“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): 1-8.
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 not and you will become that specialist. As well, this is meant to give you insight to ask your health care professionals to take a look at the entire system, especially if you’ve had multiple treatments with no results, or if you keep going back with the same issue time and time again. Ask them, if they think the way you walk or that stiff foot you’ve had for years is exacerbating your pain. If you ask these type of questions it leads to outside of the box (or joint) thinking and has greater potential for better results. So I end this by saying put the power back in your hands, explore your body, know your body, become your own specialist and begin to see the results you’ve been looking for.
A great article that talks more about body awareness ‘What the Foot’.
Tyler Dillman is a physiotherapist with One to One Wellness. Learn more about Tyler.
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 two main factors:
Teaching people how to do this as well as helping them to identify their aggravating factors allows them to stay active while addressing the problem. Knowing that you may experience some soreness after an activity without doing harm allows you to maintain a certain level of activity until things can return to normal.
Your body has the capability to repair itself when doing the right things. Our role as physiotherapists is educate, guide, and assist you so that you may achieve this.
Is there a connection between what you eat and your pain?
Well here is a potential answer. An in depth look at gut bacteria and its anatomical/physiological connection to the nervous system and the brain.
By Nick Matheson
Once again, the world is reeling from tragic circumstances. Once again, we are faced with the fear brought on by random and senseless attacks. Once again, the world is on high alert. The goal of terrorism is to terrorize and make us change the way we live.
It just so happens that Lori and I are traveling to Paris this week. I cannot say that I have not had second thoughts, though I am inspired by Parisians insisting that they will not be afraid and continuing to celebrate liberty. After all, #parisisaboutlife. Though there will be mourning, I am inspired to bring whatever love I can to and from this great city.
Reading countless news articles and travel advisories over the last couple of days, I was reminded of the counsel I’ve often offered to those struggling to overcome pain: benign vigilance. In other words, pay attention and notice what the body is communicating; however, do not be overwhelmed and immobilized by fear. Ignoring a problem does not make it go away. Facing challenges with awareness, compassion, and intelligence is, in my experience, the best response. This week I will travel with a new vigilance, but I refuse to be afraid.
The world is full of pain. At its best, pain is a means of elevating awareness. My heart goes out to those personally touched by hateful acts, including those that perpetrate them. Once again, the world needs all that la ville de l’amour represents.
Love and Peace.
Does it matter to your body what position you sleep in? Well, yes and no. I would like to give you a short answer, but in order to make sense, I am going to have to take the detour route on this one. Let’s start with a little background and a bit of a review from a prior post (May 2010 “Help Yourself Help Your Neck”).
The musculoskeletal system of our body, meaning the stuff we can actually control in some manner (good luck altering the position of you liver…) is made up of muscles, bones/joints, and nerves. Nerves basically tell our muscles how to move our joints, though this process function is much more complex than that. Muscles are pretty much reactors to what our brain is sending signals through our nerves to do, and since they really only know how to do one thing, and that is to either contract (shorten) or relax (lengthen) to move the joints and nerves that are attached to them, I consider them sort of the “dumb brother” of the three siblings. Here’s why:
Muscles only know how to move (by contracting and relaxing), and when they do, the joints and nerves they are moving are happy. The problem is, when we aren’t moving (most of us aren’t like 2 year olds who are in a constant state of changing position), the muscles still want to contract, and will. And then they get stiff, tighter, and they make you feel stiff and tighter, along with not allowing the joints to get the lubrication they need because of the lack of movement and the nerves may even get a little sensitized because you have been sort of ignoring them.
Now imagine your daily routine. You go to work, you sit at a desk, you look straight ahead most of the day and your back gets slumped until the 5 o’clock bell sounds. You go home, make some dinner, watch some tv or read a book, and then maybe go for a light walk if it’s a nice evening. How much do you think your neck and back muscles have actually moved through their full range of motion (meaning flexing, extending, rotating, and side bending)? My guess (from hearing the history of seeing many clients) is not much. That being said, do you think your body is stiff before you even go to bed? Yup.
So that brings you to the end of your day when you are going to be in a mostly static position for another 8 hours. I’m thinking you shouldn’t be looking for a “looseness miracle” in the morning to make you feel like you are 15 years old again. Proper positioning during night is helpful (see below) but even more importantly is having a good, quality sleep. That means your are rested and relaxed and you have a better chance of waking up without pain. But you need to go to bed a lot more mobile so you don’t stiffen up further during the night or you have no hope of waking up looser! Just talk to a physiotherapist on ways to get yourself looser throughout the day and my bet is your sleep will improve lots.
Specifically speaking though, and keeping in mind the above, I am most often going to recommend side sleeping (possibly with a pillow between your knees if you like that) or on your back (also possibly with a pillow below your knees if you arch a lot in your lower back in this position). Stomach sleeping can lead to a bit of neck problems because you have to breathe and so your head has to be turned one way or the other most of the night, which can stiffen your neck over time. For proper pillow information, check out my other blog (July 2011, “Can You Recommend A Pillow?”) which can affect sleep comfort as well as position.
