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The Beginner’s Guide to TeleHealth and Virtual Care

If you feel like you’ve been hearing a lot more about TeleHealth in the last few weeks, it’s because the current social distancing norms have forced some big changes in the way that non-essential health care has to be delivered. While most people have heard the term “TeleHealth” or “Virtual Visit”, they still have questions about what it really means and when to use it. If you are one of those people, read on for an overview of TeleHealth and what to expect from a virtual health care visit.

What is TeleHealth?

Telehealth refers to “the delivery of healthcare services, where distance is a critical factor, by all health care professionals using [communication technologies] for the exchange of valid information for diagnosis, treatment and prevention of disease and injuries, research and evaluation, and for the continuing education of healthcare providers, all in the interests of advancing the health of individuals and their communities.”1

It might sound like a very modern concept, but in fact a 1879 article published in the Lancet medical journal talked about using the telephone to reduce unnecessary office or home visits. And no, it’s not a typo. The article was actually published in 1879, three years after Alexander Graham Bell invented the pone.

What’s the Difference between TeleHealth and Virtual Care

Nothing really. TeleHealth is just a term for all health care services that are delivered remotely. TeleRehab is a term that specifically refers to physiotherapy services. Virtual Care is a term that involves “live, two-way, audio-video communication”.

What are the Benefits of TeleHealth?

In most cases, TeleHealth is a benefit. The original benefit was that it could provide treatment for patients who were located in remote places far from health facilities or in areas with shortages of health practitioners. While it is still used to address these problems, it has become an increasingly popular tool for convenient and accessible care. TeleHealth engages patients by allowing them to connect with their practitioner more frequently, in a convenient way which results in a stronger relationship and patients who feel empowered to manage their care.

Who is TeleHealth For?

Although it has long been an option for patients who live in rural areas, the current COVID-19 pandemic has created a new reason for this type of delivery method. Many communities have had to institute physical distancing measures requiring brick and mortar clinics to temporarily close to all non essential services. Additionally, people have become reluctant during this time to be in close personal contact with a health care practitioner if not absolutely necessary.  

TeleHealth can be a great primary or additional form of care for:

    • Any individuals with transportation or mobility difficulties (acute or chronic)
    • New moms who find it difficult to come in person
    • Individuals whose care no longer requires manual therapy, but is focused more on exercise progression, education, lifestyle management and integration
    • When inclement weather prevents you from getting to the clinic
    • Other medical practitioners who are looking to consult with our multi-disciplinary team
    • Those who travel frequently for work and have difficulty making it into the clinic
    • Patients who want to ask a question about whether or not therapy is needed for a new injury

TeleHealth and Musculoskeletal Problems

Just because you are at home, injuries and falls can still occur and people are still trying to manage the musculoskeletal conditions they had prior to the pandemic. Evidence suggests that rehabilitation through real-time TeleHealth interventions are effective for improving pain and function in individuals with spinal conditions, osteoarthritis and other musculoskeletal conditions. Ruling out serious pathologies, and providing education, exercise and self-management strategies are essential first-line management for musculoskeletal conditions. This first line management is effective in improving function, facilitating recovery and maximizing independence. Patients and caregivers have demonstrated satisfaction with the convenience, usefulness, and perceived benefits of TeleHealth.

Although TeleHealth is naturally devised for services that don’t require physical examination, it can still be an effective way to gather all the history and many important pieces of the examination necessary to provide safe, effective treatment for many health issues. The history provided by a patient is always one of the most important pieces of any health care visit and that can be accomplished remotely. 

Available treatment includes care for musculoskeletal and orthopedic conditions, acute and chronic pain management, self care for headaches and migraines, support for post-concussion recovery, strength and conditioning coaching (personal training), and running assessments (if you have access to a treadmill) for any individual who can not make it to the clinic for an appointment.

TeleHealth sessions can empower, support and motivate patients to keep up with their personalized rehabilitation program. Most importantly, it can be an important tool to facilitate the transition from passive care to active care and finally to self care.

