Neurogenic Thoracic Outlet Syndrome – Making big headlines lately

If you even remotely follow the NBA you might have heard the ongoing drama regarding the health of Philadelphia 76ers’ young guard, Markelle Fultz. The former number one overall draft pick has begun his once-promising career with a bizarre sudden inability to properly shoot a basketball. You don’t need to be an expert to understand that a player who mysteriously loses his jump shot is both equally unheard of as it is concerning for their future career. After over a year of endless speculation Fultz recently saw a specialist and was diagnosed with neurogenic thoracic outlet syndrome (nTOS).

What is Thoracic Outlet Syndrome?

Thoracic Outlet Syndrome (TOS) is a complex and controversial disorder. Generally speaking, it refers to a very broad group of conditions that stems from the compression of nerves and blood vessels between your collarbone and first rib. As both nerves and blood vessels are potentially affected, TOS can be further subcategorized as either neurogenic thoracic outlet syndrome or vascular thoracic outlet syndrome.

How do I know if I have it?

TOS can be a very difficult diagnosis to make even from a clinician’s standpoint. The number of structures that can cause TOS is enormous as it includes all sorts of different muscles, bones, nerves, etc. Compression of your vessels and nerves can also occur at multiple points in your upper extremity and symptoms of TOS can mimic symptoms of other shoulder and nerve-related pathologies. Consequently, the symptoms for one person will not necessarily be the same for another. Often times the condition is diagnosed by ruling out all other potential pathologies. Statistically, if you do have TOS you are far more likely to have neurogenic thoracic outlet syndrome than its vascular counterpart.

Below are some of the most common symptoms of nTOS:

  • Numbness and/or tingling down the arm into the hands
  • Fatigue of the arms particularly with overhead movements
  • Weak grip
  • Vague shoulder pain

What causes it?

There can be many different causes for developing nTOS. It can range from something as simple as poor posture to something more traumatic such as whiplash from a motor vehicle accident. Certain jobs can also predispose an individual to developing TOS – particularly those involving repeated overhead movements such as hairdressers or assembly line workers. Interestingly, women have been found to be up to four times more likely to develop TOS than males.


Before doing any treatment, it is important to first seek out a physiotherapist to get a thorough assessment done to rule out any other potential causes. A multidisciplinary approach involving clinicians from varying healthcare disciplines is generally recommended for both assessment and treatment given how complex TOS can be. If TOS is indeed suspected, then treatment typically involves targeting whatever structures are at fault through rehabilitation, manual therapy and exercise. Education regarding eliminating any behavioural or environmental causes is another important component of treatment.

If you are experiencing any symptoms of thoracic outlet syndrome, come into see one of our Registered Physiotherapists for an accurate clinical assessment today.


Orthopaedic Physical Assessment 6th Edition. Magee.

Dr. Marvin Shedletzky Joins the Ace Sports Clinic Team

At Ace Sports Clinic we’re dedicated to providing the best experience and inspiring high performance for all our clients. Collaboration is a cornerstone to the success our clients are able to achieve and we would like to welcome Dr. Marvin Shedletzky to our team of skilled knowledgeable experts.

Dr. Marvin Shedletzky is highly experienced and well known Doctor of Chiropractic. He takes a personal interest in the health and wellbeing of all his patients, including players on every NHL team, Leafs, Raptors, as well as high-profile celebrities, actors and musicians. Over the years he has developed a very gentle, specific chiropractic adjustment to allow maximum nervous system flow and functional performance. He also utilizes the DRX9000 Spinal Decompression machine to help reduce pain and slow down degenerative changes caused by bulging/herniated and/or degenerating discs. Several neck and back surgeries have been cancelled due to the combination of the DRX and Dr. Shedletzky’s therapies. For a full bio click here.


“I’m excited to join a growing multidisciplinary team of professionals that are truly interested in the best for their patients. The ability to collaborate together regarding the health and wellbeing of a patient excites me. With this approach we’ll be able to help the most difficult patients, who have spent months or years with pain and degenerating functionally, with limited understanding of why their symptoms continue to wax and wane. We’ll not only communicate the root issues that lead to the symptoms in a way the patient can understand but we’ll also help them feel and function better. Everything is connected to the central nervous system flow and your self talk.” – Dr. Marvin Shedletzky

Visit us at to learn more about our team and approach to helping you achieve your health and wellness goals.

