Top Blog Posts From 2018

It's been a big year at our clinic, and I thank all of those who have been with us during the way and following our progress. Between growing Cain Exercise Rehab, adding on additional practitioners to our team, and finally making the move to our new office, it's been a full 2018! We look forward to another great year.

With that in mind, let's look back at our top five most-popular blog posts from 2018. You chose them! If you haven't given them a read, please take a look and share the information with those who may need it.

5: The Nocebo Effect - Why Belief In Treatment Is Vital

We spoke about the nocebo effect, which is the opposite of the placebo. It's very possible and common for the belief of harm being done (or simply just the belief in a treatment being ineffective) to turn into reality. This is important in highlighting the need to find a therapist who can productively educate you, as the client, so that trust in the treatment and therapist is there.

4: Get Out Of Pain - 3 Steps For Maintaining Motivation

Everyone tells us that something should be easy to do as long as we want it enough. This disregards the complex, messy, and irrational way our brains work, however. That being said, there are other steps that we can take to make sure that we stay on the right track when it comes to exercise or other lifestyle changes.

3: Cannabis Research - Things To Consider

With the legalization of recreational cannabis in Canada this year, a increase questions and speculation have started cropping up when it comes to the use of marijuana for pain treatment.

Not to rain on the parade, but I just need to remind everyone that our understanding and study into cannabis is still very fresh. While I won't discredit the use of cannabis for medicinal purposes, it's important to take anecdotes and news updates with a grain of salt until we know more.

2: The Stressful Effect Of Stress On Pain

One of our first posts from 2018; stress is EVERYWHERE in our lives, and it absolutely can have an effect on the way our bodies physically feel. When pain is present, stress can exacerbate and prolong it, contributing to the development of countless chronic pain conditions.

This shouldn't be an article to worry you, however; rather, it's a reminder that we can help ourselves by treating our emotional and mental health when we're in pain, as well as the physical.

1: Making Rehab Fun

Our most-read post from 2018, and I'm happy this is the one that took! Rehab, or any exercise for that matter, can often be grueling and unenjoyable. For that reason, it's important to incorporate fun movements and the client's preferred activities into the recovery plan. Having fun during recovery is going to both benefit your mental health as well as ensure that adherence to that physical activity will be maintained.

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Don't Be A Hero - Use Crutches

I sprained my foot pretty good, this past weekend. There was a crunch. It hurt. Ruled out a fracture and went on with my next few days. Thankfully, it started feeling better quite quickly, but I definitely needed crutches to walk without a limp.

Bringing me to my point; I have athletes, very commonly, be too stubborn to use crutches when they sustain minor lower limb injuries.

True enough, the pain isn't so severe that walking isn't impossible, albeit with a limp (as was the case for me.) But, despite the fact that you might feel "soft" for using the assistance, the fact of the matter is that you're prolonging your recovery time by limping around.

When an acute injury occurs, we know that consistent movement and range of motion are crucial in those early stages in order to promote proper tissue healing. In the event of soft tissue damage, scarring will start to form. Taking the joint through its regular range of motion means that that scar tissue, as it forms, will align itself in those directions of pull, developing as closely-resembling the healthy tissue as possible.

When limping and protecting that joint, you're preventing proper movement and avoiding stressing that healing tissue, resulting in irregularities in the scar formation. This is likely to prolong the pain and potentially result in mechanical dysfunction later on in time. Conversely, using that walking assistance allows you to deload the limb while maintaining regular (or as close to) movement of that joint and increases the speed and effectiveness of healing.

So, I know that you may not expressly feel the need to use a cane or a crutch when in minor pain from an ankle sprain, hamstring tear, or other lower limb injury. However, buck up and use the assistance until you can walk without a limp; you'll recover faster and stronger for it.

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4 Explanations For Common Pain Conditions

Nearing the end of 2018, I've compiled a short list of go-to explanations and busted myths about some of the most common pain conditions that walk in my door. These can hopefully summarize many of the questions that individuals have about their afflictions.

Back Pain

May as well start with the most common! Back pain clients will often have no specific diagnosis and generalized symptoms. It can be a hard thing to wrap one's head around, so here are three major points that I educate my clients with.

