Get Out Of Pain - 3 Steps For Maintaining Motivation

I tend to harp on New Year's resolutions a lot, mostly because of how well-documented it is that they don't work.

That's not to say that it's not possible to make changes at this time of year. However, "because it's January" is a reason for change with a rather abysmal success rate. I see many clients at this time of year who have looked at the calendar, groaned, and decided that it's time to deal with their back pain, and it often becomes my challenge to make sure that they take advantage of that temporary drive and turn it into a permanent one. Here are a few things to think about when you're considering taking the first step.

1) Determine Your Reasons Why

A lot of people will walk into a therapist's office saying that they want to get out of pain, but without much more reason in mind other than "knowing they should" or "have to". Especially in chronic pain cases, this attitude is very detrimental to the recovery process, as it reflects a kind of "going through the motions" approach.

If you've had severe back pain for years, it's easy to default to this attitude, but if you want to make an earnest attempt at progress, then you need earnest reasons for it. Try to find intrinsic, rewarding factors to motivate you such as family, quality of life, return to activity, or longevity to keep you adherent to the healing process.

2) Start Small And Create Goals

Next, those reasons you've determined are important, but going all in with only that end-goal in mind often leads to failure as well. Long-term plans are tough to keep to when the going gets tough and the end barely seems any closer.

If your long-term goal is to run a marathon in two years, remember that you need something to keep your motivation during all 24 of those months. Have a one-week goal, a one-month; two, half-a-year, and so on. Those steps are vital in order to maintain a sense of realism and attainability with the entire process.

3) Expect Speed Bumps (And Prepare For Them)

Clients can often be dismayed by the fact that they've been doing incredibly well in their rehab and feeling fantastic, then hitting a hump and experiencing a relapse in pain. They can often feel like this is an indicator of the treatment not working or that their condition is, in truth, there to stay with no hope of permanent recovery.

This is wrong, however, and it's important that clients know that these are only speed humps, not complete road blocks. Even in drug addiction rehab, a relapse is not considered to be a failed recovery; rather, it's a delayed one with a lesson learned.

If a perfectly healthy person can't expect to never experience an injury, then recovering pain clients don't need to expect to never experience reirritation. Just know that it's coming, have tools to help cope with that temporary increase in pain, and then be prepared to hop right back on the train.

One step back, but always two steps forward.

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Is There An Athletic Bias In Our Health Research?

I sat down for a conversation on health research with some friends and colleagues. We were looking at various topics regarding nutrition, exercise recovery, and weight-control, but throughout our discussions, one thing stuck out to me.

An incredible amount of our information pertaining to exercise, recovery and nutrition comes from research sources looking exclusively at athletes!

This occurred in the back of my mind a few months ago when I researching static stretching. I was trying to find information regarding the effects of stretching on injury rates and recovery. Using a research database, the first page consisted of 14 relevant articles on the topic.

TEN of these articles involved athletes or otherwise-healthy, young and active individuals.
Only three articles actually involved injured subjects.
Finally, one sole experiment looked specifically at non-athletic individuals.

This struck a chord which I revisited this week during our health nerd brainstorming research session. While trying to discuss proper nutrition for recovery after exercise, including for individuals attempting to lose weight, the majority of the information we were pulling kept using science from athletic populations.

What's more, a lot of the research tends to observe the effects of different stimuli on performance. Let's be frank; there's a BIG difference between athletic sport performance and health. This is why things like the female athlete triad exist.

I'm not saying that research on non-athletes is non-existent, or even hard to find, but there does seem to be a heavy bias on the test subjects for any topics that approach exercise science. There is some sense to be made of why this happens, however. Plus, athlete researcher is, by nature, very popular.

We need to remember that the general population will have different physiology and needs than an Olympic athlete. While many people may strive to have athletic and active lifestyles, the demands of a high-performance marathon runner don't necessarily apply to a weekend-warrior or everyday gym-goer who are just beginning the journey to shed some inches.

So is this a problem with health science, per se? I don't believe so. High-level athletes are one of the most readily available groups who are able to withstand extensive testing and endure some of the more-invasive methods of research. The data we collect from this population is valid for the sake of science. The thing to be careful of is how we apply this data. As researches and health professionals, we need to be responsible in the way that we relay information to the public and not use data from athletes to make sweeping generalizations for the public.

For example, Usain Bolt's body and chemistry not only varies from the average person, but also is going to be quite different from an elite level endurance runner or basketball player.  It is important to recognize that what may work for one person, may not be the best approach for another. Therefore it is important to learn from the research that exists, but recognize the limitations and that it can’t be applied to everyone.

What works for one does not work for all.

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The System Treatments Target (Isn't The Muscular One)

Have you ever had to tenderize beef? It can take a good amount of work to actually get it to soften enough the way you want it. And this is dead meat. It has no bloodflow, muscle tone, outer wrapping (skin) or reflexes to resist the deformity.

That being said, how can we expect to be creating actual mechanical changes to our own muscular tissue using only a foam roller or our hands?  Look at this picture of a cadaver and see how tightly-packed all of that "soft" tissue is! It's not thin and compartmentalized like anatomy textbooks make it look. It's a giant mass of hard, stiff, muscle. Ain't no cylindrical piece of foam changing the structural makeup of that.

