Welcome to Apple Creek Sports Medicine


The Aging Athlete – Fall Prevention

Fall Prevention – The Aging Athlete

Nejin Chacko

Have you had a fall in the past year? Do you feel unsteady when standing or walking? Do you worry about falling? If you answered YES to any of the above three questions you may be at a high risk for falls. 

Fall among aging adults are considered the major contributing factor for fractures, physical impairments, hospitalizations, and fatalities. About one in every four older adult reported falling at least once every year, and among the one who fall 50% will fall again in the same year. Ironically falls are partly a consequence, and to a great part cause of physical inactivity in older adults. 

Consider following preventive strategies to reduce your fall risk:

Manage your pain: Persistent pain can cause reduced strength, mobility, reaction time and balance. 

Monitor and report any significant decline in your balance, strength, endurance, posture and cognitive function.

Perform periodic vision check-ups. Screen for glaucoma and cataract. Aging can also lead to loss of depth perception, difficulty in detecting low level light, and inability to focus.

Monitor for signs of postural hypotension and vertigo. Unsteadiness or dizziness when getting up from lying or sitting is identified in almost 1/3 of older people.

Fight de-conditioning: lack of activity resulting from unexpected bed rest or hospitalization can lead to de-conditioning. 

Environmental: consider night time lighting, use non-slip mats, remove area rugs and uncluttered.  Use assistive devices such as cane/walker or walking poles, shower/tub rails, reachers, etc when required.

Medication review: You may be at risk for fall, if you take more than 4 medications. Talk to your physician/pharmacist for identifying medications that can affect nervous systems or cause drug interactions, and to consider safer alternative, smaller dosage or change in dosing time/interval.

Role of Physical Activities

Strength/power training can improve muscle weakness and mass at any age. Activities like Tai Chi and dancing is beneficial for improving balance. Aerobic exercise can counteract the effects of decline in cardiorespiratory function. Being physically active, engaging in resistance training, high-impact sports, etc can improve bone density.

Guidelines for Exercise

  • The programs should be created and supervised by an exercise expert
  • Advised a multi-component activity 2-3 times per week that consists aerobic, strength training, and balance exercise.
  • Ensure appropriate shoes, proper lighting, choose barrier free environment, and avoid slippery weather
  • Ensure nutritional supplementation, together with physical activity.

Your physiotherapist can:

  • screen for fall risks using standardized tools, and assess for physical impairments,
  • create goals  and exercise program that are tailored based on the findings.

Boost your Immunity Today!

Boost Your Immunity – Stay Healthy This Cold and Flu Season.

I am not a physician, naturopath or a nutritionist, but I get asked all the time by my patients about what they can do to help themselves stay healthy.  These days – I talk about steps to boost their immunity – build a good defence so your body can express health and build resiliency.

A quick call to a colleague at Turquoise Health on Main St in Markham, Jeff Millet, helped me outline some of the important things we can do to stay healthy today, tomorrow and in the future.

In these cold winter months we don’t get enough sun exposure – we need to supplement our Vitamin D absorption with a VIT D DROP.   Research says that Canadians/North Americans can take 1000 IU’s per day, and some evidence suggests we could even take double or triple that.  Also, with Vitamin D you can super dose if you forget it yesterday, add a little extra drop today – it won’t hurt you.

Zinc is another one that we can add to the immunity boosting list and an easy additive to our vitamins list.

Vitamin C – we all know how important vitamin C is and we remember our  mom’s making us take them when we were kids.  It still works!

Vitamin A  and Vitamin E are also on the list of supplements Jeff mentions can keep us healthy.  Vitamin A is an infection fighter and Vitamin E is a powerful anit-oxidant.

Most of these supplements can be found in food, but the reality is our diets are not always ideal and we need a little help.  If you take a multivitamin, consider grabbing a couple of these other helpers next time you are at Turquoise or your local health food supplier.

For a list of foods that contain some of these immune boosters, head over to the post by Cleveland Clinic, 8 vitamins and minerals to boost your immunity – its simple but packed with valuable information.

Don’t forget to exercise, get some fresh air and take some time to yourself – this can help keep your batteries charged and build your reserves for when your body needs to fight.