Frequently Asked Questions About TeleHealth

What kind of equipment do I need?

Accessing TeleHealth is easy and does not involve any specialized equipment.

All you need is a strong Internet connection and access to a webcam and microphone through a desktop or laptop computer, tablet, or smartphone. You can use a Chrome, Firefox or Safari browser, and it works on both Android or iPhone. The video platform we use (Phzio) is safe, secure and compliant with government privacy laws (PIPEDA). There is no special software needed and you don’t have to download anything to your computer.

What could I expect during a TeleHealth session?

  • You can expect the same service you would receive during an in-person appointment:
  • History-taking, and review of your current goals and expectations
  • Education about your condition
  • Education regarding self-care treatment techniques
  • We can answer any questions you may have about your condition or health

**For chiropractic and physiotherapy appointments:

  • Virtual physical assessment including range of motion, movement scan/screen, etc.
  • Adjust and improve the efficacy of you current management plan
  • You may get exercise prescription, progression and modifications
  • Detailed walk throughs of exercises and show the specific areas to use self-massage and rehab tools
  • Education about activity/movement modification to decrease pain and speed healing, and to understand how load management affects symptoms

What do I need to do before starting my TeleHealth session?

  • Ensure you have an up to date emergency contact should something happen to you during your session.
  • Be connected to a strong Internet connection and access to a webcam and microphone through a desktop or laptop computer, tablet, or smartphone. PLEASE NOTE: The Phzio platform works BEST when using the Chrome browser.
  • Be sure that your device and/or your phone batteries are fully charged or plugged in if needed.
  • Test your video camera and microphone to make sure they’re working.
  • Ensure that you’re logged in to the same email account that you used to book the appointment. Please be logged in and prepared at least 10-15 minutes in advance.

**For chiropractic or physiotherapy appointments:

  • Try to set up in a relatively quiet, private and clear space (approx. 4’x4’ area) around you to move and exercise. Think about where and how your device will sit or be supported to allow for the best view and interaction through video. Don’t stress too much about it. Most setups work fine.
  • Have any exercise or therapy equipment that you may need for your session close by. This could be exercise bands, weights, balls, rollers, yoga mats, yoga props, a chair, etc. If you don’t have any of these things, don’t worry! We can get creative with common items you have in your house like a hard water bottle, soup cans, tennis ball, etc.
  • Please wear shorts and a tank top/sports bra, or form-fitting clothing (for us to be able to more easily assess your movement).
  • Please have an alternative way to communicate (telephone) at the ready in case there is a disconnection.

For more information, read our FAQ’s About TeleRehab.

The Last Thing You Need to Know About TeleHealth:

Virtual appointments are just as effective as person-person appointments. This even applies to neck pain, back pain, knee pain, osteoarthritis and post-operative conditions. Thanks to the latest technology, your rehabilitation and health goals don’t have to be quarantined by COVID-19.

Some of the most important parts of our time with patients is when we are talking with them and asking a very detailed series of sequential questions. This is called history taking. For musculoskeletal care, this discussion along with the visual assessment of the body and posture allows us to understand what is happening inside the body. When we combine this with movement-based tests and screens, we have the ability to determine the underlying issues related to your symptoms. We can then show you the path forward to better function, decreased pain and improved quality of life.


With the social distancing precautions that are now upon us, we at The Well-Life Centre are pleased to offer “Remote Therapy” to help meet your health care needs.

As part of our “Remote Therapy” program, we now offer TeleRehab—a multimedia approach to delivering physiotherapy services remotely. From the safety of your own home, you can now access Physiotherapy remotely using telecommunication technologies (video chat, email, phone, etc.). This will allow us to connect with you to collaborate over your healthcare plan.

Benefits of TeleRehab:

  • Saves patients time and money.
  • More flexibility in scheduling appointments.
  • Eliminates geographic, transportation and physical distancing barriers.
  • Observing a patient performing exercise in their own environment enables the practitioner to better personalize a program specific to each patient’s space and equipment availability.
  • Convenient for those who do not live close to the clinic.
  • Safe, effective treatment method for immunocompromised individuals.

