Mental Illness Awareness Week - Blog Posts To Read

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

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

Exercise And Why You Aren't Lazy

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

Guilt And Recovery

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

The Stressful Effect Of Stress On Pain

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

When Loved Ones Are In Chronic Pain

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

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Guilt and Recovery

How many of you have been to a therapist's office in the past and felt guilty during the follow-up appointment? Maybe you didn't do your home exercises or pushed it too hard before you were ready. Maybe you're simply not feeling better and think that there was more that you could have done.

The less mindful therapists out there may look at a client who didn't quite perform up to par and simply utilize that shame as a lesson-learned to push that client into further adherence. How far does this shame help an individual's motivation, though?

Quite a ways back, I wrote about health-shaming with the assistance of a sports behavioural consultant. With the example of guilt in relation to diet, it was shown that higher levels of guilt were associated with a poor perception of control and decreased rate of success when it came to changing a behaviour.

In short, the more guilty a person feels about poor progress when trying to change, whether it's with diet, fitness, or pain-control, the lower rate of success to make that change!

From a personal standpoint, I've experienced this with clients who simply "fall off the wagon" and relapse in their pain and health. Regardless of whether it was their own doing (ie: poor exercise adherence) or not (time barriers or accidents), this sense of guilt has resulted in a lack of drive to continue forward.

As far as I'm concerned, if a client feels guilty, then the onus is on myself just as much as it is on them. It's my job, as the therapist, to create and enforce realistic expectations with a client's habits that they are happy with as well as to help them plan for any contingencies or relapses. Clients of any type of medical practitioners must not feel like they aren't "being good" and can't face the person who is working to help them. If any professional is making you feel bad about your performance, you may be developing a toxic relationship.

So to any individuals out there who are in pain, please don't feel guilty.

To the clinicians, stop making your clients feel guilty!

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How Getting Past Pain Relapses Is Like Quitting Smoking

We made it to February!

How are those New Year's resolutions coming....?

Mmmhmmm!

Stepping aside from New Year's-specific goals (as you already know my opinion on them), let's discuss the realistic situation of regression.

Across the board, regressions and relapses occur in every type of behaviour or lifestyle change, whether it's recovery from pain, smoking, or weight loss. While the ideal is that we persevere through the road block or speed bump and continue on through the recovery process, often, hitting a point where pain returns, a cigarette is lit, or a few pounds are gained back are enough to shatter motivation and derail progress altogether.

One research group categorized pain relapse responses into four possibilities, some less ideal than others.

1) An unpleasant mystery that leaves negative feelings towards oneself and the situation.
2) A fact of life that should just be ignored.
3) A reminder to keep within physical limitations in order to avoid a future relapse.
4) An indication to change your behaviour to avoid another relapse.

You can probably assume that the first option is the least constructive, likely resulting in an ever-increasing level of negativity regarding the pain and loss of motivation to pursue further recovery.

The second option, ignoring the pain, is dangerous, as it may result in the individual becoming too content with their pain to the point of identifying with it.

The third possibility is good to a point. During a more acute phase of healing, learning to stay within limitations is vital, and sometimes the reminder is necessary. However, avoiding behaviours for too long can end up in a person simply using avoidance as a long-term coping mechanism.

Lastly, the fourth option is the most ideal in the long term. Understanding triggers or becoming aware of an increased need for self-work for your health is the most productive response to have if reexperiencing pain. However, sometimes coaching (whether it be self-coaching or help from a therapist) is necessary to reevaluate a relapse in order to maintain a positive foreseen outcome on the situation.

As it turns out, you can closely relate behaviour change relapses between health behaviours fairly well across the board! For instance, these tips of quitting smoking are amazingly applicable to this very process!

1) Focus on the next 24 hours:
Manage the acute phase of the relapse. Modify the environment so that further aggravation doesn't occur. Understand that this was an acute occurrence only and that you shouldn't become down on yourself and treat all the work up until this point as a failure.

2) Talk to someone:
Seek advice or support as needed. Seek your therapist or even consult a doctor if it puts your mind at ease that this wasn't a complete reset to square-one.

3) Analyze what happened:
Did you decide to get too aggressive with the weight you were squatting? Did you take a week off of your rehab exercises in too-early of a stage? Try and ask yourself exactly what may have caused this relapse to happen so that you can use that knowledge for future recovery.

