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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Canucks limp into 2011/12 season: what Kessler, Nolan & Raymond should be doing

Blackhawks
(photo: hockeybroad)

The Vancouver Canucks had an amazing season and playoff run last year.  They did everything they could short of winning the Stanley Cup and they did it being one of the most injured teams in the league all season long.  That speaks to the depth the organization, the heart of the players and the support of the medical and training staff to get players back on the ice.  But why were we one of the most injured teams in the league?  Hockey is a tough sport and injuries are part of the game, but some injuries are preventable and some don’t have to be recurrent.  I believe the Canucks have a great medical team behind them, but I think they are missing out on a hidden gem that the Vancouver medical and physiotherapy community has brought to the world….and that is IMS acupuncture.

I have been a physiotherapist in Vancouver for eight years and a Canucks fan for thirty two.  I write this article to educate the public on the nature of pain and injury as it relates to hockey injuries like groin pulls, back pain and labrum tears.  I am not affiliated with the Canucks in any way, but I do have interest in seeing them win the Stanley Cup this year and hope to see the players get the best possible care available.  I do not have access to their rehab programs, but if the following information is new to the athletic therapists and doctors in the organization, I suggest they pursue the help of a physiotherapist that can provide IMS to the players.

Ryan Kessler is the best two way player in the NHL right now, but he has torn his labrum in both hips in the past few years.  Your labrum is a rubbery piece of cartilage that surrounds the socket of your hip to effectively make it deeper and create stability.  Tearing it is similar to tearing your meniscus in your knee.  It can screw up the mechanics of the joint and lead to pain in the groin, hip and leg.  The labrum doesn’t have a very good blood supply to it, so if you tear it, the body is unable to heal it properly and surgery is usually required to get players functioning properly again.  Kessler has had both hips operated on and is training to get back into form for November as far as I know. Read More

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Elbow Pain: Why it can last so long & how to fix it properly

In-Line Chiropractic Cypress, TX (281) 894-5020

Tennis elbow and golfer’s elbow are the typical names given to elbow pain; tennis being pain on the outside of the elbow and golf being pain on the inside of the elbow.  The more technical term is lateral epicondylitis which simply indicates tendonitis in a specific location.  Putting a name to elbow pain doesn’t really help you get rid of it, but understanding why it happens and where it comes from will.
Tendons are the tough bit of tissue that attaches muscle to bones, and tendonitis literally means inflammation of the tendon.  This term can be misleading when it comes to elbow pain because many people have pain that persists for months in the complete absence of swelling and inflammation.  That is because elbow pain is not just an overuse injury.  It happens when the muscles being used are in an irritable state due to a nerve irritation stemming from your neck and shoulder.  Nerves are the electrical wiring of muscles and when they are irritated, it doesn’t take much to overuse the muscles and tendons that they innervate, resulting in inflammation and pain.  If you rest the joint, the body will heal the inflammation, but the nerve irritation may persist and thus the inflammation and pain will return as soon as you attempt to use your arm again.

Radial nerve extends from base of neck, through shoulder, down to elbow

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.  If the nerve is irritated as it extends from the spine, or anywhere in the periphery it will result in an altered signal getting to the muscle.  Read More

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What is IMS Acupuncture? Intramuscular Stimulation vs. Traditional Acupuncture

IMS stands for intramuscular stimulation and is an anatomy specific form of acupuncture performed by specially trained physiotherapists and some doctors.  It has its roots in traditional Chinese acupuncture, but is fundamentally different in many ways.  IMS uses Western medicine’s understanding of the neurophysiology of pain and Dr Chan Gunn’s assessment techniques of identifying underlying nerve irritations to treat chronic pain issues.  The technique does use acupuncture needles, but not in the way someone practicing traditional acupuncture would.  Traditional acupuncture focuses on pre-mapped out points in the body that relate to different organs and meridians of energy running through the body.  Fine acupuncture needles are then inserted into a number of these points and the person rests with them in for 10-20 minutes.  It can be very useful for the right condition, but it is not as specific or as purposeful as IMS.

To understand why IMS is performed the way it is you should have a basic understanding of how your body experiences pain.  If you haven’t already, please read the article titled Why Things Hurt: Explain Pain.

When a physiotherapist performs IMS he will first assess your basic posture and movement patterns to look for some common signs of underlying nerve irritation.  The most common one is to palpate for tender bands or knots in particular muscle groups.  He will look for restriction of movement in major joints such as your hips and shoulders and note the appearance of the skin and muscle tissue on either side of your spine.  When there is an underlying nerve irritation in an area, the skin can start to look like the rind of an orange peel, feel thickened and respond differently to light touch.  A person may develop goose bumps easily and/or have areas of coolness or hair loss.  The therapist will take all these things into account when determining where to treat you. Read More

Posted in Blog, Elbow, Healthcare, Low Backs, Necks, Pain, Shoulders Tagged with: , , , , , , ,
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