What is Good Treatment?!?

As a physiotherapist I pride myself in giving my patients the very best in rehabilitation, injury prevention, and performance based treatment. However, I often find patients don’t always know what this looks like. So what does good treatment look like when it comes to physiotherapy? What should you expect from your physiotherapist to help you achieve your movement/health goals?

I would argue that there are three things which make for good, effective treatment:

1.       Education

2.       Hands on care

3.       Exercise

Education – More important than you might think!

As a physiotherapist, I am privileged to have people entrust me with their bodies, and ask for guidance in their time of need. This starts with education on their pain, injury or performance needs (basically whatever brought them in for help). At very least education should give you an idea of what you can do, what you might want to minimize in the short term, and how to help yourself move forward.  Education should also encourage and empower you with the knowledge that your efforts will get you better – as a physiotherapist I see myself as the guide in this process of getting you better.

Not all education is created equal! There is evidence that poor education does not enhance recovery (ref, ref), while positive and encouraging education improves patient satisfaction and recovery (ref, ref). With this in mind, make sure that the education you get from your health practitioner doesn’t scare you. If it does let them know, and talk more about it. Your recovery will go much better if you are not scared of moving.

Hands on care – To get you moving better!

If education instills knowledge and hope, then hands on therapy can show you that this hope can be a reality. Possibly most important of all in hands on care is the use of test re-test approach to show your that your pain or symptoms can be improved (i.e. some movement hurts to start and then doesn’t after hands on treatment). This shows you that you can get better! And most often, get better fast!

So what does hands on care look like? In physiotherapy it takes the form of soft tissue work, moving joints, stretching, and things like IMS or dry needling to help you move better and have less pain… What about those “tingly machines” (TENS and IFC) or “magic wands” (Ultrasound) you ask? They maybe helpful early on if the pain is very intense, but this should be a very small part of good treatment, and should give way to a focus on movement and exercise as quickly as possible. In my experience it is rare that we need these machines, and most often we can find away for a movement to help ease your pain and symptoms. Hands on care helps identify what movements those might be.

You also might be asking, why does hands on care (like massage or chiropractic) take away your pain for a while, but then it comes back again? We know that the affects of hands on care are only temporary (between 5 minutes and 24 hours; ref), but the realization that your pain and symptoms can improve quickly can last much longer. This is obviously intoxicating for both patients and therapists, and can become the focus of treatment in some cases. But our goal is lasting change, which means we can’t just stop at hands on care. It is really combining education, hands on care and exercise that is the “secret sauce” to making things stick long term.

Exercise – For lasting change!

Exercise is medicine!... and if was in pill form, everyone would be taking it three times daily! In rehabilitation exercises is the thing that changes pain, injury, and performance long term. It helps rebuild your body tissues, improve your heart and lungs, improve your strength, and just as importantly helps you build confidence in your body and movement again. Physical therapy sessions should always include exercise! It is the part of your treatment that will make a lasting change. And most important is that you can do it yourself, and what better gift is their in this process than knowing how to improve pain, injury and performance yourself. This is where your physiotherapist guides you when and how to push into things, and when to pull back.

The end goal of physiotherapy is to providing you with the tools and knowledge to achieve your goals, move better again, and lead strong, happy, and healthy lives. All our physiotherapists at Tall Tree are here to help you in this way. So if you have any nagging pains, acute injuries, challenges returning to the active things you love to do in life, or just want to improve your performance and movement, give us a call and let’s get started today!

So what is good treatment? An encouraging mix of education, hands on care, and exercise designed to allow you to develop independence and demonstrates that your efforts will turn the tide towards recovery and away from injury and pain. Obviously, these elements will be mixed together differently for each patient, as well as through your treatment, but without each aspect involved your care could be better. And you deserve not just good, you deserve the best!

Move. Improve. Live life to the fullest.

Written by

Curtis Tait, BSc, MPT, DPT, IMS

Doctorate of Physical Therapy

When Stretching Doesn’t Resolve Your Tightness…What Do You Do?

Stretching!... some people hate it & some love it. For those in pain stretching often feels good, however for some stretching doesn’t ease their pain. This often turns into trying to find that perfect stretch that will ease their pain or tightness as it once did. As a physiotherapist I see this type of thing often, and get asked, “What stretches will help me, because the ones I am doing don’t get to my tightness?”

There are a few things to understand to be able to answer this question:

1)      What is the sensation of tightness?

2)      What does stretching do?

3)      Is stretching actually what you need?

What is the sensation of tightness?

