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Case Study #1: How a 34-year-old physiotherapist overcame his foot, back, hip & knee issues

I get asked by my clients all the time: ‘what made you want to be a physio?’ So I figured I would make myself Case Study #1 in a series that I am writing to help you relate to pain, injury and rehabilitation in a realistic and practical way.  My short answer to clients is usually ‘I’ve been an active athlete my whole life and have always been very good at hurting myself so I spent my fair share of time in physio.  I was quite familiar with it and always had a fascination with the human body so it was a natural progression for me after my Human Kinetics degree to go into Physiotherapy.

This article will summarize the lessons I have learned from both hurting myself repeatedly and working with people in pain every day.  I will outline the path I took to overcome some chronic issues that are very common to people of all ages and the things I try to teach to both my parents and my kids.

Brief Background …

I tend to refer to your teens and twenties as your invincible years.  You can punish your body without experiencing that much consequence because the pain, stiffness and soreness doesn’t last long enough to deter you from doing the activity again, or to change your behaviour significantly.  I was a long, lanky kid that played a lot of soccer, rugby, baseball, track & field, water-skiing, wake-boarding, basketball and volleyball.  I sprained ankles, broke my wrist, and dislocated my shoulder many times, but I kept on going.  Now at 34, after being a physiotherapist for ten years, starting a business and having three kids in three years, I have come to realize that I am the cumulative product of everything I have done up to this point and that I better take care of my body because it’s the only one I’ve got for the next 60 years (Click here for related article). Read More

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Dealing with Injuries as an Aging Tennis Player

Tennis
I treat a lot of the top Seniors level (35+) tennis players in British Columbia, many of whom compete in the national and world championships every year.  These are not professional athletes, but very active adults with full time jobs that work hard and play harder.  The combination of work + age + sport inevitably results in aches, pains and unfortunately injuries.

The top five things that tend to bring tennis players into the physio for servicing are:

1.  Tennis Elbow
2.  Rotator Cuff Impingement
3.  Knee Pain
4.  Torn Calf/Achilles
5.  Low Back Pain

Below I will briefly touch on some of the principles you should follow in dealing with these injuries as they relate to tennis, age and work.

Tennis Elbow

Lateral elbow pain does not necessarily follow the “if it hurts, ice it” rule.  Nine times out of ten the root cause of lateral elbow pain stems from your neck and the back of your shoulder.  It is usually an irritation of your C6 nerve root in your neck and the radial nerve in your arm…that being said, if your elbow is hot, red and swollen, go ahead and ice it, but don’t expect just ice and rest to fix the problem.  Hands down the best way to fix tennis elbow is to go for IMS acupuncture to calm down the nerve irritation.  Once the arm feels better have a physio teach you how to move more efficiently so your swing doesn’t create too much strain on your neck and shoulder.  You may also need a tennis pro to adjust your technique and/or your racquet.
Suggested articles:
Elbow Pain: why it can last so long & how to fix it properly
Why Elbows Hurt

Rotator Cuff Impingement

Most shoulder pains are some form of an impingement (which implies a pinching of one or more of the tendons of your rotator cuff). 

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Posted in Blog, Elbow, Knees, Low Backs, Pain, Shoulders Tagged with: , , , , , , , , , , ,
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Principles to follow when your back is sore

 

one


 

Acute (Days 1-7)

  • Ask yourself “what have I done and do I need someone else’s help?”
  • If you have had an accident or acute injury, it is best to seek help
  • If you are concerned you may have broke something or need some medication to deal with intense pain: SEE YOUR DOCTOR
  • If it is not an emergency, but you need help with pain, function and mobility: SEE YOUR PHYSIOTHERAPIST FIRST, not your doctor
  • If you determine you don’t need help just yet, but your back is acutely sore:
  • Lie down on your back on a firm surface and ice your back for 15 minutes at a time every hour you are able to for the first 3 days
  • Start doing gentle pelvic rock movements to help your back from seizing up
  • Start doing gentle hip stretches on your back and pelvic rock movements on your hands and knees
  • Avoid soft couches and beds for the first week
  • Once the intensity of the pain has subsided start using heat and ice for days 3-5
  • Shift to just heat when you feel your problem is more stiffness than acute pain
  • Visit a physiotherapist if the pain has persisted more than a week