While TeleRehab does not replace in-person appointments, it allows us to maximize what we can do in the current situation and can be a useful tool for all moving forward.

We have partnered with Phzio to provide virtual Physiotherapy and Chiropractic services. Phzio is a simple, easy-to-use platform that is HIPPA compliant. Take a look to see what a TeleRehab session can look like:


Commonly Asked Questions about TeleRehab:

What is the difference between Virtual Care, Telehealth and TeleRehab?

For the most part, all these terms means the same thing. Virtual Care and Telehealth are umbrella terms for remote healthcare, while TeleRehab is specific to physiotherapy.

What is TeleRehab?

TeleRehab specifically refers to the delivery of physiotherapy remotely, including all aspects of patient care including assessment and diagnosis, treatment, maintenance, consultation, education, training and injury prevention.

How does it work?

The most common method for TeleRehab is videoconferencing (Zoom, FaceTime, etc.), but can also include email, phone calls and apps.

Is it appropriate for everyone?

During the initial consultation, the patient and physiotherapist will jointly decide if TeleRehab is appropriate. Physiotherapists have a duty to the patient to disclose if they feel the patient is not suitable for remote therapy.

Is it covered by my benefits/ extended health insurance?

Most major extended health benefits plans, such as SunLife and Manulife cover TeleRehab. Coverage is dependent on the plan you have, so it is advised to check with your provider to determine the coverage.

What do I need?

For most appointments:
• A webcam is needed for the video chat—either on a computer, laptop, tablet or smartphone.
• A quiet, private room that has strong internet connection.
• Clothing that is suitable for a Physiotherapy appointment.

Is TeleRehab effective?

There have been many research studies over the past 10 years looking at the effectiveness of remote therapy/TeleRehab, they have shown that diagnostic accuracy, functional results and patient satisfaction to be comparable to traditional face-to-face therapy (Russell T. 2011, Cottrell M.A, 2018 & Owuso-Akyaw K.A., 2019).

The Last Thing You Need to Know About TeleRehab:

Not every person or every condition is perfectly suited to TeleRehab. However, the risk of COVID-19 transmission in most cases outweighs the benefits of in-clinic manual therapy. This is the most effective way for us to continue supporting your rehabilitation and health goals despite the restrictions currently in place.

We provide evidence-based and highly effective care. This means we use techniques that have been shown, in research studies, to be effective. If you’re still not sure this is an effective form of therapy, Take a few minutes to review the research studies yourself. We’ve listed them here for you.

Mbada, C., Olaoye, M., Ayanniyi, O., Johnson, O., Odole, A., & Dada, O. (2017). Comparative Efficacy of Clinic-Based and Telerehabilitation Application of Mckenzie Therapy in Low-Back Pain. Archives of Physical Medicine and Rehabilitation, 98(10), e46-e47.

Azma, K., RezaSoltani, Z., Rezaeimoghaddam, F., Dadarkhah, A., & Mohsenolhosseini, S. (2018). Efficacy of tele-rehabilitation compared with office-based physical therapy in patients with knee osteoarthritis: a randomized clinical trial. Journal of telemedicine and telecare, 24(8), 560-565.

Mani, S., Sharma, S., & Singh, D. K. (2019). Concurrent validity and reliability of telerehabilitation-based physiotherapy assessment of cervical spine in adults with non-specific neck pain. Journal of telemedicine and telecare, 1357633X19861802.

Cottrell, M. A., Galea, O. A., O’Leary, S. P., Hill, A. J., & Russell, T. G. (2017). Real-time telerehabilitation for the treatment of musculoskeletal conditions is effective and comparable to standard practice: a systematic review and meta-analysis. Clinical rehabilitation, 31(5), 625-638.

Nelson, M., Bourke, M., Crossley, K., & Russell, T. (2020). Telerehabilitation is non-inferior to usual care following total hip replacement—a randomized controlled non-inferiority trial. Physiotherapy, 107, 19-27.

