Blog Archives

My Name is Lance- Remember Me…

st pauls

Today I find myself sitting in a coffee shop across the street from St Paul’s Hospital in Vancouver, Canada waiting for my mother to have a procedure on her heart.  I just admitted her through the emergency room that has the insurmountable challenge of helping the people of our downtown Eastside caught in the epidemic of our opioid crisis.  It was an eye opening experience that inspired me to write this post and think further on the topic that I know is plaguing my city.  I am a healthcare professional that deals with people in various levels of pain all day.  I am also a person that due to a freak accident has found himself in the emergency room, in the operating room, given OxyContin, morphine and other drugs to try and help my immediate pain on a cycle of over three months.  My experience talking to Lance today in the St Paul’s ER has made me reflect on my experience and realize how slippery of a slope it can be for a person to go from a normal life, to an injury, to being a homeless drug addict living among throngs of others living out their own journeys on the street.

We arrived at the ER at 8:45am on a Saturday morning to a relatively quiet waiting room for downtown Vancouver’s only hospital.  There was one very talkative man being processed by the nurse.  He was seemingly a drug addict in withdraw and his father was quietly waiting in the chair looking like he had been through this before.  The dad was about my mother’s age and the talkative man was about my age.  I made sure my mom was taken care of at the admitting desk and then I was told to wait for about twenty minutes while the nurses processed her.  Read More

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My Eye Injury: A physical and emotional battle

This article is a detailed account of the past 90 days of my life.  A big part of me wants to forget everything that happened to me over the past three months, but something inside of me wants to tell the story.  I warn you, that every time I go into detail about what I actually went through, people squirm and shy away, so this is my forum to get it all out.  It was the darkest, lowest part of my life to date and I am still only just collecting myself to re-establish some normalcy for my family and business.  I returned to work just a few weeks ago, under three weeks after my fourth eye surgery in two months after I was struck in the right eye with a hard orange floor hockey ball on August 19th, 2014.

My wife and three children were away at our family cabin.  I had returned to work for the week after an amazing almost 3 week holiday, but I only made it to Tuesday before my world changed.  Earlier in the summer a client had told me about a regular pick up floor hockey game at a nearby community centre.  I went a few times before my vacation, but I was the new guy amongst a group that had been playing together for a while.  The only guy I somewhat knew was my client who had told me about the game.

The game was social, but competitive.  Every guy had a different level of protective gear, but most did not have any form of eye protection.  I happened to have my squash goggles with me, but forget them in the car because I was running late.  I had never worn eye protection playing floor hockey before, but was definitely considering it with this group; unfortunately I never got the chance.  I decided to jump right into the game and was having a great time.  I scored five goals in the first two games before it happened.  I ended up in the corner just off to the side of net.  I turned back to follow the ball when I saw a split second of an orange ball flying right at my face. Read More

Posted in Blog, Case Studies, Healthcare, Miscellaneous, Pain Tagged with: , , , , , , , ,
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Your Invincible Years are Over: how to stay strong, fit and pain free as you age

Old Superman #famousoldies

I used to beat the hell out of my body when I was in high school.  I played soccer, basketball, rugby and a variety of other sports on almost a daily basis.  I would bang and crash and hurt myself, but it never really slowed me down because I just took it for granted that within a few days or a few weeks my body would heal up and be ready for more.  In University I tested my body with little sleep, more sports and a lot more alcohol, but I still always bounced back and kept going.  Around my mid-twenties to early thirties a few things happened that started changing my perspective on life.

By the age of twenty four, I had completed two university degrees and was officially a registered physiotherapist.  I’d like to think I was a lot smarter after six years of university, but I learned much more in the following six to ten years than I ever did in school.  It was a time when my body seemed to start getting less and less invincible and I started gaining more and more perspective on the importance of physical health.  I still played soccer, hockey and squash, but my body started taking longer and longer to recover; things that used to take days to feel better, starting taking weeks and I was forced to consider the physical consequences of my activity choices more than ever.

As a physiotherapist, working with clients from nine to ninety years old, I started recognizing that I was not alone in the weakening of my invincibility around age thirty.  I would hear an average of ten ‘getting old sucks’ complaints a week, equally spread amongst the thirty, forty and fifty year-olds.  The sixty and seventy year-olds tended to phrase it more around ‘this old body is falling apart,’ and the eighty to ninety year-olds just seemed to be happy if something actually didn’t hurt.  Read More

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Allied Healthcare: your options outside of the medical model

Physiotherapist
photo: Beta Klinik
The medical model is one that most people are familiar with.  You get hurt or sick and you go check in with your family doctor, walk in clinic or even hospital to see what a doctor thinks about what you have done.  When it comes to illness and major trauma a physician is definitely the one you want looking after you, but when it comes to pain, injury and preventive health, both physical and cognitive, doctors are not your best choice.  The fact that you even have a choice comes as a surprise to many people; most are under the assumption that their doctors know best.  If you live in a moderate sized city, the chances are you have a choice of a variety of allied health workers that have exceedingly more specialized training in physical health and rehabilitation than any doctor you will visit.

