I think I have a knot - What exactly is a knot ?

Sascha Boulet

“I think I have a knot” “What exactly is a knot?” “How did I get this knot?” “How do I prevent knots?”

These are the most popular reactions and questions I receive as a Registered Massage Therapist. More than likely, you have experienced a tender, achy knot causing limited range of motion and pain. The most affected areas to experience this are in your shoulders, neck, lower back, and calf muscles.

A muscle knot, also known as a myofascial trigger point, occurs when muscle fibers tense and tighten, causing a hard, bump-like area. This is what you feel to be a “knot”. Trigger points can either pop up spontaneously (active) or when directly pressed on (latent).

There are two different types of trigger points (knots).

1. An active trigger point is extremely tender and causes local to regional referred pain.
2. A latent trigger point generally does not cause pain unless pressed on, but has potential to become active if it is aggravated enough.

The most common place for knots to form is in the trapezius muscle. This
muscle makes a triangular shape from the neck to the shoulder, and down the middle of the back. Tension and knots in this area are often caused by poor posture and stress.

Muscle knots can be caused by many different daily factors, such as:
· Stress
· Poor ergonomics
· Bad posture
· Fatigue
· Dehydration
· Unhealthy eating habits
· Sleep disturbances
· Prolonged sitting or laying
· Repetitive movements

Now you may be wondering “how do I prevent knots from forming”. Here are some ways to help prevent them:

· Improve your posture. Remind yourself to sit relaxed with your shoulders down and back, with your head held high.
· Hydrate!! Drink lots of water.
· Start a stretching routine during your work day. If you’re not one to remember, set
an alarm on your phone .
· When needing to lift heavy objects ask for help or make multiple trips.
· Move your body!! Engage in regular physical activity
• Maintenance massages. Book your next appointment before leaving, this helps you to remember to take care of yourself before actually doing it.

Do you think you have a knot? Are you experiencing any of the above or have limited range of motion? Give us a call at (506) 325-1565 (Woodstock) or (506) 473-7064 (Grandfalls).


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Returning to the gym: “Post-Covid”

Sascha Boulet1 comment

Returning to the gym after over two months of shut down can be an exciting time, but, keep in mind that it is important to take care of your body during the process. Oftentimes, we miss a week of our typical gym routine due to vacations and other priorities, and when this happens we return to the gym at the same pace and usual resistance with minimal repercussions. Since the pandemic began and gyms were shut down, some of us created an at-home gym, while some of us took the time to do other forms of exercise (e.g., yard work, spring cleaning, etc.). Either way, while we return to the gym “post-covid” we need to be mindful of a number of factors to minimize risk of injury.

 Here are some things be aware of as you start back into the gym, or even if you are just getting started on your fitness journey!

  • Stretching: beneficial for a warm up before you work out to prepare your muscles for any sort of exercise, as well as after an exercise session for recovery of muscle tissue. You can use a foam roller as well as a good muscle recovery tool! Allowing the body to warm up before exercise encourages blood circulation and delivers oxygen and nutrients to these areas of the body.
  • Low and Slow: if doing any resistance/weight training, we shouldn’t expect to jump back into the same weights, find an appropriate level to start at and then progressively increase by ~10% increments as necessary with each session. If necessary, lower your repetitions as well.
  • Hydration: it is summer after all! Keeping hydrated with plenty of water throughout the regular day and during workouts is important. Water helps to regulate body temperature and maintain performance so we can get the most out of each workout.
  • Rest days: Not everyday can be leg day! It is important to allow your body the time it needs to rest and recover. This can provide your body with the opportunity to energize, as well as your muscles to rebuild tissue.
  • Listen to your body: don’t push yourself to the point of exhaustion right off the bat. If something does not feel good, what is it that you need? Is it stretching, a change in weight/resistance, hydration, a rest day, or something different? It is very important to do what feels best for your body in order to minimize the risk of injury.

This has been a challenging time both mentally and physically, be gentle on your body as your mind also needs to slowly progress back into exercise as it has been an exhausting few months. If you’re concerned about returning to the gym or if you would like to begin your gym experience for the first time, a kinesiologist might be who you are looking for!


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Are you ready for golf season ?

