Can You Treat A Labral Tear?

Labral tears of the hip or shoulder are generally regarded as very detrimental injuries. A result of significant trauma to the joint, such as from a car accident or sport impact, these tears to the joint cartilage are considered to be structurally limiting and requiring surgery in nearly all cases.

With that being said, many people tend to assume that there is little to be done in terms of rehab before (or unless) the operation has been done.

It's good to point out, however, how often labral tears are completely asymptomatic in individuals. For perspective, one study found 43% of tested subjects without symptoms to have a labral tear in their hips while another recorded that rate as high as 69%! As far as the shoulder goes, we found results of up to 72%.

So what does that imply?

It means that, while conservative therapy can't repair a torn labrum, that there is a possibility of relieving the symptoms as if it they weren't there. After all, look at those numbers of people walking with damaged labrums and had no idea!

Manual therapies such as massage in combination with active rehab and exercise can recondition the joint, in many cases, to perform its functions with minimal or no discomfort. True, other cases will certainly require surgery, but it goes to show that it's well-worth exploring the conservative options first.

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Remember, Scar Tissue Doesn't Break Down

Scar tissue is a natural product that comes out of a tissue injury. Skin, muscle, tendon; most of the body's bits and pieces will scar over when an injury occurs.

Realistically, the song, "Scar Tissue", probably also resulted from some type of past deep-hurt.

A lot of therapy claims center around the ability of a technique to break down scar tissue.

However, let us remind everyone of the deep, dark secret of the therapy world: Scar tissue does not "break down".

And it doesn't have to! (Just putting that out there before you lose hope and close your screen.)

To be quick and make things simple to understand, consider when you have a large cut on your skin which then scars over. Do you think any amount of aggressive massage would make that scar go away? Does manual pressure cause either that scar OR the skin to "break apart"?

No? Then you can imagine how counter-intuitive it is to think that those same forces can break down a scar inches beneath the skin.

However, this doesn't need to mean that all hope is lost in the recovery process, as we mentioned. Consider this; does the scar on your skin continue to be tender and cause pain years later, even when it remains visible? Does it do a poor job replacing the skin that was damaged?

No, that scar is an effective bridge between the gaps in healthy tissue. And the same goes for scarring that occurs within muscle, tendons, and ligaments.

Yes, muscles and ligaments are more complex in their functions to hold the joints securely together and will typically cause more pain at the onset of injury. But that's where the manual therapies come into play. While they do not physically break down any of that scarring, what these techniques do do is decrease the sensitivity and pain in the area to allow the healthy tissue to learn to carry on its function despite the presence of that scar.

(Remember, these therapies have a more direct effect on your nervous system rather than the tissue itself.)

In the end, none of this really changes the way that treatments work except for providing a better explanation behind them. That knowledge comes in very handy, however, in order to have the confidence to accelerate in your own recovery and to avoid false claims and money-grabs.

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Weightlifter's Guide To Warming Up

We're returning to the second-busiest season of the year for the fitness industry. As such, we created a quick guide to warming up for the weight room based on facts that aren't typically discussed in the mainstream.

1: Going heavy? The warm up should be heavy.

Working with athletes, Athletic Therapists see the difference between a good and bad warm up once the game starts.

The fact is, the light going-through-the-motions warm up commonly seen at the gym is often not going to be enough. Especially when intending to do a very heavy and hard workout, the warm up should build up to be equally so.

Realistically, a hard workout (or competition) should require a warm up that leaves you sweaty and out of breath. It seems counterproductive, but this is the only way to truly prepare your muscles for the work it's about to do.

2: Warm up all the joints you intend to work. As well as many that you don't.

Warm ups should be specific. If you plan to have a heavy arm workout, then 20 minutes on the treadmill won't effectively get your shoulders ready for the load. While getting a nice, systemic bloodflow effect, warming up should target the joints you intend to use.

But, let's remember that other joints are at play during exercise, even when you're not specifically exercising them. The shoulders are under a lot of stress when doing barbell squats on leg day. The lower back is under a lot of use when picking up your dumbbells for a shoulder workout. You'd be surprised how often injuries to the non-targeted joints occur during workouts.

