Blog Archives

Resistant Pain: A 3-Dimensional Moving Puzzle

Supernova Remnant Cassiopeia A (NASA, Chandra, 1/6/09)

The following is a copy of an article I recently wrote for BC Physio Magazine:

After fourteen years of literally poking and prodding other people’s bodies all day, I have learned a few things about pain, anatomy and human nature.  I have done more than my share of market research in the hurting yourself category and have managed to work with or train under some of the world gurus in the pain and rehab space.  My name is Brent Stevenson.  I am the co-owner of Envision Physiotherapy in Vancouver and the author of the new book Why Things Hurt: Life Lessons from and Injury Prone Physical Therapist.  It is a collection of stories and lessons, written in a humorous, conversational tone, that I have found to be the most meaningful and helpful for my clients as they navigate their journeys down the path of resistant pain problems.

I refer to pain as a 3-dimensional moving puzzle due to the entanglement of physical and emotional factors that contribute to the end perception of a person’s pain.  When I started my training as a physiotherapist I learned about anatomy and the different systems of the body, like the boney framework of the skeleton and all the muscles that attach to it.  I learned about the nervous system and the basic electrical wiring of the body followed by a superficial look at some of the organs that the skeleton was protecting.  I was then released into the healthcare world to try and help people with my new found knowledge, but quickly realized how superficial my understanding of the body and my ability to help people really was.  I knew about most of the pieces but didn’t really grasp how most of them integrated together as layers of systems within the body.  I helped people, but not the way I am able to today. Read More

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Is your head twisted? Cranial Nerves: A missing link for head, face and body pain

Cranial Nerves

Hello from down a rabbit hole!  I have now officially taken ten post-graduate courses in a manual therapy approach to assessing and treating the body called osteopathy.  Specifically, I have focussed on two techniques called visceral and neuromeningeal manipulation (NM).  Visceral manipulation (VM) refers to the use of my hands to treat fascial restrictions around organs that may be causing physical restrictions to blood flow, movement, alignment and posture, while Neuromeningeal manipulation is the act of treating the nerves, membranes and brain itself by means of light touch.

I recently just completed a course called NM4 where I learned all about the role of the cranial nerves and how to affect them with my hands to help my clients.  Your cranial nerves extend out of the base of your brain and branch to provide the electrical wiring to your face, eyes, head and organs.  They are kind of important to your daily life, but largely fly under the radar until they get annoyed for one reason or another.  They can be responsible for headaches, eye pain, ringing in the ears and even referred sensitization and irritation into the body due to their connection to numerous organs through the vagus nerve.

As a person who has woken up with a headache every day for two years since my eye injury, I found this class fascinating.  My empathy for people with head and face pain is substantial so I tried to learn as much as I could from this class to help my clients and hopefully myself.

There are twelve cranial nerves:

I- Olfactory-smell

II- Optic-vision

III- Oculomotor- eye movement

IV- Trochlear- eye movement

V- Trigeminal- movement & sensation to your face, tongue, nose, ear

VI- Abducent- eye movement

VII- Facial- facial expressions & taste

VIII- Vestibulocochlear- sound & balance

IX- Glossopharyngeal- swallowing, speech, taste

X- Vagus- control heart, lungs & digestion

XI- Accessory- neck muscles

XII- Hypoglossal- tongue muscles

Don’t bother trying to remember them all, but just consider that every movement, sensation and process that happens in your body is somehow connected to your brain and nervous system.  Read More

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My Eye Injury: One Year Later