As always if you have any questions – please don’t hesitate to ask, and to quote a friend:

                                          Stay Positive and Test Negative 🙂

John Sage, R. Kin DOMP CAT(C)
Clinic Director

The difference between a Manual Osteopathic Practitioner vs. a Doctor of Osteopathy? Brock Palma, DOMP

Now that Brock is DOMP’ed, completing his Thesis and obtaining his credentials, see below to explain the difference between and Osteopathic Manual Practitioner and an Osteopathic Physician!

Osteopathy was named by an American Physician, Dr. Andrew Taylor Still in 1874. He opened a school in Kirksville, Missouri in 1892 and began teaching students mechanical mobilizations to the human body in order to promote health and heal disease. Today, there are over 22 countries that contain osteopathic schools and over 43,000 Osteopaths worldwide.


Over the many years, there are two branches of the osteopathic profession that have been evolved into two distinctive practices. These two types are:

  1. Manual Osteopathic Practitioner (D.O.M.P)
  2. Medical Osteopath (D.O)



Manual Osteopathic Therapists specialize in manual therapy and are proficient in manual approaches to healing the body. This differs from a Medical Osteopath, as they use pharmacy, surgery and other medical practices to their approach. In Canada, there are currently no colleges of osteopathic medicine, and DOs that practice in Canada have trained in other countries such as the United States. Therefore, most Osteopathic Practitioners in Canada are Manual Osteopathic Therapists.


In Canada, the title “Osteopath” or “Osteopathic Physician” are protected by the medical regulatory college for physicians and surgeons. Therefore, the type of Osteopathy that is practiced in most Canadian provinces is Manual Osteopathy. As of 2014, Manual Osteopathic practice is not a government-regulated health profession in any province, but the Osteopathic Associations are trying to get that changed. 



Manual Osteopathic therapists use a variety of techniques to help restore the body back to its optimal state. These techniques include:

  • Articulatory Techniques which move the joint through their respective range of motion
  • Soft tissue Techniques which can be applied directly or indirectly to muscles, fascia and other soft tissue
  • Visceral Techniques which involve gentle pressure through the abdominal muscles to help treat the internal organs
  • Cranial Sacral Techniques which focus on the brain, spinal cord, cerebrospinal fluid, cranial bones and the sacrum



Some of the most common reason people visit Osteopaths is lower back and neck pain. Some of the other regions of the body that get most treated are spine/pelvis, legs, pregnancy/infants and internal organs. It is safe for use in patients with traumatic brain injures such as whiplash or concussions. It has been shown to treat back pain as effectively as medication. 



  1. http://osteopathyontario.org/wp-content/uploads/2014/01/OIA_Osteopathy_and_Osteopathic_Medicine_Summary.pdf
  2. World Health Organization benchmark. http://apps.who.int/medicinedocs/documents/s17555en/s17555en.pdf
  3. Degenhardt BF et al (JAOA, 2007) & Andersson GB et al (NEJM, 1999) 
  4. https://www.healthlinkbc.ca/health-topics/aa106363spec

My Jaw Clicks & Is Sore Sometimes – How Come? TMD / TMJ Dysfunction

Jaw Pain – Temporomandibular Disorders

Pain and functional limitations in our jaw are described as Temporomandibular Disorders (TMD). Common temporomandibular disorders include joint disorders resulting from arthritis or internal disc derangement, and pain disorders that arise from myofascial structures around the joint. Common causes of TMD include inflammation, trauma (direct hit, whiplash, etc.), age related degeneration, prolonged chewing, poor neck, and upper back posture, or related to dental issues like missing teeth, grinding, teeth misalignments, prolonged jaw opening for dental procedure or surgery.
Presentation of TMD
Joint disorders are often presented with clicking or popping of the jaw with movements, joint noises, reduced jaw opening, jaw deviations, and sometimes associated with the jaw locked in closed or open positions. Patients experience clicking, popping, or locking of the jaw resulting from an atypical displacement of a cartilage disc present within the joint.
Pain disorders are presented as pain localized to the jaw muscles or as widespread myofascial pain and headache related to jaw movements/chewing or direct pressure on muscles. Often pain and myofascial restriction can lead to constant pain and reduced jaw movements.
How can you manage TMD?
You must seek treatments if you experience localized or spreading pain or headache with chewing/jaw movements and symptoms like jaw clicking, locking, limited opening (less than ~3 fingers wide opening or 40mm). Conservative treatments that consist of manual therapy, exercises, and modalities (ultrasound, LASER, acupuncture, etc.) have been found to be effective in the management of acute and chronic TMD. You may also need assistance from your dentist for occlusal splints and other dental issues. Physiotherapists are trained to assess TMJ pain and provide you with a treatment plan. They can liaison with your dentist for an issue that cannot be addressed with physiotherapy or dental treatments alone.
The most successful tools that we use include manual therapy (myofascial release and mobilization for neck and jaw, including intra-oral mobilizations), motor-control and mobility exercise, postural correction, and home exercise program as well as education. LASER and acupuncture are other treatments we use that have shown to have effective in reducing pain.