As such, while you want to target the bulk of the warm up on the joints that are going to be worked the most when in the gym, a broader focus on the rest of the body, in general, will help avoid unexpected strain elsewhere.

3: Stretching? Well...

It's fairly common knowledge that an active warm up should be utilized prior to exercise while stretching is best reserved for after.

BUT, did you know that static stretching (stretch and hold) may not even be as beneficial as once thought when done at any time?

But how will everyone know that I just worked out if I don't stretch?

In reality, static stretching hasn't been shown to result in significant decreases in injury rates or long-term gains in range of motion.

In contrast, we actually see greater range of motion increases as we strengthen our muscles through their full range. As well, greater injury prevention rates have been found by means of an active warm up prior to exercise and an active cool-down after. (So basically a warm up, except backward.)

4: Don't mobilize in ranges you don't intend to use.

This is a fun one. "Mobility" is a big hot topic in gyms these days, and a lot of us assume that mobilizing and freeing up all the joints in every direction is the key to keeping them healthy.

However, this is a concept taken out of context. If you don't intend to use and strengthen through a particular range, then you shouldn't be trying to mobilize it. By increasing range and not replacing restriction with strength, all we're doing is creating laxity.

Preparing to do all those resisted shoulder hyperextensions
that we see ALL the time at the gym.

What's more, remember to mobilize gradually, even when hitting the properly-targeted joint. Otherwise, we see the same issue of too much laxity being created too soon before the musculature is ready to accommodate for it.

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Willingness To Change

In essence, a willingness to change is mandatory when seeking any expected new outcome.

But is it mandatory right from the start?

A client once came to us with absolutely no expectation that she could ever get better and vocalized her adversity to any type of exercise. Essentially, she let us know to not expect her to follow an exercise routine for treating her pain at all.

Ok, pressure was on.

Like we discussed previously, we're not proponents of the, "Just do it" approach with clients. We can guarantee that this client would have walked out of our door at the end of the session and we would have never seen her again after that.

Props to her, however. She was willing to discuss her unwillingness to exercise and the reasons behind her pain prognosis.

And as the professionals, it was our job to work with her from her starting point. Wherever that starting point was.

That starting point revolved mostly around pain and body education coupled with some gentle movements to do when getting out of bed to limber up the joints. Nothing that we would normally consider exercise.

From there, it was a building process. As results started to trickle in, no matter how minor, it became apparent to the client that success was based upon her own input. After starting with the most minor of homework requests, we slowly developed a willingness to change.

Today, this client is still on her road to recovery, but feeling much better than she did on day-one and feeling proud that she is adhering to an exercise routine for the first time in her entire life. In fact, she's close to perfect when it comes to sticking to her rehab plan every day!

And so we digress: A willingness to change isn't necessary from the start, but a willingness to discuss it is.

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That First Step

Whether it's pain, diet, or general health, people are constantly seeking solutions for improvement.

Unfortunately, the world is full of trolls spouting the whole, "Just do it!" approach.

Which is know, as a fact, is a flawed philosophy.

It's a sad reality; even among the educated professionals that serve the public are individuals who are telling patients and clients that improvement is a flicked-switch away. There's an implied expectation that an individual can change every required habit in a matter of weeks.

Have you been anywhere outside a gym lately? You would know that it's easier said than done.

And that is just demeaning. The fact that it's easy (or at least routine) for one person to stay healthy does not, at all, speak to another person's lifestyle.

As pain and injury professionals, we want our clients to feel comfortable that visiting us will not result in a guilt-trip on your habits or an expectation that you need to change overnight.

Rather, all we need from you is that first step to come and ask for help. As mindful professionals, it's not our job to judge OR to dictate. We work for you,  so it's not our job to simply write the manual for you and hope you'll follow it. It's our job to assist you with mapping your own game plan with as small of steps as required.

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Is Sitting Really Killing Your Back?

