I Don't Know It All

I admit it! I'm not perfect! While I wish I could know every minute detail about human anatomy and physiology to a "T" and call myself an expert on everything that is rehab, the reality is that this is not the case.

Don't worry, this isn't me going on a depressive rant and feeling sorry for myself. (That's what Valentines Day is for.) This is a productive admittance of the limitations that all medical professionals have but don't always like to verbalize.

We also don't always like to admit our Valentine woes, either.

The thing is, there is a LOT to know about the body, and as humans (Yes, therapists are humans! Gasp!) we can't perfectly log, file, and access that information without flaw like computers. Speaking for myself, I'm probably pausing every fifth or so new assessment that I do with clients in order to check a reference. (If you follow my social media, you've probably seen my textbook collection. And to tell you the truth, it's a very small collection compared to others out there.)

Yes, I need another bookshelf. Nerd problems.

Thankfully, I've been gifted with clients who are perfectly fine with me, as their clinician, taking a minute to check a reference. In their words, they're happy to know that I'm absolutely sure on what I'm doing rather than just trying to guess, and the anecdotal message I get is that they wish more medical professionals (doctors included!) would do the same more often.

Frankly, my opinion is that any clinician who claims to always be 100% sure without a fault and never needs to reopen a textbook probably, in fact, knows the least. (Or is just being irresponsibly stubborn.)

What's more, this piece of humble pie goes a bit further. What if that textbook doesn't give me the answer that I need? Well, it sometimes hurts to have to go to my client and say it, but ethically, I have no choice: "I am not entirely certain on what this is."

At least it tastes like cherry!

The saving grace here, again, is the trust that this level of honesty instills in my clients. Knowing that I'm not going to feed them false information, I'm often allowed the chance to have the client return to, at the very least, see if whatever treatment I performed worked. If it does, then we know that we're on the right track and can keep plucking away. If not, it's time for a referral.

To sum it up, no Athletic Therapist, chiropractor, nurse, or even doctor can have the answer 100% of the time. Perhaps some people there expect us to, but I feel like the majority of the population understands the raw amount of information out there. As long as we clinicians are honest with our limitations of knowledge, it seems like the public will accept that as a sign of integrity and be willing to work with us.

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Happy World Spine Day

October 16 is World Spine Day! Today, organizations and people, worldwide, join together to raise awareness of spinal health and illness.

Listed below is a compilation of back health-related articles written both by myself as well as outside sources. They're all very informative and easy to read, so please take a look and empower yourself with some knowledge!

Cain Exercise Rehab Posts

Core Strength And Why Sit Ups Will Hurt You

One of my earliest posts outlining the basic functions of the core as an "anti-movement" system and the reason why the medical community is vigourously recommending against sit-ups.

Core Before, Not Abs After

It's common for weightlifters to fit their ab workout at the tail-end of the session following training another area. However, here's my reasoning on why it's beneficial - for the long-term and for the workout - to do a few sets of core exercises before the rest of the workout instead.

Core Strength And Hyperextension

A short article (with video) on how to train your core to stabilize during the much-neglected range of hip-extension for when you walk or run.

Weight Lifting Belts - The Gym-Goer's Crutch

Weight lifting belts are a crucial element for weightlifters who are pushing those heavy one-rep maxes or doing fatigue-sets. However, what happens when a person becomes over-reliant on the support?

Do You Need Traction?

Traction is an extremely popular alternative treatment for back pain, but here's a short discussion on whether or not there are sound benefits for the long term.

Why Planks Are Not Enough

Planks are what the media is currently pumping out as the solution for spinal health and tight abs. However, this is more out of the simplicity of the exercise for the purpose of quick explanation. In reality, planks are only going to get you so far.

X-Ray and MRI Results: How Concerns Your Should (Not) Be

This may be one of the most important articles to read! If you have had imaging that revealed degeneration or other concerning problems in your back, click this link!

Source

External Sources

If You Keep Texting, Your Head Will Fall Off

You've probably seen some variation of this headline in the past. However, rather than fear-mongering for likes, this writer dug up the research debunking the claims of "text neck".

Why All Those Back Pain 'Cures' Just Make It Worse

Dr. Stuart McGill discusses many popular forms of back pain treatment and why they're likely ineffective - or even counterproductive! Don't worry, he also gives solutions to the problem.

Chronic Back Pain? Journalist Investigates What Works And What Doesn't Work

An investigative journalist scours the research to come to her own conclusions on what is actually proven to be beneficial for the spine and what is not.

Behind Tiger Woods' Arrest And Pain Meds Lies A Problematic Surgery

Spinal fusion is still commonly prescribed by doctors much too early in the process of finding a solution for back pain. More often than not, it only results in more problems down the road.

What This Biomechanics Professor Wishes People Knew About the Real Causes of Low Back Pain

One more article from Stuart McGill as he debunks the most common back pain myths and offers helpful alternatives to address your pain and injuries.

