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Fitness. Down to a Science

Pain Management

Living Well With Chronic Pain

As this fantastic reflection demonstrates, being more empowered to manage pain and promote better health does not necessarily mean cure. The often elusive search to be “fixed” or even labelled with a diagnosis, can be a surrender of your ability to live well in spite of limitations you experience. We generally see that some improvement in symptoms and/or function is almost always possible; however, it always begins with accepting where you are and working from there. Nothing “works” except to the degree that you work...

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Learning Opportunities

Many thanks to those who came to our seminar series “Understanding and Overcoming Persistent Pain” at the Halifax Library. It was great to help people gain more knowledge about treating and, more importantly, preventing pain. Based on our experience, we know there is a gap in people’s understanding of pain. We wanted to let people know that (1) that they are not alone, (2) that help is available and (3) that it’s possible to regain control over that aspect of life. Our passion stems from helping people who are suffering with persistent pain live more fulfilled lives. Education, movement, and exercise are key to achieving this. We are firm believers that knowledge is power and it is the first step in gaining freedom from persistent pain. We were very pleased with the turnout for the last series of workshops and recognize that people want help managing their pain or a loved one’s pain. Here are some upcoming opportunities to learn more: April 27th at One to One Wellness: “Health Empowerment: 4 Steps for Shifting From Pain to Performance” June Seminar Series at the Halifax Library: “Strengthen Your Health” Monday, June 5, 7:00pm:  Expressing Authentic Movement Monday, June 12, 7:00pm:  Strength Training for Managing Chronic Conditions Monday, June 19, 7:00pm:  What the Foot: A Game-Changing Philosophy of Human Movement Monday, June 26, 7:00pm: From Pain to Performance  We will explore different wellness principles and how putting all the pieces together helps to not only overcome pain, but to optimize performance as well. Please come along and bring a friend. If you have any questions in the meantime, feel free to...

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Mysterious knee pain and/or swelling?

Without any thorough examination, you may have been given the diagnosis of osteoarthritis and be expected to just live with it. However, you may be experiencing Saphenous Nerve Entrapment. Saphenous nerve entrapment is a frequently overlooked cause of persistent medial (inner) knee pain. I chose to write about it because I saw 2 cases of random knee pain and swelling recently. Nerve entrapment is often the cause of pain when you cannot recall a mechanism of injury. This condition can result from low grade irritation over a long period of time from sustained postures or repetitive activities, or perhaps resulting from guarding mechanisms that never fully resolved from a previous injury. Symptoms can be episodic (come and go), may come on randomly, and may resolve randomly as well. The saphenous nerve is the longest branch of the femoral nerve. It travels from the groin, down the front of the inner thigh, past the inner knee, and into the inner lower leg. Because of its long course, it can become entrapped in multiple locations from the thigh to the lower leg. The saphenous nerve is often entrapped by connective tissues where it pierces the muscles of the inner thigh, or where it takes a sharp turn at the inner knee. The nerve can also be injured as a result of an improperly protected knee during surgeries or activity that puts pressure on the nerve (kneeling). It is a pure sensory nerve, meaning it is responsible for sensation and not muscle contraction. As this is a purely sensory nerve, weakness should not be noted with an isolated injury or entrapment of this nerve. Some mild weakness may be present because of guarding from pain, but no significant direct weakness will result from the nerve impingement. Symptoms of entrapment: may include swelling of the knee, a deep aching sensation in the thigh, knee pain, tenderness along the nerve pathway, and altered sensation in the knee and lower leg such as numbness, tingling, pins and needles, reduced sensitivity to heat or cold, reduced vibration sense, and dullness to touch. The main diagnostic features of this condition are altered sensation (vibration sense is usually the first to be affected), and reproduction of symptoms during a femoral/saphenous nerve neurodynamic test. Other diagnoses given for this condition may be arthritis, bursitis, patella femoral pain syndrome, or chondromalacia patella. Treatment to resolve this issue may be as simple as learning to do some gentle nerve gliding exercises. Effective treatment may also involve soft tissue release (via massage or physio); and gentle manual mobilization techniques that reduce mechanical forces on the nerve, improve nerve mobility, reduce muscle guarding, and restore blood flow to the affected nerve. It may not be arthritis, and you may not have to just live with...