Welcome to the 21st century, where the average hours of sitting per person seem to be on the rise. And with that, we increasingly discuss the role of all of those seated hours on our health.

We've all heard about how sitting is the new smoking, and it makes perfect sense. More sitting automatically means less exercise, which is a clear pathway toward an all manner of health concerns such as cardiac illness and obesity.

But what about the effects of sitting, specifically, on our back pain?

It should be of no surprise that an increase in the number of sitting hours is correlated closely with an increase in back pain.

With that being said, standing desks are the answer, right? Well, unfortunately, standing without the option to sit is also shown to relate to back pain.

What information online usually fails to show us is how other factors, such as frequency of breaks from the static working posture, come into play.

In fact, the larger increase in back pain is shown to occur in prolonged sitters who have fewer interruptions from their positions. Meanwhile, those who regularly moved from their chairs (whether it was for work away from the desk or a deliberate break) were shown to circumvent back pain much more easily.

We found one small study that looked closely at cycling between three different static working postures to show a significant decrease in overall discomfort.

All in all, it should be emphasized that the only bad posture is the one held for too long. Regular breaks from your working position, whether it's sitting or standing, will be the most effective piece of the puzzle to avoid discomfort.

It's time to quit worrying about how we sit and just take those quick moments throughout the day to interrupt the sitting.

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Learning To Move

It's the understanding that your therapist is going to be the expert in teaching you how to exercise.

But there's a step further that's vital when recovering from an injury.

After you learn how to exercise, you must learn how to move.

We wrote before on how exercises in the gym tend to not practically mimic our day-to-day movement habits.

It's one thing to know how to deadlift weight. But it's also necessary to learn how to drop form and allow the body to comfortably and naturally move outside of an exercise setting.

For instance, it's common at our clinic to have to teach even very fit and strong individuals how to comfortably round their spines.

The answer is, "No".

This hesitancy (and sometimes inability) for even healthy individuals to be unable to attain these textbook-IMperfect positions doesn't boil down to either a strength or a flexibility deficit. It's simply a trained response that we've taught our bodies.

Oftentimes, a conditioned fear of movement develops, whether it's appropriate or not. It's regardless of whether we teach it to ourselves or it's a doctor or fitness professional that instilled it; telling the brain that rounding the spine, lifting overhead, or jumping is going to be harmful enough times will result in your body having a poor reaction when those movements are attempted. And it doesn't matter if the raw strength or flexibility to perform those actions is present or not.

So while we therapists are the experts in how to exercise, the right one will also be the expert in how to move. It goes beyond strengthening and stretching muscles; it's about teaching the body how to be tolerant of movement beyond what we see in the weight room.

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Fighting The Pain

If it hurts, don’t do it.

Except do it a little.

That’s the working philosophy with rehab, and while it may seem to make sense to avoid painful movements completely when they bother us, there’s something at play that can make that a very counterproductive idea.

We’ve spoken on why too much resting when injured can complicate returning to activity. Movement restrictions develop, muscular strength is lost, the tissue might even heal inefficiently.

As well, we talk a lot about avoidance habits being created when in pain. If overhead movements with the shoulder hurt, for instance, it can become habitual to simply never reach for a top shelf for years to come, further deconditioning the joint for future use.

Now this becomes a problem because, as we avoid movement to protect an injury, we actually allow that injury to continue taking a little more away from us as time goes by.

You avoided overhead movements with your shoulder? Now simply up to shoulder height is starting to ache.

You don’t raise past your shoulders now? Now any sideways raise movement pinches.

Stopped moving your arm completely? Well, now your shoulder is meeting that demand.

It doesn’t need to happen like this, however. In a way, a fight back against the pain is often necessary. If the pain threatens to continue taking more movement away from you, then the clear solution is to push back and reclaim it.

We encourage clients to move and exercise through very mild and moderate levels of discomfort. Not because we simply need to “toughen up”, but because that allows us to work at a level that lets the body know where to accommodate and improve without causing a flare up.