Nejin Chacko PT, BPT, MSc(Sports Medicine), MSc(OMPT), FCAMPT.







  1. Calixtre LB, Moreira RFC, Franchini GH, Alburquerque-Sendín F, Oliveira AB. Manual therapy for the management of pain and limited range of motion in subjects with signs and symptoms of temporomandibular disorder: a systematic review of randomised controlled trials. J Oral Rehabil. 2015 Nov;42(11):847–61. 
  2. Shukla D, Muthusekhar MR. Efficacy of low-level laser therapy in temporomandibular disorders: A systematic review. Natl J Maxillofac Surg. 2016;7(1):62–6. 
  3. Schiffman E, Ohrbach R, Truelove E, Look J, Anderson G, Goulet J-P, et al. Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) for Clinical and Research Applications: Recommendations of the International RDC/TMD Consortium Network and Orofacial Pain Special Interest Group. J Oral Facial Pain Headache. 2014;28(1):6–27. 
  4. Wu J-Y, Zhang C, Xu Y-P, Yu Y-Y, Peng L, Leng W-D, et al. Acupuncture therapy in the management of the clinical outcomes for temporomandibular disorders. Medicine (Baltimore) [Internet]. 2017 Mar 3 [cited 2021 Feb 13];96(9). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340435/

Headaches? Here is some help at home.

Headache Help at Home

Dr. Livia Chiarelli

Headaches are one of the most common health complaints of people presenting to my office.  The World Health Organization (www.who.int) estimate that 47% of the world’s population has had a headache at least once in the last year.  

Although there are several different types of headaches, 150 diagnostic headache categories approximately, tension headaches are the most common type of headache.  Tension headaches are often a result of neck tightness, poor posture, stress or fatigue.  

Tension headaches feel like constant pressure or a band around the head and are often helped by over the counter medication.   Symptoms of tension headaches often worsen with poor sitting posture and are usually relieved by rest.

A great at home remedy for tension headaches is the Tennis-Ball-Sock-Peanut.  Simply place two tennis balls (or balls of similarsize) in a long sock and push them toward the toe.  Next, tie a knot in the sock securing the tennis balls together forming what looks like a peanut.  Now lay back on a somewhat solid surface like the floor and place the peanut under the base of your skull where it meets the neck.  Perform a small chin tuck and roll the peanut along the tight muscles of the upper neck to help reduce tension.  

If the Tennis-Ball-Sock-Peanut does not help reduce your headaches it is then a good idea to come to the clinic and see a therapist.  A therapist will help determine the cause and type of your headache and will help improve neck mobility, reduce tightness, increase strength and show you exercises to help correct poor posture, which can be contributing to your headaches.


Home Workstation got you Cranky? Read This!

Upper-mid Back Pain? Unlock your Thoracic Spine!


Are you hunched over at your desk all day long? With lockdown after lockdown, work from home doesn’t seem to be going anywhere. That doesn’t mean that your upper-mid back pain & stiffness needs to stick around as well. So, let’s talk about the thoracic spine (T-spine). 

The T-spine is made up of 12 vertebrae. It’s actually the longest region of the spine which connects with the cervical spine (your neck) above and the lumbar spine (your low back) below, and yet it’s so often ignored! The thoracic vertebrae serve as attachment sites for our ribs which allow for optimal breathing and provide support for our torso/chest areas which house important organs such as our heart & lungs. 