So why do we pay clinicians money to massage us? Why do we foam roll? What's with those trigger point balls? Well, if we can't directly affect the muscular system, there's another system that is extremely responsive to these methods...

The nervous system.

The brain: The strongest muscle.

The nervous system is what controls muscle tone, tightness, spasm, cramps, and essentially every other muscle thing that muscles do. We won't go overboard with the exact neuroscience and types of receptors within the tissue, but here we go. When you go in for a massage for a muscle that's seized up or too tense, what the therapist is essentially doing is overriding the stimuli that cause the nervous system to believe that it needs to be tight and contracted, initiating a relaxation effect. It's sometimes quicker, sometimes a more gradual process, but at the end of the day, the nerves are the only true structure affected by mechanical pressure; that is, unless you run over the person's leg with a steamroller. (The above link cites another study demonstrating the absurd amount of force actually required to deform human tissue.) This is the reason why contract-relax techniques and modalities such as electrical stim are able to exist with the same end-goal as massage of muscle relaxation and decreased tone.

Even when it comes to scar tissue built up in a muscle, the treatments that any therapist does is simply promoting the healthy tissue to mobilize better around the scarring. (Long-term changes from exercises-induced bloodflow and tissue stress might have a different effect, however.)

For this reason, I don't subscribe to the belief that massage has to be excruciatingly painful to be effective. In fact, I see it as counterproductive if you're triggering enough pain to create a new spasm response. Also, this is the benefit of exercise rehab in conjuncture with treatments such as massage, mobilizations, or muscle stim. Once we remove the (allegedly) dysfunctional situation of a muscle when it's hypertonic, in spasm, or in too much pain from an oversensitive nervous system, we can then go in to retrain the body's mechanics to work around the physical structures that exist in an optimally-functional manner.

End of the story, the treatments you receive at the clinic, whether it's massage, stim, mobilizations, or contract-relax stretching, are still incredibly useful; just not for the reasons that you thought. The peripheral nervous system reigns with much more power than we're often inclined to think, and I think that by switching gears to focus on the effects of that system as opposed to having tunnel-vision on the muscles and ligaments themselves that we'll be able to advance our abilities in the healthcare and fitness fields.

Bonus Trivia!

We're talking about the nervous system, so take a look at this Michaelangelo comparison and mull it over.

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Positivity in the Clinic Space

There's a definite difference in the progress my clients will make depending on the emotional spin that I put on their conditions. Picture that you're in the therapy clinic having your injury assessed. Which of the following sounds better to you?

" You have a pretty major problem going on right now that needs to be addressed."

 or...

"There's definitely some work that needs to be put in here, but your outcome looks good."

Or: "Sorry, we're gonna need to cut it off."

Both are fairly common kinds of attitudes that clinicians - whether it's an Athletic Therapist, chiropractor, or physiotherapist - take towards their clients. There's a difference, however. The first instills more fear and dependence on the practitioner; the second generates more optimism and empowerment toward a positive outcome.

This sort of topic traces back to my previous post about honesty and transparency when working as a clinician. As healthcare practitioners, there is a responsibility on our part to deliver information to clients in a way that is going to encourage them to progress in their treatment rather than instill fear and avoidance habits of their conditions.

We've all seen this tactic used distastefully, in that a practitioner will use fear-mongering language in order to create a sense of dependence for the client to constantly keep coming back, which is poor ethical practice indeed. However, it's incredibly easy for well-meaning professionals to unintentionally do the same as well. Fairly enough, someone's back injury might really be a major problem. It's just important to remember that the message that we send, though, dictates the client's belief and self-efficacy when it comes to being able to recover from those injuries.

At the end of the day, it's an easy concept to understand. For instance, with one client of mine who has chronic stress and anxiety that causes her to be unmotivated to do her rehab exercises, my instructions to her this: Do not think, "I have to do the exercises, but I'm not feeling well enough," but rather, "I'm not feeling well, but the exercises will make me feel better."

Psychology 101: Positive reinforcement.

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The K-Tape Review

We all remember the 2012 Olympics where Kinesio Tape (K-Tape or KT) first became widely-known to the public. Whatever the use for it, slapping patterns of brightly-coloured adhesive on insanely fit and tan world-class athletes sure brought the stuff to popularity.

There are a lot of claims surrounding the use of KT. Some people swear by it, others have thrown it into the alternative category of pseudoscience, right next to aura-rearranging.

One thing that I immediately notice is that the KT website is purposefully vague about it's claims. Citing them, KT "helps"with a variety of injuries. It "provides support" as well as 24-hour relief. A lot of very nonspecific stuff. The most specific it gets is that KT provides proprioceptive feedback to help with relaxation or activation of muscles.

But let's find out what weight Kineseo tape (or whatever other knockoff brand of it) really holds... with science!

Increased Muscle Activation and Strength

One of the biggest uses cited by KT lovers is that the application over certain muscles or tendons can facilitate an increased activation of that muscle. The mechanism supposedly works by providing neural awareness (proprioception) of the area that will trigger the nervous system to more-easily contract the targeted muscle.