This is the basic concept of how we improve physically, not just in active rehab, but in working and exercise in general. A safe level of stress on the body is required to initiate positive changes.

Be smart with an injury. Don’t push it, but maybe push it a bit.

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International Self-Care Day

Today, July 24, is International Self-Care Day. It's a day for raising awareness of programs and habits that can promote a healthy, happy lifestyle.

In regards to today, here are some tips for making sure that your body remains healthy, your pain stays controlled, and your energy is always positive.

Sleep

We all know that we need to get plenty of sleep. It's surprising, however,  how underrated and unacknowledged a good night's rest still remains, with a large number of Canadians still either under-sleeping or experiencing poor sleep quality.

In a world where we constantly seek therapeutic or nutritional fixes for illnesses, energy deficiencies, or mental performances, we need to remember the benefit of actually going to bed early (when permitted) and sleeping through the night.

Oh, and did you know that a lack of sleep can correlate to an increase in your persistent pain?

Destress

Speaking on pain again, let's recall that high stress and cortisol levels have a direct effect on how our nervous systems sense and tolerate pain. But again, we all know that high levels of stress are going to have negative effects on us, but deliberate methods of stress-relief are often left unsought-after.

When it comes to relieving stress, simply going home to put your feet up is not always sufficient enough. Whether it's exercise, meditation, or professional services to help unload mental distress and lighten your burden, those deliberate measures are often a necessity to allow you to live well.

Listen To Your Body

Very often, persistent pain conditions that last for years start as minor pains or discomforts that we don't give much thought to.

Whether it's something with a gradual onset, like a sore back, or something acute like a torn muscle, we want to make sure that we're treating ourselves right to properly recover from this minor occurrences before they become big. Otherwise, it's easy to become used to pain as it becomes greater, normalize it, create avoidance habits, and eventually have a significant problem on your hands.

So whether you've noticed your neck pain starting to spread, your fingers or hands gradually becoming more sore at work or just sprained and ankle, it's always best to jump on those situations sooner than later.

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Does Age Equal Pain?

"I'm just getting old."

You or someone that you may know may very well be using these words to justify their pain and discomfort. It's just the understanding in our society that as our bodies start to age, they will, inevitably, begin to hurt more.

Is this true, though? Does it have to be that way?

Stats Canada findings show that, indeed, increased age correlates closely with increases in chronic pain.

However, it is at a younger age, a broad range between 12-41, that persistent pain is found to onset in the most-significant rates. This suggests to us that older age isn't the cause of chronic pain, but rather habits that we do when we're younger.

Interestingly, some studies that track chronic pain in aging populations have often shown a steady increase in pain rates up to the age of around 60, followed by a mild but steady decrease thereafter. With that retirement age marking a downward trend in some cases, it seems like we could reasonably name workplace habits and stress as a primary pain trigger; not age itself.

Some jobs are more hazardous than others.

In summary, it's very easy to simply blame age on our pain, but it's our lifestyle factors that surround us as we age that are at greater work. With no one coming up with a way to reverse the aging process any time soon, we need to look at other places to intervene in people's discomfort.

The prime focus should be to focus on prevention during the career years in order to minimize the impact of poor habits and prevent pain onset in the first place. Failing that, what we can show is that the older age is a great time to reverse what those habits may have done over the years.

It's not hopeless. In fact, there's opportunity at every age to do something to make the body feel better.

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National Injury Prevention Day

This past Friday was National Injury Prevention Day!

We compiled a small collection of our past blog posts on the topic of preventing injury for your interest. We hope you enjoy and have a great, injury-free week!

Growth Spurts and Injury

Hey, parents! Do you remember how awkward puberty was? Do you also remember all of the drastic ways your bodies changed around that time?

The sudden increase in limb length and its effect on motor control can often create an increased risk of injury in teens; especially for those involved in sport? But that shouldn't be a fear-mongering fact, as there are things that can be done to subvert it!

Is There A Case Against Stretching?

One of our favourite past posts! We redid the research on static stretching and its use for preventing injury, and you may be surprised!

