Tuesday, 28 February 2017

Segmenting the Problem

Nowadays, everyone is preaching "holism". Whether it's rehab, weight loss, or strength training, everyone has become aware of addressing the entire body as a whole rather than segmenting it apart. After all, the body is multiple units that must work as one, not independently of each other.

This is a principle that rings very true. After all, minor changes at the top of the kinetic chain are always being found to affect the bottom and vice versa. When treating someone's ankle, I very likely am addressing their hip stability. Wrist pain? Correct the shoulder biomechanics. Back pain? Take a look at what's happening at the extremities.

However, I've been finding situations where segmentation plays a very helpful role. The time that I found where it may necessary to segment the chain is this: when the entire chain is screaming PAIN!

I have one client who has run into a bout of misfortune. Broken wrist, broken ankle, back pain, whiplash, concussion, neck pain, knee issues...and fibromyalgia. The intake form caused some nerves to bubble for me, to say the least.

How do you go about addressing this client? This client who has spent 20 years in pain and seeing minimal results or improvement at any of the joints that she is trying to treat? This client who's stress and depression can cause setbacks by triggering the additional pain of fibromyalgia?

The answer is this.

Right of the bat, I knew that the potential downfall of this client's recovery was that there would absolutely be no way to treat every problem at once, and so the pain at one joint could very easily overshadow any progress being made at another.

And so, what I told her was that we were going to pick one joint to begin treating and rehabilitating. Her instructions were to ignore everything else. We picked the most central and most problematic area - her neck - to begin with and she was to not dwell on the soreness in her hands and feet, for instance, as we went.

This method proved successful. Instead of going around in circles from joint-to-joint and running into constant steps back, we have been able to make leaps in her recovery by simply addressing one area at a time. My client still has a ways to go - her ankles, hands, and feet are still in pain - but we have branched to recovery of her mid- and lower-back, providing her the most pain relief that she has had in two decades.

This is a clear lesson that when problems are rampant, trying to address everything at once is going to get you nowhere. Once significant, sustainable progress in one realm is made, then it is possible to expand to the next without so much fear of regression.

This principle doesn't only apply to rehab and training. The leading experts in diet and nutrition have been proponents of this for years. Small changes at a time rather than trying to alter everything is the only sure-fire way to maintain long-term progress.

Summing up...

Tuesday, 21 February 2017

Your Tight Hip Flexors and You

I get plenty of people complaining about how tight and sore their hip flexors are. The mainstream likes to blame sedentary lifestyles and the flexed-hip position of sitting in chairs on this condition. However, if sitting were to blame, why have my new clients had no luck lengthening them, even if they stretch excessively?

Furthermore, I see clients of both the active and sedentary demographics.While those sedentary individuals certainly have plenty of physical ailments befalling them, the group that complains about their hip flexors the most are the active ones. Interestingly, in my experience, the most vigourously active of them are the ones with the most complaints.

Curious. While spending ample amounts of time sitting may contribute to shortened hip flexors, they don't seem to be the most significant factor at work. So where is the blame to be pointed?


The most major of the hip flexors is the psoas major, originating from the lowest of the spinal vertebrae and inserting onto the femur. The psoas minor and iliacus are present as part of the "iliopsoas" complex as well, but those two tend to be less clinically-significant.

The last hip flexor muscle is the rectus femoris, which duals as a quadricep muscle for extending the knee.


I'm always talking about the importance of core strength. Essentially, every muscle surrounding the spine is going to contribute to its protection.

However, let's remember that that big, strong psoas major muscle attaches to the spine! What comes of this?

Well, normally, your major core muscles such as the abdominals and obliques are the main stabilizers of the spine. The dysfunction occurs, though, when those muscles stop meeting the demand of the load being placed upon the spine. Without those main muscles being able to bear the load, any other muscle in the surrounding area, such as that psoas, are going to increase in tone and stiffness to try and compensate for that instability.

In a sedentary person who does not typically exercise, this affliction may go more unnoticed. The difference with an active individual is that, since they are experiencing more regular physical activity, the psoas has a greater amount of inherent strength and tone, causing an increased sense of tension.

The Fix

It should be obvious that restrengthening the primary core stabilizers is key in allowing the hip flexors to release their protective stiffness.

This doesn't always prove to be enough, however. A number of times, those dysfunctional mechanics have been so ingrained for so many years that the psoas has a difficult time learning to make the switch back from core stabilizer to hip flexor, even when the core muscles themselves are retrained. Getting the psoas to contract into hip flexion independently of the rectus femoris, for instance, is one method I've employed, but that's another topic for later.

All in all, core stability work is the best start, whether it's for rehab or "prehab". If you don't have a problem, make sure it stays that way by keeping your spine sound and supported. (And for crying out loud, minimize your weightlifting belt use.)

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Tuesday, 14 February 2017

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!


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.

Tuesday, 7 February 2017

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.