Sascha Boulet

Now is the time of year when all us golf enthusiasts grab our clubs and head to the range or the course. If you're like me, I start hitting ball after ball at the range to get my swing in shape. But after doing this for a few days my back, legs, and arms get really sore.

Back pain is the number one injury that recreational golfers suffer from. If not treated properly, it can become chronic. Shoulders, knees and hips are also susceptible to injury.

There are a few things you can do to prevent these problems:

1. Use the right equipment - make sure all your equipment fits properly and is still in good condition.

2. Walk 20-30 min a day - start doing this before the season and try to continue this as you get started to get your body in shape and prevent injury.

3. Stretch before and after golfing - one of the best ways to warm up is stretching before you start hitting the ball. Also, to prevent soreness and stiffness after your round, make sure to go through stretching for those tight areas.

4. Use the driving range - practice your first swings with shorter clubs and even start with half swings to get your body loose and less force on your body to start. This is a good practice before any round at any point in the golf season.

Even movements such as bending over to put down and pick up your ball can be painful. There is a lot of force applied in particular areas of your body from swinging your clubs.

Strength and mobility in these areas is extremely important for a healthy and happy golf season

The Thoracic spine

Golf requires a lot of rotation. The thoracic spine provides a lot of this rotation. If it is stiff, the rotation (or rotational forces) end up going elsewhere. Often this means to the Lumbar spine (which is not designed well to do this) and can lead to injury.

The hips

Having good range of internal and external rotation in the hips is important to allow a full and efficient swing with correct loading and weight transference. Limitations in hip rotation have been shown to be linked with increased low back pain in golfers.

The shoulders

Golf is an asymmetrical sport requiring different
movements and actions from the lead and non-lead arms and legs. A right handed golfer will require greater range of external rotation of the right shoulder than the left and also more adduction of the left than the right during the swing. Having a good range of movement in both shoulders helps both technique and reducing excess forces to other areas of the body during the swing.

Physiotherapists are frequently involved with numerous clients experiencing stiffness, weakness, and/or pain in their spines, shoulders, elbows, knees and ankles. There are many exercises, manual techniques, and modalities that our therapists use to improve the physical health of these areas of concern.

If you would like to get some help for your injuries or just get set up with a good program to try to prevent golf injury and pain, call us to get started!



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What are you doing, at home, to relieve your pain?

Sascha Boulet

“What are you doing, at home, to relieve your pain?” This is a question I ask to all of my patients. These are the answers that I frequently get: “Nothing. I don’t want to take medication and don’t know what else will help.” or “I thought about putting ice or heat but I just don’t know which one I am supposed to apply.”

 One of my goals during a first visit is for the patient to leave the clinic with confidence that they will be able to control their pain with resources available in their home. Effective pain control strategies at home are important as they can increase your feeling of self-efficacy, help you maintain an active lifestyle, reduce limitations in your daily activities and facilitate your recovery. Being aware of these strategies can be useful when our services are limited, like during the weekend or even during a global pandemic.

So first off, ice or heat?

 Ice is often very effective on hot, swollen, and painful joints. It is mostly applied in the first 48 to 72 hours following a fresh injury (with a clear mechanism of injury and obvious signs of inflammation). Ice will numb the pain and restrict blood flow to the area to reduce swelling. Application of ice can be done with Gel packs, ice cubes/crushed ice, snow or bag of frozen vegetables.

 Heat is often very effective to decrease pain, muscle soreness, muscle tightness and stiff joints. Heat is useful after the acute phase of an injury because it increases blood flow to the area bringing oxygen and nutrients to help tissue healing. Application of heat can be done with a bean bag, electric heating pad, hot water bottle or even a hot bath.

 Recommended application of ice or heat: Apply 15-20 minutes on painful area. Heat and ice can be applied multiples times in a day. Make sure you wait 1-2 hours in between applications – this allows the skin and other tissues to return to their regular temperature and prevent adverse reactions.


- Always have a layer of cloth (i.e. a towel) between your skin and the source of heat or cold.

- Never apply heat or ice to an area that has very poor or no sensation.

- Never apply ice to an area that has poor circulation.

- Do not fall asleep on heating pads!

 There is no clear-cut, black and white answer to this question as many unrelated factors to the injury can help us make the decision between ice or heat. The bottom line is: use what relieves you best.

What else can you use to relieve your pain at home?