See Ya Later, Functional Training!

"Functional training" is a buzzword in fitness these days. Let's recall that "functional" should be referring to its applicability to our daily life and habits. Remember this next time you think that standing on a BOSU ball is going to prevent back pain at the construction site.

The Sixth Sense You Need For Injury Prevention

Have you ever been hiking and nearly rolled your ankle, only for your body to notice and catch it in time to jerk back and prevent the sprain?

You just utilized proprioception, your sixth sense referring to joint awareness that is absolutely vital for injury rehab AND prevention!

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Don't Give Up Before Beginning

Athletes will know this feeling very well, but non-athletes will understand the feeling too.

Imagine being on a hockey team. You show up to the game and roughly half of your teammates are absent due to injury or personal matters. The remaining players are feeling sore and low-energy. The team that you play against today is top in the league. You don't really see much chance of anything going well here.

As a result, everyone who showed up does their part, fulfills their role, and goes through the motions, but no one's heart is really in it. They may not be trying all that hard. Everyone is suspecting a loss. And that's what eventually happens. The heart wasn't there.

Now imagine that you are that team of hockey players and that your opponent is your pain. You've shown up at the rehab clinic for treatment, but the pain has been so great, so persistent, and been bothering you for so long that you don't see much possibility of success. But you're there anyway.

It's very common for individuals who are seeking treatment for pain to mentally defeat themselves before the appointment even begins. It's not for a lack of conscious effort; you may be desperate and and craving pain relief, but past success has now just subconsciously instilled an expectation of failure. And unfortunately, having those low expectations will often create a similar reality.

Now, I'm not saying that everyone should just chin up, suck it up, and try harder. As I always say, "Just do it," is probably the lamest advice that any shoe company could possibly put out.

The message that I want to relay instead is that you, as the client, should try to be open and transparent with your experiences when you see the next therapist. Explain your experience with pain and with past practitioners. Help your therapist understand your goals, your expectations, and your hesitations. It's our job to not only treat with our hands, but to help create as positive of an expected outcome in your mind as possible in order to propel your recovery forward. And through careful education and goal setting, trust us, it is possible.

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Should You Exercise Your Neck?

A lot of us deal with tension and tightness in the neck, tension headaches, and other related symptoms. What's to be done about that?

Clients will often inform me of doing regular stretching for their necks to no avail. Well, that's weird!

Truer words have never been spoken.

Regurgitation time: Muscles are tight for a reason! And that reason is usually a need for more strength, not for more tugging them to their end-range. As always, I remind you that there's probably a good case against static stretching for that reason.

But how does strengthening the neck work? Well, for the love of all that's mighty, please refrain from the gym bro neck extensions which are more likely to leave you with a massive kink in the neck and splitting headache.

Figure 2.0: No.

Instead, applicable strength through the neck will majorly come from the deep flexors at the front of your neck, which tend to be underutilized in many of our sedentary lifestyles.

Progressions exist, but this is a starting step. If you have neck pain, strengthening to keep the joints secure is the key; not just excessive stretching. Go gentle, be mindful, and give your neck muscles a reason to feel relaxed.

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Fascial Pain - Your Fascia Isn't Tight

We've been here for, but we're always good for a reminder.

Many of you have experienced fascial symptoms before, like the burning of plantar fasciitis or the discomfort through your IT band.

The first instinct is, of course, to rub it.

Now, a bit of self-massage is not a bad thing. All pain that we experience is neurological in nature and sent out by our brain, and by stimulating the painful area with some massage, we're overriding the pain with our own self-made busy signal.

But let's remember that that's about as far as the effect will go. Rubbing the sore spot out will absolutely not break down muscle, adhesions, or scar tissue. It's not a thing that can happen. Please don't argue the fact. In fact, fascia itself is a static and passive tissue that neither contracts nor lengthens (much like ligaments).

So how do we treat fascial pain in the long term if we can't physically "loosen" it up?

Well, as you know, everything in the body is interconnected, and so, logically, that sore fascia connects to something. Your IT band originates from your hip muscles. Your plantar fascia is an extension of your calf and achilles. Those areas can be treated in the long term.