Looking at the literature, it seems that, indeed, KT does have a proprioceptive effect on the muscles and can increase bioelectrical activity to the area. However, the significance of this is still in question. Other studies have found that while the tape improved sensory perception of force, actual muscular strength and power was unaffected.

The verdict here might suggest that the KT can be useful as a tool for sensory feedback propagation, possibly allowing for the correction of motor habits. However, expecting the tape to actually increase the contractile strength of the muscle is likely to be a folly.

Range of Motion

On the support side for KT, though, there was a use found for the application when it comes to range of motion. Specifically, it seems like if there is a limited range of motion due to muscular reasons (such as tension or weakness) there may be some proprioceptive mechanism that causes an increase range with the tape applied. I found studies experimenting with this concept on both the lower back as well as the knee following ACL repair. It must be noted, however, that the jury is still out on what this exact mechanism may be.

Pain and Injury

This one is another gray area. Can KT decrease pain caused from specific injuries? Yes and no.

I selected experiments using KT on subjects with patellofemoral pain who saw improved symptoms due to the aforementioned proprioceptive effects of the tape promoting more-balanced activation of the quads. Similar results are suggested in subjects with chronic low-back pain. Shoulder interventions have been mildly positive as well, but not significantly more effective than other modalities. Interestingly, one more study on shoulder pain found that subjects improved in one specific range of motion only from the tape but not overall function, suggesting that there may be limited application of biomechanical corrections with the application. If no direct motor pattern is present to offer immediate pain relief, such as with knee osteoarthritis, the KT proved useless.

I think we'll be waiting a few more years on anything concrete in this realm.

Drainage

This is one of the few effects that I really enjoy using KT for.

One fascinating use of KT is its ability to increase drainage of swelling, bruising, and edema. Looking at the research, it looks like there's a definite increase in the distance between the epidermal and dermal layers of the skin with KT applied which may allow for an increased lymphatic flow. Another study found the tape even more effective than some manual drainage techniques. However, there is also an definite limit in the effectiveness of KT when it comes to severe edema.

Conclusion

So can we put stock in Kinesio Tape? Well, it definitely may be useful for providing the neural feedback to cue the correction of certain muscular firing patterns and motor habits. Don't expect it to magically increase your strength or whisk away your pain, however. If you have a bruise, though, give it a shot!

Just don't wear it to play sports without covering it. Otherwise, you're advertising to every single opponent of what kind of injury you have.

It should be noted that virtually every one of the studies that I cited involved very small subject groups. Furthermore, KT is still in such an early stage of research that repeated validity is hard to confirm at this point.

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Does Ultrasound Work?

Here's a doozy. Does ultrasound actually work?

Ultrasound is a favourite tool of both clients and clinicians. Using a machine that sends high-frequency sound waves into the body's tissue, the idea is that it increases circulation and stimulates cell metabolism in order to speed up the healing process.

However, ultrasound has been under fire in recent years. By no means is anyone suggesting that ultrasound may be harmful (unless you misuse it), but the question is this: Is there actually any healing benefit happening?

The Research

There has actually been a lot of recent research done on ultrasound's effectiveness, making my own delve into this rather quick and painless.

On one hand, when using ultrasound on human tissue in vitro (that is, samples removed from the body and placed in test tubes), the results are promising. The vibration and mild heating effect of the ultrasound on those human cells definitely shows evidence of increased proliferation. So it makes sense that ultrasound works, right?

On the other hand, let's remember that a cell in a petri dish is different than a cell that's still in the human body.

Two of the best reviews of past studies that I could find concluded that there is insufficient evidence to back up the use of ultrasound as having any beneficial effect on the healing process when it comes to actual clinical use. While some studies may show that there is something occurring underneath that ultrasound head at the cellular level, the consensus seems to be that those minor changes are not significant enough to speed tissue regeneration.

In fact, looking back on even the older research, it seems that most studies that support the use of ultrasound were heavily flawed, such as being done only on rabbits or rats.

We're people too!

Conclusion

So, does ultrasound work? As far as I can tell, probably not. Can it be ruled out? I'm gonna say no, but it's going to take something groundbreaking, at this point, to save the reputation of this particular modality.

But hey, some clients love it. Maybe there's something going on that we haven't been able to detect yet, or maybe it's just that good ol' placebo effect. At least the therapist is getting a break from using his or her hands, though.

While you ponder that, I'll go ahead and give my clients a massage instead.

Honesty and Transparency as a Clinician

Potential clients may see this as a promise. Other clinicians may use this as marketing advice. To me, it's a personal message regarding my integrity.

So far, I would say that my practice as an Athletic Therapist has been successful in the short time that I've been working so far. The client stream has become steady, my patients have seen success, and most of those who walk through my door have been very satisfied with my services.

Notice that I say, "most". Admittedly, I cannot claim to have been successful in helping every single person who has sought me out for treatment.

There are those out there who would call me crazy to make this statement. They see it as a belittlement of my abilities as a practitioner and consider it damaging to my credibility to not be able to say that I can help anyone and everyone. However, let's be honest here. Can we really act on the belief that anyone is able to treat everyone?