- Most of us have hot/cold rubs (i.e. Biofreeze, Medistick, RubA535) that can be applied to the area of pain.

- If you have a TENS unit at home – talk to your physiotherapist, they will show you where to apply the electrodes for your injury.

 Still unsure or have questions? Contact your physiotherapist at PhysioFirst/Capture therapeutics.

- Michelle

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Sascha Boulet

Stress is something we all experience, especially during this time of COVID-19. It can be defined as the body’s non-specific response to any demand made upon it. It is not a disease but it can contribute to ill health. Stress can contribute to tension in muscles, breathing problems, a suppressed immune system, and more. For that reason it is very important to identify where your stress is coming from so you can deal with it.

The causes of stress can vary drastically. It can come from emotions; such as anxiety, depression, or fear; pain, from disease or injury; or even excessive coffee or energy drinks. When you start to experience stress it is important to take a moment, find the source of it, and acknowledge it so you can face it head on. Keeping in mind that this is much easier said than done.

Some ways to cope with stress are through lifestyle changes such as drinking less coffee, getting an adequate amount of sleep, having a healthy diet, and exercising regularly. It is also helpful to identify situations that will cause you stress so that you can anticipate it. My personal way of dealing with stress is just to lay down, take a nice deep breath, set productive goals that will help to relieve the stress if possible, and then go get those goals done once I’m calm and collected; or I acknowledge that I can’t do anything about the situation. Realizing that was my way of coping has helped me gain a clarity I didn’t have before. I encourage you to go out and find yours!


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Activity During Covid-19

Sascha Boulet

Staying physically active is important for a healthy lifestyle. Since the outbreak of Covid-19, more people are quarantined inside their homes. Even during Covid-19, staying active still offers many great benefits to your health! The first one that normally comes to mind is loosing weight, but physical activity can also improve your mood, your ability to sleep, your immune system and help to decrease stress! The Canadian activity guideline recommends 150 minutes of moderate intensity or 75 minutes of vigorous activity per week. Moderate intensity exercise is any activity that makes you breath a little deeper or makes your heart beat faster but you are able to still talk while doing the activity. Vigorous activity takes more effort, you feel yourself breathing much deeper, and your heart rate is faster.

During Covid-19 there are many stressors, including the virus itself, changes in work or daily routine, worrying about family and so on. Using physical activity is one way to help combat these stressors!  When you’re active, your brain releases a chemical called endorphins. Endorphins can help relieve stress, help to reduce pain and make you feel happier by boosting your mood. Being active can also give you a distraction from work, school and daily stress, which can have positive affects on anxiety and depression.

So lets talk about some things you can do at home to stay active, not only during quarantine but anytime! For starters, if you’re working or studying from home, taking frequent breaks to get up from your chair and walk around helps to stretch your legs and gives your mind and eyes a rest from your screen. Setting a timer on your phone is one way to remind yourself to get up and move. You can grab a glass of water, play a quick game with your kids or simply walk around your home to stretch your legs. Involving your family is another way to make physical activity fun and there are lots of different options to choose from. Going for a walk near your neighborhood or on a trail (while social distancing) is a great way to get out of the house to get some fresh air and Vitamin D.  YouTube is also a great resource to help you stay active as well. It has hundreds of exercise videos including yoga for all levels, high intensity, cardio and full body workouts. Many of these videos do not even require equipment. There are videos at different lengths so you are able to fit it in the day when it works best for your schedule. This is also a great way to try different activities and types of workouts to see what you like best.

Even if you’re not normally an active person, now is a great time to start.  Any activity is better than no activity so you can always start small and increase as you go! Have fun and enjoy any form of physical activity!


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Benefits of Massage Therapy for PTSD

Sascha Boulet

Post traumatic stress disorder is a mental health condition caused by a traumatic event that is experienced by or witnessed by. Symptoms of PTSD include flashbacks, nightmares about the event, depression, chronic pain and severe anxiety. Symptoms can include all of these and more.

The stress of coping with PTSD, can cause high blood pressure which in turn is hypertension. Learning to cope with hypertension, through yoga or meditation is helpful in decreasing the sympathetic nervous system firing. Adding massage therapy as one of the tools in helping eliminate some of the symptoms of PTSD can aid greatly.