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You Fix You

You Fix You

You Fix You. “I am not going to fix you”. A powerful, but necessary message for someone who is looking to be “fixed” by their rehabilitation specialist. A study out of Alberta showed that individuals who took a passive coping strategy to their whiplash injury (i.e., relying on others for pain management) had a slower recovery rate than those who took a more active coping strategy1. What I gather from this is if you are depending on your health professional to fix you, you are in for a long road of recovery. The good news is that if you are depending on your health professional to provide you with the tools to fix yourself, the road will be much shorter. A simple but important mindset switch can make all the difference. So instead of asking “Can you fix me?” try “ What do I have to do to fix myself?”. We don’t have magical hands that can fix; we have knowledge and understanding of how pain mechanisms and the body works. Our job is to provide you with this knowledge in a way that you can understand and provide you with tools that give you the power to fix yourself. Think about this. You get out of bed and your back hurts and you have no idea why. Not a great way to start your day. Well now imagine if you knew the pain mechanisms and the structures that are affected and what they do. The more you know about your condition, the more it normalizes. Things are not random anymore, they are occurring for a reason; a reason that you now understand. Knowing that already gives you insight and a better sense of control.  Now you can wake up in the morning and know if you move a different way you can start your day with less pain. That is what we can do for you; insight, knowledge, and understanding. Now, how we do this is up to you. You need to be active in your recovery. Ask questions, do your own research, exercise, continue to do your day to day activities, use the advice given to you to empower yourself. Instead of asking ‘what can you do to help me recover’, ask ‘what can I do to help me recover’. We will give you our best and everything we have to offer, but we will not fix you. We will help you fix you. Carroll LJ, Ferrari R, Cassidy DJ, Cote P. Coping and recovery in whiplash-associated disorders: Early use of passive strategies is associated with slower recovery of neck pain and pain related disability. Clin J Pain, 2014; 30(1):...

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Power Shift

Power Shift

As health care professionals we have transitioned into a collaborative team with our own specialized areas to help the patient/client become their best self. However, among all the medical jargon and expert advice/opinions, sometimes it is lost in translation that YOU are part of this team, and ultimately the most important member. That means it is best for you to become specialized in knowing your body, because you live in it, we do not. How do you become that specialist? As Gary Ward, author of ‘What the Foot’ states “don’t change your body, challenge it.  Our society is finally coming to the realization that we are not static creatures, we are movers, and in order to move without pain, we need to have a better understanding of our bodies. There are approximately 360 joints and 700 muscles in the human body (among many other things), and you possibly have pain in one or more of them. Simple right? Focus on my knee since my knee hurts. It makes sense because that’s where the pain is, but sometimes you need to take a step back, or even two, to grasp the entire picture. I’ve just started working at One to One and have engulfed myself in reading books that examine this idea of meaningful movement where the entire body is involved. The idea behind this is that when you squat down to pick something up or are taking a leisurely stroll in the park, all 360 joints and 700 muscles have a role to play in helping those movements occur, not one. So if your therapist starts assessing your ankle, or neck for that hip or low back pain, don’t panic, they are beginning to look for those middle pieces of that 1000+ piece puzzle we call our bodies. I challenge you to start this exploration process to better understand your body as more likely than not this has not occurred since you were first learning these movements as a toddler. Next time you are walking, move slow and try thinking about all the things that are going on to allow you to move forward. How does your ankle move? How does your hip move? Now break it down even further, where are you putting weight through your feet, feel where you are experiencing tension and tightness. Know what your body likes and dislikes, then challenge it. Why are you stopping me here? How come my pain starts when I do this but not this? It goes on and on, but the more you do this, the more you get to know your body, the more control you have over those 360 joints, and the better you will feel. Ultimately, this post is to encourage you to put the power back into your hands. The best thing you can do is explore your body’s movements, what feels right, what does...

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Hurt Versus Harm

Most people that book an initial physiotherapy assessment are in pain. Quite often they do not have mechanism of injury that is apparent to them. It is common to hear, “I’m so sore but I didn’t do anything that I can think of to feel this way”. Not knowing what made them sore in the first place adds fear into the equation. When I ask them what their goals are by seeking help from physiotherapy, they often reply, “I don’t want to do anymore damage or permanent damage so I want to know what is going on”. When people are afraid of doing damage they decrease many of their favourite activities. Therefore, it is our goal to get you back to doing what you like to do as soon as possible. The first step to doing this is educating people about pain mechanisms. To simplify things, I like to divide pain into one of two categories.  The first is INJURY where there is tissue damage. This includes sprains, strains and fractures. Injuries have an apparent mechanism, and while the tissues heal you may do HARM if you load the tissues too much. This is why these injuries may require splinting or bracing as they heal. The second category is PERSISTENT PAIN where the main mechanism is a guarded nervous system rather than a tissue problem. If we do something our nervous system is uncomfortable with, it will start to guard and then it will begin to let us know we are exceeding the tolerance limit by HURTING. We are programmed to avoid pain, so by causing hurt our nervous system is trying to control or change our actions. If we are sore after doing an activity in this instance, we have not done damage to something. Rather we have upset our nervous system that is monitoring and processing all forms of sensory input that is coming at it. Why is your nervous system upset? The main reason….OXYGEN. More specifically, a lack of oxygen. The metabolism of cells is dependent on oxygen which is carried via blood flow. If blood flow to a tissue is restricted, metabolism in that area is compromised and the nervous system registers this as a possible threat. When this scenario happens often enough or it builds to a significant level, then your body hurts. This usually causes us to change our actions in one of two ways: move or fidget to return blood flow to the area, or restrict activity to minimize loading the tissues. When your nervous system gets irritated and starts to protect, it keeps some muscles turned on continuously to splint movement to try to minimize strain on structures. However, this continuous muscle tone can later become problematic by partially compressing blood supply thus registering as a threat to the nervous system and causing hurt. Treatment of persistent pain I boil down to...

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