Tuesday 24 April 2018

Progressive Overload - Treat Your Rehab Like Training

Progressive overload is the gradual increase in stress placed on the body during exercise. Weight training relies on this concept, as the body requires increased stress, resistance, or challenge in order to adapt and become stronger.



The funny thing, however, is how often this rule is forgotten as soon as we switch from the fitness world to the healthcare one. Oftentimes, I'm witness to individuals in pain who have received prescriptive exercises from a therapist, but have attempting to use that same movement - and same volume - for months or even years!

This is essentially the same as trying to gain bicep size by curling with the same-weighted dumbbell for the same number of sets for a year. How effective do you think this would be for initiating physiological change?


In fact, numerous studies are demonstrating that a progressive increase in the frequency and volume of the load that pain patients are undergoing - essentially, having them partake in rehab that closely reflects a fitness training schedule - resulted in greater improvements in condition. This shouldn't be a surprise to anyone, but what is surprising is how easy it is to neglect this principle in the therapy world.

Perhaps we get stuck in the mindset that injured or pain-afflicted clients should not be taken to realms of discomfort. Fairly enough, even many clients are hesitant to exercise beyond a very mild comfort level. Let's remember, though, that there's a difference between the healthy discomfort of a challenging exercise and the noxious sensation of when it becomes to be too much. (This is part of the reason why I allow my clients to work through a 3/10 pain scale, the other reason being so as to not train their nervous systems to avoid pain.)




Long story short, challenge the tissue and be mindful of the pain, but don't totally avoid discomfort. (Am I starting to sound contradictory? Welcome to healthcare.) All in all, we need to ensure that we're varying the intensity and type of movement. After all, that's life!

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Tuesday 17 April 2018

Do No Harm - Treatment Intensity And Consent

"This other therapist I saw just beat the crap out of me."

People seldom expect to see an Athletic Therapist, physiotherapist, RMT, or chiropractor without experiencing some level of discomfort during the treatment. After all, we, as the clinicians, are applying manual pressure into your body to exert some kind of physiological change. Things could get tender!

However, I hear, time and time again, stories of individuals who see practitioners that seem to have a particular level of sadism for making their treatments as excruciating as possible.


As I've covered before, pain tolerance is a very individualized factor when it comes to any treatment. Some people will be able to handle more pressure and discomfort than others, and as a result, those few may actually require a more intense treatment in order to attain the desired desensitization effect from it.

Inversely, if someone has a much lower tolerance to pain, they do not need to - nor should they - receive any treatment method that is more intense than they can handle. Remember, any therapeutic treatment is targeting the nervous system only, rather than causing any true physical change to the tissue. That being said, a client should only need to be taken to their personal threshold for the intensity of a technique to have an effect. What's more, exceeding that threshold may actually result in heightening that person's pain sensitivity.

With that in mind, I cringe when I see these photos - from both clients and clinicians - who are proudly showing off their treatment bruises. "More pain, more gain," is not a principle that applies to healthcare, and taking these extremes is unnecessary at the best and damaging at the worst!


In my view, these mistakes are being made both intentionally and unintentionally. While even the professionals may be prone to forgetting that higher intensity may not be necessary, there are definitely those cases out there where the clinician is trying to use that "more pain, more gain" belief as a placebo or a means of creating some sort of dependency for return-visits. (What can I say? Workers with shady ethics can be found in every field.)

So as a message to other clinicians, be mindful of your treatment and make sure to follow the first rule of your field by doing no harm! To clients, you have a right to tell your therapist to ease off, and if they're too insistent that, no, they need to go that hard, then you also have the right to leave their office. No one has a right to cause you pain without your consent.

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Tuesday 10 April 2018

4 Fact-Checks On Osteoarthritis

Osteoarthritis affects approximately 10% of all Canadians. It's a condition characterized by the degeneration of cartilage within a joint and, at more-advanced stages, the addition of irregular bony growth in those spaces, often causing debilitating pain and loss of function.


The diagnosis of OA can be a terrifying reality for people, as it's immediately seen as a one-way ticket of progressing pain, dynfunction, and an inevitable joint replacement. How about we take a look at the common believes regarding OA, however, and see what there is to learn?

Belief: My X-Rays Show Arthritic Changes; Therefore, I Have OA

Verdict: Sometimes, but not really.


I allude to this quite frequently in both my practice and my writings. Individuals often get scared by the fact that their x-ray results show a degenerative change in their joints, whether it be their spine, knee, or shoulder.