Double
photo: Andrew Kovalev
Imagine walking down the sidewalk on a nice summer day, enjoying the scenery and the sunshine all around you.  Now imagine taking a visual picture of what you see in front of you and copying it.  Take that copy and paste it diagonally up and to the right so that it overlaps half of the nice beautiful scene you are looking at.  Now take that second copy and strip all the detail out of it and cover it with a thin layer of milky water.  While you are at it, put a big smudge on anything that ends up in the centre of the picture and add distortion to anything that might be a straight line.  I have this milky, distorted, hologram version of the world superimposed over my proper vision now and it sucks.  And that’s not even the worst part, when I walk or drive I get the sense that the shitty hologram world is moving at me faster than the clear real world.  For example, every morning when I walk from my parking spot to my office there are a series of tree shadows across the sidewalk and a set of two manholes that I walk over.  As I approach the shadows and the manholes, I see double of everything, but as I get closer and closer to the real objects, the amount of the displacement of the second blurry pictures gets less and less to the point that they almost become one object as I pass over them.  The fact that my double vision gets worse the further an object is away creates the illusion that the world on the right of me is coming at me twice as fast as the world on the left of me even though they are actually distorted pictures of the same thing. 
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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

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Plantar Fasciitis: an illustrated explanation of why your foot hurts

171/365:
photo: who am i today

Plantar fasciitis is a very common form of foot pain and one that I find really interesting because it manifests in both really active runners and relatively sedentary people.  How can a person that is training for their third marathon develop the same pain as someone that doesn’t exercise much more than walking from their desk to their car?  You can’t purely blame it on over or under-use if the desk jockey and the super athlete are getting the same thing.  So what is causing the bottom of people’s feet to hurt so much and for so long?

The short answer: (a combination of the following factors)

  1. The shoes you wear all day (not just while running)
  2. Your posture & movement patterns (how you sit, stand, walk and breathe all day)
  3. A nerve irritation in your low back
  4. Weakness in your feet and tightness in your calves
  5. Fascial restrictions in your visceral system affecting the blood and nerve flow to your feet

The long answer:
It is typically a series of on-going events that leads to you developing that burning, pulling, aching pain on the bottom of your foot.  You may have one or all five of the above issues.  If your pain has lasted a long time, it is worth exploring all of them.  Read on for details…

1. The shoes you wear all day…

It is hard to talk about foot pain and not mention shoes.  I have written a number of articles on this blog already about feet.  If you are convinced that your shoes are the culprit please read these articles too:

All too often, plantar fasciitis gets blamed on a ‘lack of support’ and this bothers me. 

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IT Band and Patellofemoral Syndrome: how did your knee pain turn into a ‘syndrome’?

Jogging
photo: Ed Yourdon

Over the years, the medical community has created a need to give everything that can go wrong in your body a name; e.g. lateral epicondylitis (‘tennis elbow’),  patellar tendonitis (‘jumpers knee’).  A lot of the pain related conditions were defaulted to something ending in ‘itis’ implying an inflammation of a particular tendon or bursa, but these diagnoses only really apply to people in the acute phase of pain or injury.  Quite often people continue to experience pain or dysfunction for months in the complete absence of swelling or inflammation.  Labeling a five month old elbow or knee problem a tendonitis is just not accurate or helpful to the person in pain.  The solution became to call them a tendonosis which acknowledges the tendon is not actively inflamed, but there is ‘disorder in the tendon.’

People tend to seek a diagnosis, but what they are really after is an explanation of why.  When it comes to persistent pain, a diagnosis just gives you something to tell your family or employer ‘what you have,’ but typically does very little to help you get rid of it and can even hinder your progress.  Most persistent pains in your body develop from a combination of mechanical, cognitive and emotional reasons and where it actually hurts is just the symptom at the end of a chain of events.  Unfortunately most doctors’ knowledge level on musculoskeletal pain is limited to the area where it hurts and not the chain of events that made it hurt.

I try my best to not tell you ‘what you have’, but instead explain to you ‘what is going on.’  It is usually way more information than you were anticipating, but makes all the difference when it comes time to convince you that you may have to change some of your habits. 