Live well. Keep Playing.

Acute Ankle Sprain: What does it mean and Where to from here?

What does ‘ankle sprain’ mean?

A sprain is a term used to describe a ligament injury, where the ligament has been over-stretched or sometimes torn. They typically occur due to joint trauma, or a joint being taken past its range of motion. An ankle sprain is therefore, an injury to the ligaments connecting the bones of the ankle joint.

What are normal symptoms?

  • Tender to touch
  • Sudden and intense pain
  • Swelling and bruising
  • Joint stiffness
  • Walk with a limp

What ligaments have I sprained?

The ligaments injured, depend on how you have sprained your ankle

Rolling your ankle inwards

Rolling your ankle outwards

How long until I get better?

Sprains are graded from 1 to 3 based on their severity, with 1 being the lowest and 3 the highest.

Grade 1 indicates mild stretching and damage, with 1-2 weeks for recovery

Grade 2 indicates partial tearing, with 4-6 weeks for recovery

Grade 3 indicates complete tearing, with 3 or months for recovery

Is this a serious condition?

Although painful, this is not a condition you should worry about, as ankle sprains make up 40% of all sporting injuries. However, if you have the symptoms depicted above you should go to the hospital for X-rays.


  • Initial Phase (Limit inflammation and bleeding)
    Rest, with the ankle elevated and compressed
  • Crutches, for the first 24 hours to allow for weight-bearing, without being excessive
  • Gradual weight-bearing, to promote ankle motion

Intermediate Phase (Restore pain free motion)

  • Begins when you no longer experience pain at rest
    Involves moving your ankle actively in all pain free directions
  •  Strengthening exercises can begin slowly
  • An ankle brace can be used to help manage pain with work, however, it is important to not become dependent on it

Advanced Phase (Restore function)

  •  Begins when pain free and swelling is no longer present
  •  Involves advanced exercises that aim to strengthen and reduce the chance of re-injury
  • They should be advised by and done in the company of a trained professional


  • Alcohol
  • Cigarettes
  • Stress
  • Overwork
  • Complete rest

Reduce Stress

  • When injured, the body produces stress hormones
  • This places strain on the body, prolonging the healing period
  • This response can be reduced through treatment focusing on the nervous system

Restore Ankle Motion

  • Mobilization techniques directed to the foot and ankle joints will promote movement
  • With this, it may also promote a faster healing time

What if I do nothing?

Doing nothing may result in a longer recovery time.  The tissues may not reach the strength they would have otherwise. The ankle joint may become chronically unstable, which can increase the likelihood of:

  • Re-injuring the ankle
  • Developing osteoarthritis

Osteopathic Treatment

Reduce Pain and Swelling

  • Pain and swelling cause discomfort and limited motion
  • If drawn-out, this can result in a longer than usual healing time and increased risk of re-injury
  • Massage and mobilization can be used to minimize these effects

Written by James Goetz for



1. Adelaide Crows Sports Medicine Clinic [Internet]. 2017 [cited 2 September 2017]. Available from:

2. Dubin JC, Comeau D, McClelland RI, Dubin RA, Ferrel E. Lateral and syndesmotic ankle sprain injuries: a narrative literature review. Journal of chiropractic medicine. 2011 Sep 30;10(3):204-19.

3. Ankle Sprains” When should you be concerned? [Internet]. 2017 [cited 2 September 2017]. Available from:

4. Inversion Ankle Sprains [Internet]. 2017 [cited 31 August 2017]. Available from:

5. Medial ankle sprain [Internet]. 2017 [cited 2 September 2017]. Available from:

6. Different Grades Ankle Sprain [Internet]. 2017 [cited 2 September 2017]. Available from:

7. Chan KW, Ding BC, Mroczek KJ. Acute and chronic lateral ankle instability in the athlete. Bulletin of the NYU hospital for joint diseases. 2011 Jan 1;69(1):17.doi:

8. Tiemstra JD. Update on acute ankle sprains. Am Fam Physician. 2012 Jun 15;85(12):1170-6. Available from

9. Ottawa Ankle Rules [Internet]. 2017 [cited 2 September 2017]. Available from:

10. When It Comes To Physical Therapy, Patients Have To Do The Work [Internet]. 2017 [cited 2 September 2017]. Available from:

11. Kemler E, van de Port I, Backx F, van Dijk CN. A systematic review on the treatment of acute ankle sprain. Sports medicine. 2011 Mar 1;41(3):185-97.