While its role in providing stability is important, the T-spine also needs to be mobile! In fact, thoracic spine mobility is actually essential to full neck and shoulder range of motion. Restricted in your neck range when looking up or down? It may not be your neck, but your T-spine at fault. Unable to get your arms all the way up? You actually need T-spine extension to allow for that full shoulder mobility.

Our T-spine, which is naturally rounded forward, is often victim to poor postures. Over time, that curvature increases and our ability to extend (straighten up) through the T-spine as well as our ability to rotate through the T-spine decreases. But it’s not just you. The average person is quite stiff in this area but that’s why it’s so important to get it moving! Try out some of the mobility exercises below today! 



  1. Foam-roll assisted thoracic extension 

Hold that stretch: 3 reps x 30 seconds, 2-3x/day


  1. Thoracic extension over foam-roll 

Hold that stretch: 3 reps x 30 seconds, 2-3x/day


  1. Cat-cow – segmental flexion/extension mobility 

Perform 8-10 reps x 2-3 sets, 1-2x/day




  1. Foam-roll assisted thread the needle 

Perform on each side: 8-10 reps x 2-3 sets, 1-2x/day


  1. Thoracic Rotation in half-kneeling 

Perform on each side: 8-10 reps x 2-3 sets, 1-2x/day

  1. Quadruped, lumbar lock thoracic rotation 


Perform on each side: 8-10 reps x 2-3 sets, 1-2x/day


Bracing – It helps!

Knee Braces – they aid recovery or prolong the inevitable – what is right for you?

Custom knee braces are made specifically for the mold of your knee and specifically for your type of injury.

Whether it is a meniscal tear, ligamentous injury or osteoarthritis of the knee, a custom brace will be molded to conform to your body/knee type.

Osteoarthritis unloading braces can be worn for your daily activities. Clinically proven to reduce the pain associated with unicompartmental osteoarthritis of the knee, these braces are designed for average to high-impact activities, indoors as well as outdoors. It can also help reduce your reliance on pain medication and avoid negative side-effects. The brace works by offloading the pressure on the affected compartment of the knee thus keeping the knee in a stable position to minimize further cartilage damage. The pain of early OA can get in the way of a healthy lifestyle. Keep moving and staying strong may help prolong the degenerative process of OA.

Braces are also used extensively following traumatic knee injuries that compromise the stability of the knee. With clinically-proven technology including specialized hinges plus innovative, high-tech carbon composite, these featherlight braces provide durable support for moderate-to-severe ACL, PCL, MCL and LCL instabilities, both pre and post operative. Plus, the low-profile design fits comfortably underneath clothing and sports uniforms, so it can been used on the field, on the court, on the slopes and in the water protecting knees and providing confidence to those who wear it. 

Not sure whether a brace would be right for you – please reach out for a consult and to learn more.  We are always happy to educate on what is best for you and your current situation.


Breathing: Try it – it is good for you!

Breathing: Try it – it is good for you!

As my practice evolves, so do the exercises I prescribe to my patients.  Of late, I have been a big proponent of asking my patients to breathe, in-between appointments with me.

My journey down this road has come from many angles which include a good book, a few good podcasts and a number of patients who have forgotten how to breath.

First, I have to give props to Dr. Andrew Weil, an integrative medicine physician in the US, who is well known for many TV appearances including Oprah back in the day.  He was the first person that I had heard of who taught people to breathe with purpose.  He is a proponent of the 4-7-8 (relaxing) method, which is quickly described as breathing in for a count of 4, hold for 7 and breathe out for 8.   Do this for 4 cycles, frequently (2x/day) for many benefits including relaxation, calming, a sleep aid and general well being.

Box Breathing
Box Breathing, 4 in, 4 hold, 4 out, 4 hold

My second contact for breathing with purpose, was with box breathing.  This is the method is I teach most often in my practice and feel it is super simple, most effective and can be done anywhere.  This popular method of breathing gained momentum when former Navy Seal, Mark Divine, started promoting the technique as early as 1987.  To do it, imagine a box in front of you, breath in for 4 seconds – up one side of the box, hold 4 seconds across the top, breath out for 4 seconds down the opposite side of the box and hold for 4 seconds as you move along the bottom of the box to the original starting position.  Four repetitions of this and your mood will change, a stateof relaxation will set in, and likely your breathing rate, pulse and blood pressure will also improve with the technique as well (once you become efficient with it).