It needs to be remembered, though, that these imaging findings are not necessarily indicative of a pathological condition. More often than not, a degenerative change within a joint is a result of the natural aging process in the same way that your skin wrinkles with age or your hair turns gray.

In fact, we've more or less shown that there's no real correlation at all between these findings and the occurrence of pain, present or future.

Yes, if you DO have a true case of OA, it will show as a positive on an x-ray, but not every positive on an x-ray is an accurate diagnosis for OA. Essentially, every apple is a fruit, but not every fruit is an apple.

[Insert Joke]

Belief: Osteoarthritis Is Caused By Overuse/Wear and Tear

Verdict: Sorta, but not in the way you think.


We often think of OA as being caused by years and years of constant use of a joint, such as the belief that runners will develop it in their knees and hips.


My joint space is a raging hellfire.
Inherently, we know this to be untrue. If it was fact, then every active person in the world would have arthritis in all of their joints simply because they're using them all of the time.

The "wear and tear" of OA is a real thing, but the risk factors involve the use of the joint with the presence of other conditions such as muscle weakness, lack of proprioception, restricted range of motion, and joint instability.

If you notice, all of those risk factors are actually correctable using exercise. This being said, too much physical activity isn't a risk factor for OA; rather, it's a lack thereof.

Belief: Cracking Your Joints Can Cause OA

Verdict: Hard no.


This is one of the most long-standing myths when it comes to arthritis, so here we go!

Whatever the belief on what is occurring inside a joint during a crack (what does everyone believe, by the way?), the reality is that it's a much more benign event than we used to think.

To put it simply, joints are fluid-filled spaces with the potential for air pockets to collect and build up. When we crack the joint, we're moving and re-positioning the joint in a way that allows those pockets to release, and that's the sound that we're hearing. Is it damaging to the joint? Not in the slightest. So go ahead and continue horrifying your sister by continuing to crack those knuckles!


Belief: If I Have OA, There's No Getting Better

Verdict: Probably Untrue.


Fair enough, there are those cases of osteoarthritis that are so far gone, so debilitating, and so beyond conservative treatment that the only option is a joint replacement. For those of you who aren't quite on that end of the spectrum yet, though, there's still hope!

Remember those risk factors we talked about above? (Muscle weakness, joint instability, etc.) Well, as it turns out, you can address those factors, not only as a preventative measure, but also for treatment after the diagnosis of OA. Doing so can improve the symptoms and often delay or even completely prevent the need for any future joint replacement!

Let's also remember that pain is driven by the nervous system, not necessarily by any physical or structural causes. That being said, treating and exercising those risk factors away can further decrease the neural sensitivity in the area and continue to relieve pain.


The hope is to shine a bit of light on this condition and to help to reperceptualize those who may be affected by it. OA diagnosis can be scary when we aren't made aware that the outcome doesn't have to be a negative one. It needs to be known, however, that osteoarthritis is both preventable and treatable.

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Tuesday 3 April 2018

About This "New" Organ We Discovered...

For those of you who follow news in science, you may have seen headlines in the past week regarding the discovery of a new organ of the human body, the interstitium.


Now, let's be clear, we didn't just blatantly ignore the presence of a human body part for the past thousand years. We were always aware that the interstitium, itself existed, but it was accepted as simply a layer of fluid and vaguely-connected fibers lying between the skin and all of the other organs. Just recently, however, researchers claimed that they found proof that this system is actually a fully-connected, single organ in the same sense that the skin is.

For the record, this shouldn't completely blow you away, as a similar discovery also occurred just over a year ago.

In terms of function, the interstitium is a network of tissue and pathways throughout the body and containing any fluid of the body that's otherwise outside of cells or other vessels (such as lymphatic or blood vessels). This is nothing new, but the new research suggests that the extent of this interconnectivity has large implications on exactly how much the separate systems of the body communicate together.

The preliminary findings are (vaguely) suggesting that this new classification of the interstitium as a more-widely connected organ may help us to understand certain things such as the mechanism of acupuncture or the spread of cancer better.



The main reason for wanting to write this, however, it to precaution everyone that all of these findings are preliminary. It won't be long before groups and individuals begin to emerge claiming to be altering, adjusting, or otherwise treating health conditions directly via the interstitium. With very little research on the implications of this organ, let alone more than minimal proof that it even is an organ yet, everyone would be wise to be critical when hearing the upcoming gospel regarding the system and to be wary about miracles to be done with it. We may, in fact, get some very exciting discoveries out of this, but let's make sure any information coming our way is concrete.

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