The way I see it, we're not in an age where the public is willing to blindly listen to anyone with a degree. In fact, we're in an era where it's encouraged to constantly question and challenge authority and expertise. If people smell dishonesty from a professional, they will certainly act on their instincts.

I see the difference between the clinicians in this field in terms of acting on this information. Absolutely, there is a certain breed of therapists who will lie through their teeth about their confidence regarding knowledge of your injury and what needs to be done to remedy it. It would be incredibly easy for me to twist my words and make a client believe that I'm the expert on what's going on, even when I'm unsure, simply to have them return again and again for treatment.

"I prescribe you to foam roll. Every week. Under my supervision. Forever."

But, let's put it this way. Being a therapist and trying to establish a reputation nowadays is a lot like dating. You can be dishonest and massage your ego to get that one-night stand, or you be upfront and give it to someone straight in order to have a long-lasting relationship.

I can't see dishonesty with clients as anything short of unethical, and if I were to lie just to try to keep business, I could expect to see people catching on quite quickly and never coming back. In my experience, people have been extremely grateful when I'm honest and transparent with how I do business and my thoughts regarding their conditions:

"I've assessed your injury, and I think it's something out of my expertise. I'm going to refer you on to someone more suitable."

"I'm really not putting the pieces together here. Give me five minutes to check some references and do some research to see if we can figure out what's going on."

"I can't pretend to be 100% confident on what to do here, but let's try two treatments and see if we're finding benefit. If you're not feeling progress, I won't be insulted if you decide not to come back."

So far, those honest statements go a long way. Telling a client that I'm unsure about what ails them actually makes them more willing to come back due to the trust that I will continue to puzzle it out. Referring them on makes them confident that I'm looking out for their own wellbeing over my own and has resulted in them returning for different injuries later or even referring more business to me. Being honest about needing to check a source instills that you're being mindful and trying your gosh-darn hardest to help them.

With that said, I encourage all clinicians to be as forthcoming as possible with patients. Clients want honesty and results, and it is our job to provide. And to those clients, I advise you to find a practitioner who will deliver those qualities. The best-possible therapist for you is out there, and you absolutely deserve them.

Do More Techniques Make A Good Therapist?

"Do you do dry needling? Acupuncture? Active release? Graston?"

These are questions that I, as an Athletic Therapist, get quite often from potential clients. People are looking for the best-qualified clinicians to trust with their health. It seems like a given that the therapist with the most skills will be the best at treating their clients, and so advertising those additional certifications and continued-education courses are a sure-fire way to pick up on that.

Being an Athletic Therapist who is still relatively entry-level, though, these questions often frustrate me. To anyone in the public, or even to we therapists while we're still in school, yes, it seems like it'd be obvious that the more techniques, the better when it comes to treating. After beginning my career, though, I saw through the ploy.

Think of it like this. If a therapist was "better" at treating clients just based on knowing how to do the newest technique, then that would be like saying that the best personal trainers are automatically the ones with the most state-of-the-art equipment. Sure, those tools help, but the skills that set you apart from other professionals are knowing when, how, and why to use them.

I don't like to blow up my own ego or discredit anyone else, but this won't be an uncommon story across the board. I have a small set of entry-level treatment techniques: massage, joint glides, electrical stimulation, and a few more. However, I often get clients coming to see me after weeks - sometimes, months - of seeing another practitioner (whether it's another AT, physio, or chiropractor) who spent every treatment throwing fancy techniques at their client. Sometimes the treatments didn't work. Often, they did, but temporarily. After feeling like nothing was working in the long term, these clients will tend to try another clinician, and when I see them, sure, I don't have all those fancy skills, but I have my problem-solving skills.

After receiving a month of shockwave therapy on the shoulder, maybe the client really just needed more strengthening at the neck to reduce pain. Instead of endless active release on the low back, maybe conservative massage and core strengthening is going to be most-effective. Acupuncture to fix those nagging post-ankle sprain aches? Maybe start focusing on the mechanics at the hip instead.

I'm not trying to disprove the use of these higher certifications and treatment methods. By all means, they are meant to make a therapist's lives easier and be a part of an all-encompassing rehab plan. The thing to take away is that virtually any treatment method - whether it's the basic massage we learn in school or the dry needling we learn to do years later - all have the potential to accomplish the same goals. The trick is knowing where to use those techniques, why, and what to do afterward, and that comes down to the individual practitioner, regardless of what kind of continued-ed they've done.

Fancy tools are all and good, but by all means, they're far from the only thing to factor in when choosing a therapist.

Do You Need Traction?

I recently had someone ask me if I thought it'd be worth it for them to purchase their own traction table for at home.

I've also talked to clients who said that they previous paid their last clinic for weekly traction - and almost no other treatment. Sometimes, the timeline went all the way up to nine months! Did this form of treatment help them to resolve their back pain?

Mmm...kinda.

Weeeeeeeeeeeee!

Mechanics

Traction can definitely help to relieve back pain. Is it going to cure it for good, however? Will it correct the mechanics that caused the pain? Likely not.