The Ace Meditation Workshop

Everything that is going on around us influences us and how we deal with the world, but these external experiences are just one part of it. Our internal experiences also have a tremendous effect on the way we think, feel,  and act.

Rush hour traffic, super crowded public transportation, challenging situations at work, difficult personal relationships, health issues; the lives we are living present countless daily stressful situations. We do not notice how stress affects us because it seems to be routine, a normal part of modern life. However, these everyday annoyances are often at the root, and can lead to us experiencing accumulated chronic stress. So how do we deal with this? How can we manage stress?

Young overworked businessman relaxing in the office.

We have all done, and will continue to do what we can to take care of what is important to us from an outside perspective. That is not only vital but also wonderful. Unfortunately, the majority of us were never taught how to explore the vastness that exists inside of us.

Ask yourself, what are you doing to take care of what is going on in the world inside of you? Let’s have a look at what is happening in our bodies.  Regular activation of the flight/fight response in non-life-threatening stressful situations can weaken our health.

Changes in Physiology:

  • Increase in stress hormones
  • Increase in blood pressure, heart stress
  • Increase in blood sugar
  • Decrease in circulation to digestive tract
  • Decrease in immunity
  • Increase in sticky platelets

Leads to:

  • Coronary heart disease
  • Anxiety, insomnia, addictions
  • Diabetes, obesity
  • Digestive disturbances
  • Premature aging
  • Infections, inflammations
  • Heart attacks, strokes

Stress is the seed of illness. It is not a mystery. It has been scientifically studied  and there are numerous publications showing this. It is old news. What is good and exciting news is that we live in a time of options. One of these options, as so many of us have already heard about, is meditation.

Meditation offers us an opportunity to explore the inside aspect of who we are. The equally vast world that exists inside of each one of us. The way to deal with stress comes from within.

Restful awareness… that is what meditation can bring you. It will not help you pay the bills, it will not make your boss less annoying, and will definitely not make a seat magically appear on a full train before 9 am. But it will empower you with the ability to respond to life’s circumstances rather than always reacting to them and feeling burned out at the end of the day.

During meditation, the body shifts into a state of restful awareness, which counterbalances the flight/fight response. Here is how you can benefit from tis:

  • Breathing slows
  • Heart rate slows
  • Blood pressure normalizes
  • Adrenal glands produce less adrenaline and cortisol
  • More rejuvenating hormones are produced
  • Immune function improves

If you are reading this, at this point, I consider my mission accomplished. I just wanted to share a little bit of information that could be of value to you. The best though, is yet to come… the chance to see you at our workshop at Ace Sports Clinic! During the workshop you will be lead to try a few simple meditation options that you can easily incorporate into your life. We are so excited to welcome you!

Collaborative Team of Ace Sports Clinic and Modern Meditators




Youth Strength & Fitness Training

Youth Strength & Fitness training has over the years been wrongfully considered dangerous and having the potential to interfere with normal growth patterns.  Research has demonstrated youth participation in resistance training has no adverse affects on structural growth, and may even favourably influence growth patterns (1).  Beyond influences on youth growth patterns strength and fitness training for school aged children is associated with many benefits, from psychological health, cognition and attention (6), overall health (4) and sport performance (1).

Benefits of Youth Strength & Fitness Training

School aged children benefit from physical activity in many aspects of overall health (5) and academic achievement measured by mathematics and reading achievement (7).  Aerobic fitness, which can be developed through resistance training and sport participation is positively associated with academic achievement in school aged children.  The opposite is seen with BMI (body mass index) which is shown to be negatively associated with academic achievement (7). Research also found school aged children dealing with ADHD saw improved motor skills, behaviour reports and information processing in school following regular pre-planned physical activity over a 10 week period (6).