4) Build a new plan:
This one is built straight into the basic rehab process. We're always modifying and changing pain-management and prevention strategies as needed, and having this relapse happen is a bit of a blessing in disguise, as it can help you and your therapist to further progress your long-term plan.

I try my best to ensure that my clients are ready for the possibility of their pain returning at some point, whether it's simply next week or a sudden reoccurrence in five years. Yes, it may happen. No, it is not the many steps back that you may think it is. And yes, there are steps that you can take to get right back on the train and continue to always get better.

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Life Doesn't Mirror Gym Movements (And Doesn't Have To)

No, I'm not telling you that the gym is bad and that you should stop going. There are many fantastic reasons why the gym is awesome.

However, there's a certain phenomenon among many of my clients that I'm noticing. Fear of movement.

The best example is the rounded-spine position. On one hand, many individuals who experience back pain are told by doctors, therapists, and more to absolutely avoid bending down and rounding their backs; that doing so will result in more pain. Having this fear of that movement instilled, however, does little to remove their pain, as these positions are, to say the least, inevitable. As a result, the nervous system, essentially, becomes primed and ready to guard against those movements, causing pain in those ranges and positions when pain wouldn't normally be a necessary response in that case. 

We call this kinesiophobia, the fear of movement due to pain which actually works to prolong pain and disability.

Here's the surprising thing. Active and healthy individuals experience this too! I've also seen this in very disciplined gym-goers who, for all intents and purposes, have nothing mechanical going on to suggest that they should be in pain. However, due to the immense emphasis on "good form" that active and athletic individuals may be bombarded with, I've been witness to the exact same avoidance-triggered pain. These are clients who are under the impression that it's necessary to square-up and keep a neutral spine curve every time that they so much as bend down to tie their shoes. And again, this belief that any other type of position is harmful is so strong that, just the same, they experience guarding and pain. Even so-called functional training isn't devoid of instilling these messages.

The takeaway from this is that the body has very natural movement patterns that it likes to use that don't necessarily reflect the strict and controlled form of the gym. Absolutely, if you're at the squat rack, moving in a single-plane only, and are loaded up with multiple plates per side, then you should definitely be observing "proper form". However, whether you're an active or inactive individual with or without formal training, the body is built for free and fluid movement. Don't let anyone, including Instagram personalities, magazines, or even doctors to tell you that dropping form as you live your life is a dangerous thing.

Credit: Greg Lehman

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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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The Stressful Effect Of Stress On Pain

It's the New Year! I hope your holidays were fantastic. However, now's the time for all of us to buckle down and get back to work. Don't let the stress get to you!

Stress! GAHHHHH!

If you read even the occasional post from myself, then by this point you know that pain is not a response that's simply caused by a physical lesion alone; it's a complex phenomenon with massive psychosocial and neurochemical contributors as well.

And just like how poor sleep can (indirectly) cause an increased sensitivity to pain, perhaps mental disstress can as well.

We all know negative stress as causing potentially negative effects on the body. Many of you may also have heard of cortisol, the stress hormone. Or, to get technical, the hormone released by your body in response to stress to take part in the fight-or-flight response, regardless of how major or minor.

Well, cortisol also has this interesting effect on pain, with several demonstrations showing an decreased pain threshold and increased sensitivity while subjects were under mental strain.

This can have huge implications from a rehab perspective, especially in chronic pain cases. Even as tissue heals and rehab programs are followed, negative stress can certainly interfere in the regression of pain symptoms. This is largely why conditions such as fibromyalgia are commonly looked into, at least in part, as a stress disorder.

This could be particularly problematic with progressive pain and stress before intervention occurs. As we are finding, chronic pain clients typically have an elevated cortisol level even when looking at them in absence of stress-specific factors. This implies that the body may be pumping out even more stress hormones simply in response to pain (as seems reasonable), resulting in a potential cycle of pain and cortisol continually causing one another to spike. (Hmm, haven't we seen a cycle like this before?)

Fortunately, this opens up more avenues of treatment as well. Simply doing mental relaxation exercises and activities is showing positive effects on many chronic pain conditions. This goes to show the importance of stress management when it comes to long-term or complicated pain cases. We often overlook this mental side of physical pain, but disregarding it means overlooking a crucial avenue for recovery.

Relax man!