There are a number of ailments that can afflict the spine. For example, a disc bulge may be pressing on a nerve root. Arthritis may be developing between the vertebrae. There could even simply be a strain to one of the muscles supporting the spine. Any number of things.

Now, traction can be a fantastic tool for relieving the pain experienced by these conditions. Decompressing the spine would relieve how much the disc bulge is pushed on the nerve root. Arthritic changes inside the joint would become spaced apart and less agitated. Traction is even reported to alleviate muscle spasm.

So yes, spacing the vertebral joints apart can absolutely relieve symptoms of a myriad of back issues. However, has this done anything to correct the problem that caused those symptoms in the first place? Of course not. You haven't actually changed anything within the joints.

Spinal Rehab

Recovery from spinal conditions involves restrengthening of muscles, retraining proper motor habits, and stabilizing the joints to prevent future recurrence. True, traction is a great in helping to relieve pain just long enough to be able to move oneself through the recovery stages, but if the posture and biomechanics are not addressed, then recovery will not occur.

That being said, it should be important to know that, firstly, you need much more than traction to fix your back. Other aspects need to be considered. Secondly, once we address the roots of the pain and correct for them, there should be no reason why month upon month of traction is ever necessary. By moving through a proper rehabilitation routine, more results will be achieved in shorter time. In fact, research shows that traction is most effective in treating short-term, acute injuries.

In brief, traction is not a one-shot magic bullet. It's simply more of a painkiller. A painkiller that takes fifteen minutes to swallow while you're hanging upside down. Once in a while, it's worth it, but like morphine, don't abuse it. (For your wallet's sake.)

How Do Pain and Spasm Work?

I had a client this week ask me why the body seizes up so violently when it experiences injury, even when the muscles that are seizing up weren't the ones that were damaged. You've sprained a ligament at your AC joint, so why has your entire upper back and neck become so tight and restricted?

As I've mentioned before, the body has this fantastic mechanism when it comes to protecting its joints. Normally, when it detects instability around a joint, the brain signals the muscles to tighten and tone in order to guard the joint from harm. However, when the instability is severe or when the body experiences an acute, traumatic injury, this tension becomes spasm.

Spasm is an involuntary muscle contraction and is how we define this "seizing up" of muscles when we experience injury. The body is desperately trying to do whatever it can to maintain the integrity of the joints by minimizing any further harm. Unfortunately, this spasm is very often even more debilitating than the injured structure itself. Why is that?

The Pain-Spasm Cycle

What happens is this delightful process known as the pain-spasm cycle. First, your body experiences pain. As we know, the body now tightens and spasms up in response. However, this tension has made the pain even worse. As a result of the increased pain, the body throws in even more spasm, and the cycle continues.

This is essentially the physiology of any injury and the reason why it's so hard to find relief. This cycle can be an extremely debilitating process and is tough to break. But it CAN be broken, and that's where I come in to do my job.

Breaking the Cycle

How do you break a cycle? Well, you remove one of its pit stops, of course. Through whatever means are used, if you can reduce either the pain or the spasm, its counterpart, by principle, will become alleviated as well. This is the purpose of modalities that therapists use. Massage and needling, for instance, help to relieve muscle tension and decrease the amount of pain that a client has. On the flip side, electrical stimulation machines are also used solely to block the pain signals from the tissue to the brain, causing the brain to allow the muscle to relax and cease its spasm.

However, these modalities are often not enough. Even IF the symptoms can be completely alleviated through a treatment (spoiler: most often, they're not), the symptoms can easily return. The way that I explain to my clients is this: Regardless of muscle tension and pain, there is going to be some degree of dysfunction or joint instability remaining from the injury. By not correcting these issues or by leaving behind even a small amount of pain and spasm still, the symptoms are likely to return full-force.

And how do you correct that? Movement. Athletic Therapists recognize that treating the tissue ourselves is only half the battle and that the rest of the work is up to yourself to stop the problem from coming back. Strengthen the muscles around the joint. Create stability. Rebuild the trust between the brain and the muscles that movement can be done safely and pain-free. This is only way to truly correct a dysfunction and prevent this painful boomerang effect.

The most useful medical tools.

These principles are well-known to most medical practitioners, but it seems that it's often missed by the public. By offering this understanding on how exactly pain and spasm work and how to correct them, hopefully it will prove to be a valuable resource to motivate people as they move through their recovery process and back to health.

Making the Case for Mid-Season Rehab

"I'll just power through the rest of the year and get healthy again during the off-season."

I'm good, Coach! There are three whole ligament fibers still in there!

If you've worked with sports in any capacity with athletes over the age of 18, you've encountered this attitude time and time again. Or maybe you're one of these athletes yourself. You got hurt in the first game but feel well enough to continuing playing the week after with only a bit of pain, so you tape yourself up and consign to go and get rehab after the season is over.

This attitude isn't restricted to the traditional multi-game season either. Maybe you're a runner, body builder, or gymnast with that one, big competition coming up in a month. You're training hard and rigorously; there's no time to for stupid little rehab exercises.