Massage therapy encourages relaxation. When first starting massage therapy, it can be intimidating. New person and new surroundings. Building a relationship with the client will help the client to feel safe and comfortable in the treatment room. During the treatment, tightness and trigger points are addressed which can help alleviate some of the muscle pain. This can aid in more range of motion and flexibility for the client, which can lessen some of the stress and anxiety that the client may be experiencing. More benefits include increasing the circulation and decreasing stress hormones.

The duty of a massage therapist is to provide human touch that is kind and positive experience for the clients. Having a client who lives with PTSD to feel comfortable and safe during the experience, is empowering as those two feelings may be feelings that the client struggles with on a daily basis.



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Can my physiotherapy continue during COVID-19 by MacGillivray Injury and Insurance Law

Sascha Boulet

As medical centres and treatment providers close their doors during the COVID-19 crisis, how can you get access to the medical treatments you need?

At MacGillivray Injury and Insurance Law, many of our clients have been injured in a motor vehicle accident and are referred to physiotherapy sessions as part of their treatment. Physiotherapy clinics are now closed across Atlantic Canada, leaving our clients without care.

For those who live in rural communities across Atlantic Canada, inadequate access to healthcare services is an age-old problem. It is not often feasible for injured individuals who live in rural areas to travel long distances for rehabilitation services like physiotherapy.

This problem is now being felt by a much wider audience. Even those who live in the most populous cities are unable to seek rehabilitative services, since medical providers are no longer conducting in-person appointments.

However, timely treatment is essential for those injured in a motor vehicle accident. As Toronto-based physiotherapist Adam Brown states, “in situations of trauma, physiotherapy is most successful if the patient is treated almost immediately after the accident...With every day and week that treatment is delayed, it gets substantially more difficult to restore full mobility in a patient.”


Medical professionals such as doctors, physiotherapists, and psychologists are now using technology to offer virtual healthcare services to patients, called “telehealth”. Telehealth involves a patient communicating with their healthcare provider via phone, tablet, laptop, or desktop computer using a camera and microphone. The healthcare provider gives instructions and assesses the client through the screen.

Healthcare providers such as Lifemark in Halifax have adopted a virtual care model. Lifemark, for example, offers the following services remotely:

Many physiotherapy clinics are adapting their systems to offer online services during this time. Check with your existing treatment provider to see what virtual services they offer. If your existing physiotherapist does not offer virtual services, we provide a list of physiotherapy clinics across Atlantic Canada that do at the end of this article.


In response to the COVID-19 crisis, many insurance companies have extended their policies to include coverage for certain virtual services, including physiotherapy. You should confirm what coverage your specific insurance plan provides when booking an appointment.


If you’ve been injured in a car accident, it is important to continue with your prescribed treatment during this time if you are able to. This helps build medical evidence to support your lawsuit, but more importantly, the treatments are necessary for your successful recovery.

We are here to support our existing clients and are fully operational during COVID-19. We are just a call or email away if you have any questions about your case.

If you’ve been injured in a motor vehicle accident at the fault of someone else and you are not already a client, we will do our best to help you. We offer a free consultation by phone or video where you can share your story and we can answer your questions. We not only help our clients with legal matters, but we also ensure that they are receiving appropriate treatment and insurance benefits during the period of their recovery.  

Contact us to set up a free consultation.


The following are clinics across Atlantic Canada that offer virtual physiotherapy services. This is not an extensive list. If you are interested in participating in virtual physiotherapy sessions, contact your existing physiotherapist or research clinics online.


Capture Therapeutics by PhysioFirst


Nova Spinal Care

pt Health and Wellness Centre

Personal Care Physio & Osteopathy

Scotia Physiotherapy

S.R. ProActive

Windsor Physiotherapy



Proactive Physio



Northside Physiotherapy Clinic


Range of Motion Physiotherapy



Body Works PEI

Thank you MacGillivray Injury & Insurance Law for recognizing our virtual care platform for video telehealth in their blog.


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Virtual Consultations: Essential to Health Care During COVID-19 Self-Isolation

Sascha Boulet

Do you have an appointment with a health care professional coming up? Imagine if you only had to take the time off work or out of your day that you needed for the appointment, eliminating the cost and time wasted travelling to your appointment – does that sound practical? 