As part of the Remote Therapy program, we will be rolling out different initiatives to help support you during these times. We are trying to foster a more collaborative approach and would love your input and feedback.

“Coming together is a beginning. Keeping together is a process. Working together is success.” ~ Henry Ford

Best Tips to Relieve Pain Naturally

Our clinic remains closed while we ride out this current global situation. Although we are available to see patients in person for urgent care, we thought we would share some natural pain relief options that you may need to hold you over in the meantime. We often recommend various natural pain relief options to help supplement our treatment. The following natural pain relief options are generally easy to try, inexpensive and have the potential for reducing your pain. Try a few to see what works best for you.


Tip 1: Release your inner endorphins

Endorphins are the natural pain killers produced by your body. They bind to the opioid receptors in the brain to block the perception of pain. Increased production of inner or “endogenous” endorphins can substantially reduce pain and produce profound feelings of pleasure and satisfaction. Any physical activity that gets your blood pumping for a sustained period will release endorphins into your system. Some of you may recognize this as “runner’s high”. As always, check with your doctor before starting a new exercise program.


Tip 2: Enjoy the outdoors

Being outdoors boosts our mood and may also promote better immune function. As a matter of fact, Shinrin-yo, also known as forest bathing, is a popular therapy in Japan involving soaking up the sights, smells and sounds of a natural setting to promote physiological and psychological health. Additionally, sun exposure can help the body produce vitamin D, which may help reduce pain. Unfortunately, many of us have a Vitamin D deficiency and may need to supplement.


Tip 3: Soak in warm water

Soaking in warm water can alleviate certain types of arthritis, muscle pain and spasm. There are many options for a warm soak including a deep tub, hot tub or warm pool. Our favourite is to soak in an epsom salt bath. Epsom salt is also known as magnesium sulphate and most of the reported benefits of Epsom salt are attributed to its magnesium, a mineral that most people do not get enough of. Add one or two cups of Epsom salt to a warm bath to relieve muscle soreness and stress.


Tip 4: Eat more anti-inflammatory foods

Anti-inflammatory foods – such as berries, avocados, broccoli, olive oil, turmeric, omega-3 fatty acids (salmon, tuna), dark chocolate and cherries. At the same time, decrease consumption of foods that promote inflammation such as junk foods; processed meats; refined carbohydrates such as white bread; fried foods; and sugar sweetened beverages.


The Last Thing You Need to Know Relieving Pain Naturally

These are just a few natural pain-relieving tips are intended as ideas for you to consider but if you need professional advice or help, don’t hesitate to contact us.

What are the best strategies you have used to relieve pain?

low back pain

Low Back Pain

How to Manage Low Back Pain

Have you ever had low back pain?  If you have, you are not alone.  It is estimated that approximately 80% of people will suffer from this disorder in their lifetime.  As a matter of fact, low back pain is currently the number one cause of disability globally.

What is Low Back Pain?

First of all its important to understand that low back pain is a symptom and not a disease.  Not only is it extremely common, it is experienced by people of all ages.  Surprisingly, back pain rarely occurs as a result of strenuous or intensive activity.  In fact, most people are doing something very simple when back pain strikes.  I commonly hear things like “I was just bending over to lift a laundry basket, an EMPTY laundry basket” or I” was leaning over the sink putting on my contact lenses”.  

It’s important to understand that low back pain is different than other injuries.  For example, when you twist your ankle you generally have intense pain that slowly decreases and goes away as the injury heals.  This is not what happens when you have low back pain.  Relief doesn’t seem to be related to healing because typically, there is no significant injury causing the low back pain.

Why Do I Have Low Back Pain

The short answer? We really don’t know.  Most of the time, a specific cause of low back pain cannot be identified.  In other words, we don’t know what the true source of the pain is.  That’s why most low back pain is called “Non Specific Low Back Pain” or “Mechanical Low Back Pain”.  Additionally, low back pain can be accompanied by pain in one or both legs. Some people experience associated numbness or tingling as well.

