Sincere empathy can be a challenge for many healthcare professionals because we are confronted with an endless stream of people that have encountered horrible life events and we can’t possibly begin to understand the psychological stressors that they are now facing, either real or perceived. Many of us work in healthcare models that give us very limited time with a client due to the volume of people we are trying to help and/or the financial constraints of who is paying for our time. The combination of these two factors doesn’t usually result in a positive experience for patients trying to navigate through their medical system armed with only a very superficial knowledge of their bodies.
Our medical systems are typically very good at keeping people alive, but after that they can become a series of very stressful life events that cause just as much harm as good to a person’s psyche. People that find themselves caught in a cycle of chronic pain are the prime example of how someone can do everything right in their search for help, but end up having the process actually cause more harm than their original injury. Chronic pain is a combination of entangled physical and psychological stressors that shifts more and more towards the cognitive side as time passes. Every new professional that a patient sees and has to tell his story to without receiving some form of empathy and/or meaningful explanation further feeds the fire of fear, stress and anxiety related to his pain.
Healthcare professionals are trained to first and foremost screen for ‘red flags,’ or signs of something more sinister than a simple muscle strain. Physicians have the most knowledge and experience of the various sinister conditions and because of that fact their approach to dealing with less threatening issues like low back pain can become both less useful and less empathetic. Read More
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 bookWhy 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
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
Below is a great talk on the topic of mindfulness, or the ability to step back from your emotions and look at your thoughts and feelings in a more objective way. The way we perceive the world is hugely affected by our past experiences and future expectations as is our perception of pain and sensation in our bodies. Developing the skill of mindfulness is commonly the path out of chronic pain for many people.
Watch this 10 minute video below for an introduction to the concept.
See below the video for a link to a great book on the topic that dives deeper into the idea and the science behind it.
Mindsight: The new science of personal transformation
Click Picture for details
Please feel free to leave questions or comments in the space below and I’d be happy to try my best to answer them.
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
This brief YouTube video captures what physical and cognitive therapists wish all of their clients understood. To say that the experience of pain is in your brain is not the same as saying it’s all in your head. The sensitization of your nervous system is a real thing and a significant component of persistent, chronic pain. Watch the video for an illustrated explanation.
For a Canadian resource have a look at these videos below. They are a longer and more in depth presentation of the topic: Overcome Pain and Live Well Again Part 1 Overcome Pain and Live Well Again Part 2 Overcome Pain and Live Well Again Part 3
The best book on this topic is Explain Pain by David Butler and Lorimer Moseley
There are a lot of systems that function subconsciously in your body that you likely take for granted and very rarely, if ever think about; among the most important of these is breathing. It is an amazing physiological process that allows you to draw oxygen from the air and filter it into your blood stream to keep you alive. Your brain and spinal cord automatically just do it for you. You breathe faster when you run and slower when you sleep; it’s a great deal, your body just figures it out how much oxygen you need and alters your breathing rate for you. The drawback of not being an active participant in your breathing pattern is that you can lose touch with what is ‘normal’ for your body and be unaware of how things like pain, stress and posture are affecting you.
A basic understanding of the biomechanics of breathing and posture will help you understand what I mean. Your ribcage and thoracic spine are the structural foundation of your torso. The rigidity of it protects your organs and supports your shoulders and neck, while the mobility of it helps you breathe, twist and move. Your lungs line the inside of your ribcage. In order for you to draw air into them, your ribcage needs to expand slightly and your diaphragm needs to contract and pull down; this will create a negative pressure and air will be pulled in. The elastic recoil of your ribcage and diaphragm passively push the air out to complete the breathing cycle. This keeps you alive.
There is a difference between being alive and breathing well. Just because you can breathe, does not mean you are doing a good job at it. Just because you can stand, doesn’t mean you have good posture. Just because you can walk, doesn’t mean you are using your body properly.
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
I am a physical therapist by training, but have become a psychologist by experience. Working with people from 9 to 90 years old and from the peak of athletic performance to the lows of neural rehab, I have come to see pain, emotion, attitude and perception in a new light. I have seen 250 pound rugby players squirm at the thought of a needle and polite 70 year old English ladies drop F-bombs while I loosen their hip. I have seen confident CEOs get lost in pain and happy go lucky blue collar workers shift into deep depressions after car accidents and battles with insurance companies. Chronic pain can have many sources and only some of them are physical; unfortunately it is usually only the physical issues that get addressed and the people that could use some help cognitively are the least likely ones to pursue that type of care.
This website is geared toward helping you with the physical side of pain, posture, prevention and performance, but to get the most out of it you will need to be mentally open to change in your body. I have created a page on the right side bar called Books to Read that recommends books that I have found particularly helpful. Here they are again for you:
The following are books that I have read and found very useful in my life. To understand your body and your pain you first need to understand yourself and make sense of your life; this is a missing element in many people that suffer from chronic pain. Most people are open to seeking physical therapy for their pain issues, but much more reluctant to seek any cognitive therapy. I recommend the following books to help you:
Understand why you think the way you think
The basics of how your brain works
The roots of your relationship with your family
The role of work in your life
The role of money in your life
What motivates you
How pain can affect you
How to get the most out of life without sacrificing a piece of yourself
A fascinating book written for the lay person about how your brain works as it relates to your personality, your relationships and your pain. Highly recommend it. Click on the picture to learn more about it.