In reality, there's actually a big problem with athletes who won't seek treatment in the midst of their sport season. I understand their thought process - in that they either don't have time or don't want rehab to interfere with their training progress or practice - but I far from agree with it. Just because you have someone to tape your ankle, get your back cracked or massaged once a week, or started wearing a back brace doesn't mean it's ok to neglect the actual rehabilitation and retraining of your injured joints.

So what are the reasons to not wait until the season is over to get better?

You're Going to Get More Injured

This one is an obvious one. Regardless of the fact that you have tape or a brace to support the area that you hurt, the structure that was injured is, by nature, now prone to further injury. Even if the tape is good enough to protect your ankle during the game (pro-tip: there's a likely chance it's not!) what about after the game when you return to work or your family? The chances of you reinjuring something, whether during sport, work, or life, are always multiplied after every injury and even moreso after each reoccurence. With that being said, why risk it if there is something to be done?

You're Developing Bad Motor Patterns

So you finally did make it to through those few more months and to your physique show, despite straining your back earlier. It was thanks to that back brace you had at work and that you wore your weight-lifting belt during even the lighter days at the gym. Now that it's all over, now is a good time to hit the clinic.

Except, now that you've waited so long, you've increased your timeline of recovery due to developing poor motor habits by compensating all this time. Whether it's having that back brace that eventually made your core weaker, that limp that mangled your hip strength, or the fact that you just straight-up stopped reaching over head with that arm to protect your shoulder, the adaptations that your body has made around the injury have only become more and more ingrained the longer you put your rehab off. What once may have been a simple couple weeks of rehab for the ankle sprain is now two months of recovery because your hip weakness has now started causing both back and knee pain.

Look at this photo and try to tell me it's ok to walk around like this.

Rehab Will Improve Performance, Not Interfere

This last one is, again, a seemingly-obvious one, but it still doesn't seem to resonate with people who have a less-than-paralyzing affliction. Honestly, I think it may stem from the belief that there's no point in rehabing something that's just going to get more hurt again the next day, but that's an awful way to think.

Anyhow, I digress; you're performance at your sport isn't exactly going to improve amidst an injury, and it's definitely not going to suffer because you added some daily rehab exercises to your training plan. I'll revisit the whole "power through it" mentality, and while that's an admirable philosophy, it's important to remember that every additional ache or pain is going to affect your performance to some degree - whether it's the ankle sprain from three weeks ago meaning you can't run as fast, the back strain preventing you from lifting as heavy, or the shoulder instability resulting in you having less shots at the hoop before needing to come off and ice.

All in all, this isn't a groundbreaking train of thought. I'm pretty sure that all of us - athletes, coaches, parents - know that we're better off seeing help sooner than later, but we get stuck in this mentality of dealing with it later because there's more important stuff in the now. It's a mentality that we're much better off with phasing out, however, for the sake of both your health and your performance. Don't be a hero; be smart.

Textbook Posture - It's A Myth

Does this sound familiar?

 "I went to get my spine x-rayed. Apparently my C5 is out by 14 degrees, my T1 by 30 degrees, and T3 by 10 degrees. I've been told that I need 3 months of treatments or else I'll be in pain for the rest of my life."

In the therapy field, I hear this a lot. Someone sees a practitioner for pain, they go get x-rays, CT scans, MRI's, and the works, and then they receive their alarming prognosis. It's hard to argue with a photo. You're taking a real-time picture of what's happening inside the body. If the imaging shows that your spine is out, then your spine is definitely out and you need to do something about it.

Well, maybe.

Textbook Perfection

Every medical professional that you've ever seen learned their stuff from textbooks. When it comes to anatomy and physiology, there are rules to how things are supposed to look. You're overall posture, for instance, should allow you to draw a straight line from your jaw joint through the shoulder, the middle of the hip, to a point just in front of your knee, and then finally to the ball of the ankle. There you go, all in black and white.

Except! The body is not black and white. Everything to do with health is a gray area, and every single body varies. Very rarely do we ever see a person with textbook perfect posture or spine that's free of degeneration. Often, it's the shape of the joints which throw things off. Other times, it's just the functional way your body holds itself due to your lifestyle. Maybe you ARE supposed to have a better posture than you do, but your tight or weak in certain areas. There are textbooks, but there are no handbooks to this. If you deviate from what your Anatomy 101 class says you should look like a little bit, it's no reason to rush to your chiropractor.

Postural Faults and Pain

That being said, if you do have a clear fault in your posture, such as rounded shoulders or an over-arched back, then could definitely be room to correct things. However, whether you're the therapist or the client, it's important that we remember to not stigmatize these imperfections.

I was reading one insightful article about disc bulges, one of the most feared and debilitating injuries that we can speak of when it comes to back pain. As it turns out, however, the images may show that you have a bulged disc, but you might not necessarily have any symptoms at all. Many faults and imperfections are natural, whether from birth or from the regular aging process. If you're asymptomatic, then there's a solid chance that you're going to remain that way, provided that your general health stays in check. I've heard many clients talk about the malaligned ways that their x-rays revealed their back likes to stay in, but guess what; chances are that my own x-rays would show many of the exact same things.