Osteoarthritis

A LOT of misconceptions revolve around the reasons for the development of osteoarthritis and the most effective ways to treat it. Does too much activity really deserve the blame? Does movement help or hurt more after diagnosis? Is surgery always necessary?

Shin Splints

"Shin splints" tends to be used as a catch-all term for any shin pain, from muscular tears to stress fractures. However, in true cases of medial tibial stress syndrome, there is a mechanism occurring right down to the level of the bone structure itself. And yes, muscular conditioning will still help or hinder the situation.

Tendinitis

Another heavily-misunderstood condition. What is physically occurring within the tissue during a tendinopathy? And hat are the best ways to treat it?

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The Reverse Domino Effect Of Health

"I sprained my ankle. Limping caused my hip to go out. Then I started getting back pain and it's traveled all the way up to my neck."

This is the domino effect occurring. We know for a fact that a dysfunction or injury left unattended long enough can lead to another. It's often small occurrences that begin individuals down a path toward long-term, wider-spread pain.

It's an unfortunate trend, but as we know, it's not necessarily a permanent one. Therapy and rehab, especially those involving movement and exercise, are proven to be able to address these dysfunctions and alleviate the symptoms.

However, it's also a trend for individuals who have experienced this sort of domino-collapse of their joints and muscular system that have a difficult time motivating themselves to begin making those changes for the better again. It can be easy to feel like the time and energy to address such a large number of different (albeit related) problems could be fruitless.

I like to remind clients, though, that it's not necessarily a matter of address every single ache and pain separately, though.

As a biological organism, the human body is good at organizing. In this I mean that this domino effect that we're considering can occur back in the OTHER direction!

I always start with broader corrective exercise when I first treat my clients, only narrowing the specificity down as needed. More often than not, broader changes with how the body moves are enough to begin making the mechanics that we want to see start clicking together. Addressing one area of dysfunction (not even necessarily in reverse of what order it occurred in) can lead to the body further correcting and managing other areas along the chain.

Not acknowledging this reverse domino effect is to not acknowledge the body's own ability to run operations on the most efficient manner that it can. We're a sophisticated system that is excellent at making do with what it has. Small changes CAN make a big difference, and only when those small changes hit a plateau in effect do we need to begin nitpicking for further progress.

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5 Neck and Shoulder Things

I'm often asked what the most common injury that I get in my practice is. As it turns out, I'm a shoulder and neck guy. A large part of my practice involves treating body builders, rock climbers, trades workers, hairstylists, and elderly who experience pain in this area.

(Funny enough, I always thought that I'd be a knee-guy while in college, due to my running background. What's more, the shoulder was the most difficult joint to get my head around in school. I guess studying actually pays off?)

Go figure.

The neck and shoulder are closely related, with dysfunction or symptoms in one often causing symptoms in the other. With that being said, here are some go-to thoughts regarding the health of these joints.

Your Posture Probably Isn't The Problem

I speak a lot on the fact that there is poor correlation between bad posture and future incidents of pain. There are too many individuals out there walking with forward heads and shoulders but no discomfort and vice versa.

Instead, we've linked lack of variety in posture closer to pain. Good or bad, spending too much time in a single position is not what the body craves, and this often is the route to muscular tension and discomfort. This is why it's recommended to take regular movement breaks while at work. It doesn't take much.

Stretching Does Not Make Unstable Joints Happy

Thank goodness, the fitness industry seems to be tapering off a bit from the whole mobility craze that it went through. But I digress, I still see numerous individuals trying to stretch and traction their shoulders to proper health.

No, I'm not saying that joint mobility isn't important. But fairly enough, we went through a bit of an epidemic of fitness buffs non-specifically stretching their joints to the point of laxity with bands. Shoulders often hurt because they're, in simple terms, too loose. And stretching something in this condition will not improve the situation.

Warm Up, But Not Just Your Rotator Cuffs

So we turn to strengthening and warming up. Many individuals think that the rotator cuff muscles are the end-all for shoulder health. After all, their function is to stabilize the head of the humerus (the ball) in the socket.