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Posted in Blog, Feet, Hips, Knees, Pain 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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Yoga & Stretching Injuries: Why people get hurt on their quest for bendiness

Yoga
photo: coordinator_tarun

I’m not sure about the rest of the world, but I live in Vancouver, BC and it seems like everyone is either doing Yoga or feels that they should be for some reason.  Its’ popularity has steadily grown over the past ten years to include a more and more diverse group of people.  Business men, athletes, seniors and kids have all joined in the sun salutations and downward dogs in a quest for flexibility and inner peace.  For the most part I think this movement is great, but as a physiotherapist I see countless injuries, postural issues and persistent pains that have their roots in people’s regular Yoga routines.  There are a lot of great things about Yoga, but it is not meant for everyone and you can have too much of a good thing.  In this post I discuss some of the negative consequences of Yoga, not to scare you away from it, but to help you go into it armed with the awareness of how not to hurt yourself.

Before you decide to start any new type of exercise you should ask yourself ‘what am I trying to get out of this?’  Many people blindly feel that Yoga is the answer to flexibility and although it can be for some, it can be an awkward, uncomfortable path to injury for others.  Flexibility is partly genetic, but largely a product of what you do all day; how you stand, sit, walk, breathe and feel will and does affect your flexibility.  It is a misconception that you are stiff because you don’t spend enough time stretching.  You are stiff because you either don’t move enough or you don’t move very well, or both.  Stretching more is simply not the answer.  In fact, I would say that there are millions of hours wasted every day by people stretching in attempt to get more flexible. 

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Why Hips Hurt- An illustrated explanation

hip

Why does your hip hurt if you didn’t do anything to injure it?

The short answer…you probably did a whole bunch of things to it, every day, for years and had no idea that you were doing something wrong.

The full answer…..read below…

Your hips are the centre of your universe.  They are the connection of your upper and lower bodies and most people have no idea where they are or how to use them properly.  It is a strange thing to suggest that someone doesn’t know where their own hips are, but take it from a guy that teaches people to move all day….most people have trouble distinguishing their hips from their pelvis or how to move in a strong, coordinated way through their mid-section.

There are way more moving parts to your body than you have the capacity to focus on at any given time so the best way to explain this to you is to simplify your body down to two pieces and then add on layers as you understand.  Start by thinking of your body as two wooden blocks with a round hinge connecting them in the middle.  Now remember that gravity pulls everything downward and imagine trying to balance the upper piece on the round hinge by holding onto the lower piece.  There are three likely scenarios:

To give these pictures some life, let’s add a head and neck onto them and see what happens.  You also need to understand that your brain has a head righting reflex that wants to keep your head and face looking straight forward, so if one part of your body is persistently leaning one direction your head and neck will accommodate for it.

So far we have block men with hips and necks; an upper body, a lower body and a head.  Read More

Posted in Blog, Hips, Pain Tagged with: , , , , , , , , ,
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Why Knees Hurt


Me day after knee surgery 

What better time to write about ‘why knees hurt’ than a day and a half after knee surgery as I sit here jealously watching joggers bounce along the sea wall on a gorgeous Vancouver day.  I am hiding out from my three little kids today to give my meniscus a chance to calm down.  It was a relatively minor surgery, but my knee is very swollen none the less.  I can add this one to my list of injuries and operations that help me experience empathy for my clients instead of sympathy.  Unfortunately, over the years, I have been way too good at market research for my work as a physiotherapist!  This article will hopefully help prevent you from sitting where I am today, or at very least know when to take the plunge and have surgery on that persistent, nagging knee pain.

A little bit of basic anatomy will give you a better context to understand your knees and this article.

 

Your knees are simply big hinge joints that are built to flex and extend.  They are held together by four major ligaments called your MCL, LCL, ACL & PCL.  Sandwiched in the middle of the joints are two C-shaped cartilage cups called your medial and lateral meniscus; these act as both shock absorbers and stabilizers.  On the front of the joints your knee caps function to protect your knees and act as levers to help strengthen the pull of your thigh muscles.

knee muscular anatomy

 

When I assess people complaining of knee pain, my first goal is to determine if one of the above mentioned structures is physically damaged or is something simply disturbing the mechanics of the joint, creating friction and causing pain.  I would say that 90 percent of the time it is the latter. 

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