What If I Do Have Pain?

If pain is present, then there is obviously something going on that needs fixing. However, in these cases, let's still remember to pause and take a breath before dropping $900 on 5 months of prepaid traction and manipulations.

Again, malalignments and imperfections are often going to be present whether or not there's pain. Sure, you do want to focus on those areas by mobilizing joints and tractioning to reduce pain and pressure, but even then, those aren't necessarily cures.

Remember, it's more than probable that most of us have a postural imperfection without symptoms. So, if we do have symptoms, doesn't it stand to reason that those faults aren't necessarily the problem? They may not be helping, but more than often, I'm willing to bet there there is a strength imbalance, acute injury, or a habitual, repetitive task that would be much more beneficial to target. The most likely fact is that you're going to rehabilitate to the point that your pain is gone and function has returned before you see significant changes in your posture.

So Does Posture Not Matter?

I wouldn't go as far to say that you shouldn't care about posture or things picked up on your MRI. I'm just saying that visuals and images are essentially one test for your health when, in reality, there's a bigger picture to be painted. Is a person able to function and bend the way they need to? Are they in pain? How old are they and could this just be natural?

The important thing to remember is that posture charts to us and to many health professionals are like Barbie dolls to young girls. They're all fine and good but don't go thinking there's something wrong with you for not looking like that.

Her posture leaves me wondering anyway.

I Asked A Physiotherapist How She And I Compare

Athletic Therapists are consistently compared to Physiotherapists, and we're constantly asked to describe the differences between us. I won't lie; I see a problem with asking one person alone to describe the gap. An AT will likely come off as prickly to try and measure up to the PT. A PT might view us as inexperienced clinicians of a young profession. So, in that case, I took the diplomatic approach and interviewed my friend Lisette, a Physiotherapist in Vancouver. Between an AT and PT, we broke it down.

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Me: Athletic Therapy is officially defined by Canadian Athletic Therapist's Association as follows:

"Certified Athletic Therapists are best known for their quick-thinking on-field emergency care of professional and elite athletes. The first to respond when someone gets hurt, they are experts at injury assessment and rehabilitation. It’s that same mix of on-site care and active rehabilitation skills that makes Athletic Therapists so effective in treating the musculoskeletal (muscles, bones, and joints) injuries of all Canadians, whether on the field or in the clinic.

Athletic therapists adhere to the Sports Medicine Model of care. They treat a wide range of patients, from kids with concussions to seniors recovering from hip replacement surgery, using various manual therapies, modalities, exercise prescription and even bracing and taping. The treatment varies but the objective doesn’t: an Athletic Therapist's goal is to help clients return to their usual activities, whether that means playing competitive sports or walking to the mailbox and back.

The five practice domains are as follows:

1. Prevention
2. Assessment
3. Intervention
4. Practice Management
5. Professional Responsibility"

More details can be found here: https://athletictherapy.org/en/about-athletic-therapy/scope-of-practice/

Can you please define your field of physiotherapy for me?

Lisette: To put it simply, Physiotherapy is a healthcare profession dedicated to working with people to identify and maximize their ability to move and function throughout their lifespan.

From our association websites, PABC and CPA, you can find more information:

http://bcphysio.org/content/what-physiotherapy

http://physiotherapy.ca/getmedia/e3f53048-d8e0-416b-9c9d-38277c0e6643/DoPEN(final).pdf.aspx

Me: The education process for Athletic Therapy is to complete a four-year Bachelor's Degree in Athletic Therapy (at which there are seven schools in Canada), which consists of extensive practical and hands-on instruction. We are then required to complete 1200 hours of practicum, and then attempt the national board exam to finally certify.

Could you  tell me about the education process of Physiotherapy? Please mention if there's any comparisons or contrasts you'd like to make.

Lisette: The education process within Canada is to complete a 2-year Masters degree in Physical Therapy, with most schools requiring slightly different admission criteria on top of an undergraduate degree. While it varies from school to school, most are looking at GPA of the last 2 years of your undergraduate degree that are 300- and 400- level courses, prerequisite courses, volunteer hours and professional references. Most have the McMaster University adapted “MMI”, or Multiple Mini Interview format, similar to that of medical school. The programs consist of theoretical and clinical components and we have separate national board written and clinical exams to pass in order to fully practice with no restrictions.

When it comes down to it, can you describe the differences between the two fields, firstly in the specific scope of practice, and secondly in terms of experience and focus of work.