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The Nocebo Effect - Why Belief In A Treatment Is Vital

We all know what the placebo effect is. It's the very real-world phenomenon of the body responding positively to an otherwise ineffective treatment or stimulus caused by the belief that there will be a positive outcome. The placebo effect is, in reality, a large reason for many success stories in the therapeutic world, believe it or not. In fact, some modalities actually rely on a patient's belief that it will decrease their pain.

Source

BUT.. did you ever stop to consider the opposite effect being a possibility as well?

The "nocebo" effect is classified as when a negative expectation results in a negative outcome, whether it's to do with movement, nutrition, a clinical treatment, or virtually anything else. Truly, it's the other far-side of the spectrum from the placebo.

This ties directly in with my past topics about how language selection and expectations of pain can propagate and cause more pain. Like I've said before, mental state has a huge effect on driving the body's outputs, whether it be pain, inflammation, or more.

This being said, the nocebo has a massive influence on the effectiveness of a therapy treatment. If a client does not believe in a certain type of treatment or modality or they think that it will cause them harm, then it absolutely can interfere with the treatment outcome!

For this reason, I do my best to thoroughly educate my clients in exactly what kind of processes are occurring in their body before, during, and after any treatment I provide in order to help them understand the targeted effect and increase the probability of success.

If a client simply doesn't believe in a modality at all, then that's ok! Therapists work for the client, not the other way around, and the client does not HAVE to subscribe to every philosophy. However, in absence of that belief, gears need to be switched with either a new approach or a new therapist, otherwise we're charging that client continually for treatments with no outcome. And that's where responsibility on the clinician's side comes in.

The brain is a funny thing, but it's the boss. We gotta work with it.

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Sleep and Pain

In the big picture, Canadians don't seem to do too bad in terms of sleep. Two thirds of adult Canadians are getting the recommended 7-9 hours of sleep. A third is still a very large number, though, and overall sleep quality may still be an issue. We all know the typical effects of sleep deprivation; the decreased mental function, the irritability, the mood swings. However, can sleep affect pain as well?

If I just never wake up, I'll never feel the pain.

The short answer is yes. It's been well-documented that poor sleep and increased pain have a strong correlation. Testing responses to specific stimuli before and after sleep deprivation in subjects has definitely shown an increased output of pain to all types of different pain sources. Heat, cold, pinprick, deep pressure, and other types of provocations all show these results.

However, when looking at sleep deprivation and the cascade of other symptoms it provides, it brings up another questions. Could these related conditions be the true cause for pain sensitivity? Indeed, some studies are finding that sleep disturbances are do have a more indirect link to pain, suggesting that increased pain perception is more-related to those depressive symptoms and how much attention to pain that these individuals may have.

So, perhaps we're looking at is a type of central nervous system fatigue. As I've discussed before, both physical and mental illnesses can propagate these chemical changes in the brain and contribute to pain.

No matter the cause, it's clear that poor sleep and pain ARE related, and unfortunately, this relationship is cyclical. Poor sleep heightens pain levels, and it doesn't take much thought to understand that chronic pain results in even more sleep disturbances.

Treating this, obviously, is a complex thing, and could very well require a comprehensive medical team, rather than one therapist, including sleep specialists, psychologists, and more. On my own, as an Athletic Therapist, what I can do is try to begin breaking that pain-sleep cycle, just like the pain-spasm cycle, and provide a bit of relief at a time in order to slowly improve sleep quality as the client and I go.

Sleep on that.

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Brain-Body Trust

Here's another scenario:

You're an avid weightlifter who hits the gym five times per week. You regularly do squats, deadlifts, and many others of those exercises that gym rats know and love.

Gains.

However, despite your ability to deadlift twice your bodyweight, one morning, you simply bend down to tie your shoe and you completely put out your back. You're in excruciating pain for the rest of the week which lingers to a lesser extent for the next month or so before you go and get it treated. All the while, you've been doing what you can at the gym but have been avoiding deadlifts and have been extra cautious when bending over to pick anything up on a daily basis in order to protect your back. Every time you try to bend down, you recreate that most-painful sensation and it needs to be avoided. Finally, you decide to go get treated. (Perhaps even by an Athletic Therapist!)

Promotionpromotionpromotion.

Treatment goes great. After one or two sessions, the constant pain is no longer a bother. You have your homework to condition and strengthen your core and protect your spine. You go on your way out of pain - except when it occurs the next time you go to deadlift again. Although your therapist told you that the tissue is all healed and the inflammation is gone, that bending motion, alone, still elicits tension and pain through your back as soon as you square up to lift heavy.