The common belief is that low back pain usually results from age related deterioration of the the spine – otherwise known as arthritis or degeneration.  But here is the conundrum, x-rays and MRIs of pain-free people show just as much degeneration in their lower spines as those with reported low back pain.  According to Brinjikji, et al., 2015, p. 813, it is estimated that 60% of people have a disc bulge at age 50 and 80% have disk degeneration. That is why the diagnostic importance of x-ray, CT scan or MRI findings are a topic of debate. There is no evidence that imaging improves outcomes. For these two reasons current clinical guidelines recommend against routine x-rays for people with low back pain unless there is a concern that the pain is resulting from something needing specific treatment such as cancer, fractures, infections or inflammatory disorders. 

Bad Genes?

It is estimated that lumbar disc bulges have approximately 75% heredity origin (Janeczko Ł, Janeczko M, Chrzanowski R, Zieliński G. The role of polymorphisms of genes encoding collagen IX and XI in lumbar disc disease. Neurol Neurochir Pol. 2014;48(1):60–62). 

The actual pain experienced may be tied to your genetics too.  The back pain symptoms are highly variable.  Pain can last from one day to three months.  Some people are prone to heightened pain, like in fibromyalgia and some people are less prone to experiencing pain.  We all know people with a low tolerance to pain and those with a very high tolerance to pain.  Turns out, it may be genetically determined. Research shows that low back pain runs in families.  This can be seen with identical twins who often have similar back pain even though they have totally different lifestyles. For example one twin has a desk job and the other has a physically demanding job. 

So Why The Pain?

Research is showing that pain is not usually related to the mechanics of the spine but with the way the nervous system is processing the information.  Typically, pain is an alarm bell telling us to stop or we will hurt ourselves but that alarm bell may in fact be a false signal.  It results from hypersensitive nerves that are interpreting normal sensations of touch or movement as a pain message.  This in turn leads to what is known as “fear avoidance” which leads us to avoid activities due to fear of increasing pain, which then leads to disability.  Just to clarify – the avoidance of activity causes the disability, not the increasing pain.  The best approach is advice and education, reassurance that low back pain is not a serious disease and that symptoms improve over time.  

How to Manage Low Back Pain

Here is the meat of your post. You’ll break down the problem into a list of easy to accomplish steps to help your reader.


  • This is the most important tip, in my opinion.  When we have really intense pain we become anxious that something is seriously wrong.  Understanding that hurt does not mean harm, with respect to low back pain, helps you to cope better.
  • Low back pain is a symptom and not a serious disease. The symptoms are typically due to simple mechanical dysfunction and will improve over time.

Avoid Rest and Stay Active

  • Our initial instinct may be to lay down and rest when we have back pain but that can make the pain worse over time. It can reduce flexibility and muscle tone, lead to an increase risk of depression and even increase the rick of developing blood clots in your legs.
  • Stand, walk and continue with your usual activities, including work.

Use hot or cold packs

  • Contrary to popular belief, there is not right or wrong answer.   You can read more about that here but just use whatever makes your back feel better.

Consult with a Chiropractor, Massage Therapist, Acupuncturist or Osteopath

  • Currently US clinical guidelines recommend non pharmacological care as the first treatment option and reserve pharmacological care for patients for whom non-pharmacological care has not worked. These guidelines endorse the use of exercise, massage therapy, acupuncture, spinal manipulation, TaiChi and yoga.

The Last Thing You Need to Know about Low Back Pain

The old advice to be careful and stop moving does not work. There is no evidence that being careful will slow down the aging process.  So live a full life and enjoy the activities that make you happy.

Please share any strategies that you have found helpful to manage your low back pain so I can create a new post to share them.

Ice or Heat?

We get that question every day.

The most frequently asked question we get is: “Should I use ice or heat?”  Since the late 1970s, therapists have often treated an injury with RICE (rest, ice, compression and elevation). It’s an easy formula to remember: RICE is nice. Its now common knowledge that nobody believes in rest anymore. You can have hip replacement surgery and be up and walking within hours.