Do you know how your brain responds to pain? This TEDEd lesson walks you through the “pain experience” and why it differs from person to person.
By Nick Matheson, Owner
It was eleven years ago; a birthday truly worth celebrating. My oldest daughter, Maryn, had reached a milestone. Three years old and she was cancer free. Born with a rare tumour in her liver, the disease had progressed to her lungs, reaching stage 4, before we had the good fortune of an accidental discovery. A fall on her belly a few months previous ruptured the tumour, threw her into shock, and propelled our family into a 4-month sprint to conquer this disease.
On this particular day, she raced all over the playground, climbing, swinging, and jumping. Not a big deal for most three year olds, but quite a feat for a kid who was only three weeks post liver transplant! Having donated a significant chunk of my liver to the effort, I was quite the contrast as I winced with pain and hobbled lethargically around the park trying in vain to keep up. At only 31 I was already envious of the energy and recovery potential of youth! My family’s brush with cancer taught me that there are many things in life that I cannot control. It was in that moment, full of joy in Maryn’s victory and facing struggle in my recovery, that I vowed to control those things I could. Until that point, health was something I took for granted. It’s easy to do that until you start to lose it. So many people spend so much time and energy focused on things that do not matter at all when their own health or the health of those they love is at risk. Illness can be an important wake up call.
I’m sure my family has claimed more than our share of Nova Scotia’s health care dollars. We are very grateful that the stress of coping with a kid facing a serious illness was not compounded by wondering how we would pay for her care. We are incredibly thankful for the exceptional care that was provided and, of course, for a miraculous outcome. I realize that it is not without problems; however, the system was there for us when we needed it. For the most part, health care in Nova Scotia works when you are sick. The challenge is that it does very little to keep us well. And, frankly, I don’t think there is much it can do. The population of Nova Scotia is aging rapidly, chronic disease continues to increase, and unhealthy lifestyle habits are among the highest in the country. Illness places a growing burden on health care budgets and personnel. I understand fully that there are many things we cannot control. I invite every Nova Scotian to accept responsibility for controlling those they can.
Wellness is too often sacrificed to denial or lack of awareness. Every choice takes one closer to or farther from a state of good health. The scientific literature is full of results demonstrating the positive impact that diet and exercise have on chronic disease. And yet many continue to rely instead on taking a few pills or being caught by the health care system once they’ve fallen. As I’ve said, I’m as appreciative as anyone for that safety net. I’m also determined to strengthen my health and give those around me every opportunity to thrive.
Thriving comes from attention to 3 main areas:
Mind: The first step toward change is awareness. The second is acceptance. In words from those far wiser, all suffering comes from wanting things to be other than they are. Learning to be aware of my ability to respond rather than react has brought great freedom. Practices like meditation and yoga can bring focus, clarity, and relaxation. Becoming more awake means recognizing that I always have choice.
Muscle: As the engine that makes us go, muscle must be maintained in order to do the things we want to do. Loss of muscle begins as soon as we stop naturally growing unless something is done to stimulate strength. Being stronger makes everything you want to do easier. Body composition, which provides an indication of muscle mass, is actually one of the most important measures of overall health and one of the most significant determinants of an active lifestyle.
Movement: Our bodies are meant to move. From a young age, we learn that we are our thoughts and we become somewhat disconnected from our bodies. Sedentary lifestyles contribute to tightness, stiffness, and weakness. Pain can cause further restriction and avoidance. Crappy weather can make us cocoon in front of the TV instead of embracing the great outdoors. There are lots of excuses and all must be overcome. Quite simply, movement is the best medicine for creating change in a person’s physical, emotional, and mental state.
Ultimately, we must all be the change we wish to see in the world. I can see a healthier Nova Scotia. I work every day to become more aware of my choices and to help others align mind, body, and spirit toward their own vision. Please accept this as a Nova Scotia Wellness Challenge and commit today to whatever changes you feel are most important to move you – and all of us – to a greater state of health. That would be worth celebrating!
By Tara Patriquin, Massage Therapist
Breathing. Seems simple enough, right? For something that is so innate and natural, many of us could be doing it wrong. I used to be a shallow breather, filling up my chest and carrying all my tension in my shoulders. It wasn’t until I started practicing Yoga, and the art of mindful breathing (Pranayama), that I started to take note of how my breath was making me feel.
Relaxed breathing should see a loose abdomen expand with inhalation, with a mild contraction on the exhalation. The rib cage will spread out to make room for the lungs that are expanding to take in the extra demand of oxygen. So why do many of us do the opposite? Pull in our abdomen and puff out our chests when inhaling? Anxiety? Stress? Habit?
Science has shown us that breathing patterns will change when the emotional or physical patterns change; faster and more shallow when we are anxious or angry, we might hold our breath when we are distracted or in pain, and so on. Studies have also shown that the reverse can be true. We can change our emotional or physical patterns (or at the very least, our reaction to said pattern) by consciously altering our breathing rhythm.