The following post is a brief summary of some of your healthcare choices and the treatment options they can provide that don’t involve medications or surgeries (scroll down to read details about each bullet).

–    Physiotherapist
–    Massage Therapist
–    Chiropractor
–    Naturopath
–    Osteopath
–    Kinesiologist/Personal Trainer
–    Yoga/Pilates instructors
–    Counselor/psychologist
–    Occupational Therapist
–    Traditional Chinese Medicine/Acupuncturist

Full disclosure: if you were not already aware, I am a physiotherapist and am moderately biased towards my own profession, but I do work closely and share clients with almost all of the different disciplines listed above.

Physiotherapy aka Physical Therapy

Physiotherapists (in Canada) are considered primary care givers, which means you don’t require a doctor’s referral to see them.  They now have a minimum of 6 years of university education and typically extensive post graduate training in various specialties.  Physiotherapy is a profession with a broad scope of practice which allows its’ therapists to take the best techniques from many other healthcare disciplines and make them their own. 

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Diagnostic Tests: a static snapshot in time of a moving being

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X-Rays, CT scans and MRIs are useful tools when your doctor is trying to determine what is physically damaged or degenerated inside your body.  They can give you tangible evidence of something physical that you can blame your pain on, but they often detract from the process of trying to determine why that structure is damaged.  A significant finding on a diagnostic test can tend to stop the clinician’s critical thinking process required to push past what is injured and instead figure out why it got injured.  This concept is particularly relevant in chronic pain issues that don’t stem from a traumatic accident, but is also important in cases that started with a trauma, but the person didn’t heal or improve along the expected time line.

An over reliance on hands off diagnostic tests is a fundamental reason why the medical model doesn’t deal very well with people with persistent pain issues and why experienced manual therapists like physios and osteopaths simply speak a different language than doctors.  Doctors will look at the pictures of inside of you, or commonly just read the report that another doctor wrote about the pictures of inside of you and then tell you what they believe to be wrong.  A good manual therapist will feel, watch and experience your movements with you to try and understand the movie that is happening in your body instead of the pictures of the aftermath.  A significant finding on an MRI or EMG study can be a red herring and distract you from what the underlying problem really is.

A healthy body is one that has good physiological movement in the joints, muscles, nerves and organs.  Tests that don’t assess the body in vertical or during functional movements shouldn’t be relied on too heavily to conclude what is or isn’t wrong with a person. 

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Getting Old Sucks: the march towards stenosis

Old
photo: susafri
My favourite part of being a physiotherapist is the perspective I gain by working with a broad array of people: young people, old people, active people, sedentary people, successful people and those just starting out.  I find it fascinating to try and see the world through these people’s eyes as I get little glimpses into their lives during our thirty minute appointments each week.  The relationships people have with their own bodies are a very curious thing to me.

Some people literally behave like their bodies are simply vehicles to walk their heads around; they have little to no awareness of how or what they are doing physically and are blinded by cognitive factors like stress and anxiety.  Others treat their body like a temple and seek help when they detect even the slightest change from their normal, homeostatic state.  Many people’s relationships with their bodies are a product of to their early childhood sports combined with their recent fitness endeavors.  Your early sport and movement experiences are responsible for molding your general postures while your more recent fitness endeavors will create the lens that you see your physical self through.

Some people choose personal trainers, others choose Yoga classes and some are determined to work out at home with programs like Foundation, or P90X.  Your choice of activity will affect your perception of what physical health means to you.  You may get focused on strength or flexibility or endurance or speed.  I see many people in my practice that were active teenagers, but are now in their early 40s with two kids and are trying to rediscover their bodies; unfortunately many people get hurt during this phase because their bodies are 10-20 years older than they physically remember and their choice of activity was based more on familiarity than need.

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Posted in Blog, Education, Healthcare, Posture Tagged with: , , , ,
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Mindfulness: The skill of living in the present

Below is a great talk on the topic of mindfulness, or the ability to step back from your emotions and look at your thoughts and feelings in a more objective way.  The way we perceive the world is hugely affected by our past experiences and future expectations as is our perception of pain and sensation in our bodies.  Developing the skill of mindfulness is commonly the path out of chronic pain for many people.

Watch this 10 minute video below for an introduction to the concept.

See below the video for a link to a great book on the topic that dives deeper into the idea and the science behind it.

Mindsight: The new science of personal transformation

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Click Picture for details
Please feel free to leave questions or comments in the space below and I’d be happy to try my best to answer them.

