Today I find myself sitting in a coffee shop across the street from St Paul’s Hospital in Vancouver, Canada waiting for my mother to have a procedure on her heart. I just admitted her through the emergency room that has the insurmountable challenge of helping the people of our downtown Eastside caught in the epidemic of our opioid crisis. It was an eye opening experience that inspired me to write this post and think further on the topic that I know is plaguing my city. I am a healthcare professional that deals with people in various levels of pain all day. I am also a person that due to a freak accident has found himself in the emergency room, in the operating room, given OxyContin, morphine and other drugs to try and help my immediate pain on a cycle of over three months. My experience talking to Lance today in the St Paul’s ER has made me reflect on my experience and realize how slippery of a slope it can be for a person to go from a normal life, to an injury, to being a homeless drug addict living among throngs of others living out their own journeys on the street.
We arrived at the ER at 8:45am on a Saturday morning to a relatively quiet waiting room for downtown Vancouver’s only hospital. There was one very talkative man being processed by the nurse. He was seemingly a drug addict in withdraw and his father was quietly waiting in the chair looking like he had been through this before. The dad was about my mother’s age and the talkative man was about my age. I made sure my mom was taken care of at the admitting desk and then I was told to wait for about twenty minutes while the nurses processed her. Read More
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).
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.
I have an immense respect for doctors and their knowledge base. They go through rigorous training in medical school to learn how the body works, how to fix it when it is broken and how to keep it alive when it is dying. On a daily basis doctors help their patients with a wide variety of medical issues from diabetes to cancer and from pregnancy to Parkinson’s. We need them in our lives because our society just cannot function properly without them. That being said, I would like to share my experience and stories in dealing with doctors from the perspective of a physiotherapist that has:
10 years’ experience working with injured clients (including many doctors) that have battled through public and private medical systems, specialists, tests, etc
5 years’ experience working as a physiotherapist within a large family practice doctors’ office in a building with the UBC Medical School and every different medical specialty available in British Columbia
2 opportunities to help teach 4th year UBC medical students how to do proper back assessments
A personal history of numerous injuries, trips to the doctor and hospital
The purpose of this post is not to make doctors look bad, it is to help the general public understand what they should and should not expect from their doctors and the medical system as a whole. Doctors are very smart people, but they don’t know everything, and most of the time they work in a model that doesn’t allow them to help you in a thorough or timely manner; we should not be mad at doctors for this, we should just adjust our expectations and understand that a doctor might not always be the one with the best advice or treatment for your ailment.
When something hurts and doesn’t go away after a couple of days or weeks most people will search the internet for their symptoms and then likely visit their doctor to try and figure out what is going on. Read More
If you have ever had your back ‘go out’ on you, you will appreciate the following post and may just learn something about how to fix your nagging back issue. Back pain can take many forms and is hands down the most common issue that brings people in to physiotherapy.
“It hurts when I bend over to brush my teeth”
“I can only sit for 10 minutes before I have to move”
“Walking triggers a pain deep in my butt”
“I bent forward and couldn’t get back up”
It happens to the best of us. I have seen lazy, overweight people with back pain; insanely fit personal trainers with back pain, elite athletes, new moms, desk jockeys and I have personally suffered from it on occasion. You can have the strongest core in the world and still be susceptible to hurting yourself or experiencing pain in or around your back. In this article I have outlined the most important factors as to WHY backs hurt because back pain requires an explanation of what is going wrong as opposed to a diagnosis of a condition. You can also watch the video Why Low Backs Hurt.
Step 1 to Understanding:
Things happen for a reason. You don’t just catch back pain like you can catch a cold. It usually is related to something that you have done or are continuing to do poorly, like stand, sit, walk, breathe, bend or lift. An accident or acute injury can set pain into motion, but how you deal with the injury, pain and mobility after the fact is the important part. You are a product of everything you have done or been through up to this point and if that product has left you with chronic back pain then something has to change. You may need someone to loosen something for you, you may need to learn to move more efficiently, you may need to lose weight, or may even need surgery.