However, what we don't always realize is that rotator cuff muscles are often simply overworked. Proper strength to control the movement of the shoulder blade is vital to shoulder health, so warming up and exercising the ability to protract, retract, and glide the scapula is key.

Your Upper Traps Are Not Your Only Traps

The upper traps seem to be the bane of many people's existence. The stress tension collects there, they take over other muscles' jobs, and the pain can be excruciating. And stretching often doesn't seem to have an effect.

Well, we know that muscle tightness is neurological. Sometimes, a muscle will present as tight because its opposing muscle is weak. The lower traps oppose the upper in part of their function, with the middle traps assisting the two. I frequently find these middle and lower traps weak in clients who complain of upper shoulder tightness, and so this is an important area to keep in mind.

Keep That Neck Strong

The muscles at the front of your neck are important for maintaining stability and control of that area of the spine. These are also one of the muscle groups that commonly become weak throughout our sedentary lifestyles.

I had to insert this somewhere.

Drawing your chin in like a drawer (or the double chin position) contracts those deep neck flexors at the front. Having these guys strong will prevent the neck muscles in the back or others from the shoulder from tensing up to try and create that stability on their own.

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The Memory Of Pain

Remember that time, years ago, when you hurt your back while bending over?

Well, your back remembers it too.

You may have heard of the term "muscle memory" in the past. It's a loose term defining the body's ability to remember past motor patterns, often triggered subconsciously as soon as the right environment presents itself. For instance, someone may not have ridden  bike in 30 years, but as soon as they feel the seat, pedals, and handlebar, all the balance and coordination comes rushing back to them and off they go.

Now imagine if, instead of that feeling of the bike seat and pedals, the trigger you felt was bending forward. And instead of the ability to ride the bike, the signal that your brain digs out of storage is pain.

This is one of our BIG contributors to chronic pain. Very often, our past experiences of what caused pain in the first place, no matter how long ago, can amplify pain we feel in the future as a conditioned response. In the same way that Pavlov trained dogs to salivate at the ring of a bell, regardless of food actually being present, the nervous system can be trained to pump out pain signals, regardless of an appropriate trigger.

This concept is closely integrated with the one showing expectations of pain causing increased pain. In this example, your back is conditioned to have an exaggerated guarding response to bending forward. What's more, this bad habit is further encouraged by the fact that you've explicitly been avoiding flexion, essentially confirming your nervous system's irrational fear of the movement.

Hopefully, this helps to create an understanding of why pain can be persistent long after tissue has healed and appropriate triggers are no longer present. There are definitely subconscious and conscious factors at play here. (Along with the physical side, which, I'm not ignoring. Don't worry!)

With this being said, this is the reason why a lot of the rehab that I do with clients doesn't necessarily involve strengthening, but instead reteaching and reassuring them of movement and ranges that has been, inappropriately, acting as triggers. This goes for active and nonactive populations as well; it's incredible how many gym rats I need to teach how to round their backs again.

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Does Weather Really Affect Pain?

We're into November and the weather is continuing to change. Rain, cold, fog and, depending on where you live (probably not Victoria), snow!

On that subject, there are those of you who might swear that you can predict the changes in weather based on the way your joints and muscles feel. "My elbow hurts; it's about to rain!" We've all heard those wives tales in the past. Is there any science that backs this phenomenon up, though?

My neck hurts! Either it's about to rain or Thor is coming!

Looking at what the research has ruled out first, there is very little support for any effects from weather on muscular pain. Low correlation between environmental changes and lower back pain has been found. Similarly, rheumatoid arthritis isn't shown to be reactive to climate conditions either.

On the other hand, there is some evidence that links temperature and pressure changes to migraines. The research needs to be expanded on to exactly narrow down the cause-and-effect, however. Let's also remember that very little is known about migraines in the first place, so we have very little knowledge of what multitude of factors could be at play here.

Osteoarthritis pain is one of the more-researched types of pain that is looked at in terms of weather. So far, there isn't a lot of evidence leaning toward one side or the other, but there are some studies suggesting that there may be a minor relationship between the climate and joint pain. Keep in mind that there are as many studies claiming the opposite as well, though.

My fingers predict a 72% chance of rain with a high of 10 degrees.