Participation in sport does qualifies as physical activity and is beneficial for many school aged children to achieve health benefits of physical activity.  Simply participating in sport is a great first step towards improved health and academic achievement.  However, literature has demonstrated that sport participation on its own may be an insufficient stimulus for developing the connective tissue strength required for reducing incidence of injury.  Strength and fitness training can form the important bridge between sport participation and injury prevention required for children to stay active and reap the health benefits of sport participation. Strength and fitness training can ensure appropriate development of all normal movement patterns and facilitate reduced risk of injury.

Bridging the Gap Between Sport Participation and Physical Inactivity

Structured and supervised strength & fitness training may be of even greater importance for youth who do not participate in recreational sport and regular physical activity.  The health benefits of physical activity were found to be multiplied in high-risk youth (overweight and obese, high blood pressure, etc.) (5).  Unfortunately high-risk you may have an inability to participate in physical activity which in turn affects a child’s desire to participate due to negative feedback and low self-esteem (1).  This is where fitness professionals can provide assistance.  In private and small group settings children can participate in physical activity that is appropriate to their ability and skill level without social anxieties in a positive environment.

In the last 25 years childhood obesity rates have tripled (2) making physical activity participation at a young age an important tool to ensure children experience healthy growth and development.  Youth participation in physical activity and resistance training can facilitate development of lifelong exercise habits leading to improvements in cardiac function, blood pressure response, body composition, psychological well-being and improved bone density (strong bones).  Improving bone density in young girls through participation in resistance training and exercise will help to reduce risk of bone diseases later in life.

Studies suggest the more physical activity the greater the health benefit (4) and greater potential for academic success (7).  Physical activity should be a regular part of school aged children’s lives.  On average to improve and maintain health youth should participate in 30 minutes a day of physical activity.  This can be achieved through 30 minutes a day or 3-5 sessions of 45-60 minutes of exercise spread through a week (4).

Safety of Youth Strength & Fitness Training

Resistance training for youth of course comes with some risk of injury.  However injury from resistance training is caused primarily due to mistakes in technique and not a result of underdeveloped youth musculature highlighting the importance for a qualified fitness professional.  Consider that the forces a child experiences while playing recreational sport, in gym class or running around with friends are significantly higher than the forces their bodies will experience during appropriate resistance training.  Bodyweight running, jumping and landing expose a child’s body to forces 3.5-5x greater than bodyweight (3).  During resistance training very few individuals outside of highly trained elite athletes with years of training are capable of lifting weights of this magnitude.  With proper supervision and coaching from qualified and experienced professionals resistance training for youth likely presents significantly less risk of injury than recreational sport participation and can contribute to reduced risk of injury during physical activity and sport participation.

Appropriate Age to Start Training

There is no minimum age that children can begin participation in resistance training provided a qualified and experienced coach is programming and supervising the resistance training sessions.  Generally if children are ready to participate in sport activities then they are ready for some type of resistance training.  Before beginning a resistance training program youth must however be mentally and emotionally ready to comply with a coaches instruction (1).

Youth Strength & Fitness Program at Ace Sports Clinic

A resistance training program for youth at Ace Sports Clinic provides a safe and positive environment as well as qualified and experienced coaches for youth to develop physical fitness and sport performance.


  1. Science and Practice of Strength Training 2nd Edition, Dr. Vladimir Zatsiorsky & Dr. William Kraemer
  2. Canada Health Services,
  3. Ground Reaction Forces associated with effective elementary school based jumping intervention. British Journal of Sports Medicine. 2005
  4. Evidence Based Physical Activity for School-age Youth. The Journal of Pediatrics. 2005.
  5. Systematic review of the health benefits of physical activity and fitness in school-age children and youth. International Journal of Behavioural Nutrition and Physical Activity. 2010.
  6. A Physical Activity Program Improves Behaviour and Cognitive Functions in Children with ADHD. Journal of Attention Disorders. 2010.
  7. Physical Fitness and Academic Achievement in Third and Fifth grade students. Journal of Sport and Exercise Psychology. 2007.