I get asked at least twice a week what I think about chiropractors. Some people have this belief that there is an ongoing rivalry between the two professions, but it is just not true. There is room in the allied health field for practitioners with different approaches; in fact we are all better off for it. As a physiotherapist, I am obviously biased, but I think for some people, chiropractic treatment may be the best thing for them and for others it may be the worst thing they could do for their pain and that is where the big difference between the two professions is the most evident to me.
Physiotherapy has a much broader scope of practice than chiropractic treatment does. A well trained physiotherapist should have the ability to manipulate the spine, perform muscle release techniques, use acupuncture or IMS needling treatments, teach core stability exercises, help work on your posture and balance or build a sport specific training program for you. Most chiropractors focus purely on joint manipulation with a smaller percentage also using muscle release techniques like Active Release (A.R.T.) or Trigenics. Chiropractors may be the best at using manipulation as a treatment technique by virtue of pure experience and practice, but I would prefer a clinician that has the ability to manipulate me (if need be), needle me (if need be), use myofascial release (if need be) and spend the time with me to help me prevent the problem from arising again. A good physiotherapist should be able to do everything a good chiropractor can do and more.
The problem is that not every physiotherapist is well trained and just like any profession there are ‘good’ ones and ‘bad’ ones. The same holds true for chiropractors. Some physiotherapists will bring their clients in hook them up to three different machines over the course of an hour and barely pay any attention to them.
This is officially the home stretch. We are moving everything into
the new clinic this weekend and will be up and running on Monday,
November 28th, 2011.
Starting next week I will get back to editing videos and writing
posts for this site. Please feel free to leave comments on the blog
with feedback. There is lots of content on here, but much more to come!
I have broken the exercise videos on this site into a 3-Step Program for you that will start by building awareness and mobility in your body, progress to higher level movement patterns and finally help you build functional strength and power without hurting yourself. Most of the exercises can be done at home with very little equipment.
*The following is a suggested order to progress through the movements, but is not all encompassing.
1. WTH Step 1: a video summary of the exercises below (same as YouTube above)
2. 4 point neutral spine
3. 4 point rock backs
4. Breathing as an exercise
5. Rib shimmy
7. Kneeling squats
8. Vacuums: introduction to strong core
9. Weight bearing tripod
10. Ankle skewer + forward lean
11. Standing squats
12. Thirsty Birds
13. Reaching up 11
14. Air Bench Press
15. Counter Top push ups
16. How to Sit & How to Stand
I grew up as a long and lanky kid playing every sport that was available to me. I loved team sports and got deeply into soccer and rugby. If I knew then, what I know now about my body, I would have stuck to volleyball and swimming. Don’t get me wrong, I thoroughly enjoyed the sports I played, but I routinely felt like I had been hit by a truck afterwards and still have two wonky shoulders to show for it.
I am what you would call hypermobile. That means that the soft tissues that help hold my skeleton and joints together are relatively looser and more flexible than the average person. It is a genetic trait that a large number of people have, but most have no concept that the way they are put together is not “normal,” or the same way everyone else is put together. It does go both ways, some people would be deemed hypomobile, implying that their spine and joints are relatively stiffer than the average population.
My estimation of the incidence of pain and injury as they correlate to genetic joint mobility:
Being loose jointed may sound like a positive genetic attribute, but let me assure you it can pose a lot of problems for people. Gravity can become particularly annoying when you are hypermobile, especially if you have a job that requires you to sit or stand still for any length of time. We are the only creatures on Earth that are built to stand and walk upright on two feet- that biomechanical feat requires a skeleton that provides both structural stability to vertically stack your body, and functional mobility so that you can move freely. Hypermobile people are built to move and have to work a lot harder than everyone else to stack everything up and stay still. Read More
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
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