As for ice, there seems to be a bit of debate going on. There’s not much research to show that ice does anything more than numb pain. Icing restricts blood flow to the area which helps numb the pain and keep the initial swelling from getting out of control. But does it work to actually heal the injury? As it turns out, there are no clinical studies of its effectiveness (British Journal of Sports Medicine, 2012). In fact, some studies suggest that icing actually seems to delay recovery from exercise-induced muscle damage (Journal of Strength and Conditioning Research, 2013).

Is it harmful to ice an injury?

When you damage tissue through trauma or develop muscle soreness by exercising very intensely, your body mobilizes your immune system to heal. It’s the same biological mechanism that you use to kill germs. This is called inflammation. When germs get into your body, your immune system sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immune system sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb. 23, 2014). Anything that reduces your immune response will also delay muscle healing. Therefore, ice is counterproductive. Interestingly, Ibuprofen is worse because it actually stops the signal of the inflammatory response.

What about rest?

Blood flow brings inflammatory cells into the injured tissue to start the healing process and the lymphatic system then removes the waste products from the tissue. Muscle contraction is necessary to move lymph and eliminate these chemicals, not immobilization! Recognizing the importance of movement in the healing process is why nobody believes in rest anymore.

So what’s the current recommendation?

For minor injuries keep moving but always within a painless range of motion. If you can’t move the injured area, for example, if your ankle is in a cast, move your toes. Elevate to help the lymphatic system drain and as always, consult with your health care practitioner if you have any concerns.

Coffee: Brewing Longevity

The proof is in – Drinking coffee can lead to a longer life!

Well, maybe it’s not actual proof but a recent review of more than 200 scientific studies supports the idea that drinking coffee every day could actually have health benefits.

The review, recently published in the British Medical Journal, aimed to dispel some of the confusion and controversy surrounding coffee consumption and looked at the evidence from 218 previous studies.

The verdict?

Researchers found drinking coffee was consistently associated with a lower risk of death from all causes and a lower risk of several cancers, as well as type 2 diabetes, gallstones and gout.

Liver conditions, such as cirrhosis, saw the greatest benefit associated with coffee consumption.

There also seemed to be beneficial associations between coffee consumption and Parkinson’s disease, depression and Alzheimer’s disease.

This study adds to previous research findings promising connections between coffee consumption and improved health.

Earlier this year, a long-term observational study of nearly 20,000 people in Spain found that participants who consumed at least four cups of coffee per day had a 64% lower risk of death than those who infrequently or never consumed coffee. They also found a 22% lower risk of death for participants who drank two cups a day. Lower risk was especially strong for older participants, with two cups a day linked to a 30% reduction in mortality.

It’s important to note that the correlation between coffee consumption and lower risk of death is not proof of causation.

The findings are applicable to people who are already generally healthy. The studies didn’t find that drinking coffee correlates with reversing existing health problems, but with preserving health.

Is caffeine the magic ingredient?

Probably not.

There are two main factors that could be considered benefits to drinking coffee. First, coffee is a rich source of antioxidants (particularly chlorogenic acids), which may exert a protective, anti-inflammatory effect in the body and brain. The more we learn about the dangers of inflammation, the more likely it seems that foods which help reduce it are “life savers”, literally. Nutritionally speaking organic, black, fresh (beans or ground) coffee is best as it is higher in antioxidants. Some research suggests that dark roast blends have higher antioxidant levels than light or medium roast blends. Coffee also contains some B vitamins, magnesium and potassium.

The second is the stimulant caffeine. However, caffeine can present potential risk factors if consumed in excessive amounts and for certain people who may be vulnerable to its effects.

So the take away?

According to the research, 3 cups a day is the sweet spot when it came to relative risk of death compared with coffee abstainers. Generally speaking, drinking two to four cups a day is associated with overall lower risk of death, particularly among middle-age drinkers. So if you are a coffee lover like me, enjoy your coffee with the knowledge that it may be helping you live a longer, healthier life.