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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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Random Thought On Exercise Adherence

As an Athletic Therapist, I'm obviously always concerned with how to keep my clients adherent to their exercise plans in order to accelerate their recovery. It's not always easy, especially when that client's motivation was low enough that they barely made it to my office in the first place.

It's funny, though, some of the methods we employ to try and keep ourselves motivated. One common thing I've noticed that people attempt to do to keep themselves true to healthy habits is bargaining the use of passive habits in order to achieve them. Allow me to explain..

Once in a while, I see a client who floats the idea of adhering to their rehab plan by doing their exercises during "down-time" to make it easy, such as while watching television. Unfortunately, not a single client who has said this has been able to maintain their routine. Where is the disconnect here?

I'm too snuggly-wuggly comfy to exercise right now!

Well, it could simply be the fact that using those passive activities is only going to motivate our psychology toward more passive habits, rather than the other way around. When it comes to exercise in general, our brain is going to activate these exercise-related habits when it experiences related stimuli that normally goes along with them. (ie: When the "switch is flipped" when you walk into a gym or get up early for your run.) Since your brain is going to have trouble associating passive activities, such as television, with activity, the chances of developing those habits are slimmer.

As well, this is speculation, but perhaps trying to bargain passive methods in order to stay healthy is a sign of poor self-efficacy. Maybe someone who attempts to use these tricks, in reality, has poor confidence in the first place that they will adhere. And as we know, self-efficacy is vital when it comes to lifestyle changes and without that sense of control, success rates are low.

In short, the clients of mine that are the most successful are the ones who are intrinsically motivated enough to set aside time to, well, get'er'done!

Does this mean that a person is a lost cause if they're not one of these go-getters who's ready to go guns-out and balls-to-the-wall with their recovery, however? OF COURSE NOT!

This article was written based on topics collaborated on with of Sasha Tanoushka, owner of Verus Systems Therapy. Sasha is a member of the BC AMFT and AAMFT  ( American Association of Marriage n Family Therapists  ). She's completing her MA in Marriage And Family Therapy through Northcentral University. She's worked extensively with families and individuals over the years in both community sports, martial arts, kids' clubs and ladies' community groups.

She has a particular interest on neuropathy and works with several therapeutic modalities but has a particular leaning towards Satir, Bowen and Gestalt.

Follow her on Facebook!

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Pain Tolerance - It's Not All In Your Head

"When you asked me to rate the pain, what happens when someone just has really, really high or low pain-tolerance?"

This was a question posed to me by a new client, and a very understandable question at that. If a client has really low pain-tolerance, does that mean we need to ignore their pain level when treating them in order to make progress? If tolerance is high, are we doing more damage to them by pushing too hard without them being able to set proper limits? Again, if tolerance is low, is that person just being soft?

"I'm smiling. Are you smiling?"

The quick answers: No, pain tolerance is not all in your head. No, you're not a wimp. And no, we are not risking going too hard or too soft with treatment and exercise because you're tolerance is higher or lower than the average person. I digress...

What Affects Tolerance?

There are too many things that affect pain tolerance to try and go in depth to them all. There is a slew of cultural differences when it comes to perception of pain which can be affected by age, sex, or race alone!

Psychological factors also affect this tolerance. Again, I'm not saying that the perception is all in one's head. Rather, certain aspects of one's psychology, such as perception of control, depression or anxiety, and expectations of pain can all cause physiological changes within the nervous system and propagate pain sensitivity.

Finally, looking at a more at the peripheral sites of pain within the body, the reactions occurring at the nerve endings, during inflammation responses, and communications between the immune system and nerve cells all affect pain sensitivity and can become more or less reactive, depending on a person's condition. It's complicated. I spent an entire night trying to make sense of the biochemistry of it in order to summarize it in my blog and ultimately had to give up. I promise that the science is there, though!

Need-to-know!

The Affect on Treatment and Rehab

So with that being said, we circle back to the question about the effectiveness of rehab and treatment when pain sensitivity and tolerance are higher or lower. If pain is preventing us from massaging a muscle hard enough to make a change, where is the benefit? If a client is insisting to keep going harder when you're already, essentially, on top of them with all of your weight, are we not going to hurt them more?

Well, as I covered in the past, the system that these treatments target isn't the muscular one. When we massage, when we exercise, we're addressing the nervous system itself, and so we're doing the body a favour by working within those limits (or lack thereof) of sensitivity and pain tolerance.

To a limit. Please don't actually try to break
someone's back because they asked you to..

With that being said, if someone is highly-sensitive and can only tolerate very light touch, then those are the means that we'll stay in. By treating or exercising within that high level of sensitivity, the goal is to try to reverse some of those physiological changes contributing to it in order to, gradually, decrease the sensitivity and allow the client to eventually be able to accept more pressure.

On the flipside, if someone is highly-tolerable to pain, then yes, the treatment does become a bit tougher and more aggressive to try and meet their needs, but you don't have to worry about causing damage. Like I've noted before, the amount of force you would require to actually deform or damage tissue would be roughly the equivalent of a steamroller.

