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Summer Newsletter






Orthopaedic Sport Institute Training Services:

  • Group exercise classes for every fitness level
  • Fitness Testing
  • Return to Sport Rehabilitation
  • Personal Training:  individual sessions and packages
  • Athlete Program Design
  • Pre-Training Physical Evaluation with a registered physiotherapist.



Programs Offered

Beginner Group ——Intermediate Group —— Advanced Group 

Pre – Mid – Post Season Training

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Embracing Aging





All you need to know to age well


                      Date & Time:                   July 14, 2015

                                                              5:30 pm – 7:00 pm

                      Topics:                             Bone Health

                                                              Muscle Fitness

                                                              Mental Focus Training



                       Location:                        500 Ontario Street

Seating is limited

RSVP @ or (705) 467-0701

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One Moment



We are proud sponsors of Theatre Collingwood and their upcoming production “One Moment”.  We will be there to enjoy the show and meet the casts on July 28, 2015.  We hope to see you there!

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Spinal Stenosis: Physical Therapy before Surgery

Spinal stenosis: physical therapy before surgery

Clinical question

Is surgery more effective than physical therapy in patients referred for surgery for spinal stenosis?

Bottom line

Assigning patients to 6 weeks of physical therapy is as effective as initially sending them for decompression surgery, with fewer complications, even in patients who have a strong preference for surgery. A trial of 6 weeks of physical therapy makes sense for many patients with confirmed spinal stenosis before getting out the scalpel. (LOE = 1b-)


Delitto A, Piva SR, Moore CG, et al. Surgery versus nonsurgical treatment of lumbar spinal stenosis. A randomized trial. Ann Intern Med 2015;162(7):465-473.

Study design
Randomized controlled trial (single-blinded)



Outpatient (specialty)

The investigators enrolled 169 patients (average age: 66-69 years) with image-confirmed lumbar stenosis who consented to surgery. This approach to enrollment eliminated many patients, presumably those with milder symptoms. The patients were randomly assigned (allocation concealed) to surgery or physical therapy. The decompression surgery was the typical procedure used in research and practice. Physical therapy, administered twice weekly for 6 weeks, consisted of lumbar flexion exercises and conditioning to identify the issues of strength and flexibility identified at enrollment. Analysis was by intention to treat, meaning that patients assigned to physical therapy were analyzed as being in that group even if they eventually received surgery, which 57% of them did over the 2 years of follow-up (most of them within the first 10 weeks of the study). Approximately 20% in each group sought additional physical therapy. Two years after identification, general quality of life (as measured by the Short Form-36 Health Survey, a typical measure of quality of life) improved equally in both groups, to an average score of 48-50 from a baseline of 26-28 of a possible 100. Analyzing by actual treatment rather than by intention to treat yielded similar results though the study may not have had enough power to find a difference if one existed. Pain, disability, and neurogenic symptoms improved similarly in both groups. Complications were common in the back surgery group, including the need for re-operation. Many patients were not returned to “normal” but continued to visit either a back surgeon or primary care physician for back pain 2 years after the intervention.

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Platelet-Rich Plasma injection (PRP injection)

Many individuals have experienced injuries to muscles and tendons and have attended therapy to assist in their recovery.  Even famous athletes, including Tiger Woods and tennis star Rafael Nadal, have suffered with chronic tendon injuries. These types of conditions have typically been treated with medications, physical therapy, chiropractic care, therapeutic exercise or even surgery.  Unfortunately, tendons have a poor blood supply – this is the reason why some tendon injuries take so long to heal.

Over the past several years, a treatment known as Platelet-Rich Plasma injection (PRP injection) has become increasingly common in sports medicine clinics.  Platelets are found in our blood – while they are best known for their importance in clotting blood, platelets also contain proteins which are crucial in the healing of injuries.

PRP injections involve:

  • taking a specific amount of blood from a patient
  • extracting the platelets i.e. the portion that helps to stimulate healing of damaged tissue
  • injecting the platelets into the injured area under the guidance of diagnostic ultrasound

According to the research studies currently reported, PRP is most effective in the treatment of chronic tendon injuries, especially tennis elbow, a very common injury of the tendons on the outside of the elbow.  PRP is also commonly used to treat golfer’s elbow, knee tendon injuries, Achilles tendon pain and plantar fascia injuries.

Depending on the area injected and the severity and chronicity of the problem one or two subsequent injections may be necessary. Following successful PRP treatments, a good program of physical rehabilitation is required to fully rehabilitate the body back to full functional capacity.