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What is Visceral Manipulation? An Integrated Part of Physiotherapy

Diaphragma
photo: euskalanato
Visceral manipulation is the practice of an experienced therapist using his or her hands to move and release fascial restrictions in your abdomen and pelvis to encourage the normal movement and function of your internal organs.  Most people are familiar with the idea of joint and muscle restrictions causing tightness, pain and limited movement in their bodies, but don’t consider the role of their organs.  It is common place for people to go to their physio, chiro, or massage therapist to treat pain and alignment issues; unfortunately, many times these practitioners may just be treating the outer shell of the problem if they aren’t considering the mobility of your organs in your alignment and movement patterns.

I have been a physiotherapist for ten years and have continued to add layers of knowledge and skills to my tool belt.  Two of those skills have been real eye openers and game changers for me.  The first big one was the profound effectiveness of skilled dry needling called IMS acupuncture.  I trained with Dr Chan Gunn in 2008 and the skills I learned completely changed my practice for the better.  I recently took a course on Visceral Manipulation through the Barral Institute and feel like I can now properly treat the body as a whole.  I had previously learned how every joint in the body works, where all the muscles attach and which nerves innervate them, but had failed to properly learn how the inside of the body effects the outside.  Visceral Manipulation is helping me properly understand just how connected everything really is.

Your trunk and pelvis form a boney, muscular, fascial outer shell to protect and encase all of your internal organs.  Your organs are not just loosely floating around in there though; they are mostly supported by tissue called fascia and pleura.  The whole thing is a sealed system under pressure that squishes everything tightly together; each organ is wrapped in its own pleura and bathed in a little bit of fluid so it can slide and move around or over its neighbouring organs.  Things that affect the pressures in the system or the ability of the organs to slide and move around in their close quarters will affect the ability of the body to move and function properly.

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Intramuscular Stimulation (IMS): Your case studies & testimonials

The University of British Columbia has recently taken over Dr. Chan Gunn’s body of work researching the effects of Intramuscular Stimulation or IMS.  As a clinician that has been using it since 2008, I have no doubt of its efficacy, but the medical community has been slow to acknowledge it because of studies showing that acupuncture yields no benefit.  I find it unfortunate that the two forms of treatment get lumped together because they are fundamentally different treatment modalities.
 
I am not a researcher, but I am confident the research will eventually catch up to the clinical practice regarding IMS.  What I can help with, is to help gather case studies of peoples’ experience with IMS and give patients some information to go to their doctor with to help educate the medical community.

If you have had IMS as a treatment by your physiotherapist and care to share your experience (positive or negative) please share your story in the comments below in the following format:

A brief history of you and your pain:
e.g. I am a 46 year old runner with a 6 month history of knee pain when I run…

A brief history of what you may have tried prior to IMS:
e.g. “normal physio” with electrical machines, chiropractor, massage therapy, acupuncture, ice, heat

Who you saw for IMS and what your doctor’s thoughts were (if applicable):
Feel free to give your physio a plug or simply share how you heard about it

Your experience with IMS (short term and long term)
You may have found it uncomfortable, but felt looser afterward.  Totally open ended….tell us what happened for better or worse.

Click here to read my article explaining how IMS works and how it is different than acupuncture

Please leave your case study and/or testimonials below.  I will be providing a variety of interesting case studies involving IMS in the coming months.

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Posted in Blog, Case Studies, Healthcare Tagged with: , , , , ,
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Pain & Function: What doctors don’t understand & what people don’t understand about doctors

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I have an immense respect for doctors and their knowledge base.  They go through rigorous training in medical school to learn how the body works, how to fix it when it is broken and how to keep it alive when it is dying.  On a daily basis doctors help their patients with a wide variety of medical issues from diabetes to cancer and from pregnancy to Parkinson’s.  We need them in our lives because our society just cannot function properly without them.  That being said, I would like to share my experience and stories in dealing with doctors from the perspective of a physiotherapist that has:

  • 10 years’ experience working with injured clients (including many doctors) that have battled through public and private medical systems, specialists, tests, etc
  • 5 years’ experience working as a physiotherapist within a large family practice doctors’ office in a building with the UBC Medical School and every different medical specialty available in British Columbia
  • 2 opportunities to help teach 4th year UBC medical students how to do proper back assessments
  • A personal history of numerous injuries, trips to the doctor and hospital

The purpose of this post is not to make doctors look bad, it is to help the general public understand what they should and should not expect from their doctors and the medical system as a whole.  Doctors are very smart people, but they don’t know everything, and most of the time they work in a model that doesn’t allow them to help you in a thorough or timely manner; we should not be mad at doctors for this, we should just adjust our expectations and understand that a doctor might not always be the one with the best advice or treatment for your ailment.

When something hurts and doesn’t go away after a couple of days or weeks most people will search the internet for their symptoms and then likely visit their doctor to try and figure out what is going on.  Read More

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