You have likely been asked to slow and deepen your breath during a massage or physio session; thereby, breaking an unconscious pattern and the negative energy that goes with it. In today’s society, we have a tendency to over-stimulate our sympathetic nervous system (our fight or flight response to stress), and we under-stimulate our parasympathetic nervous system (our rest and digest responses). Living in a heightened state of stress has been shown to contribute to a number of illnesses, ranging from heart disease, diabetes, sleep disorders, and a host of pain.
A daily breathing ritual will strengthen your parasympathetic nervous system, providing you with the long list of benefits and reducing the risks associated with having an over-stimulated sympathetic nervous system. Start and end your day with one of these exercises designed to strengthen your diaphragm. The diaphragm is possibly the most important muscle for efficient breathing.
1. Lying on your back with a phone book on your stomach breathe deep in to your stomach allowing the phone book to rise and fall with your breath. When you have taken a deep breath in, hold for 10 seconds and the release, letting the gentle weight of the phone book aid you in letting go of all air before breathing in again.
2. Breathing in to the belly as practiced in the first exercise, plug one nostril and breathe deeply through the open nostril. Then plug the open nostril and breath out the opposite nostril. Repeat several times each side.
3. Breathe through a straw for one minute or until you start to feel dizzy then return to regular breathing. Again, making sure to breathe deep in to the belly. Try this three times.
I have witnessed these exercises work for people with asthma, athletes who wanted to improve their stamina and respiratory endurance, and for those who wanted a deeper meditation.
You can test the strength of your diaphragm using the Snider’s Test. Open your mouth wide and try to blow out a lit match that is six inches away from you. With a strong diaphragm you should be able to do this easily.
There is another simple test that you can do for yourself to measure the general capacity of the diaphragm and lung volume. This one is a favourite among kids. Remember holding your breath under water and having competitions with your friends! For this test you don’t need to get in a pool, but you do need to take a deep breath and see how long you can hold it in. Don’t pass out please! If you can hold it for 50-60 seconds then you are considered to be in good health and to have a good capacity. Of course, these tests are better done with someone else who can watch how the rest of your body is responding to the exercise. It’s no good if while you are holding your breath you are also tensing up through the shoulders and neck, you should be able to perform these tasks with ease, not with tension or awkwardness.
It is interesting to note that abdominal muscles that are too tight can inhibit the freedom of the diaphragm and can in fact cause more anxiousness with deep breathing rather than a sense of relaxation. So, don’t worry about letting your belly hang loose when working on your breathing exercises. The same can be said about tight neck muscles, such as we see with a forward head carriage, since the anterior neck muscles are our secondary respiratory muscles. If this is the case for you, you might want to do the Serenity Roll exercise. Sitting, bring your chin to your chest and exhale fully. Inhale deeply as you roll your head to one shoulder. Exhale as you return to centre. Repeat to the other side, and for about 10 repetitions. Ensure that you are only rolling along the front and avoid tilting your head backwards, and stop at any point of pain, discomfort, or dizziness. This exercise helps relax the neck muscles and to retrain the natural relationship between breathing and the secondary respiratory muscles.
Getting proper oxygen (read: our body’s #1 life force) throughout the body, and the elimination of toxins out of the body, will without a doubt help improve your overall well-being and contribute to a healthier mental state.
There is an awful condition called adhesive capsulitis, or more commonly referred to as frozen shoulder, that shows up in about 2% of the population, mostly between ages 40 and 60, and more often women than men. It is associated with stiffness and pain in your shoulder and can be treated in many manners with relatively the same outcome. Unfortunately, the outcome, which is usually that the pain and stiffness resolve, doesn’t happen very quickly, often requiring 2-3 years to fully return to normal. The reason why I decided to write about this subject is to hopefully save someone who has this terrible pain even more, and rather unnecessary, pain because of treatment to supposedly help them.
First we have to look at what it is to understand how we can know what we should do if it happens to you. Anatomically, the shoulder joint, which is made up bones, ligaments, and tendons is surrounded by connective tissue which forms a type of capsule to further support of the “ball and socket” joint. See the picture below. Systemic issues can increase the likelihood of frozen shoulder (Diabetes, Parkinson’s disease, thyroid issues) but more commonly the capsule, for many reasons such as tendon injuries, a broken bone, post surgery, all at the shoulder area, or following a stroke, can thicken and tighten and become inflamed. Now it hurts every time you move your arm. So then the less you move, then the stiffer it gets, but also the more forceful you make it move, the more painful it gets. Darned if you darned, darned if you don’t it seems!!
Frozen shoulder is characterized into 3 stages:
Options on how to treat frozen shoulder: (this is not an exhaustive list but these are two more common attacks!)
Having frozen shoulder is terrible, but there is a light at the end of the tunnel for you. I would strongly suggest if you decide to try to get some relief through active treatment that you really look into the research and hopefully find the treatment that will not increase your pain and/or possibly delay your progress. I believe that proper, gentle physiotherapy can be helpful and somewhat pain-relieving and should be a part of a frozen shoulder recovery.