Lisette: It is actually quite difficult to describe the differences between the two fields, at least from my perspective. The scope of physiotherapy is quite broad and encompasses several different and varied practice areas. I think the biggest overlap of a PT and an ATs scope of practice is with sport and orthopaedics, which a large portion of PTs work in, sometimes within the same clinics as ATs. As from our association website, physiotherapists are employed in multiple settings, not just in private clinics that many people are accustomed to:

Arthritis

Asthma

Back pain

Cancer

Cardiovascular Conditions (including post heart attack, 
Chronic Obstructive Pulmonary Disease (COPD), and pneumonia)

Cerebral palsy

Chronic Pain

Concussions

Critical Care

Dementia

Developmental Delay & An Array of Paediatric Conditions

Diabetes

Falls & Fractures

High Blood Pressure

Incontinence

Multiple Sclerosis

Neck Pain

Neurological Conditions (stroke, concussions, spinal injury, Parkinson’s disease),

Occupational Health

Oncology-Related Conditions (including lymphedema)

Osteoporosis

Pregnancy-related Incontinence

Rehabilitation

Vestibular Disorders (dizziness)

Just to name a few. :)

Taken from CPAs website, our scope of practice is as follows: The ‘foundation practice acts’ are in all provincial legislations and include assessment of neuro-musculoskeletal and cardio

respiratory systems, therapeutic exercise, electrotherapy, hydrotherapy, soft tissue techniques, manual therapy, wound management, and tracheal suctioning. The knowledge and skills required to perform these acts are taught in the entry-level physiotherapy curricula in all Canadian university programs and are included in the blueprint for the Physiotherapy Competency

Examination administered by the Canadian Alliance of Physiotherapy Regulators.

Other acts, such as spinal manipulation or dry needling (acupuncture) are within the profession’s authorized scope of practice but are not considered entry-level. They require additional education and training following graduation.

For more information, https://www.physiotherapy.ca/getmedia/e2541bbc-f95d-4d8b-b689-98365bc4abbd/Scope-of-Practice_EN.pdf.aspx

Me: Definitely, a physiotherapist’s scope of practice extends across a much more broad range than an AT’s, but as you said, there is a lot of overlap in our skillset when it comes to orthopedics, musculoskeletal rehab, and sport. If I were to just pull from your same list, my list would, of course, be shorter, but still encompass quite a range itself.

Arthritis

Back pain

Chronic Pain

Concussions

Critical Care

Falls & Fractures

Neck Pain

Neurological Conditions (stroke, concussions, spinal injury, Parkinson’s disease)

Occupational Health

Rehabilitation

We also have the addition of being the on-field specialists, as you said. On sports fields - and in labour fields and factories as well, in fact - we are trained professionals in quick on-site assessments, shorter-term injury care, and first responders in the events of emergency.

As well, if I dare to make a slight side-step, many AT’s receive full training as Exercise Physiologists as well. While we’re not all necessarily certified as such, and while the exact scope of our skills are different, we are known to be adept with chronic diseases such as high blood pressure, diabetes, and osteoporosis ourselves.

Also like a PT, ATs will further-specialize in specific sub-fields; simply within a smaller pool, but no-less skilled in them. We do have a wide-array of entry-level skills and techniques, but, like I’m sure is the case for you as well, the continued-education is endless if we so choose.

Can you provide an example or two of a type of client or situation that you would refer away to an AT?

As a physio, I firmly believe in client-centred care. To me, that means if a patient is better-served by a different practitioner, whether it be within the same profession or not, that is the most important thing. As I mentioned previously, I think that the scope of an AT falls within that of a physical therapist’s. From what I understand, the majority of an AT’s focus in school is sport and rehabilitation, as well as on-field assessment. When we graduate from physio school, we are entry-level PTs that are considered generalists. I would say that the majority of my classmates have gone on to orthopaedics, and some have started to specialize in sport rehabilitation. I think this is where the lines get quite blurry, because of the overlap in scope. I don’t think one or the other would be better or worse for a patient to be treated by, just as within the domain of physio there are different treatment styles, techniques and theories which seem to have all had success and have better success with some patients than others. Let’s put it this way: if I have a patient who is a basketball player and after trying some things, the patient did not seem to improve, I would consider referring him to either another PT that I knew could potentially be more successful, or another rehabilitation expert, such as an AT.

I often feel like, as an AT, I’m almost akin to a physio that fast-tracked a speciality. While I don’t receive any training when it comes to MS, cerebral palsy, or cancer, I graduated school with speciality-level skills in the orthopedic field immediately. I think a lot of people view us as less competent due to our fewer years of education than a Physio or Chiro, but it’s important to remember that there’s a tradeoff. Fewer years with a narrower, but more specialized scope of practice versus a longer program with a broader, but more general knowledge-base.

That isn’t to say that that, by default, makes me more qualified than a Physiotherapist when it comes to musculoskeletal conditions. If I know of a Physio with more experience with certain types of injuries than myself and I think that my client is better off with them, then of course, they’re referred on. On that note, while AT’s can safely treat orthopedic conditions of clients who also have other chronic diseases (MS, cancer, etc.), if those diseases are complicated to the point that they would start directly affecting my treatment process, then there isn’t a question of if I send them on or not.

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A quick interview for sure, but thanks so much, Lisette, for answering my questions. I hope that this sheds some light on the comparisons and contrasts between these two professions. My goal is to see Athletic Therapy as a well-known and widespread option available to everyone in the coming years. It helps if I can show people that we're more than just soccer team-tapers or a baby-profession that hasn't found its legs yet. At the same time, we're not here to replace Physiotherapists or discredit the amazing work that they do.

If nothing else, I also hope that this post triggers questions to be asked of Athletic Therapists. If you have one, please do not hesitate with it.