The Case For Pre-Surgical Rehab

We can fix most injuries conservatively and with exercise. But yes, sometimes surgery is the answer. Going under the knife does often become necessary, whether it's a hip replacement, ACL reconstruction, or labral repair.

I often encounter these individuals as they wait on the list for their operation. They say to me, "Oh, great, I can come see you after my surgery.

My answer: "Great, but why not see me now?"

This isn't just a personal plug. (Although I know that I make a lot of them, so it's hard to tell.) There are true benefits to beginning treatment and rehab BEFORE you get your surgery, however. By doing so, you're actually greatly improving the speed of your recovery and the overall outcome!

Firstly, let's remember that any injuries are seldom isolated to a single joint. Especially in the case of chronic issues, but also in acute ones, conditions result from a combination of mechanical deficits up and down the kinetic chain. Addressing these early on will alleviate the joint from aggravation both before the surgery as well as afterward as it works on recovering. Letting those issues remain, on the other hand, might cause them to excel and create an even tougher environment for your body to heal throughout after surgery.

But if keeping the joints above and below your surgical site is too much of a stretch, then let's consider the site itself. True, you may have an injury or degeneration in the area, but by keeping the musculature surrounding it as strong as possible and maintaining proprioceptive control, you're setting yourself up to have those facets return to you much more quickly after the operation.

And of course, there's no denying that overall fitness will greatly improve your body's ability to move, circulate blood, and heal more quickly as well.

If that's not enough, let's also just recall how significantly pre-surgical rehab is able to delay the need for surgery, potentially alleviating your symptoms enough to put the operation date off for years to come. (And sometimes, even eliminating the need for it altogether!) To me, that sounds like it's worth giving some early exercise a try.

So my advice to anyone who's waiting around for the phone to ring with a surgery date is to not simply sit around, allowing your body to decondition even further, and then expecting the surgery to be a final, quick fix. Get a head start on your recovery well before even stepping into that hospital room, start addressing your symptoms now, and minimize the complications following the operation later.

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What To Do When Your Therapists Disagree?

Incredibly often, I have clients that come in my door after having seen other practitioners that gave them advice and assessments that I completely disagree with. Maybe I think the pain is shoulder-related, but someone else is convinced it's all in the neck. Well, I'll consider what the last guy said, give my two cents, but after doing my own examination, I'm likely to stick to my guns on what I, myself, can determine with my own hands and eyes. It's not my ego; it's me doing my job.

But wait! I understand that this might put you, as the client, in a bit of a sticky situation! What should you believe? If your Athletic Therapist, massage therapist, chiropractor, and even doctor all gave you different opinions, where are you to go from here? It's certainly hard to simply ignore what your last clinician said and replace your beliefs with what your current thinks on a whim.

Well, here's a few pieces of advice that you can keep in mind.

1) Be clear with what opinions you've been given.

One important thing I can suggest to potential clients is to not hold anything back with what's on their mind. It's helpful when you can tell your current practitioner what kind of examinations you've had done by other therapists, what they thought, what kind of treatments were done, and the resulting effects. It's perfectly reasonable that your past or present therapist missed something or happened to catch on to something that no one else did. It may help the practitioner to piece the own assessment and their own into a larger picture.

Are your past assessments and treatments a bit hazy to you? Well, some clinics may charge a fee, but law otherwise dictates that you are entitled to a copy of all of your records.

2) Be honest with your doubts.

If you verbally agree with a therapist but, in reality, doubt that what they have to say is true, then you're not helping either one of you. At the end of the day, it's your body, and it will help your situation more if the therapist understands that you're not buying in to their opinion. This should give your therapist either an opportunity to thoroughly educate you to understand better or prompt them to dig a bit deeper to see if there's anything else that was missed.

3) Understand that therapists can be wrong.

No professional is flawless. Like anyone working in any job, errors may occur, things can be missed, and incorrect opinions can be made. Please try not to negatively judge your practitioner too quickly if you think they erred. In fact, if they admit to doing so, then that's the sign of a thoughtful therapist who will continue to try harder!