If you have any questions please contact Dr. Olivia Cheng, Orthopaedic Surgeon, at the Orthopaedic Sport Institute for timely consultation.  Diagnostic ultrasound is utilized for PRP injections to ensure that PRP is delivered directly to the diseased tissue.

For further information on managing your injury, please contact the Orthopaedic Sport Institute at (705) 467-0701 or and ask for a consultation with one of our friendly healthcare professionals.

Darryl Novotny, BScPT

Registered Physiotherapist



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Welcome Sarah Hornby!

We would like to welcome Sarah Hornby to the Orthopaedic Sport Institute.
Sarah has extensive training in physical rehabilitation with a focus on sports injuries and post surgical recovery. She is a Registered physiotherapist and a registered massage therapist. She also carries a certificate in Acupuncture.

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Women Top the List for Orthopedic Surgeons in Canada

Women Top the List for Orthopedic Surgeons in Canada

dr olivia cheng top orthopedic surgeon in canada

According to, the top two orthopedic surgeons in Canada are women, which is surprising given that this field of medicine is traditionally dominated by men.Dr. Andrea Veljkovic and Dr. Olivia Cheng have higher ratings from surgical patients undergoing orthopedic procedures than any other surgeons in Canada, but the rest of the top ten list looks more familiar, with all eight of the other top spots taken by men.





The Top 10 Orthopedic Surgeons in Canada 

  1. Dr. Andrea Veljkovic
  2. Dr. Olivia Cheng
  3. Dr. Andrew Berkshire
  4. Dr. Sebastian Rodriguez-Elizalde
  5. Dr. Marc Beauchamp
  6. Dr. Duong Nguyen
  7. Dr. Mohammad Al-Sahan
  8. Dr. Dale Williams
  9. Dr. Markus Bischoff
  10. Dr. Bradley Allan Petrisor

Dr. Cheng operates in Collingwood, Ontario, while Dr. Veljkovic works out of Toronto, Ontario. Both have an average 4.9-star rating from patients, despite familiar complaints about inefficiencies in the hospitals in which the surgeons work.

Dr. Cheng focuses on musculoskeletal and sports related issues, having completed her medical training, and training in orthopedic surgery at the University of Toronto. She became a Fellow of The Royal College of Surgeons of Canada in 2009, and has received extra fellowships training in trauma and upper limb reconstruction at St. Michael’s Hospital, Toronto. Dr. Cheng and her husband, chiropractor Dr. Todd Starr, recently pledged $100,000 to the General & Marine Hospital’s New Age of Care campaign.

Dr. Veljkovic is a foot and ankle orthopaedic surgeon interested in alignment restoration in complex foot and ankle deformities, arthroplasty, and advanced arthroscopic reconstruction. She is currently completing an MSc in Epidemiology, when not replacing people’s ankle bones.

Unfortunately, none of the top ten specialises in spinal surgery, so perhaps 2015 will be the year spine surgeons in Canada step up their game and make some changes in this list of top orthopedic surgeons.

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Treating Osteoarthritis of the knee : Popular supplements don’t work

Treating osteoarthritis of the knee: Popular supplements don’t work

Released October 29, 2014

Osteoarthritis is the most common type of arthritis, affecting 1 in 10 Canadian adults ( The knee is one of the most common and most symptomatically affected joints, causing knee pain in many people. They often try over-the-counter remedies to help the pain, and to avoid knee surgery. Amongst these treatments are the supplements glucosamine and chondroitin sulfate, which are very popular.


Because glucosamine and chondroitin are building blocks of cartilage, and because osteoarthritis is related to cartilage degradation, many believe that adding these building blocks to the diet of a person suffering from osteoarthritis will help rebuild cartilage and lessen pain. While on the surface this may seem logical, in reality these supplements do not provide effective pain relief. Here’s why:


These popular supplements don’t work.

Many studies have shown that glucosamine and chondroitin sulfate do not help to relieve pain from arthritic knees. People who take the supplements often report less pain or swelling of their joints. But people get similar results if they take a placebo—a “sugar pill” with no active ingredients. Pain relieving drugs, such as acetaminophen (Tylenol and generic) and ibuprofen (Advil, Motrin IB and generic), help a lot more.


The supplements can be dangerous.

Glucosamine and chondroitin are not harmful by themselves, but they can interact with other medicines. For example, the supplements can increase the effect of warfarin (Coumadin and generics) on blood clotting. This increases the risk of bruising and serious bleeding. Problems with warfarin frequently lead to emergency room visits.


