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
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.
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
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
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
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.
“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
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
Please review each level below then read the explanation that follows.
Level 1: Personal Control
Level 2: Gravity
Level 3: Mobility
Level 4: Function & Prevention
Level 5: Athleticism
Level 6: Pushing Physical Limits
The Six Degrees of Movement Framework is a categorization of day to day movement challenges that people face throughout life. The first two categories are the most important as well as the most mentally challenging. You learn how to move at a very young age when you can, and do, take everything in life for granted. Who you are, both physically and emotionally, develops before you are old enough to have any control over it. Your parents play a big role and so does gravity. As you get older, you progressively take back most of your emotional/personal control from your parents, but unfortunately most people don’t learn to take back their movement control from gravity. Just because you can sit, stand, walk and breathe doesn’t mean you are doing any of it correctly. Movement and posture are skills that some people learn well and others do not; those who do not, tend to suffer from far more pain and health concerns throughout life than those who move well.
The six levels are not a linear progression of how we learn to move as humans; instead, they are a categorization of the complexities of each movement skill. Day to day life provides us with ample opportunity to be strong, mobile creatures, but poor Level 1 skills tend to make people move very inefficiently and in an inherently lazy way. There is nothing more persistent on Earth than gravity so one of the best things you can do for yourself physically is to learn how to be persistently aware of how it affects your day to day life. Read More