4) Understand that multiple therapist can be right!

So I think it's your shoulder. Someone else thought it was your neck. Where do we go from here? Well, maybe everyone was right all along! The body is a complex sack of meat and bones...and nerves, and blood vessels, and organs...you get the picture.

Cause-and-effect in the body is often hard to determine, and there's a chance that every practitioner that you've seen has been right to some extent. Oftentimes, the symptoms that someone feels can be caused by contributions from multiple areas of the body. In this case, you can continue to see both practitioners if they continue to compliment each other or choose your favourite as long as you're seeing results.

5) Question if there's financial incentive.

This is the point that I dislike having to bring up, but it's the reality of the world that we're in. Unethical clinicians do exist out there, and they may be thinking about their own well-being before yours.

Is the therapist who's the most adamant and assertive about their own opinion the one that's charging the most for the treatment or trying to book you into the most appointments? Could they be receiving kickback from other therapists for referrals? Are you part of an insurance claim that could prove to be very lucrative to someone's business?

Again, they're dreadful questions to have to ask, but they're important ones to keep in mind in order to protect yourself.

At the end of the day, pick the therapist who makes you feel the most comfortable and provides you the best results. Be wary of any subtext and read between the lines, but also trust that the majority of clinicians have your best interest at heart and are providing you with the best answers that they can.

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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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Stop Blaming The Sport And Start Helping The Athlete

I have a bodybuilding client who has thanked me multiple times for my non-judgmental stance toward individuals in their sport. When seeing other healthcare practitioners, including medical doctors, they often don't find the help that they need due to an assumed attitude that their chosen activity is the inherent cause of any health issue; thus, the problem is their own fault.

Let's speak strictly from a pain and injury standpoint. (And I'm firmly putting pharmaceuticals aside from this conversation.) Yes, so we CAN safely assume that bodybuilding and its training style comes with a specific host of injuries and conditions; tendinopathies, back pain, even potentially arthritis. But do you know what other sports also come with their own set of injuries as well, though?

How about soccer, running, gymnastics, skateboarding, and every other physical activity in existence?

It's an easy fact that every activity has its own inherent rate of injury. That rate inevitably starts to climb as the level of sport increases. I recall one of my instructors in school, who worked with many of Canada's national athletes, state, "all high-performance sport is inherently bad for you." It's very true, with the high physical demands of high performance taking an eventual, heavy tole on any body.

Unfortunately, some sports, such as bodybuilding but also including others such as cross-fit or X-Game-type events, hit an unhealthier range before reaching as high of a level. That doesn't excuse medicine from taking a double-standard approach to it, however, treating any one athlete differently because any health issues are "their own fault".

It's not a moral qualm for me. Whether it's a bodybuilder, an ultra marathon-runner, or an extreme skateboarder, I'm well aware that these individuals may be choosing to put their bodies at risk for the activities they love. If they're aware of the risk, not putting themselves in critical danger, and they're not risking the health of anyone else, then it continues to fall in line with my drive to help by helping them to continue their sport, but in AS healthy of a manner as possible.

It's the least I can do. It's not my job to criticize, it's my job to help.

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Can Injury Be A Blessing In Disguise?

It's autumn! The weather is cooling down and the leaves are falling. Time to get out there to rake them up, but, oh wait! You got halfway through and wrenched your back!

Agony ensues, so you check in with your therapist, get your rub down, do the rehab, and feel better. That's all and good, but man, what a waste of time and money that was! It's great that the rehab worked, but don't you just wish that you had never had all of that happen in the first place?

Well, maybe not. Perhaps there was some good that came out this mess.

Consider this; in most cases, there's an underlying condition that contributed to injury or there was a method of prevention had the body been in a different physical shape. There was an existing dysfunction present or there was a healthier state that you could have been in to avoid incident.