One limit of the research, too, is that they have been unable to factor in psychological contributions to pain. The belief of weather-changing effects on pain is one that has been so heavily ingrained into several cultures. As a result, there's potential that any physiological changes could be triggered purely by the intensity of those beliefs.

Surprisingly, though, there isn't even a great link between weather and fibromyalgia, which we know has major psychological contributions. In that circumstance, we might have expected this condition to be one of the most-affected by weather, but it seems to not be the case.

So what can we conclude from all of this? Well, as far as the scientific research shows, there's only minimal, if any, support for the effects of weather on nearly any type of pain. This could be a frustrating read for many of you, as we certainly all have friends or family that are able to predict weather changes with eerie accuracy, though. One explanation could simply be that individual variance between people could show a link in a very minority of cases, but the fact is that this link does not seem to exist across the board.

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The Lost Concept Of Fun

I've had clients ask me, "Should I start going to the gym?"

My answer: "Do you want to?"

If the answer is yes, and the person is truly going to enjoy the experience of working out, then I absolutely encourage them to do so. However, this isn't the case for a lot of people, and those ones will find traditional exercise grueling and punishing.

20 more laps and you just might have time to get some sleep before sunrise!

Strangely, "exercise" becomes a deliberate, demanding, and labourous feat for us as we grow up. It wasn't always like this, for every one of us, though. As children, we ran, jumped, climbed, and otherwise played to stay active and healthy. And no one had to instruct us to do so! (For the most part.) It wasn't exercise to us, back then; it was just fun.

This concept of fun is, unfortunately, lost to a lot of us during development, possibly in due part to physical education simply not taking a focus on the fun aspect of being active. When a game of tag becomes replaced by laps around the field, for instance, it's not so hard to understand why so many people have a negative emotional view on exercise.

For this reason, I'm not a proponent of someone "making" themselves work out if they do not genuinely enjoy that activity, provided that there's another way that they can exercise and enjoy that instead. And there are TONS of alternatives out there. I have one client in her middle-ages who fills her time with gardening, hiking, line-dancing, and Tai-Chi, and this has definitely kept her fitness level well above average for her age!

So, circling back, if the answer to, "Do you want to?" is, "No," then we options. Is there an activity that you enjoy doing that you didn't realize is already keeping you healthy without having to think about it? Is there a sport you used to do when you were younger that would be fun to take up again? How about something that's brand new and you've been curious about trying for a while?

In this manner, I'm able to promote a great range of better health among my clientele. As they recover from pain, I can encourage them to maintain an active lifestyle to keep them out of pain. And it's much easier to keep individuals adherent to physical activity when they enjoy it!

If you'll excuse me now, I'll be busy putting down the dumbbells and climbing things like I'm 10 again!

I fell. A lot. But I had fun!

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The Case For Pre-Surgical Rehab

We can fix most injuries conservatively and with exercise. But yes, sometimes surgery is the answer. Going under the knife does often become necessary, whether it's a hip replacement, ACL reconstruction, or labral repair.

I often encounter these individuals as they wait on the list for their operation. They say to me, "Oh, great, I can come see you after my surgery.

My answer: "Great, but why not see me now?"

This isn't just a personal plug. (Although I know that I make a lot of them, so it's hard to tell.) There are true benefits to beginning treatment and rehab BEFORE you get your surgery, however. By doing so, you're actually greatly improving the speed of your recovery and the overall outcome!

Firstly, let's remember that any injuries are seldom isolated to a single joint. Especially in the case of chronic issues, but also in acute ones, conditions result from a combination of mechanical deficits up and down the kinetic chain. Addressing these early on will alleviate the joint from aggravation both before the surgery as well as afterward as it works on recovering. Letting those issues remain, on the other hand, might cause them to excel and create an even tougher environment for your body to heal throughout after surgery.

But if keeping the joints above and below your surgical site is too much of a stretch, then let's consider the site itself. True, you may have an injury or degeneration in the area, but by keeping the musculature surrounding it as strong as possible and maintaining proprioceptive control, you're setting yourself up to have those facets return to you much more quickly after the operation.