Lastly, I listened to a great book last year called The Oxygen Advantage.  Written by Patirick McKeown, he breaks down the art of breathing, the proper why and how of breathing and the many benefits that can be experienced in the mind, body and spirit through proper technique.  Being a chronic mouth breather, the book encouraged me to tape my mouth shut when sleeping (you read that right, I actually have been taping my mouth shut for over a year now when I cuddle in at night) with huge success.  The benefits are many, but ultimately it has taught me to use my nose for breathing and my mouth for talking.

In my practice, patients present with various ailments but most with a common secondary complaint of overwhelming stress.  Stress has numerous effects on our bodies, but I often see people in a sympathetic state (survival mode) and encourage them to use breathing techniques to promote relaxation (encourages a rest and relax feeling – parasympathetic state).  This can also assist the patient to mobilize their ribs, stretch the muscles through the torso and up to the neck, and indirectly mobilize the digestive organs in the belly.  All good things to assist your body through the recovery process.

So – give yourself a few minutes, get quiet, focus on your breath, take stock in how you feel before and after one of the above exercises and begin a daily practice to optimize your health.  Your body will thank you on many different levels!

Always happy to discuss if you have questions,




John Sage R.  Kin, CAT(C), DOMP

Clinic Director

Virtual Therapy – Jordan Katz

VIRTUAL THERAPY – the silver lining  

When Covid 19 struck the GTA, Apple Creek, along with almost every other business and service, was compelled to temporarily close its doors.  At the time,  I was concerned about my patients, my practice and my family (maybe not in that order!) but I discovered that every cloud has a silver lining 

When the directive to isolate ourselves was first given, I had many concerns and questions; mostly I wondered how I would manage full-time with my 3 young children; how they would manage with me; and how my patients would manage without me?  I was concerned about those of you who were dealing with pain, healing from strain, repairing from injury and recuperating after surgery.  I honestly had my doubts that virtual therapy would be able to meet your needs and allow me to provide the level of service that I am committed to giving to my patients.  I know, that many other practitioners and patients shared my doubts

Over the 12 weeks of isolation and 4 weeks since gradually and carefully reopening Apple Creek, I have discovered many things.  In addition to learning lots about kids’ games and tv programming and earning the silver hair that comes along with home schooling, I have come to believe in the benefits of virtual therapy.

  • Virtual Therapy puts the client in control 
  • Virtual Therapy provides the possibility of treatment when pain, time, or quarantine impact the ability for clinic visits
  • Virtual Therapy promotes clear communication
  • Virtual Therapy allows for assessment and education in much the same way as a clinic visit
  • Virtual therapy provides the therapist with insight into the equipment available in the client’s home
  • Virtual therapy allows those who are anxious about entering public environments, the peace of mind of being treated in their own homes.
  • Virtual therapy is an effective way for therapists to assess, treat and educate their clients

What about hands-on assessment and treatment?

While I love working with my hands and helping my patients recover through manual techniques, what most patients don’t realize is that a large part of what we do as therapists is actually achieved through conversation with, and observation of you, the patient.  Using Virtual therapy, I can listen to what you, the patient, tell me, and see how you respond to my questions. Using technology to connect with you, I can glean much of the most important information and aspects of your pain or condition, formulate most of my diagnoses, and develop a plan of action to help you get better. 

Our initial concerns about Virtual Therapy, were like so many other things in life, fear of the unknown.  When you face those fears, travel down that unpaved road, or test out those unknown waters, the results can be amazing, and to the shared delight (and better sleeps) for myself and my patients, Virtual therapy has proven to be a very effective, efficient and convenient tool for assessing and treating new and current patients.

If you have any questions or are looking for more information about virtual therapy, or our safe re-opening, please contact Jordan@applecreeksports.com or call the clinic at 905-475-0484

Jordan Katz MSCPT, HBa(Kine) Registered Physiotherapist