But still not just with a lacrosse ball.

Changes occur in the body due to its mechanics. If any particular muscle is putting undue stress upon the fascia, then there's a change in the way it moves that's required to alleviate it. Sure, rub out your calves, but they're tight in the first place because the hip muscles aren't working enough and making the calves put in overtime. It's when we address the way those relationships are occurring that we can see some long-term relief.

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Concussions (Are Not Just A Sports Injury)

Concussions are a hot topic in sports, and the world watches all news and developments closely. They’re a real danger, and sport organizations are, thankfully, catching on quick to the need to treat them seriously.

However, there’s an odd disconnect between how concussions are considered in sport versus any other aspect of life. While it’s widely known that standard protocol dictates no sport participation until a concussion is fully healed, schools and workplaces are still lagging behind. Even insurance companies (*coughICBCcough*) do not treat concussions with the seriousness they require.

The fact of the matter is that concussions do not require a sport or even a car accident to occur. Workplace head injuries are incredibly common, but even simple household accidents such as a tumble down the stairs can be enough. And the struggle with concussion injuries outside of sport is a lesser awareness of the issue resulting in many cases going under-reported and undiagnosed.

Furthermore, anyone who’s been involved in sport understands the hardship of the time-off requirement when these head injuries occur, with almost forceful intervention often being needed to keep recovering athletes out of play. What happens, though, when an employee or student doesn’t have that same watchful eye to prevent them from returning to work or study too early? Unfortunately, pushing through these situations can result in the same complications as an athlete playing through concussions.

Fortunately, concussion reporting at work is seeing an increased rate, and almost assuredly due to increased awareness and not an increased true rate of injury. That being said, there is still room for growth as we work toward seeing brain health in everyday life being treated with the same urgent protocol as it would in sport.

Remember, just because you don't play football doesn't mean a knock to the head shouldn't be taken seriously. Physical AND mental rest and slow return to activity is vital for the brain to recover and best done under supervised, gradual exposure.

Athletic Therapists are one type of healthcare professional specifically trained for recognition and assessment of concussions as well as in return to activity protocol. Consider a consultation with one if you or someone you know is coping with this type of injury.

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Am I Feeling Better?

It's funny how often that my clients, when asked how they're feeling, answer that they feel roughly the same as the last treatment.

I then proceed to interrogate question them on their symptoms, and they suddenly realize what improvements that they've made!

Sometimes, the changes are simply just gradual, so the improvement isn't as apparent. Other times, a person's symptoms had become so day-in-the-life that the client noticed neither the symptom anymore nor the progress.

Here are a few questions to ask yourself when you're unsure if your rehab is working.

Is my pain less severe, less frequent, or both?

Many people, habitually, focus on only severity or frequency of their pain, but not always both. It sometimes is worth taking a moment to simply question both of those factors next to each other to remind you that things are getting better.

Is my pain the same but while I'm doing increased work/activities?

This one is humerous. A client will tell me that their pain is still a 7/10....however, they did an hour hike instead of a half hour walk. I think we can put the math together on this one.

Is the pain the same but require more activity to trigger it?

Similar to the last point, but a bit different. Sometimes, people have pain that isn't a gradual buildup, but rather a quick trigger for a flare up. But often, it's easy to miss that the trigger is getting harder to pull, with more work or activity being required before that flare up occurs.

Is my life being affected less by pain?

And finally, pain is sometimes directly affecting very specific aspects of our lives, such as sleep, energy, and even diet. It's good to evaluate all of these sorts of areas to see if there's any improvement and indication that pain is dictating your life even a little bit less.

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Shattering The Glass On Exercise Promotion

"It's easy to fit exercise into every single day."

"Just take 20 minutes to get up and move!"

"Time is only an excuse to not exercise."

How often do we see statements like this plastering our media? According to fitness and health professionals out there, exercise is the easiest, simplest thing to insert into your day or week, and no one has an excuse to skip it.