And of course, there's no denying that overall fitness will greatly improve your body's ability to move, circulate blood, and heal more quickly as well.

If that's not enough, let's also just recall how significantly pre-surgical rehab is able to delay the need for surgery, potentially alleviating your symptoms enough to put the operation date off for years to come. (And sometimes, even eliminating the need for it altogether!) To me, that sounds like it's worth giving some early exercise a try.

So my advice to anyone who's waiting around for the phone to ring with a surgery date is to not simply sit around, allowing your body to decondition even further, and then expecting the surgery to be a final, quick fix. Get a head start on your recovery well before even stepping into that hospital room, start addressing your symptoms now, and minimize the complications following the operation later.

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What To Do When Your Therapists Disagree?

Incredibly often, I have clients that come in my door after having seen other practitioners that gave them advice and assessments that I completely disagree with. Maybe I think the pain is shoulder-related, but someone else is convinced it's all in the neck. Well, I'll consider what the last guy said, give my two cents, but after doing my own examination, I'm likely to stick to my guns on what I, myself, can determine with my own hands and eyes. It's not my ego; it's me doing my job.

But wait! I understand that this might put you, as the client, in a bit of a sticky situation! What should you believe? If your Athletic Therapist, massage therapist, chiropractor, and even doctor all gave you different opinions, where are you to go from here? It's certainly hard to simply ignore what your last clinician said and replace your beliefs with what your current thinks on a whim.

Well, here's a few pieces of advice that you can keep in mind.

1) Be clear with what opinions you've been given.

One important thing I can suggest to potential clients is to not hold anything back with what's on their mind. It's helpful when you can tell your current practitioner what kind of examinations you've had done by other therapists, what they thought, what kind of treatments were done, and the resulting effects. It's perfectly reasonable that your past or present therapist missed something or happened to catch on to something that no one else did. It may help the practitioner to piece the own assessment and their own into a larger picture.

Are your past assessments and treatments a bit hazy to you? Well, some clinics may charge a fee, but law otherwise dictates that you are entitled to a copy of all of your records.

2) Be honest with your doubts.

If you verbally agree with a therapist but, in reality, doubt that what they have to say is true, then you're not helping either one of you. At the end of the day, it's your body, and it will help your situation more if the therapist understands that you're not buying in to their opinion. This should give your therapist either an opportunity to thoroughly educate you to understand better or prompt them to dig a bit deeper to see if there's anything else that was missed.

3) Understand that therapists can be wrong.

No professional is flawless. Like anyone working in any job, errors may occur, things can be missed, and incorrect opinions can be made. Please try not to negatively judge your practitioner too quickly if you think they erred. In fact, if they admit to doing so, then that's the sign of a thoughtful therapist who will continue to try harder!

4) Understand that multiple therapist can be right!

So I think it's your shoulder. Someone else thought it was your neck. Where do we go from here? Well, maybe everyone was right all along! The body is a complex sack of meat and bones...and nerves, and blood vessels, and organs...you get the picture.

Cause-and-effect in the body is often hard to determine, and there's a chance that every practitioner that you've seen has been right to some extent. Oftentimes, the symptoms that someone feels can be caused by contributions from multiple areas of the body. In this case, you can continue to see both practitioners if they continue to compliment each other or choose your favourite as long as you're seeing results.

5) Question if there's financial incentive.

This is the point that I dislike having to bring up, but it's the reality of the world that we're in. Unethical clinicians do exist out there, and they may be thinking about their own well-being before yours.

Is the therapist who's the most adamant and assertive about their own opinion the one that's charging the most for the treatment or trying to book you into the most appointments? Could they be receiving kickback from other therapists for referrals? Are you part of an insurance claim that could prove to be very lucrative to someone's business?

Again, they're dreadful questions to have to ask, but they're important ones to keep in mind in order to protect yourself.

At the end of the day, pick the therapist who makes you feel the most comfortable and provides you the best results. Be wary of any subtext and read between the lines, but also trust that the majority of clinicians have your best interest at heart and are providing you with the best answers that they can.

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Mental Illness Awareness Week - Blog Posts To Read

We're mid-way through the Canadian Mental Illness Awareness Week. I'm a big advocate for mental health and try to constantly remind others as well as myself to remain mindful of these hidden diseases and the way that they might be affecting a person's life.