Don't try this at home.

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Foot Joints and Running Health

It's trail running season! Runners at the grade school, post-secondary, and recreational level are all out and gearing up for races. City marathons, cross country meets, and more will soon begin.

Many people assume that, to train for running, you simply need to run, but I've spoken at length on important weight-training tips for distance runners as well. After all, do you think that any other type of athlete - be they a wrestler, boxer, football player - only repeatedly performs their sport as training? No, I thought not.

Additional training, however, does not simply mean heavy lifts and explosive forces. The health of each joint of the lower limb needs to be considered in order to have longevity as a runner. There's an important balance of mobility and stability that must be maintained.

Take the foot. You've heard the importance of foot health for most of what you do in life, as it's obviously the first line of defence - so to speak - when it comes to impact forces as you walk and run. This doesn't necessarily mean it's as simple as wearing supportive shoes for good lower limb health, though.

The foot has 26 bones to it. That's a lot of joints! That being said, pliable mobility (allowing the joints to move, glide, and compress) is vital in allowing those joints to absorb shock and impact, as is strength of the muscles of the foot in order to prevent those forces from being too damaging to the tarsal joints.

Modern-day running - specifically, the footwear - has taught the Western world to bypass the majority of these impact-buffering joints by running heel-first. As a result, these forces are greater by the time they reach the knee, hips, and back than they would be if a forefoot strike was used, resulting in an increased injury risk.

However, with the birth of minimalist running, Western runners attempted to make a quick switch back to forefoot running in order to benefit their joint health and performance. This is all and good, but it needs to be remembered that the body takes time to condition itself to new mechanics and activities. After a lifetime of stiffer, highly-supportive footwear use, the joints of the foot are, conversely, going to be stiff and immobile as well. Furthermore, the muscular strength in the foot may be lacking due to years of disuse. As a result, while the foot may now be diverting much of the impact away from traveling up the chain in too-great amounts, the foot's own joints may not be durable enough to accept that force itself. This is why there was a spike in new and previously-uncommon running injuries as soon as minimalist running became popular.

The takeaway here is that, like the rest of the body that you train for performance, the feet must also be carefully conditioned for the uses you intend of it. Adequate mobility through the toes, forefoot, and midfoot as well as enough muscular stability are key if you want to prevent the high-impact of running from developing into pain. That being said, changes to running and training routine must also be gradual and progressive, just like a routine for training any other joint. You need some variability to shock the body into improving, but be kind with how quickly you introduce it.

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What Are Shin Splints?

If you haven't had them yourself, you've at least heard of them. Shin splints: the bane of existence for many runners. This delightful condition involves stabbing pain in the inner shin region, exacerbation from running and impact, and can often include radiating pain traveling through the entire calf muscle.

Medial tibial stress syndrome is a condition so common that it affects nearly 10% of all runners. However, surprisingly little is known about it. Often, people boil the pain down to muscle strains, tendinopathies, or stress fractures, but these internet diagnoses are inaccurate.

For the longest time, I, myself, considered MTSS to be something that it wasn't out of error. Among many professionals, it was thought to be periostitis of the tibia - inflammation of the top layer of the bone caused by traction from muscular tension. Unfortunately, upon a journal search for this article, this theory was quickly proven wrong.

As it turns out, science still hasn't completely agreed on the etiology of MTSS. There is one prevalent theory that just cropped up during the new century.

One pair of researchers was able to demonstrate a pathology to do with bone remodeling as related to shin splint pain. As you may know, bones are not a lifeless tissue. The body's cells are constantly breaking down bone and replacing it with new. Usually, this is done at a healthy, even rate, but in examples such as osteoporosis, the breakdown occurs more quickly than the regrowth, resulting in the frail-boned condition.

In the case of shin splints, the breakdown of bone tissue increases when the bone is subject to new and sustained mechanical stress, such as an unconditioned individual who suddenly starts to overdo the pavement running. This is done in order to remodel the matrix of the bone tissue and allow it to adapt to the new stressor, but in the interim of this remodeling being complete, the bone structure is unable to accommodate the stress. As a result, microdamage to the bone itself occurs.

It's like a highway that's in the middle of being converted into a traintrack, except the train has already started being run along the route during the construction. The structure is going to take a beating!

Yeah, something like that.

In terms of the recovery from shin splints, even though many practitioners may not have had the reasoning correct, many of the same rehab and exercise methods still stand. Weakness or excessive stiffness of the calf muscles still must be addressed in order to allow the muscle tissue to transmit forces properly, rather than directing them back into the bone. Hip muscle activation is still key to ensure the impact can further travel up the chain rather than remaining in the lower leg. Finally, gait and footwear should not be disregarded, due to improper loading through the foot and leg resulting in increased fatigue to structures that are needed to buffer impact forces.

So, just remember to be conservative when increasing your training volume, be mindful of your form, and change your shoes regularly. Keep all this in mind, and....

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