There is a separate blog post on pain (read it here) so I will focus on tightness. What causes the perception of tightness is not well known, but in popular culture it is often thought of as “short” muscles. While this “short muscle” theory is a possibility, it is rare and only after some form of prolonged immobilization like a cast or prolonged bed rest, and in such cases one session of stretching does not show changes. So what most of us are likely feeling is an increase in muscle tone, or possibly a muscle who shouts “I AM STRETCHED TOO FAR” when it still has a lot more room to lengthen. As an analogy, imagine your car’s low fuel light would come on when you actually have half a tank left, there is still a lot further you can drive, but you would likely be nervous to go much further.

Why would this happen?... Well, our muscles have length receptors that actually can adjust the point at which they shout “STRETCH!” This point is set by your nervous system and some properties of your muscles (basically if you are warmed up this takes care of the muscle stuff). Additionally, your muscle tone (which is like the idle of your car) is controlled by your nervous system, and sometimes this idle runs high. SO, the take away point is - we have both muscle length sensors and muscle tone that can change based on our nervous system control. The most important point here is that it is changeable!

What does stretching do?

Again there is a subtle difference between popular belief about stretching (“my muscle gets longer when I stretch”) and what actually happens, but usually the end result is you can go further before feeling stretch. When we stretch muscle length receptors get set to a new point and we can go further without the muscle shouting “STRETCH” (like the low fuel light has been set back to the point where your tank is actually close to empty). Interestingly we see that you don’t have to stretch for this to happen. You can foam roll your muscles, exercise the opposite muscle, “floss” your nerves or mobilize your low back (talk to your physiotherapist about how to do these things) and you will see improved motion in the muscles of your legs. In fact, a recent study (reference here) showed that if you foam role one calf the motion of both ankles improves!?! This all suggests that these things help reset your nervous system control on your stretch point, and allows greater motion.

However, There are those that stretch and stretch and STRETCH, and never have the sensation that they can go further. What might be going on for them? If this is you, PLEASE read the next section!

Is stretching actually what you need?

There are those people that continue to stretch in the hopes of relieving their tightness without success, but all they can think of is to stretch due to the relentless tightness! So is there another way? Yes (otherwise this would be a very short blog)! Often people in this situation are very flexible despite feeling tight, or have a large difference in how far someone can move their body (i.e. an assisted stretch/passive range of motion) and how far they can actively move through range of motion (for example actively raising your leg, with its own muscles, into a hamstring stretch). Both of these things suggest that actually focusing on conditioning the muscles around the joint you want to move will help… but what does that mean? Here are a few examples:

“Tight” hip flexors eased with glute endurance training

Hamstring “length” improved with trunk muscle training

Thanks to Erson Religioso & JessePhysio1 for the videos.

So what is going on here? The way I explain this to patients, is that your muscles are likely not working together as a team. This leads to that “tight” muscle “telling” you that it needs some help. Just like pain, this tightness is a messenger and not the problem itself, and stretching it to death is not the thing it is asking for. When the other muscles around the joint are better conditioned & coordinated through exercise to work as part of the team that “tight” muscle will not feel tight any more, without ever having to stretch! The best news here is that after conditioning the body has a reason not to send the “tightness” signal anymore. If it does, you will now know what that "tightness" actually means for you.

I would also go so far as to say that no matter whether or not stretching works for you, if you can train the muscles around the joint of the tight muscle, then your body has a reason to stop sending the “tightness” signal. So, in either case don’t just stretch it out… condition it up, and you will feel and perform better!

For help with understanding this idea or which exercises will be most effective for you, book an appointment today, or talk to your physiotherapist.

A physiotherapist at your gym!?! It doesn’t get any better!

By Curtis Tait, BSc, MPT, DPT, IMS

Doctorate of Physical Therapy

Panorama rec centre now has an in-house physiotherapy, I thought you might what to know why that is good for you.

For those struggling to get back to the gym due to pain, those having pain with their normal exercise routine, or having difficulty reaching their full potential in their training, physiotherapy can make all the difference. Unfortunately this often means that you see a physiotherapy in a clinic with different exercise equipment than you normally use, and making the transition back to the gym can be a bit of a guessing game.

What if your physiotherapist could actually watch your workout at your gym, correct your technique, treat your condition, and help you achieve your maximum fitness? Wouldn’t that be the best of both worlds? Well this is what the members of Panorama rec centre have access to! As the physiotherapist at Panorama, I have already had the opportunity to help clients get back to the exercises they love to do, while simultaneously treating their pain, or rehabilitating an injury. It has been greatly rewarding to see my clients in the gym succeeding with their exercise and bettering their fitness! It also allows me to check in on them in passing and help tweak an exercise or routine right there on the spot.