Sub- Acute (Days 8-90)

  • Ask yourself “why did this happen and what am I doing to make it worse?”
  • Seek to understand the root cause of your problem by referring to the Why Backs Hurt and discussing what you’ve learned with your physiotherapist
  • Consider how repeated daily tasks like sitting, standing, breathing, walking and lifting may be contributing factors
  • Consider what type of treatment is most appropriate for you:
  • Massage Therapy, Osteopathy, Visceral Release, Craniosacral
  • Chiropractic, Active Release Technique, Spinal Decompression
  • Pilates, Yoga, Basic Fitness, Strength & Conditioning
  • Start to create more body awareness about how you may have been compensating for the pain you have been experiencing for the past week to month
  • Look at your posture and alignment in a mirror
  • Pay attention to how you are breathing
  • Try to note your pain patterns (i.e.
Read More
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Basic Low Back Anatomy

Here is my YouTube video outlining the basic relevant and functional anatomy of the low back using an anatomical model.

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Core Training: When less is more

Big Myth:
–    If you have low back pain that means your “core is weak” and a “core strengthening” program would help you.

Sometimes the above statement is true, but just as often it is absolutely not.  There is not a direct correlation between low back pain and core strength.  In fact, many people that have incredibly strong “core” muscles suffer from regular low back pain, which is because strength is only one element of having good posture, alignment and movement.  It is the overall muscle balance in your body and your relative ability at controlling movement that is the true sign of good core stability and a preventative factor to low back pain.

Many, many, many people are stiff as hell, many of these people have low back pain and many of these people think that their planks, crunches and strength program will make them better.  Well I am here to tell you that there is a good chance it will make them worse.  Granted some will get better, but the most efficient way to improve your strength, flexibility, alignment and pain is to first learn a bit about your body type before pursuing any type of new program.

From a very young age, as you were learning to function in the vertical position, you have been developing strategies for how your body deals with gravity.  You picked up some by watching how your parents stand, walk and move.  You picked up others from your gymnastics classes and soccer practices when you were six.  The hard fall you had on your butt 20 years ago likely altered things and that car accident 5 years ago probably created some compensations.  Long story short, your posture, flexibility, movement and breathing patterns are a cumulative product of everything you have done up until today. Read More

Posted in Blog, Fitness, Low Backs, Pain, Posture Tagged with: , , , , , , , , ,
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The Deep Inner Unit: "light core"

Your deep inner unit consists of four muscle groups that should work subconsciously to stabilize your pelvis, spine and ribcage under low load postures and movements like standing, bending and walking.  Accidents, injuries and developed muscle imbalances can cause portions of the deep inner unit to not do their job properly; the result can be pain and/or compensation from other muscle groups to try and brace to hold everything together.  Some of your other stronger muscles can make up for the deep inner unit, but this usually leads to too much compression on the joints and immobility in the area.  You function best when your body can use the little muscles to do light stuff and the bigger muscles to do harder stuff.  You can get away with purely building strength in your outer sling muscles, but you will be prone to breaking down more often if the little guys aren’t firing.

The four muscle groups are your pelvic floor, transverse abdominus, multifidus and diaphragm.  They form the bottom, front, back and top of your abdominal and pelvic cavity.  Recruitment of these muscles is more about thinking than doing.  They provide gentle compression to stabilize so your bigger muscles can move you.  I don’t like to re-invent the wheel so the best resource to learn about recruitment of these muscles can be found on Diane Lee’s website here: Training the deep muscles of the core

Although becoming aware of these muscles and consciously training them can be very important, they are supposed to act subconsciously and if you align your body in the proper way they will likely fire on their own.  I find it is the compensation strategies people choose in their posture that are inhibiting these deep inner unit muscles and that helping a person unlearn bracing strategies helps to fire up the deep inner unit more than trying to focus on them alone.  Read More

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What is my core? Depends who you ask

The word core has been very popular for quite a while now in the health, fitness and rehab worlds, but there isn’t really a true agreement as to what it actually means; it really depends on who you talk to.  If you ask physiotherapists, most will focus on the deep, subtle, picky muscles like your transverse abdominus.  If you ask strength and conditioning coaches, most will strive to build bracing stability using the obliques.  If you ask a Pilates instructor, most will focus on breathing and dissociation of movement.  Finally if you ask a lay person, most will just pat their stomach and say ‘I know I need to work on my core,’ without really knowing why.

