Saturday 28 July 2018

The Biggest Step I Had To Take To Be A Rehab & Fitness Educator

First of all – I want to say thank you to everyone who has supported my site over its first year of existence. I really appreciate all the feedback, likes, shares and other benefits you have given me. Thank you.

I sometimes get asked how I’ve gotten into the role that I have – writing for two sites, having contributed to two books and having contributed to multiple university courses. Also, given the amount of outdated & questionable material out there in health & fitness, I’m sometimes asked how I stay sane and keep a level, positive attitude. This article, which I feel is an appropriate “1 year anniversary” article, delves into that….

Back in 2013, as I was preparing for physio school application interviews, Stu McGill was gracious enough to take some time out of his insane schedule to let me work with him. When I asked him about some of the schools he told me that some of them do teach a lot of outdated materials.

Alo and behold - during my first term of PT school I was getting taught, what I knew was outdated, information and was angry, bitter, frustrated, and depressed about it. Sometimes I felt like I took my anger out on my fellow classmates which, along with my lack of taking care of my physical and mental health, sits as my biggest regret from PT school. This is why I’ve always appreciated when someone sends me a message or posts a comment complimenting me for having a positive, balanced attitude as I wasn’t always that way and have tried to work in that direction. Due to these issues I almost quit PT school more than once along the way and have known many people who have struggled through similar journies.

Side note: so many people comment on my successes but they don’t see the hardships, failures, or low points along the way. Such is true with a lot of people’s stories on social media.

Those frustrations, to be honest, were the biggest spark for me to want to make change in the educational system for both rehab & fitness professionals.

In 2014, during a casual phone call, my old professor and great friend Lora Giangregorio asked me if I would help her design a course on exercise for people with chronic health conditions for the University of Waterloo KInesiology program - to which I said hell yes. I’ve been involved with UW ever since.

In 2014/15 I got asked by Brian Carroll, James Cerbie, and Alexander Cortes to write for PowerRack Strength, Rebel Performance, and EliteFTS respectively. For a 24 year old, still in grad school, the opportunity to write for those high level sites was nothing short of amazing.

Fast forward a couple years – I got asked to be part of a review panel for Western University, contributed to two books, started my own website, and am currently a writer for Mash Elite Performance.

Even though I’ve had the opportunity to reach people from Alaska to Australia … I felt something was missing in my work and my attitude up until a few months ago. The event that tipped that off was the passing of my former physio school instructor Deb Lucy. Deb was one of the main masterminds behind the way the Western University physiotherapy program runs today. She always had a lot of energy and cared a lot about her students. When you’re in the same classes Monday-Friday with the same 50 or so people for months on end … you become a family.

 That made me realize – it was time for me to let go of the anger and bitterness that I harboured towards the education system. It wasn’t helping me and, if anything, it was bringing me down and negatively affecting my relationships with colleagues.

I’m not saying that every piece of material out there in rehab or fitness is peachy or perfect. Far from it. What I do believe though is this - "If you change the way you look at things, the things you look at change" to quote Wayne Dyerr.

When I first learned about pain science & the biopsychosocial model in 2014, near the end of first year physio school, it really shook me and made me question a lot of things I thought I knew. It created some cognitive dissonance and it took me a while to rewire my thought pattern.

That, and the desire to be diplomatic in order to get my knowledge across, are the two main reasons I try to be patient with other professionals who I educate & deal with. I operate under the premise that most professionals mean well and want to help patients – and that belief change is tough especially when you’ve emotionally invested yourself into your methods & the results you get with your clients.

As such – my attitude has shifted. We still have a long way to go and a lot of work to do in improving rehab & fitness education for professionals & students. But I look at the positives – we have a lot of great rehab & fitness professionals who care a lot and want to learn and get better and we have great opportunities and educational methods through schooling, courses, and social media to get the information out there. We can’t change the world – but we can make a little part of the world, a little bit better.

Thank you for your support for the past year, and as always, thanks for reading.

Sunday 22 July 2018

What I'm Doing Differently In My Third Year Out Of Physiotherapy School - Part 1

On a rainy summer day by Elborn College - the building where I spent the bulk of my two years in physiotherapy school.

August 28, 2018 marks the 3rd anniversary of my last day of physiotherapy school. This time last year I wrote a series where I discussed several changes I’ve made in my own practice. In this article I will share some of the things I’ve been doing differently since that time period.