Top 4 Chiropractic Myths

There are a number of myths associated with chiropractic that dissuade potential patients from visiting chiropractors and experiencing quality healthcare.  Our hope is to dispel these myths to encourage more people to enjoy the health benefits of chiropractic and experience the “Ace Difference”.

Common myths associated with chiropractic:

  1. Chiropractors only deal with necks and backs

Chiropractors are highly trained to diagnose and treat any and all parts of the human musculoskeletal system.  In other words, chiropractors deal with not only necks and backs, but conditions related to shoulders, elbows, wrists, hips, knees, ankles, and more.

  1. Chiropractors only “crack bones”

The fancy term for “bone cracking” is referred to as joint manipulation.  Joint manipulation is used to facilitate joint health by creating better movement within a joint.  This in turn can decrease pain and improve performance.  Although joint manipulation can be quite effective for certain conditions, it is only one tool of many and often isn’t necessary for successful treatment. At Ace Sports Clinic, your chiropractor will often use a combination of soft tissue therapy, exercise prescription, rehabilitation, and acupuncture. 

  1. Joint manipulation is dangerous

Current research states that joint manipulation is safe and effective for a range of conditions. The “cracking” heard during a joint manipulation isn’t actually bones cracking or smashing together at all.  On the contrary, joint manipulation causes a quick and subtle separation of a joint causing the release of gas.  This release of gas is the “crack” or “pop” often heard during a joint manipulation.

  1. Once you’ve seen a chiropractor, you have to keep coming back

Once a diagnosis has been made by your chiropractor, a treatment plan will be developed based on your chiropractor’s recommendations as well as your preferences and goals.  Naturally, the recommended course of treatment will vary depending on the patient and the patient’s condition.  Nevertheless, the development of a treatment plan is a shared-decision making process between the patient and chiropractor and the choice to continue care is ultimately up to you – the patient.

Book a personalized health assessment with one of our Chiropractors today and experience “The Ace Difference”

Personalized Golf Performance Package available at Ace Sports Clinic

Ace Sports Clinic is pleased to offer a Personalized Golf Performance Package to improve your game this summer.
Limited to ONLY 8 participants, the program will run over 8 weeks and include a complimentary assessment and re-assessment from our Exercise Physiologist and Physiotherapist.
Visit our website for further details or Call 416-792-4223 to book your place now!

Massage Therapy at Ace Sports Clinic

Massage therapy is the perfect complement to Osteopathy, Chiropractic, Physiotherapy, Personal Training and Pilates. It is also a superb treatment on its own or as part of a regular maintenance program to promote optimal tissue health. Taking time away from your computer, phone and other life stressors and simply focusing on your breath, listening to your body’s subtle messages of vitality, joy and relaxation help restore your mind and body. The ancient Chinese, Egyptian, Indian, Greek and Roman civilizations all reference the use of massage techniques as playing an important role in the healing process. With good reason, as there are countless proven and perceived benefits of massage such as improved sleep, reduced muscle tension, improved joint mobility, improved posture, better lymphatic drainage, decreased stress hormones, reduced inflammation and pain along with improved immune function.

3 Wellness Enhancing Benefits of Massage Therapy

1. Improved athletic and fitness recovery

The ancient Greek athletes used massage pre-& post exercise, a theory still practiced today. A decrease in swelling and delayed onset muscle soreness (DOMS) by 30% was found in a 2005 study on The effects of massage on delayed onset muscle soreness, swelling and recovery of muscle function. “This suggests that a massage performed post exercise but before DOMS develops can alleviate soreness, no matter how the massage is performed”. Interestingly, the upper arm circumference was measured pre and post massage and the treated arm had a significantly smaller increase in circumference, demonstrating a prevention of swelling

2. Improved immune function

In a 2010 preliminary study by Rapaport et al, a 45-minute massage therapy vs light touch therapy group found “the data do support the notion that a single session of Swedish Massage therapy may have fairly profound acute effects on the immune system” compared to baseline results and a light touch control group. There was a decrease in cytokines, interleukins, cortisol and vasopressin, and an increase in the number of lymphocytes (white blood cells).