You can watch the associated video at the end of this article.

So who’s right and who’s wrong?  The answer is you should be able to selectively use your body for whatever task you ask it to do.  The picky little muscles should work subconsciously while you stand, sit, walk and breathe.  The bracing muscles should work when you pick up or push something heavy and you should be able to bend, twist and stretch if you choose.  The people that are wrong are the ones that think their method is the only and best thing for everyone.  Typically the personal trainers need to be introduced to the Pilates instructors and the Pilates instructors need to do some personal training.  Most people have a need to work on something, but it is a misconception that building more strength and stability is always the best option.

Some people are naturally strong and stiff as a board while others are loose jointed with low muscle tone.  The first and best thing you can do for yourself before you attempt to do more of anything physically is to learn about your body type and learn what type of exercise would give you the most benefit.  Read More

Posted in Blog, Fitness, Low Backs, Posture Tagged with: , , , , , , , , , , , ,
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Everything your mother taught you about posture is WRONG

Big Myth:

  • Chest up, shoulders back and down is the best posture

Most people think of posture as simply the need to keep your chest up and your shoulders back and down.  Sounds like a simple feat right?!  Then why will most people admit that they think they have bad posture?  The answer to that is because good posture is not a simple thing, it is actually a learned, coordinated skill that encompasses the whole body.  We are what we repeatedly do and our posture is a reflection of our childhood, our sports, our jobs, our emotions and our attitudes.

There is a continuum of flexibility and mobility among the population.  Some people are naturally very loose jointed and hypermobile while others are compressed and stiff as a board.  Where you end up on the spectrum seems to be partly genetic and partly personality.  The people that fall in the middle or the average/normal people tend to have the least pain and injury problems.  The further a person strays in either direction from the average the more and more posture, movement and pain problems they tend to develop.  There is not one perfect posture for everybody, but there is a norm that we should all be trying to achieve no matter which side of normal we are on.

Compressed/Hypomobile——————Average———————-Hypermobile
“Stiff as a board”                                            “Normal”                             “Loosey-goosey”

Our bodies are brilliantly built to deal with gravity as a constant downward force, unfortunately most people don’t know how to use their bodies properly or efficiently and end up with muscle imbalances, pain and dysfunction.  Posture should be looked at as a life skill not a genetic trait we can blame on our parents.  A very basic understanding of anatomy and biomechanics can save people a lot of grief throughout life. Read More

Posted in Blog, Knees, Low Backs, Mid Backs, Necks, Pain, Posture, Shoulders Tagged with: , , , , , , , ,
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Why Things Hurt: Explain Pain

This article has an accompanying video titled Why Things Hurt and a follow up article about the use of IMS dry needling

Reference: Dr Chan Gunn,  istop.org

If you experience an acute accident or injury, like spraining your ankle, it is easy to understand why your ankle may hurt.  You likely tore some of the ligaments and or muscles around the joint and experienced subsequent swelling, bruising and inflammation.  Over a four to six week period your body typically fills in the torn tissue with scar tissue and then slowly remodels it back to its original state.  Sometimes though the pain persists beyond six weeks even though all the swelling and bruising have long disappeared.  Other times pain appears for no apparent reason in the complete absence of an injury and you can’t understand why or what you did wrong.

Nerves are the electrical wiring of your body.  They supply the energy for all your muscles and organs to do their jobs.  Your brain and spinal cord are like the electrical fuse box of your body and your spine and skull are their protective coverings.  Peripheral nerves extend out from your spine at every level on both the left and right sides.  The nerves that extend from your neck are responsible for most of the muscles in your shoulders, arms and hands, while the nerves that come from your low back enervate all of the muscles in your hips, legs and feet.  The nerves in the middle are responsible for your trunk and a lot of your organs.

Muscles are comprised of a whole bunch of stringy tissue that can stretch and contract.  The muscle should have a certain amount of resting tone in it, i.e. at rest it is slightly contracted, not flaccid or extremely tense; this is dictated by the input of the nerve.  Read More

Posted in Ankles, Blog, Elbow, Feet, Knees, Low Backs, Mid Backs, Necks, New Moms, Pain, Shoulders Tagged with: , , , , , ,
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