As an Athletic Therapist, it's not my place to treat mental illness, but it is my job to recognize when it's present and how it might be affecting a client's physical health and recovery. Here are a few posts from this past year regarding how an individual's psychology may be altering someone's pain.

Exercise And Why You Aren't Lazy

Many people assume the "Just Do It" approach to exercise and berate others as "lazy" should they not be following through with an active lifestyle or rehab plan. As one psychologist broke down, though, an inability to adhere to change may be a result of anxiety.

Guilt And Recovery

As an Athletic Therapist, with a lot of focus on exercise and lifestyle for the purpose of rehab, it stands to reason that I encounter clients who may have difficulty adhering to behaviour changes I attempt to help them make. It's important for clients to know, however, that they do not need to feel guilt or shame, as these emotions might derail our progress even further!

The Stressful Effect Of Stress On Pain

We've known, for a long time, the biological effects that the stress-response can have on our bodies. It stands to reason that the chemical and hormone mechanisms at play during high-stress periods can have an effect on the pain that we feel.

When Loved Ones Are In Chronic Pain

When you have a parent, child, partner, or friend living in a great deal of pain, the situation quickly transcends a purely physical one. The individual in pain can experience a complete 360-turn in their lives, and so it's important to know, as their loved one, what to consider as they go through and try to manage the way they feel.

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Stop Blaming The Sport And Start Helping The Athlete

I have a bodybuilding client who has thanked me multiple times for my non-judgmental stance toward individuals in their sport. When seeing other healthcare practitioners, including medical doctors, they often don't find the help that they need due to an assumed attitude that their chosen activity is the inherent cause of any health issue; thus, the problem is their own fault.

Let's speak strictly from a pain and injury standpoint. (And I'm firmly putting pharmaceuticals aside from this conversation.) Yes, so we CAN safely assume that bodybuilding and its training style comes with a specific host of injuries and conditions; tendinopathies, back pain, even potentially arthritis. But do you know what other sports also come with their own set of injuries as well, though?

How about soccer, running, gymnastics, skateboarding, and every other physical activity in existence?

It's an easy fact that every activity has its own inherent rate of injury. That rate inevitably starts to climb as the level of sport increases. I recall one of my instructors in school, who worked with many of Canada's national athletes, state, "all high-performance sport is inherently bad for you." It's very true, with the high physical demands of high performance taking an eventual, heavy tole on any body.

Unfortunately, some sports, such as bodybuilding but also including others such as cross-fit or X-Game-type events, hit an unhealthier range before reaching as high of a level. That doesn't excuse medicine from taking a double-standard approach to it, however, treating any one athlete differently because any health issues are "their own fault".

It's not a moral qualm for me. Whether it's a bodybuilder, an ultra marathon-runner, or an extreme skateboarder, I'm well aware that these individuals may be choosing to put their bodies at risk for the activities they love. If they're aware of the risk, not putting themselves in critical danger, and they're not risking the health of anyone else, then it continues to fall in line with my drive to help by helping them to continue their sport, but in AS healthy of a manner as possible.

It's the least I can do. It's not my job to criticize, it's my job to help.

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Can Injury Be A Blessing In Disguise?

It's autumn! The weather is cooling down and the leaves are falling. Time to get out there to rake them up, but, oh wait! You got halfway through and wrenched your back!

Agony ensues, so you check in with your therapist, get your rub down, do the rehab, and feel better. That's all and good, but man, what a waste of time and money that was! It's great that the rehab worked, but don't you just wish that you had never had all of that happen in the first place?

Well, maybe not. Perhaps there was some good that came out this mess.

Consider this; in most cases, there's an underlying condition that contributed to injury or there was a method of prevention had the body been in a different physical shape. There was an existing dysfunction present or there was a healthier state that you could have been in to avoid incident.

While the fact that the injury, well, sucked, the saving grace in the matter is that it has now highlighted areas for improvement. As long as the rehab is taken beyond the realms of getting rid of pain and we can continue to condition the body past recovery and toward prevention, it's possible to come out of the fray being better off than you were even pre-injury.