3. Shift towards a more Parasympathetic (Relaxation) state

Are you stressed?
Do you live in sympathetic overdrive?
Our autonomic nervous system consists of the sympathetic nervous system (“Fight or Flight”) and parasympathetic nervous system (“relax and digest”).
A 2009 study by Diego and Field, from The International Journal of Neuroscience reported the 1st half hour of moderate pressure massage calms the sympathetic nervous system and shifts to a more parasympathetic state vs the light pressure group which provoked a shift towards a sympathetic response.

So, consider a regular maintenance massage as less of a luxury, and more of a necessity for your physical and mental well-being.

Written by Ashly Metcalf, Registered Massage Therapist & Osteopathy candidate

1. Zainuddin Z, Newton M, Sacco P, Nosaka K. Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function. Journal of Athletic Training. 2005;40(3):174-180.
2. Rapaport MH, Schettler P, Bresee C. A Preliminary Study of the Effects of a Single Session of Swedish Massage on Hypothalamic–Pituitary–Adrenal and Immune Function in Normal Individuals. Journal of Alternative and Complementary Medicine. 2010;16(10):1079-1088.
3. Miguel A. Diego & Tiffany Field (2009) Moderate Pressure Massage Elicits a Parasympathetic Nervous System Response, International Journal of Neuroscience, 119:5, 630-638

Had a Concussion? Ace Sports Clinic can help with ImPACT

ImPACT: Immediate Post-Concussion Assessment and Cognitive Testing

What is ImPACT?

ImPACT, or Immediate Post-Concussion Assessment and Cognitive Testing, is a computerized test used in Toronto Physiotherapy at Ace Sports Clinic. It is an objective measurement tool used in the assessment and management of concussion and post-concussion syndrome (PCS). It is a scientifically validated and FDA-approved test that allows clinicians to track progress of neurocognitive symptoms throughout the management of head injuries. ImPACT should be accompanied by a full clinical evaluation of PCS symptoms.

What does ImPACT assess?

ImPACT involves a variety of computer-based tests that assess domains such as visual and verbal memory, reaction time, and visual motor speed, all of which can be affected with PCS.

What does ImPACT involve?

ImPACT can be completed as a Baseline test (pre-injury) or as a Post-Injury test. Baseline testing is done to determine values for the domains listed above prior to head injury and is highly recommended for athletes that play contact sport. Post-Injury test scores can be compared with the athlete or client’s own Baseline scores, and/or within population normative values (if Baseline data hasn’t been assessed). The computer test takes approximately 30-45 minutes to complete; however, may take longer depending on symptom severity with head injury.

What occurs after ImPACT?

Your clinician will use the values from the ImPACT test to help guide treatment, and can compare values as a means of objectively measuring improvement by completing a second or third test throughout the course of recovery.

For more information, please visit

Written by: Hilary Mallinger, Registered Physiotherapist and Concussion management provider

Sources: Shift Concussion Management, Inc.
ImPACT Applications, Inc.
Picture Source:


MAT LIVE Functional Assessment, Treatment and Training Course

Toronto – September 15-16, 2018
Ace Sports Clinic is pleased to announce we are hosting a Professional Development Course on the weekend of September 15- 16, 2018 in Toronto.
The course is the MAT LIVE Functional Assessment, Treatment and Training course by MAT (Movement Assessment Technologies).
The course is designed especially for Health and Movement Professionals (Physio / Osteo / Chiro / Trainers / RMTs) who want to help more patients and clients with enhanced decision making and move beyond the traditional testing and rehab protocols, by collecting reliable, objective data using an evidence-based test and assessment tool, the MAT (Movement Assessment Tool). 
Learn why over 3,500 other professionals in 30+ countries are using the MAT with their patients and clients around the world.  This will be the first time the MAT LIVE course has been presented in Canada. 
Sign up today, as spots are limited.  Facebook at 
You can find out a bit more about the course by visiting their course website
There is a free online module that you can sign up to and watch to get a feeling about what the course is like.