The value in having your physiotherapist at your gym:

1.       I can see how you do your exercise in your natural exercise “environment” and correct you right there.

2.       Returning to your exercise routine after pain or injury is a smooth transition. You already know the equipment and now you know how to use it for your rehab.

3.       I am will be around for you to ask questions in a place that you go regularly. We can solve the problems even before they start.

So don’t hesitate, start capitalizing on having a physiotherapist at your gym! We can get you back to your favorite exercise, recovery from an injury or pain, as well as keep you on the right path for the future. Book to see me at Panorama rec centre, and let us improve your movement and get back to the activity that you love to do.

Prevent Your Next Knee Injury!

by Curtis Tait, BSc, MPT, DPT, IMS,

Doctorate of Physical Therapy

Prevention is the big buzz word in health care these days, and for those that agree with the old adage of, “a penny saved is a penny earned,” this idea should resonate with you. Prevention is important in all chronic diseases and exercises is the best and most under promoted prevention strategy to keep you healthy, pain free, and active into your golden years. However, some times in our rush to start burning calories we can over reach and end up in pain… This slows down our ability to exercise and stay health. So what is important to consider in our prevention of muscle and joint pain (for those who want to get straight to the point scroll down to “3 ideas to prevent your next knee injury”):

EveryBODY is different (3 Principles):

-       What are your needs? The needs of a ballet dancer are different from a basketball player; the demands of a football player is different from a marathon runner. The key is knowing what you need to be successful in your exercise, sport and activity. This helps prevent injury and helps you perform better.

-       What is your body good at? Some people are naturally flexible, some are naturally strong, but it is very rare to be both. It is hard work to be both flexible and strong. Those that are strong, but tight could often benefit from a little more mobility, and conversely those that are flexible could use a little more stability/strength. Know your body type and where you could improve it for your specific activity and demands.

-       Start where you have success and build from there: As humans we all thrive on success and try to avoid failure. While it is always good to challenge ourselves it is important to have the building blocks in place to succeed. This is true in life and in the body. It is not uncommon for me, as a physiotherapist, to see someone who is new to exercise, training for a race, or trying to lift heavier that has pushed too far too fast and ended up with pain and unable to exercise. The best way to push your limits is with success! Flirt with the boundary between success and failure, but keep it safe, challenging and successful.

3 things you need to prevent your next knee injury, and how to tell if you are lacking them:

-   Have a good trunk control program – Do you do any form of core exercise? Does this consist of lots of sit-ups or leg raises? If you answered no to the first or yes to the second, then you most likely need a good trunk control program.  Sit-ups and leg raises are not bad exercises by themselves, but are higher level exercises… remember the principle of starting with success, and not over reaching.

-   Be mobile in your ankle – use the ankle to wall test to test you ankle mobility (see the video below). Remember, ideally we want to see symmetrical distance from the wall for left and right ankle, greater than 10 cm. However if this seems like a challenge, than at least equal distance left and right.

-   Be strong in your lateral hips and knees – test your-self with a single leg squat. Can you get to 45 degrees knee bend with your foot, knee and hip staying in a line? If you could improve your strength and coordination here, you will see your knee move inward or pelvis drop.

What else can I do to be preventative?

-       Variety is the spice of life… and movement. If you are extremely flexible consider working on your control and strength, if you are strong and tight consider working on your flexibility. If you love that stair climber, change it up with the rowing machine some times. In each case, listen to your body and don’t over reach!

-       See your Physiotherapist

o   Prevention goes a long way! Your Physiotherapist can help you identify those areas of mobility and stability that need to be improved for your specific activity. They can also help with some great hands on techniques to speed up the process, decrease pain, and improve performance!

o   We are working on spreading the word about prevention to local soccer team by providing free info sessions on a warm-up program shown to reduce injury risk by 50%. This is particularly important for early to mid-teenage players as they go through a growth spurt. If you know a team or player that would benefit from this, have them contact us.

So, if you are getting back to a long forgotten exercise program, if you want to improve running distance but aches and pains are stopping you, or just want to move better and with less aches and pains – THINK PREVENTION! It is always easier to prevent injury than to rehabilitate after one happens.

If you are not sure where to start with you prevention, or if you have an injury that is holding you back, book an appointment. We will work together to empower you to achieve your goals and get moving at your best!

