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.

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.

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.

Does Symmetry Matter?

I've had a few clients who see me regarding an injury or condition who have expressed a lot of worry over their muscular asymmetry.

Symmetry is a big concern in the fitness world; particularly in the circles of physique, fitness, and bodybuilding competitors who rely on the aesthetic of it for their performance.

However, when it comes to our health, fitness, and function, does symmetry really matter that much?

The answer is, frankly, nope.

You see, outside of the gym, our lifestyles don't really allow for the perfectly equal use of our limbs between left and right and the promotion of a symmetrical body-type. You have a dominant hand, a dominant leg, a preferred sleeping position. Without the focus of isolated exercise to specifically target the growth of individual muscles, it's unlikely you'll attain that perfect mirrored figure.

Does that translate to pathology, however? Probably not. Obviously, if there's a severe discrepancy such as a smaller quad due to a 6-month limp or one arm that's smaller after recovering from a fracture, those are more clinically significant. When it comes to a typical population group, though, smaller differences between left and right will usually be negligible.

Take the shoulders, for instance. I've heard many individuals remark on the fact that one of their shoulders - and thus, the entire arm - hangs quite a bit lower than the other other and worry about the implications of the "muscle imbalance" behind it. This is a perfectly normal occurrence though, with the dominant arm often - maybe even nearly always - hanging lower due to the more-constant reaching and lengthening of the musculature on that side.

And this isn't an isolated circumstance. Development of traps on one side, tone of spinal erectors, asymmetry of the abdominal muscles, and more. These discrepancies do not signal poor health; only habitual differences between sides. When flexing in the mirror, do not be alarmed by those subtle differences. You don't not need to be equally sized, toned, or flexible on both sides.

Don't get me wrong; I still will always note these asymmetries when examining a client who sees me in my clinic, as perhaps they are part of a larger problem that I haven't quite picked up on yet. However, it's important to keep those notes in the back pocket until needed, as it'd be useless to get hung up on every small change right off the bat. It's good to remember to not get hung up on how alike left and right look and to just focus more on each joint's ability to perform it's required functions overall.

In the words of Eric Cressey:

X-Ray and MRI Results: How Concerned You Should (Probably Not) Be

I'm going to draw off a few studies (Yay science!) as well as a couple personal clients that I've treated as an example here. Let's see if this sounds familiar:

You (or someone you know, a friend of a friend, an uncle's twice-removed cousin in Guam) have some x-rays or an MRI done. This person may or may not be currently experiencing pain. The results come back and BAM! "You have arthritis in your neck/two bulged discs/severe scoliosis," says your doctor. The doctor (or some other health professional) then reasons that these abnormalities are either the cause of your back pain or will soon be causing you severe pain in due time. These conditions are unlikely to ever get better and will probably get worse and worse with time. Too bad, tough luck; try again in your next life!

But hold on!

*Record screech*

Let's take a moment to consider exactly how much stock we should be putting into these imaging results.

I know, it's hard to argue with a picture that says that a condition is there. In fact, I'm not arguing that at all. If an x-ray says that you have degenerative arthritic changes in your neck or the radiograph shows a disc herniation in your low back, then those things are absolutely present!

What I am arguing, however, is how much those pictures actually matter.

I have one client who has been "plagued" by scoliosis that she found out was genetic and had been present for her entire life. She works out religiously and see's her chiropractor for adjustments, but was increasingly frustrated that she continued to be afflicted with back pain and fearful that she would eventually be crippled due to the condition worsening. Now, I'm not the world's greatest therapist by any means (I figure I have another 1-2 years before attaining that award). However, let's just say that after two treatments of assessing her "abnormal" anatomical formation and prescribing exercise to correct for some spinal instability, she has recently been without pain for the first time in years.

Even more recently, I had another client who had been shown the x-rays of degenerative arthritic changes in her neck. She attributed this "osteoarthritis" to her neural pain going down her arm. After examining her, I concluded that, indeed, she had nerve root impingement, but her localized neck pain and range of motion were not severe enough for me to think that those degenerative changes were the major factor. Rather, I can't help but believe her forward head and shoulder posture as well as her hypomobility in her neck segments to be the cause. But that's just me.