So here's the question: Even after receiving treatment and home exercises, after the tissue is healed and the inflammation is gone, once you've gotten strong enough that you core should be stabilizing your back without a problem, this one movement still causes you pain. Why could that be?

Pain science is a fascinating field and I'm not about to go into the neurobiology and in-depth psychology of pain today. However, I will quote the Pain Science Podcast that I listen to in this.

"Pain is a conditioned response," and "Pain is an output, not an input".

If you know of the Pavlov experiment, this is like how he was able to trigger salivation in dogs every time he rung a bell. Essentially, all physiological responses, pain included, can be conditioned to occur whether the stimulus is appropriate or not. This is related to when I talked about pain avoidance habits and how they can propagate pain rather than prevent them. After such a prolonged period of time of an individual telling their nervous system that bending down is going to cause pain, the nervous system is now trained and hyper-reactive, sending out pain signals every time that movement is performed even after healing has occurred.

Not kidding. This picture is how pain can work.

This is actually a common occurrence. Clients who should be out of pain are still experiencing it due to their nervous systems, basically, working against them. In a way, although there is not actually anything wrong with those tissues anymore, the brain no longer trusts that particular movement pattern and will have a sympathetic response every time that it's attempted.

Stupid nervous system!

This case I'm discussing is, in reality, actually one of the more simple ones. In severe chronic pain cases, those inappropriate pain triggers can extend to nearly every movement and even light touch to the body!

In any of these cases, careful rehab considerations to both the physical and psychological side of the recovery are required. It's the responsibility of the therapist to guide the client through those movements - or other stimuli - very carefully to progressively allow the nervous system to adapt and trust the pattern again. At the same time, coaching a client away from expecting pain is important, otherwise it may leave a barrier that the individual might never overcome. 

Pain is a funny thing and pain patients are kind of like the Murphy's Law of healthcare: Expecting the worst can cause the worst to happen. However, responsible therapists can recognize these barriers; no person should be trapped by their pain.

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Let's Talk Mental Health

Yesterday was World Mental Health Day.

It's my job, as an Athletic Therapist, to take care of the physical side of health, but through that, I run into the overlapping cases of depression, anxiety, eating disorders, self-confidence issues, and more. Often, my clients trust me enough to open up to me, and hopefully we, as a society can continue to do so more and more.

Below is a quick compilation of mental health and psychology-related posts that I've written in relation to my Athletic Therapy work as well as sport and fitness in general.

Athletic Therapy and the Opioid Crisis

I didn't write on the mental health aspect of addiction, but with addiction being a mental illness itself, I'm including this post to talk about the benefit of active rehab measures in order to avoid these negative outcomes.

Coaching Sport, Coaching Confidence

A passionate article I wrote about the importance that I discovered when it comes to building confidence and ability in youth for the benefit of their mental health in future years.

Positivity in the Clinic Space

I discuss the importance of careful language when treating clients. When reeling from the mental distress of an acute or chronic injury, it's vital to not cascade the issue with poor word choices.

Identifying With Pain

Discussing some of the mental health changes that occur when it comes to chronic pain that may impede the recovery process.

Central Nervous System Fatigue

Fatigue of the CNS can easily result in detrimental changes to the physical body. What's more, we are finding more and more than mental illness, among other things, can propagate this central fatigue, highlighting the importance of mental health for the sake of the physical.

Pain Tolerance

Again, I talk on another factor that mental illness can affect. While pain tolerance can be affected by mental health, we cannot consider these effects to be all "in your head".

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Overcoming Pain - Perception of Control

There are many psychological facets that result from or contribute to pain, one such as I described in last week's post. It's important to remember, though, that no trait is independent of one another; they'll occur concurrently and are interrelated. That being said, I'll continue to break it down to help both my readers and myself understand the psychology of pain better in order to overcome it.

After a large sample of patients were interviewed, another of one the biggest predictors of chronic pain that was found was poor perception of control.

In a nutshell, when individuals are in pain, (even if it's only acute pain) and they don't have high self-confidence in their ability to recover from it, the result can be that those misconceptions may come true. Why is this?

To quote the above study, perception of low personal control can "lead to passivity, inactivity, reduction or cessation of coping attempts, avoidance of specific behaviours and poor adherence with advice". It may sound like a deplorable attitude toward one's own body and wellbeing, but if you think about it, it makes sense. If you were a mechanic and were told by your boss to do everything you could to repair a car while every inherent ounce of your gut told you that it couldn't be done, would you still put in the same amount of effort in the attempt?