In theory, this makes sense. We all definitely spend 20 minutes or more doing unimportant work during our days. Replacing it with a 20 minute walk should be no problem.

The problem that I have with promotional messages such as this is that they ALL come from professionals who work and spend their entire days in health-promoting environments. Personal trainers who work at gyms, therapists who do exercise with clients all day, doctors who maintain health initiatives for their entire staff; the list goes on.

Let me make this clear. We professionals say that exercise is easy to work into a day because, for us, it IS easy! We work in settings that contain exercise equipment. We spend all day positively enforcing the idea of movement. Our job is to focus on health!

But for the individual who works an office job on the 20th floor of a building in the downtown core with little surrounding greenspace; the member of a staff that is, overall, not active or interested in health promotion; the person who works a second or third job on the side to support their kids, this message has little hold.

If you're not part of that environment, yourself, can you just imagine so for a second? Access to exercise is one thing - and one that many people still do not have to a great extent. Motivation is another. When you spend your days surrounded by people and work that do everything but promote exercise, what is the inclination to partake. (Aside from gorgeous Instagram trainers who make you feel guilty for skipping something soooo easy in your day.)

Now, I'm not saying that the public is a lost cause to convince to exercise, and I'm not guilt-free of trying to make broad, general statements on ways to incorporate exercise into the day. However, as a mindful practitioner, I realize that access and motivation for exercise is a highly-individualized thing, and generalized tips will not go far. It boils down working with each client, one-on-one, to develop methods and ways to increase a client's participation.

And don't feel bad because that guy on Facebook says it should be easy.

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Trust Your Body - The Bridge Between Recovery And Comfort

I had a client who I helped to rehab a dislocated shoulder. We got their shoulder strong again and returned its range of motion, and thereafter we went several months without seeing each other again.

Fast forward, and the client returned for a visit after reaggravating the old injury. Upon an update on the past few months, I found out that this client was still having a lot of hesitation, before that point, when it came to supporting weight through the shoulder with a hand on the floor.

To me, this highlighted the importance of making sure that rehab was carried forward beyond simply removing the pain and getting strength in each range of motion back.

Rehab is essentially relationship counselling between the brain and body.

This comes back to what I've talked about before regarding helping clients through avoidance habits. When the hesitation and lack of trust regarding certain movements is too great, it's easy to avoid anything resembling that movement to the point that we see a weakening in that joint's function again.

And with that lack of specific activity, the more likely it becomes to re-injure that joint as soon as you do anything resembling that activity again.

For this reason, as a client, we always recommend perseverance in the rehab program beyond the point where there's simply no more pain. As we return the strength and range of a joint, we then turn the exercise plan into something practical and reflecting the demands of your life and any physical activities that you do.

What's more, the sooner we can start the rehab process, the fewer avoidance habits you'll develop and the more easily we can transition to your life-specific reconditioning.

Rehab is essentially relationship counselling between the brain and body. Being strong is great, but if you can't build trust that your body can perform again, the chances are that it will struggle to ever do so.

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3 Ways To Incorporate Your Rehab Into Your Day

We all live busy lives, which can sometimes make following a recovery plan difficult. With that said, it can be very frustrating to be handed a list of exercises by a therapist with orders to do them every day, unconditionally.

As we know, it's just not realistic for many people to simply create a block of time during the day. As well, motivation and energy, fairly enough, may not be in great supply first thing in the morning or at the end of the night.

Some kind of commitment and regularity is needed when it comes to exercise rehab, however, and simply planning to exercise in front of the TV just never seems to work.

So what are some ways that we can work our exercise routines into our daily life without having to feel like we're punishing ourselves or sacrificing other aspects of our day?

1) Pick A Consistently-Free Time

Maybe you find yourself with 15 minutes to relax between finishing breakfast and leaving for work. Maybe it's directly after getting home, before cooking dinner. Perhaps you have a second wind after dinner, and can set aside a moment before hitting the couch and catching up on Big Bang Theory.

