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BC Physiotherapists RCA Updates

I have created this page in preparation for my meeting with Brenda Hudson (Registrar), Phil Sweeney (Chair of Board), and Heather Leslie (Vice Chair of Board) of the College of Physical Therapists of BC on January 27, 2016.  We will be discussing the Registrant Competence Assessment (RCA) exam that all physiotherapists in BC are currently required to write.

For background on this on going matter please read my November 2015 post titled BC Physiotherapists Rally Together to Have a Voice

Since writing the above post I have learned a lot about the history of this exam and have had phone calls, emails and in person thank yous from all over the province for speaking up.  Apparently I am not alone in my feelings about the principle of this test just being way off the mark.  We have tried to challenge it from its inception but the College has marched forward despite our concerns.

The PABC has spent a lot of hours over the years trying to help resolve this issue to no avail so the challenge falls on our shoulders if we want to challenge what the College thinks is a good idea.  My challenge is to create a platform that will reach all 3000 physios in the province because the PABC is protective of its email list and I’m guessing the College will be the same.

My original post had a much further reach than I expected, but this time I am shooting for ALL of you (3000+).  Together with the small advisory team I have built, we will be emailing out a short questionnaire to get a sense of everybody’s stance on this subject and depending on the outcome of our January 27th meeting a petition to change the RCA exam to something more appropriate.

If you are a registered physiotherapist in BC, PLEASE sign up for the email list below so I can build the platform for us all to talk about this and have a powerful voice in dealing with the College.  Read More

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BC Physiotherapists Rally Together to Have a Voice

Head in Hands

UPDATE 2018: It Happened AGAIN!

After all I/we went through to voice our concern about the RCA exam in 2015, they stuck to their guns and made a new group of BC physios write the exam three years later with the same result of technology failure causing the whole thing to be canceled.  I received countless emails, phone calls and even hand written letters from all over the province thanking me for trying to stand up for us in 2015 and now it is starting all over again.  Physios are mad about the inconvenience, but still madder at the underlying principle that this test is not a valid or appropriate measure of our competency.  I hope the College of Physiotherapists of BC starts taking the feedback of its members more seriously…lets see what happens!

Original Article Below

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. 

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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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How sports affect your body throughout life

Untitled
photo: jeff_whiteside
“We are what we repeatedly do.  Excellence, then, is not an act, but a habit.” -Aristole

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.

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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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Beth’s Story: an ex-runner turned mother rediscovers her body

pep talk from Mom...

Beth (as we will call her) was an energetic nurse in her mid-thirties with two young boys to chase around.  She was an elite runner in her early twenties, but these days walking a few blocks was a painful chore and picking up her kids was nearly impossible.  Pregnancy had done a number on Beth…twice.  She had endured the slow nine months of body changes.  She had powered through the labours and deliveries and ended up with two lovely little boys to watch grow and thrive, but her body as a result decided to stop cooperating with her desired lifestyle.  She went from competitive running, to running a few times a week with discomfort, to just chasing her kids around in pain, to simply walking being a painful task in a period of just a few years.

When Beth first walked into my office she had “tried physio, massage, chiro, core training, prolotherapy and IMS” for her back problems with mixed success.  IMS (intramuscular stimulation) had provided her with the most relief, but she still sat in front of me with a dysfunctional body so she obviously needed something more or different to help her get her body back.  Her goals were simple: walk without pain, play with her toddlers and generally live an active lifestyle.  I had to push her to include running on that list because she had resigned herself to the idea that she would never run again at the age of 37.

To look at her, Beth was a thin, lean looking runner with a big smile on her face and a positive attitude, even though her body had crapped out on her.  She appeared to have all the pieces, so why was she still having so much trouble?  Therapists had massaged her, needled her, stretched her, cracked her and strengthened her but she still couldn’t even walk without significant discomfort in her back.  Read More

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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

__________

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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