You aren’t always getting what you think…

To make matters worse, often the labels on the bottles are misleading. In 2013, Consumer Reports tested 16 joint pain supplements and found that seven had less chondroitin than the label listed.


Other approaches often work better.

There are more effective ways to relieve arthritic knee pain:

  • Physical therapy
  • Losing weight
  • Acetaminophen (Tylenol and generic)
  • Ibuprofen (Advil, Motrin IB and generic)
  • Naproxen sodium (Aleve and generic)
  • Other anti-inflammatory medications

If these don’t help, you can talk to your doctor about treatments such as injections or surgery.


Steps to help ease the pain of osteoarthritis of the knee

Lose excess weight. Losing a pound of excess weight can take about four pounds of pressure off your knees when walking.


Physical activity. To build support of the knees, do strength training, especially of the quad muscles on the front of the thigh. Aerobic exercise builds strength and can reduce pain. Stretching can help prevent stiffness. Ask a local YMCA or gym about exercise programs for people with arthritis.


Mechanical aids. A cane, crutch, or walker can take a load off painful knees.


Heat and cold. A heating pad can ease ongoing stiffness and soreness in joints. For acute pain and swelling, switch to ice packs.


Massage. Deep-tissue massage got high marks in a 2010 survey of Consumer Reports online readers. Half of them said that it “helped a lot” with their osteoarthritis.


Use drugs carefully.

  • Ibuprofen (Advil, Motrin IB and generics) and naproxen (Aleve and generics) can ease pain and inflammation. But they may cause stomach bleeding and high blood pressure, if taken over a longer time. Try to use them only for short periods.
  • Acetaminophen (Tylenol and generic) can also help reduce pain, but high doses can damage your liver. Make sure you take less than 4,000 mg a day.
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Choose Wisely Canada – Orthopaedics



Five Things Physicians and Patients Should Question

Released April 2, 2014


Avoid performing routine post-operative deep vein thrombosis ultrasonography screening in patients who undergo elective hip or knee arthroplasty.

Since ultrasound is not effective at diagnosing unsuspected deep vein thrombosis (DVT) and appropriate alternative screening tests do not exist, if there is no change in the patient’s clinical status, routine post-operative screening for DVT after hip or knee arthroplasty does not change outcomes or clinical management.


Don’t use needle lavage to treat patients with symptomatic osteoarthritis of the knee for long-term relief.

The use of needle lavage in patients with symptomatic osteoarthritis of the knee does not lead to measurable improvements in pain, function, 50-foot walking time, stiffness, tenderness or swelling.


Don’t use glucosamine and chondroitin to treat patients with symptomatic osteoarthritis of the knee.

Both glucosamine and chondroitin sulfate do not provide relief for patients with symptomatic osteoarthritis of the knee.


Don’t use lateral wedge insoles to treat patients with symptomatic medial compartment osteoarthritis of the knee.

In patients with symptomatic osteoarthritis of the knee, the use of lateral wedge or neutral insoles does not improve pain or functional outcomes. Comparisons between lateral and neutral heel wedges were investigated, as were comparisons between lateral wedged insoles and lateral wedged insoles with subtalar strapping. The systematic review concludes that there is only limited evidence for the effectiveness of lateral heel wedges and related orthoses. In addition, the possibility exists that those who do not use them may experience fewer symptoms from osteoarthritis of the knee.


Don’t use post-operative splinting of the wrist after carpal tunnel release for long-term relief.

Routine post-operative splinting of the wrist after the carpal tunnel release procedure showed no benefit in grip or lateral pinch strength or bowstringing. In addition, the research showed no effect in complication rates, subjective outcomes or patient satisfaction. Clinicians may wish to provide protection for the wrist in a working environment or for temporary protection. However, objective criteria for their appropriate use do not exist. Clinicians should be aware of the detrimental effects including adhesion formation, stiffness and prevention of nerve and tendon movement.

How the list was created

The Canadian Orthopaedic Association (COA) established its Choosing Wisely Canada Top 5 recommendations by asking its National Standards Committee to review the evidence base associated with the five treatments and procedures chosen by the American Academy of Orthopaedic Surgeons for the Choosing Wisely® campaign in the United States. Satisfied that the list was relevant to the Canadian clinical context, the Committee recommended its adoption to the COA’s Executive Committee, and the motion was then unanimously approved by the Board of Directors. Therefore, all five items were adopted with permission from the Five Things Physicians and Patients Should Question. © 2013 American Academy of Orthopaedic Surgeons

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