It's a common fact that regularity with a time of day to exercise is the best method of making it a long-term habit. IF you have the time during your day or evening that you know you'll always (or nearly-enough) have available, then it becomes easier to make it a rule to yourself to do your exercises then.

2) Warm Up Before Activity

This is an easy one if you're someone who has a workout routine or sport that you stick to on a regular basis. However, it can apply to you if you have a dog that you take to the park, like to go for bike rides, or enjoy any other physical work and activity, such as gardening.

Using your rehab plan as a warm up before any other physical activity that you do, whether it's a traditional workout or simply a walk in the park, is not only a great way to make your exercise a habit. It's also excellent for getting your body accustomed to new ways of moving that the rehab plan is meant to achieve.

Now it's a treat for both of you!

3) Breaks

We all (hopefully) have breaks during our work days that allow us to decompress and take a moment to ourselves. If so, this provides one more opportunity to create an exercise habit.

It stands to reason that work tasks are a common cause of individuals' pain, and so taking routine breaks from those duties to relax and move around is both efficient and a great way to relieve some pain or discomfort while on shift. While not realistic for every single type of workplace, if there's a chance for you to take a corner, or even just stand up at your desk, to perform even part of your rehab plan, then take it.

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Don't Chase Your Pain

Wrist pain that has nothing to do with your wrist? Elbow pain that's doesn't stem from a structure of the elbow? Hand pain...well, you get the picture.

Many of our clients see our therapists for pain that just can't be traced to the area where the pain is perceived. Classic examples of this are symptoms in the elbow, wrist, and hand that we find rooted from the neck and shoulder.

It's not at all uncommon for nerves, as they travel from their origin to the spine, to cause pain at the furthest extremities. In the shoulder, for instance, the bundle of nerves leaves the neck and travels through a pathway in the shoulder before innervating the rest of the arm. 

At both of those locations do we often see a restriction of the nerves, whether it's from muscular tension, poor mobility between joints, or anatomical bone structure. That restriction can then result in pain, numbness, tingling, or other neurological symptoms.

However, nerve pain is interesting in that it follows trends, but not rules. Individuals often expect that they need all of the symptom criteria in order to identify the cause as a nerve. Radiating and electrical pain is a classic sign, as is the numbness or other sensory changes throughout the arm.

Neuropathies do not follow strict guidelines, though, and can easily present as localized sensations, resembling muscular soreness, tendinitis, or arthritic pain.

For this reason, we cannot simply point to the pain and assume that that's the spot that we need to rub and exercise. Our therapists will ensure to rule out the joints above and below the site of pain to narrow down, exactly, where those symptoms are originating from. (Fun fact, it could be MORE than one place. Fun.) With that being said, to the carpal tunnel or tennis elbow clients out there that seem to have found no relief, it may be time to seek an additional opinion to make certain that the right area is being addressed.

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Don't Ignore Your Finger Health

They may not be the most common joints to injure, but when it happens, it becomes quickly apparent how nagging and debilitating finger pain can be.

Finger injuries occur both acutely and gradually from sudden incident or overuse. From sport to occupation, from rock climbing to typing, from judo to construction.

While the injury itself isn't as common as others, what is common is the tendency for individuals to ignore the pain and wait it out until the pain subsides on its own.

I suppose the thinking is, since the joints are so small and seemingly-less complex than the larger shoulder or hip joints, that there is less to be done except to let time take its course when pain onsets.

However, we know that resting and waiting out any injury can be a detriment, whether it's due to the loss of strength and range in the meantime or simply due to the development of irregular movement habits to work around the pain.

Furthermore, neglecting rehab and failing to effectively restrengthen the joint can result in a predisposition to further conditions down the road, such as osteoarthritis.

Like any other joint, a finger injury shouldn't come with the guarantee of long-term complications, but we need to treat it like those other joints and properly address and rehab it. Reattaining range of motion in the early stages will be vital to curb restrictions later down the road, and further strengthening to both the flexors and extensors of the wrist and fingers will keep the joints conditioned to be durable against the constant activity stress that work and life demand.

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