Being Active With Pain? Be Smart About It.

by Curtis Tait, BSc, MPT, DPT, IMS,

Doctorate of Physical Therapy

In our busy society we do not take time to care for ourselves as much as we should with things like relaxation, getting together with friends, and exercise. When we do get the opportunity to do something important for our well-being like exercise, we often expect our bodies to operate at full capacity and without complaints. This is quite unrealistic and can often lead to aches, pains, and possibly injury. Often when these things show up, we don’t take the time to properly care for them, rather we continue to exercise the way we normally do, and expect the aches and pains or injury to resolve on its own – and sometimes it does. But what if it doesn’t?

This goal of this post is to help you better understand how to stay active while dealing with pain. We will cover the different views of pain, highlight the contemporary view of pain, as well as discuss how to interpret your pain and work with it.

3 views of pain:

The Old View of Pain – In the old view, pain meant damage to a body part. It was thought that the body sent a pain signal to the brain informing if of damage. This can lead to a mentality of “always listening to the pain.” We now know that the body actually does not have any pain receptors or send pain signals to the brain. Instead we have receptors which tell us about potential harm (nociceptors), but these can’t tell the difference between potential and actual harm.

Sport & Performance View of Pain – This is the “No Pain, No Gain” attitude that is commonly found amongst athletes or die-hard exercisers, and is often accompanied by the belief that “pain should be ignored.” However, training to improve performance it is always a matter of balancing enough stress to create physical improvement, but not so much that we cause injury.

The Modern View of Pain – We now know that pain is an OUTPUT of the brain. It is a behaviour modifier, meaning that your body and brain are trying to get your attention! As an OUTPUT of the brain, pain is influenced by all our senses, past experiences, and stress/emotional level, which all reside inherently in the brain. As an example, professional violin players will report pain in their pinky finger at a lower temperature and pressure that the rest of us, demonstrating greater sensitivity as their little finger is vitally important to playing the violin and to them as a whole person (Zamorano et al., 2015).

To put it simply – Pain is complicated! However, this modern view from pain science demonstrates that “pain should be respected, and can be worked with.”

Bottom Line on Pain – Pain is good in that it serves a purpose! It is the messenger that gets your attention, BUT it is just the messenger and not the problem! Pain is your brain and body’s assessment of your own health, and it can be influenced by many things. Your pain should be respected, but it can and should be worked with to help you improve. This is the idea of training and being active intelligently!

How to be active with pain:

Respecting Pain – The first question that you need to ask when you are learning to deal with pain is how is it behaving? Is it always there (constant)? Is it only there sometimes (intermittent)?

Constant Pain – Here I mean truly constant, as in the pain never goes away even for a second. There are a few reasons for constant pain, but the one that we are most familiar with is after an acute injury. If you have an acute injury, you will know it. There will have been something you did that lead to pain immediately and you will see signs of inflammation such as redness, heat/warmth, swelling, pain, and loss of function.

Look for redness, heat/warmth, and swelling – if these are all there, this is likely an acute injury and it deserves to be cared for. This is when progressive rest, ice, compression, and elevation, or PRICE, is the thing to do. Progressive rest means that movement is good and helpful, but start with gentle movement and build from there.

Intermittent Pain – This is great news! It means that there are some things that are perpetuating the pain and some things that are relieving the pain. This pain can be worked with!

1.       Determine which things cause your pain, and then minimize these for a short period.

2.       Keep pain after activity down  (i.e. irritability). Here are some helpful guidelines to assess your pain with activity, think of it like a traffic light:

·       Green Light – the activity helps my pain; I should do more of this.

·       Yellow Light – I feel my pain while I perform the activity, but when I stop it goes back to normal in less than 5 minutes

·       Red Light – My pain is aggravated by this activity and stays aggravated for more than 30 minutes or I have notable pain the next morning.

The big take-away here is that pain does not always mean damage and, while it should be respected, you can work with it if you know how. Hopefully now you know a little more of the “how.” Think of pain as the messenger that the brain and body uses to get your attention. This messenger is meant to change your behaviour, so don’t ignore it…work with it! Finally, if you continue to have difficulty or pain, reach out to your physiotherapist (book an appointment here). We can help with some hands on treatment, exercise and education to help you get moving better and pain-free again.

Reference:

Zamorano, A. M., Riquelme, I., Kleber, B., Altenmuller, E., Hatem, S. M., & Montoya, P. (2015). Pain sensitivity and tactile spatial acuity are altered in healthy musicians as in chronic pain patients. Frontiers in Human Neuroscience, 8. doi:10.3389/fnhum.2014.01016