Actually, it's not just me. There have been numerous studies supporting the fact that individuals can, extremely commonly, have degenerative changes in their spines and be completely symptom-free. Take this one study that scanned subjects who experienced absolutely no pain, resulting in the conclusion that over half of them had disc bulges! And this isn't an isolated case of asymptomatic people having abnormal findings in their low backs. As for neck pain, how about this study showing that normal and abnormal changes in the cervical spine were found in equal amounts between patients who reported pain and those who reported none at all?

The lesson to take here is that while there are an endless number of reasons that the body may experience pain or dysfunctions that could be present, our bodies have a natural resiliency to them. Humans are adaptable to countless situations and environments, and thus, our bodies are extremely adept at working around physical irregularities, be they genetic or acquired. It is true that oftentimes we need therapeutic intervention in order to guide our mechanics back on the right track. At the end of the day, though, it's very seldom that you need to write yourself off as a lost cause, and we need to be cautious of practitioners who are going to try and capitalize on our fear of that photo. That x-ray photo doesn't have the final say when it comes to your quality of life, though, and clients should always seek second opinions if they feel that their so-called prognosis is unnecessarily bleak.

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How To Be Healthy In 2017

The New Year is around the corner and that means hoards of people will soon be flocking to the gyms, health food stores, and supplement shops with every intent that 2017 will finally be the year that they get fit, healthy, and lose weight.

By now, however, we all probably know that the ever-popular New Year's resolution is mostly fallacy. It's no surprise that a quarter of individuals don't even make it past their first week of working on their goals.

With that being said, January is still a fantastic time to kickstart new programs and lifestyle changes. Sure, most people don't follow through their goals by the time the year is over, but that still leaves adherence rates up compared the other eleven months.

So what can be done to keep to those goals? Here's a few tips..

1) Micro-Goals over the Big Resolution

The main issue you've all probably heard discussed before is the lack of realism or attainability that comes with creating that one huge, daunting resolution. You want to run a marathon? Lose all that weight? Do a bodybuilding competition? Well, great, but what about all the stuff between here and there?

Health and fitness professionals are taught a lot about the importance of creating short-term goals, but it's a facet that's still often overlooked. However, those micro-goals are really the only good way to maintain your motivation and create attainable stepping stones when it comes to the big end-result. So this year, sure, pick a resolution, but have weekly goals in the meantime to help you on the way there.

2) Chip Away Slowly

You used to deadlift three plates per side every day, so let's start with that after a year off from the gym. You want to eat healthier, so how about we flip that diet plan of your's completely upside-down? New to exercise? Time to start hitting the gym six times per week!

You know where we're going here. The best case scenario here is that you simply won't be able to maintain the volume of change (or weight) you've placed upon yourself in such a quick period. The worst case scenario is you throw out your back deadlifting or send your body into some sort of metabolic dysfunction by screwing with your food intake.

Make those changes slowly and gradually. Start small, build upon it, and modify as you go to suit your needs, not the internet's.

3) Address Your Deficits Before Removing The Vices

John Berardi posted a great article about fixing broken diet plans, and the first step in creating a healthy food program for his clients is to address nutritional deficiencies before removing unhealthy items. Doing so will help them maintain their energy, keep their hormones in check, and help with appetite.

I'm willing to expand this with other health habits as well. It makes much more sense for your psychology and motivation to add to your lifestyle early on rather than take away. In the grand scheme, it may be easier to hit the gym twice per week for a while before quitting smoking cold turkey. Add more vegetables to your diet before taking away cheesecake. Start biking to work before giving up alcohol.

It makes perfect sense once you think about it. Changes to lifestyle and habit should be positive. By adding good habits to the mix as a first step, even though it's work to do so, it creates more of a positive feeling than cutting things out will. And remembering our first-year psychology class (you know, the one that made you understand the world and everything in it), positive feedback produces the best outcomes.

4) Focus On Feeling Good

Lastly, I like to tell clients, whether through the gym or the ones seeing me for Athletic Therapy, to focus on how their body feels. Most people who are going into healthy resolutions have an image in mind; one of a slim body or big muscles. However, let's be frank. Those results are a long time coming, and the fact that they are can be demoralizing. Even when it comes to more attainable milestones, such as weight or circumference, you'll still typically see plateau's and results that are inconsistent with your true progress.