It's not uncommon for clients to come in for a visit for pain, but after a longer period of discomfort of inability to perform specific movements or functions. After fully rehabbing these individuals and addressing mechanical habits that they had that contributed to their state, they often come back exclaiming how their squat at the gym has gone up in weight, that they no longer wake up in the morning feeling stiff, or how amazing it is that they're now touching their toes for the first time in 30 years!

So yes, injury sucks. Take the silver lining, though, and treat it as an opportunity to improve. We learn from our mistakes and what doesn't kill you gives you a chance to make yourself stronger.

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Staying Involved - The Social Side Of Recovery

When pain or injury hits us, especially when it's severe, it's easy to become disconnected from the world around us.

An example might be of the elderly individual whose back pain has resulted in their inability to go out, see their friends or family, or be involved in their community anymore.

Another might be the athlete with the sprained ACL who hasn't been seen by any of the his friends on the team in months.

It could simply be the person who feels depressed in their month not getting to go to the gym while recovering from their muscle strain.

It's the reality; pain can often prevent us from remaining involved in the activity, communities, and social circles that make us part of who we are. And the tragedy is that this social isolation, as well as the often-prevailing depression and anxiety, are correlated closely to the increase of physical pain! Pain increases, depression worsens, pain increase further, and so on in an unfortunate cycle.

But it doesn't have to be this way! We tend to have an all-or-nothing approach to our activities and involvement, often writing our engagements altogether due to not being able to participate as fully as before. However, this is exactly what leads to that isolation!

Instead, it's crucial to keep individuals in pain involved in the world around them. Whether it's from pain, injury, or illness, we know that greater social support is strongly related to an increased chance of recovery.

With that being said, whether it's you, a friend, or family member, maintaining engagement in social circles is a major factor in recovery. If you're an athlete that sprained your knee, keep coming to practice and involving yourself as much as you can on the sideline. If you're missing out on hitting the trails with your running club, grab coffee with your fellow runners and stay up to date on their going-ons and lives. If your elderly mother hasn't been able to garden or walk with her neighbour, encourage her to have a friend or two to her own home for tea. There's always a way to modify the activity and environment to maintain one's place in the world outside.

Social isolation isn't fun. Add pain to the mix and it can become unbearable. Stay involved, call your friends, and engage in the world rather than let it pass by; you may find that it's what you need to propel yourself back to better health.

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If It Hurts, Don't Do It (Except Do It A Little)

Traditionally, we healthcare practitioners get used to telling clients that if something hurts, then don't do it. Seems pretty obvious.

Exhibit A

However, wait! We've talked about how avoidance of movement out of fear of pain may actually make the problem worse! Let's say that you're wishing to squat, but squatting hurts your hip. Telling you to not squat at all is likely to decondition you even further and prime the nervous system to expect pain when you do attempt the movement again. And thus, the movement does continue to hurt more and more when performed.

As we know, pain and the treatment for pain are primarily nervous system-driven. When certain movements hurt, yes, the tissue may be damaged in the case of acute injury, but the area has also become accustomed to having a lower load tolerance.

With that being said, if you've had long-term wrist pain when squeezing a fist, then retraining both strength and load tolerance will probably see you...squeezing your fist as an exercise. But maybe at 50% rather than 100%.

This is the basis of exercise rehab. The last thing that we therapists want to see is the complete cessation of any particular movements or exercises. Obviously, our job comes in when those movements need to be modified in order to reintroduce load within pain tolerance, and Athletic Therapists are the experts for recognizing when, where, and how those adjustments need to occur to get you better.

So no, when a movement hurts, it's not necessarily a call to stop that movement completely (unless it's absolutely something that the body isn't supposed to do, of course), but adjusting the method and volume of that movement is likely necessary. It's all about re-accustoming the body to the performance that we want it to do.

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Air Quality and Pain

If you're reading this from anywhere on the West Coast, you're likely aware of the smoke conditions we're experiencing due to the record-breaking forest fires. The amount of smoke and toxins in the air had BC pegged as having some of the worst air quality in the world!

