Symptoms of tennis elbow include:
- Pain slowly increasing around the outside of the elbow.
- Pain is worse when shaking hands or squeezing objects (flexion of the wrist).
- Pain is made worse by stabilizing or moving the wrist with force.
- Examples which aggravate pain include lifting, using tools, opening jars, or even handling simple utensils such as a knife, fork or toothbrush.
Tennis elbow affects 1% to 3% of the population. Interestingly, less than 5% of all tennis elbow diagnoses are related to actually playing tennis!!! Tennis elbow affects men more than women. It most often affects people between the ages of 30 and 50.
What is Golfer’s Elbow?
Golfer’s elbow also known as medial epicondylitis causes pain and inflammation in the tendons that connect the forearm to the elbow. The pain is on the inside aspect of the elbow (area the rests beside the torso when your arms are down).
Golfer’s elbow is caused by overusing or straining the muscles in the forearm that allow you to do the following motions – grip, rotate your arm, and flex your wrist. Continuous or repetitive flexing, gripping, or swinging can cause pulls or tiny tears in the tendons.
This condition doesn’t just affect golfers. Those who do activities with repetitive hand, wrist, or forearm motions can lead to golfer’s elbow. Furthermore, sports include tennis, bowling, and baseball can cause the same symptoms.
Tennis and Golfer’s Elbow are not that different!
Yes, Tennis and Golfer’s elbow are not that different. In other words, they are very similar types of strains or tendon aggravation (tendonosis) conditions. One occurs on the inside of the elbow (golfer’s elbow) and the other on the outside of the elbow (tennis elbow).
SO now that I understand the difference, how to I treat these conditions? 
At our clinic, we provide patients with a variety of both active and passive treatments. Passively, chiropractic care, acupuncture, soft tissue therapy, mobilizations, electrotherapy, ultrasound and laser therapy are effective. Actively, eccentric elbow exercises work well. An exercise is eccentric when a muscle contraction lengthens the muscle, rather than shortens it. The opposite is called concentric exercises.
Furthermore, some individuals do well with golf and tennis elbow supports. These are fairly inexpensive and assist with controlling some of the discomfort experienced at the elbow (see image to the right).
Back to the Case Studies
1) 45 Year Old Female
Pain on the outside area of the elbow. Patient was closing a number of jam jars over the weekend. Pain is becoming progressively worse. No shooting pain down the arm, only localized pain in the elbow. What can it be?
Yes, this is a case of TENNIS ELBOW!
-Pain localized to the outside area of the elbow and mechanism of injury is closing jam jars (twisting wrist and using the extensor muscles in the forearm).
2) 50 Year Old Male
Pain on the inside of the elbow after playing a bocce (lawn bowling). Patient explains that extending the wrist is painful. Patient finds it difficult to use his wrist due to the progressive pain found along the inside of his elbow.
-Pain localized to the inside area of the elbow and mechanism of injury is using the flexors of
YES, this is a case of GOLFERS ELBOW! 
MEDICAL DISCLAIMER: The following information is my personal notes about this subject matter. It is intended for informational purposes only. Consult a health practitioner to help you diagnose and treat injuries of any kind.
Dr. Luciano Di Loreto, HBSc., DC
Chiropractor in Woodbridge, Ontario
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Headache Referring Behind My Eye!
Have you ever experienced a headache that refers from the back of the neck to your eye? The sensation that I experience is often quite sharp and localized to one side of my head (usually the right side). These type of headaches are quite commonly experienced by many individuals in the population. Perhaps, increased stress, working at the computer for long hours or long commutes maybe responsible for these headaches…
There are a variety of headaches out there – migraine, cluster and tension-type to name a few. The headache that I am referring above is known in the medical literature as a “cervicogenic headache”.
What is a Cervicogenic Headache?
A cervicogenic headache is caused by an abnormality of the structures in the neck. What structures you ask? Basically, the muscles, nerve, bone, fascia and other soft tissues located in the neck area. A cervicogenic headache is sometimes debilitating and is a condition that accounts for 15% to 20% of all headaches. The criteria for diagnosing a cervicogenic headache is as follows:
A. Pain is referred from a source in the neck and perceived in one or more regions of the head and/or face, fulfilling criteria C and D
B. Clinical, laboratory and/or imaging evidence of a disorder within the cervical spine or soft tissues of the neck known to cause headache
C. Clinical signs that implicate a source of pain in the neck.
- 1. Reduced range of motion
- 2. Mechanical exacerbation of pain
- 3. Focal neck tenderness
- 4. Trigger points that refer to the head
D. When myofascial tender spots are the only cause, the headache should be diagnoses as tension-type headache and not cervicogenic.
What is the cause of a Cervicogenic Headache?
An issue to the neck muscles and other surrounding tissues/structures (bones and joints) are responsible for this type of headache. Whether it be a strain or strain, trauma or fall, our soft tissues and joints can become involved and negatively influenced. Sometimes the C0-C1 joint (first neck joint between the spine and head) or those neck joints below become tight/locked or restricted for whatever the reason. Furthermore, sometimes the muscles in the areas also become tight and tender. A question that is difficult to answer is what causes what – Is it the joint tightness that causes the muscle pain/tightness OR is it that tight muscles that cause the joint pain and thus the cervicogenic headache? This is like the classical chicken and egg scenario. What came first the chicken or the egg? My guess is that the headache can be caused by either structure (joint or muscle/soft tissue) and that both structures influence one another. When the joint is tight, the muscle become tight and when the muscle is tight, the joint does not move as well.
What Evidence Based Treatment Options are Available for Cervicogenic Headache Suffers?
I find that a chiropractic adjustment helps to alleviate my neck and cervicogenic headache symptoms quite quickly. I get cervicogenic headaches periodically – once a month. When I feel that my neck is tight and stiff and a headache is coming on, I have a colleague of mine adjustment my neck and upper back area. Sometimes the relief is instant!
According to some of the latest research on cervicogenic headaches, the following treatments are effective. Spinal manipulation therapy two times per week for 3 weeks. Joint mobilization 8-12 treatments over 6 weeks. Deep neck flexors exercises twice daily for 6 weeks. It is important to note that there is no consistently additive benefit of combing deep neck flexor exercises and joint mobilization for cervicogenic headache. Sourced from “Clinical Practice Guideline for the Management of Headache Disorders in Adults – Jan 2012?
After each treatment, it is important to reassess the condition.
I hope you have found this blog educational. Remember, it is always important to rule out serious conditions which may also be a source to a headache. These conditions should be ruled out first before any treatment is commenced. Always consult your health practitioner prior to commencing any treatment. Thank you for reading my blog Headache Referring Behing My Eye.
Dr. Luciano Di Loreto, HBSc., D.C.
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