In a time when accessing quality health care is becoming increasing difficult in rural areas, and especially during these periods of self-isolation imposed by the COVID-19 outbreak, telehealth or virtual consultations is an essential tool to provide quality health care to people without them having to leave the comfort of their home or office. 

How does telehealth work? As your Registered Dietitian, I use phone conversations to do regular follow-ups with my clients in between appointments to check progress and modify treatment plans and answer quick questions through FREE 15-minute mini consultations. Instead of having these conversations over the phone, I would send you a link that would bring you directly to a video conversation with me allowing us to communicate on a more personal level, and so I can see your lovely smile.  

What are the advantages of telehealth? I’ve already mentioned that you avoid wasting time and money by having to travel to and from your appointments. But another advantage is it helps all of our health professionals – Dietitian, Physiotherapists and Kinesiologists - to track your progress more regularly and make changes to your treatment plan as needed. And we are still able to directly bill your insurance if applicable. If you have any questions about how any of our therapists can help you during this challenging time, reach out to us for more information. 

One big advantage if you are at home, is you can walk me through your pantry, fridge and freezer and show me the foods that you are buying so that I can give you more accurate information on the products your are buying, including how to make use of what you have in your pantry and freezer during these challenging times. 

What are the limitations of telehealth? Luckily the only thing required for a telehealth session with me is a reliable internet connection since as a Registered Dietitian all I need to do is ask questions. For consultations with health professionals other than myself, you sometimes need to get creative. Sometimes another therapist such as a doctor or Physiotherapist might require you to self-examine. If you are having digestive issues they may ask you to feel your abdomen and describe what you feel, you will need to describe to the best of your abilities what you are feeling and the practitioner might need to get creative with the questions they ask you in order to get the information they need. In my opinion, that is not much of a limitation at all. 

What about payment? At PhysioFirst, in most cases we are still able to direct bill your insurance as I mentioned earlier as many private insurance plans cover the cost of our services either partially or entirely.  You can pay with a credit card over the phone or if you are in the Grand Falls N.B. area, you can pay next time that you visit the clinic. 

Some of the ways we can help you via telehealth are: 

  • Nutrition questions with me – Gabby, your Registered Dietitian. These can be related to managing blood sugar, lowering cholesterol, digestive issues, food allergies or intolerances, prenatal nutrition, baby’s first foods, meal planning and strategies to better manage your food supply and food safety during COVID-19. 
  • Women’s health questions and treatment progression with Sascha
  • If you have questions about your treatment plan or need a program with one of our therapists Physio, Kinesiologist or Dietitian - or are concerned that you need adjustments, and you are not able to make it in – book a telehealth consultation. 
  • Do you have wounds that you are concerned about? Our Physiotherapist Michelle is certified in wound care and can help address concerns and prevent an un-necessary hospital visit. 

Have any questions about how we can help you? 

Give us a call at 506-473-7064 

Send us an email at admin@physiofirstinc.com

Or find us on Facebook @physiofirstgrandfalls  

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What's the deal with cupping?

Sascha Boulet

Has your friend or partner come back from physiotherapy or massage therapy looking like they got attacked by an octopus? Not to worry, you shouldn’t be concerned about your friend/partner’s therapeutic relationship with their treating therapist, you should be asking yourself – is cupping something I could benefit from too?

If you haven’t heard about cupping, you can think of it as the opposite of massage or compression. Instead of pushing the structures across each other, as in massage, cupping pulls the tight structures apart allowing blood to flow between the layers.Over top of all of our muscles, there is a layer of connective tissue called fascia.

When muscles get tight part of the contributing problem could be myo(muscle)-fascial(connective tissue) restriction. In other words, the connective tissue overlaying the muscle has gotten stuck down to the muscle itself. Cupping works by helping to pull the fascia away from the muscle, allowing better movement between the two structures.

There is one catch! Because we are pulling blood into the area, bruising occurs. This bruising is simply broken blood vessels and because of this, the bruises you may sustain from cupping don’t hurt the way a regular bruise would. Most patient notice an immediate improvement in muscle tension and the associated pain in one session!

If you have tight muscles or trigger points (those knots of muscle you can feel) ask your physiotherapist or massage therapist if cupping is right for you! You may just have to explain your bruises to your friend/family for the next couple of days.


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