I am writing this article tonight because I am mad, I am offended and I  want to help create change and I know that I am not alone.  I have been a physiotherapist in British Columbia for twelve years, a path that required me to attain two university degrees and pass a written and practical certification exam.  I have taken over twenty five post-graduate courses, run a private clinic and work closely with countless other healthcare professionals and was just recently required to write a three hour exam to prove my ‘competency’ as part of our college’s Quality Assurance Program.

Physiotherapy is a regulated profession in British Columbia, meaning that we have a regulatory body called the College of Physical Therapists of BC (CPTBC) that creates standards and provides licenses for therapists to work as certified health care professionals in the province.  Apparently in 2007 the BC government passed a law called the Health Professions Amendment Act that requires regulatory bodies to monitor our ‘continuing competency’ defined as: the ongoing ability of a practitioner to integrate and apply the knowledge, skills, judgments and interpersonal attributes required to practice safely and ethically in a designated role and setting. 

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. 

Sports become a part of who you are, both mentally and physically.  For children, sports become a means of socialization, but they also play a prominent factor in the development of movement.  For adults, sports become a means of fitness, stress relief, competition and commonly injury.  No matter where you find yourself on the spectrum of young to old, or novice to professional, sports have likely impacted your body in some way.  Appreciating how and to what extent may help you address chronic problems, prevent future ones and likely maximize your performance.

Each sport comes with its own particular set of movement patterns required of its’ athletes.  Dancers have chest up, shoulders down, butt clenched, toes out drilled into them.  Tennis players and golfers spend hours twisting one way and not the other.  Bikers ride hundreds of kilometers with their bodies tucked into a tight aerodynamic position with their head poking up, and runners get used to just going straight forward all the time.  How much these movement experiences will affect you really depends on what stage of your life you do them, how much you do them, and if you also have a variety of other sports you do, or have chosen to specialize and commit to the performance of just one.

Early movement experiences will really mold a child’s posture and coordination later in life, which is why I encourage physical play with my kids.  Activities like chase, wrestling, rolling, jumping, throwing and catching really help kids build an awareness of how to use their bodies.  They get some bumps and bruises along the way, but it helps them learn that pain is temporary and that their bodies are really amazing at healing themselves if they give them a chance.  As a physiotherapist, I can quickly tell the difference between adults that have a physical, athletic history and ones that have lead a fairly sedentary lifestyle, both in their body awareness and their outlook on their current pain or dysfunction.  Past athletes tend to have a more optimistic and in-control attitude about their rehabilitation because they have relationships with their bodies due to past experience.  Conversely, adults that haven’t competed in sports in their youth tend to be much less assertive in their healing and much more dependent on health professionals because they are less in tune with their bodies.

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. 

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. 

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.