This fact isn't helped by the fact that so many individuals go through the rungs of  other medical professionals who use language that enforces these beliefs!

• "You'll have this for the rest of your life."
• "It's only going to get worse with time."
• "You have the knees of a 70 year old."
• "You need to see me every week if you want to keep walking."

"My elbow hurts."
"We'll have to cut it off."

No wonder why so many people plateau in their rehab! Everyone is telling them they can't do it and bringing them down!

As an Athletic Therapist, specializing in exercise rehab, I can provide one of the best methods to help my clients boost their confidence in their recovery. What better way is there to increase their perception of control over their health than by giving them the tools that allow them to do the work themselves? (In contrast, if an individual only sees a clinician that massages or adjusts them without any other intervention, that puts all the control of their recovery into that clinicians hands.)

To help the matter, I make very sure to educate my clients on what every single exercise that I prescribe is doing; which muscle it's helping, what this stretch will do, how it replicates their daily activities. Clients need to know exactly how much power they have in propelling their own recovery. They want to know how their bodies are working. They need to hear less about what their therapist can do for them and more what THEY can do for them.

At the same time, I'm careful with my language. Essentially, it's important to put an optimistic spin on things in order to maintain a positive outlook and efficacy.

• "This muscle could be stronger," instead of, "This muscle is weak."
• "We need to get your hip moving better," instead of, "Your hip keeps getting stuck.
• "You'll feel better the more you do your exercises," instead of, "If you don't do your exercises, you'll be in more pain."

See what I did there?

This topic was written with consult and collaboration with Alison Quinlan, a Sports Behavioural Consultant in Victoria, BC who is also pursuing continued education in dietetics. Follow her on Twitter and visit her website and blog to see some of her own authored articles. 

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Psychological Barriers of Recovery

Pain hurts..obviously. So when presented with a method of managing and removing that pain, it should be easy to do what needs to be done to comply. Experience, however, tells us that this is not the case.

We've seen it. The individuals who simply won't seek help despite being in chronic and excruciating pain. The ones who make their appointments but cancel the majority of them on a whim. Those who show up, but simply won't adhere to their exercise rehab plan enough in order to progress in their recovery.

I'm feeling to "blah" to go to my appointment today..

I often joke about the "fantasy client"; the one who always shows up on time and never misses a single day of their exercises. These clients are few and far in between.

Why is this? If there's a road to healing, why are are so many people reluctant to take it? Well, there are several psychological barriers to recovery, and it won't be possible to try and touch on them all. There are some common ones that I see in my practice, though.

One big one is a lack of client education regarding the condition and treatment; therefore, a lack of trust in the process for recovery. I find that many people, while seeking treatment, are almost just going through the motions due to consciously knowing that they have to try and get better, yet subconsciously having little faith in succeeding. I've seen many clinicians experience a downfall in this realm in that there is minimal communication on what's happening and how things - whether it's the body or the treatment - work, resulting in poor success rates in the rehab.

There's also those who would like to be pain-free again, but are weighed down by thoughts of unattainable (or at least perceived-so) situations about their lives and bodies which might make recovery seem like it has less meaning. What I mean by this, for example, could be an elderly lady who has back pain she'd like to be rid of but is less motivated because she still won't regain her 20 year old figure. The retired athlete who no longer has a competition goal to work toward. The spinal cord injury patient who can't expect to regain his full nerve function again.

As an Athletic Therapist, how do I work around these barriers? It's my job to help clients get better despite their other facets of life, not to try and fix their entire personal situations (which I couldn't do if I tried). Instead, it's important to help these individuals pave their own ways to success through over those hurdles.

My method isn't complicated. Education, obviously, is key. Client understanding of their injury is important in order to understand how the healing is going to work, and so I spend an ample amount of time making sure I explain exactly what is happening with the individual's body and what our treatment aims and mechanisms are. This is one of the most surefire ways to give clients faith in the process and maintain their perception of treatment efficacy.

Goal-setting, as well, is vitally important during the healing process. Sure, maybe the client isn't going to be training for professional hockey ever again, but maybe he'd like to aim for that biking trip with his son. That elderly lady may not regain her 25 year old figure, but how about a goal of walking (or running) that next city 10k race? Those long-term goals are help to re-perceptualize the process to help the short-term ones have more meaning.