Obviously, there have been the obvious health concerns of this occurrence, mostly in regards to asthmatics, COPD, and even cancer in the long term. However, is there a link between air quality and musculoskeletal pain as well?

I had a client this week who I've been treating for shoulder pain involving nerve entrapment between the shoulder and neck. After weeks of improvement, she came in on Monday frustrated over a severe relapse in her symptoms. The relapse began on Wednesday of last week with no apparent trigger.

I thought for a minute. In Victoria, I remembered Wednesday as being one of the peak days for smoke in the air.

So I doublechecked her intake form for health conditions. There it was: asthma! Upon questioning, we were able to come to the realization of how irritating the smoke has been for her, resulting in persistent coughing and tightness throughout her chest. Thus, reaggravation of the nearby structures regarding her injury and the return of her pain! With that in mind, we were able to treat appropriate and reassure my client that this relapse was temporary with no true set-backs; only speed-bumps.

This being said, this is a good lesson in how things such as air quality and smoke can be a cause for pain, even when it's not completely obvious. If we look at COPD patients, we can easily find a prevalence of upper back pain. I wasn't able to find statistics, but from here, it's not a difficult leap when considering similar effects that might plague individuals who live in areas that experience smog or industrial workers with regular exposure to toxic fumes.

Could there be links between air quality and pain that aren't purely mechanical as well, though? There isn't a ton of research on this subject, but we do have findings of air pollution having neuroinflammatory effects that, while are mostly looked at in relation to central nervous system disease, is likely transferable to neuropathic (chronic) pain as well. More specifically, airborne chemicals also are linked to neuropathy in painters and the exacerbation of neurogenic pain in smokers.

This information shouldn't be taken as something to scare you, but hopefully it makes everyone think and be cautious. Whether it's your outdoor environment, your job, or another type of exposure, protect yourself and save yourself some pain! Hopefully this forest fire issue will resolve soon, cigarette smokers can clue in and change their habits, and for those in highly-polluted areas...I don't know, vote?

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The Secret In Simplicity

We’ve all witnessed the unfortunate reality of therapists who don’t look toward progressing an individual’s rehab program enough for it to be effective. You the know stories I’m talking about; the person who’s done clamshells for their hips or the one performing forward band flexions for the shoulders for the past eight months and for some reason still isn’t feeling better.

Has anyone not been given these?

On the flipside, I’m also privy to those practitioners who are overcomplicating what they prescribe to clients to the point that they’re either unable to perform their exercise effectively or just left totally confused and unclear as to what the goals of the plan are.

There are big hypes around new and fancy fitness and exercise methodologies, (such as DNS or Ido Portal’s training, for those of you in the know) and they are absolutely fantastic philosophies! I won’t argue against the scientific basis and benefits of any of these schools of thought and I’m eager to continue to study and learn from them more.

BUT, should a new client have all of that content thrown at them in the first few appointments?

I'll let your imagination run wild here.

I was listening to the Adam Meakins’ NAF Physio podcast and heard a great quote when they were discussing tendon health and exercise simplicity. “When treating an organism, let the organism organize.”

What this refers to is that the human body is an extremely sophisticated system. It works within itself incredibly well to perform its functions and adjust to its environment. Note that I never call the body a machine. It neither has a single manual on how to fix it, but neither does it need every single gear and function specifically programmed by us to work properly. Often, as soon as we make one or two adjustments to the faults that it’s experiencing, the body is intelligent enough to do the reprogramming and reorganizing on its own.

Going back to the quote, why it resonated is because it correctly suggests that the body has the potential to recover on its own accord with very simple changes or exercises. What’s more, simplicity translates to a better understanding for the client on how everything works, allowing them a better feeling of control for better treatment success.

So, absolutely, I will begin by showing a person a simple chamshell or forward shoulder flexion exercise to get them started, and sometimes that has actually been enough to get them feeling better! In the event that those simple measures are unsuccessful, then that’s our cue to compound and layer on top of the plan with more complexity. But, by having those simple changes first, we’re building a foundation for both the conditioning and the knowledge in order to most-effectively progress the plan.

You don’t teach a person to multiply without first showing them how to add. Remember the K.I.S.S. principal: Keep it simple, stupid!

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