I'm not saying that you shouldn't track these results, though, but I like to ask clients if they can feel progress first and foremost. What's more, that's the question which is likely to produce the most immediate and consistent results. Is your energy up? Has your mood improved? Is your body in less pain? Do you feel stronger? When it comes down to it, those more-subjective ways of tracking progress are better indicators of your overall health than the mirror, scale, or measuring tape.

In the end, the whole New Year's resolutions deal will continue to forever be a crap-shoot. Many will make their goals, many more won't. Just remember to set yourself some realistic milestones, plenty of short-term goals, ease into the changes slowly, and give to your body before you take. And finally, make sure you feel good doing it.

Muscle "Knots" (Are Not All Trigger Points)

We've all experienced knots, kinks, aches, and pains in our muscles. "Knot" is typically the predominant layman's term for specifically tight spots in muscle tissue. However, the term "trigger point" has also made its rounds through popular schools of thought, recently becoming a big thing in the fitness industry rather than solely in the therapy world.

We need to avoid trying to define all symptoms under one umbrella term, however. "Knot" is a catch-all, non-specific term while "trigger point" is a very specific condition that cannot be applied to all muscular pain. People commonly confuse the presence of fascial adhesions and scar tissue as well. How do we define it all?

Trigger Points

Firstly, let's tackle the well-known myofascial trigger point...as best as we can, anyway. You see, there's actually very little consensus on the cause or even the existence of trigger points. Nonetheless, there does exist a phenomena that clinicians define and treat as trigger points, and so here's the best explanation I can provide.

Trigger points are localized points in muscle and fascia that become tightened and hyperirritable. It's generally believe that they arise due to neural responses to injury and/or joint instability. Contrary to common belief, not every tender spot in muscle is a trigger point, the condition having a few requirements before we can consider its presence:

1) Trigger points cause and are found within a taught band or rope-like length of fibers within the muscle. 

2) Trigger points will cause referred pain away from the site of the point itself, such as one found in the back of the shoulder causing dull pain lower down in the arm.

3) The trigger point, upon stimulation, will cause localized twitching - but not contraction - of the muscle.

Not all trigger points are active enough to exhibit these symptoms until manual pressure is applied. However, this should be enough to help you stop identifying everything as the same and to cease trying to treat every bump in your muscles with a lacrosse ball. That being said, how do we define other tender, restricted spots of muscle tissue?

Scar Tissue and Adhesions

Whether it be a result from acute injury or repetitive stress, scar tissue and adhesions tend to form in the muscle and fascia as well.

If you've ever taken a close look at scarring on the skin, you have a good idea of what muscular scarring is like; irregularly formed, stiff, and lacking tensile strength. The same occurs in muscle after said damaged tissue heals. Areas where scar tissue has developed and not been addressed may cause dysfunction of the muscle itself, restrict range of motion, affect strength, and potentially be a cause for pain.

Likewise, fascia can become damaged as well. Being the layers of connective tissue that separate muscle from organs, muscle from skin, and muscles from other muscles, this damage can also affect kinetic function and be tender and palpable as well. As fascia attempts to heal, it does so in the irregular fashion that we see with scarring, and these adhesions develop that restrict the ability of muscle to glide effectively.

Being irregularly-formed tissue, simply applying pressure to these points like many of us attempt to do thinking that they are trigger points is an ineffective method. Scar tissue and adhesions must be "broken" apart and then the areas restrengthened by movement. However, when it comes to breaking down these points, even the the popularized self-massaging from foam rollers probably doesn't provide enough pressure to assert physical changes within the tissue.

Summarizing, trigger points are a thing, but can't be identified as every nodule you feel in the muscle. Scar tissue and fascial adhesions exist that must be considered. Foam rolling and self-massage techniques probably don't exert enough focal pressure to achieve therapeutic effects. And, as always, exercise and range of motion drills are likely going to be the most effective method for treating these irregularities within the muscle, supplemented when needed by therapeutic manual techniques.