While the fact that the injury, well, sucked, the saving grace in the matter is that it has now highlighted areas for improvement. As long as the rehab is taken beyond the realms of getting rid of pain and we can continue to condition the body past recovery and toward prevention, it's possible to come out of the fray being better off than you were even pre-injury.

It's not uncommon for clients to come in for a visit for pain, but after a longer period of discomfort of inability to perform specific movements or functions. After fully rehabbing these individuals and addressing mechanical habits that they had that contributed to their state, they often come back exclaiming how their squat at the gym has gone up in weight, that they no longer wake up in the morning feeling stiff, or how amazing it is that they're now touching their toes for the first time in 30 years!

So yes, injury sucks. Take the silver lining, though, and treat it as an opportunity to improve. We learn from our mistakes and what doesn't kill you gives you a chance to make yourself stronger.

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Staying Involved - The Social Side Of Recovery

When pain or injury hits us, especially when it's severe, it's easy to become disconnected from the world around us.

An example might be of the elderly individual whose back pain has resulted in their inability to go out, see their friends or family, or be involved in their community anymore.

Another might be the athlete with the sprained ACL who hasn't been seen by any of the his friends on the team in months.

It could simply be the person who feels depressed in their month not getting to go to the gym while recovering from their muscle strain.

It's the reality; pain can often prevent us from remaining involved in the activity, communities, and social circles that make us part of who we are. And the tragedy is that this social isolation, as well as the often-prevailing depression and anxiety, are correlated closely to the increase of physical pain! Pain increases, depression worsens, pain increase further, and so on in an unfortunate cycle.

But it doesn't have to be this way! We tend to have an all-or-nothing approach to our activities and involvement, often writing our engagements altogether due to not being able to participate as fully as before. However, this is exactly what leads to that isolation!

Instead, it's crucial to keep individuals in pain involved in the world around them. Whether it's from pain, injury, or illness, we know that greater social support is strongly related to an increased chance of recovery.

With that being said, whether it's you, a friend, or family member, maintaining engagement in social circles is a major factor in recovery. If you're an athlete that sprained your knee, keep coming to practice and involving yourself as much as you can on the sideline. If you're missing out on hitting the trails with your running club, grab coffee with your fellow runners and stay up to date on their going-ons and lives. If your elderly mother hasn't been able to garden or walk with her neighbour, encourage her to have a friend or two to her own home for tea. There's always a way to modify the activity and environment to maintain one's place in the world outside.

Social isolation isn't fun. Add pain to the mix and it can become unbearable. Stay involved, call your friends, and engage in the world rather than let it pass by; you may find that it's what you need to propel yourself back to better health.

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If It Hurts, Don't Do It (Except Do It A Little)

Traditionally, we healthcare practitioners get used to telling clients that if something hurts, then don't do it. Seems pretty obvious.

Exhibit A

However, wait! We've talked about how avoidance of movement out of fear of pain may actually make the problem worse! Let's say that you're wishing to squat, but squatting hurts your hip. Telling you to not squat at all is likely to decondition you even further and prime the nervous system to expect pain when you do attempt the movement again. And thus, the movement does continue to hurt more and more when performed.

As we know, pain and the treatment for pain are primarily nervous system-driven. When certain movements hurt, yes, the tissue may be damaged in the case of acute injury, but the area has also become accustomed to having a lower load tolerance.

With that being said, if you've had long-term wrist pain when squeezing a fist, then retraining both strength and load tolerance will probably see you...squeezing your fist as an exercise. But maybe at 50% rather than 100%.

This is the basis of exercise rehab. The last thing that we therapists want to see is the complete cessation of any particular movements or exercises. Obviously, our job comes in when those movements need to be modified in order to reintroduce load within pain tolerance, and Athletic Therapists are the experts for recognizing when, where, and how those adjustments need to occur to get you better.

So no, when a movement hurts, it's not necessarily a call to stop that movement completely (unless it's absolutely something that the body isn't supposed to do, of course), but adjusting the method and volume of that movement is likely necessary. It's all about re-accustoming the body to the performance that we want it to do.

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