As I said, it seems like a no-brainer that if you want to be rid of pain, it should be easy to adhere to the process; but that's in theory only. Often, people need help and guidance in order to increase their perceived efficacy of the treatment and to adjust their goals to something attainable, but still meaningful.

Health: It's not all in your head, but the head is sure part of it!

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Athletic Therapy and the Opioid Crisis

I heard a terrifying statistic on the radio last week: The rate of individuals in British Columbia who are dying from the fentanyl epidemic is greater than that of the AIDS epidemic at its zenith throughout all of Canada.

Vancouver Sun

Ok, that's f****d up. What, as a society, are we doing about this?

Well, I'm an Athletic Therapist; not a doctor, not a drug councilor, not a political expert. There's a lot on this topic that I'm in no way qualified to speak on. It’s someone else’s job to address childhood trauma, poverty, and those other socioeconomic factors that contribute to addiction.

But there is one facet to this epidemic that is relevant to this health and physical rehab field that I reside in, and that factor is education and intervention for pain management.

One of the huge factors that we've found has contributed to this crisis that we're in is that, for so long, mainstream society has relied heavily on opioid prescriptions for pain. It's clear, now, that we need to find alternatives for pain, and fast.

My profession revolves around providing conservative, non-invasive, and long-term management for pain and the mechanics behind injury. Most cases of back pain should be manageable without chronic use of painkillers. Statistically unsuccessful surgeries such as spinal fusions and knee arthroplasties need to be phased out in favour of conservative rehab. Exercise, in general, is even shown to be an amazing tool for conditions that are defined by chronic pain such as fibromyalgia. And we haven’t even gotten into the correlation between exercise and mental health.

In fact, Canada's Physiotherapists, a profession with many close parallels to Athletic Therapy, are creating an entire campaign based around using them as an alternative to surgery and pain!

Athletic Therapists are experts when it comes to movement, and the body has an amazing inherent ability to heal itself and manage pain, provided that we’re allowing it to move and function properly. Don’t get me wrong, opioids as a prescription painkiller do play a vital role in modern medicine, and we shouldn’t be trying to abolish it, but we do need to start replacing it as a management method where it’s shown to be unnecessary. With four people per day in BC dying from overdose, it’s our responsibility, as clients and clinicians alike, to raise awareness to this transition.

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Building Confidence in Ability

Back when I was in high-school, I took a class that involved a weekend practicum in the role of an outdoor camp counselor. There were a few typical rules asked of us in this position: Don't flash your cellphone or other technology around, don't swear in front of the kids, etc. One rule resonated as being particularly important to me, though.

"Girls, please no Lulu's or yoga pants. Boys, don't wear beaters. We want the kids attending camp to be motivated to do the things you're teaching them, not to aspire to look like you."

 

"You kids go canoeing while I stand here looking fabuloussssss!"

This was one of my earliest impressions that paved my philosophy as I became a professional with health and fitness. I heavily emphasize ability and performance over aesthetic regardless if I'm teaching a fitness class or rehabing a client. I find a much greater sense of achievement when my clients tell me they were able to run without pain that week than I do when they tell me they dropped a waist size.

Don't get me wrong. I'm not knocking the importance of developing healthy body image and allowing people to feel beautiful. I'm just not the best person for that job. As the "tiny" kid while I grew up, I quickly came to the terms with the fact that I'd never be the large, flashy muscle-dude in the magazines, but would always find solace in my ability to outrun my peers. For this reason, I find a particular speciality when it comes to training and coaching young people in their confidence in physical capability. Even more fulfillment comes when I'm able to guide someone to a physical achievement that they always assumed was out of their reach, such as introducing a previous non-athlete to success as a runner.

Pictured: A lot of runners who had never done a sport one year ago.

Training ability and function, I find, will leave an individual with a much more sustainable confidence and sense of identity than simply training towards a certain aesthetic. Especially when considering the toxic ideals instilled by modern media, training for an appearance involves a very different type of anxiety and mental coaching that I can't call myself experienced with. In fact, when asked on whether I still do personal training on the side with my rehab business, my answer is usually "no". With the exception of youth and sports-specific training (mostly speed and sprinting), I don't have a particular love for that kind of work these days. There are plenty enough workers who can focus on the aesthetic or coach someone in believing in their body image, but I'll use my time the way that I use it best.

Focus on what you can do rather than how you look while doing it.