1) Doing more neck strengthening instead of stretching

The traditional, stereotypical PT approach to neck pain rehab consists of a lot of stretching, soft tissue work, and needling of the upper traps, levator scapulae, scalenes and/or SCM muscles. For whatever reason, and maybe it’s just me, this approach never worked well for me or my clients with neck pain and just left a lot of people feeling sore.

By contrast – I’ve gotten much more out of isometric neck exercises (sets of 7-10 second holds within a tolerable level of force) and dynamic shoulder strengthening exercises such as front/side/rear raises, rows, shrugs and shoulder presses (based on the patient’s activity tolerance and physical capabilities). This approach is (in my opinion) better tolerated by my clients.

Side note: this isn’t to say I don’t do any stretching or soft tissue work in people with neck pain as I do see an anecdotal benefit in certain populations (ie radiculopathies) but many people I work with tend to  not enjoy being stretched and are limited more by pain before their neck movements even encounter resistance.

 Image courtesy Focus Fitness

2) Doing less more often in people with persistent pain

Working with persistent pain can be a challenge in terms of exercise prescription as it may be entirely possible that every movement/activity hurts and they can be easy to flare up. It leaves us in a bit of a conundrum as we want to be able to improve/maintain our clients mobility & fitness but we also don’t want to flare them up.

A solution I found came from a podcast I listened to with Greg Lehman last year where he suggested “doing less more often” with people with fibromyalgia and other chronic pain conditions. For example – I would prescribe a set of 3-10 of 1-2 exercises (depending on the client’s goals, limitations, level of irritability, and whether they are having a “good” or “bad” day) to be done repeatedly through the day.

I found this approach helped my clients immensely with maintaining (or even improving) mobility & fitness while minimizing the chances of flaring up.

3) Referring out (or at least backing off) if I’m not the right person to treat someone’s pain

This may seem like common sense physio. If someone has
-          Red Flags: ie tumor, infection, cauda equina syndrome and/or
-          Major orthopedic issues requiring surgery: ie fracture; dislocation; progressive neurological deficit; ligament/meniscus tear creating locking, instability, and/or giving out;
…. Then you need to refer out

I’m not talking about those in particular. I’m talking about cases where, quite frankly, physio just may not be the most valuable use of a client’s time and resources even in the absence of the above issues.

I’ve seen a fair amount of clients this past year with significant levels of pain and disability that were linked to significant psychosocial factors such as job stresses or even deaths/family illnesses. These clients would even tell me that as their stressors went up, so did their pain. After a couple of these cases I realized that, while physio can still have a benefit for maintaining/improving mobility & physical function, that the drivers of their pain were likely beyond my skillset and required counselling or psychotherapy to deal with these issues.

Over the past year I’ve also had patients referred to me for conditions that were clearly medical in nature – such as polymyalgia rheumatica. Again, while we can help with mobility in function, most of the treatment for conditions like PMR is medical in nature.

I’ve ranted before about how I don’t like personal trainers & strength coaches trying to be half-assed PTs but at the same time I don’t believe a rehab professional should try to be a half-ass psychiatrist or doctor. That’s where we need to realize our limitations and refer out to other professionals.

Side note: this isn’t to say that I completely stopped treating them – but we both came to a consensus that other resources were needed.

4) Bubble diagrams for pain science

Quite often I find patients want to know “what causes this?” That’s a great gateway to get into some pain science education. But instead of bombarding people with a bunch of neuroscience – I take the time to do a bubble diagram (similar to Peter O’Sullivan) to show all the different factors that can be involved with a patient’s pain including (where applicable)…
-          Tissue changes
-          Too much (or too little) activity
-          General health factors (i.e. body weight, smoking, poor sleep)
-          Psychosocial factors and maladaptive behaviours

This is a great way to get some practical, applicable information about pain out to the patient without bombarding them with info.

5) Giving patients exercise set/rep ranges

This follows in from Point #3 – I like the idea of giving patients set/rep ranges for exercises so they can adjust if they’re having a good day or bad day. I find this useful for people with persistent pain (or any fluctuating pain) and/or for “borderline” cases where you’re not 100% confident about how far you can push them.

That’s the end of Part 1 of this article. Tune back in a few weeks where I discuss four more changes I’ve made.

How I've Adapted The McKenzie Method Over The Years

If someone were to ask me “what are the biggest influences on your therapy philosophy” they would be (in no particular order) ·  ...