Monday 3 December 2018

My 2018 In Review: Top Things I Learned + My Top 5 Most Viewed Articles Of 2018

2018, especially its Fall, was an exciting time for me. I’m grateful for all the people who I’ve met and talked to over the past year through working at Altum Health, SWIS, taking the Canadian Powerlifting Union Coaching Certification, guest lecturing at UW and becoming a writer for Mash Elite Performance. Thank you all.
Through all the excitements and highlights of 2018 I’ve learned quite a few things, some of which the hard way, that I’d like to share in the final article of 2018.

Side note: This does not include anything that I learned at SWIS 2018 as that would basically involve regurgitating another article that I have written here.

1) You may not always get all of your patients’ psychosocial factors on Day 1

In my career I’ve worked hard to gain a complete understanding of my patients’ psychosocial factors through subjective history, questionnairres such as the Orebro Questionnaire and just good interviewing skills.

I’ve had a few experiences this past year with patients where patients didn’t open up about various psychosocial issues, stressors or traumatic events until a few weeks (or even a few months) into therapy.

When you think about it – it seems like common sense. You wouldn’t tell a random dude on the street your most personal secrets on the first day … so as such I (and you) need to not assume that we’ve detected all of a patients’ psychosocial factors on Day 1.

This shows the importance of
-          Taking your time
-          Listening to the patient’s story
-          Validating their story
-          And just being an overall good person to build that rapport with your patients

2) Core exercises & core stiffness may not be a bad thing (at least for a short time period) in certain people with LBP

With some of the research that’s came out showing that core exercises are equal to (or maybe slightly better than) general exercise for LBP – many practitioners wonder why we even bother with them.

However in some LBP cases, to paraphrase a quote from Greg Lehman, people may be aggravated by specific movements/postures/or loads in a more “nociceptive” manner. These are the cases most people refer to when using terms like “flexion intolerant,” “extension intolerant,” and others. While we know back pain can’t be attributed to just mechanical factors – sometimes a person’s movement or posture can make a big difference on their individual symptom presentation.

In these populations I do believe there is a place for McGill-esque core exercises, if anything else, to teach them the control required to move in a way that doesn’t aggravate the problem. This is where approaches like McGill and McKenzie make a ton of sense – you move and exercise in a way that doesn’t exacerbate the symptoms long term.

 That said
-          You don’t want to have people avoid movements forever and/or walk like Tin Man from The Wizard Of Oz
-          For some people other factors (i.e. stress, poor sleep, fear of movement) may be bigger drivers of your clients’ sensitivity. In those situations I care less about “core stiffening” and more about managing these other issues.

3) You’re never gonna please everyone

Having worked at a couple different clinics, and having talked to many different clinic owners, I’ve learned that … you’re never gonna please everyone whether its patients or other physios.

Some want more manual therapy … some want less. Some want more exercise … some want less. Some want more education … others want less talking more doing. Some want more modalities … some want less.

At the end of the day you can’t please everyone. That said – it is important to ask patients (and clinic owners if you’re searching for a job) what their expectations are.

Therapy shouldn’t be a dictatorship but there has to be some give and take on both ends.

While I’m not a huge modality guy – if doing 5 minutes of ultrasound gets a patient to do everything I need them to do – I’ll take that tradeoff. That said if a patient doesn’t want to follow any of my recommendations outside of the clinic and just wants me to “fix” them – then we have problems and have some work to do.

I’m also more OK now with just letting the occasional patient go rather than feeling like I have to excessively bend over backwards to please everyone when I know it’s not in their best interest.

4) Don’t be intimidated by fibromyalgia & chronic pain diagnoses

This came partly through my last job at Impact Physiotherapy & Performance but was more solidified through my current job at Altum Health in Cambridge, Ontario, Canada. Approximately 80% or more of my caseload is people with persistent pain.

I, like most physios at some point, got intimidated by these more complex and more irritable cases & was more cautious with them. While you have to be careful to not flare them up – quite often many people, even those with chronic pain, are capable of more than we realize and a process of starting super slow and building up gradually can (in my experience) provide great benefits for fitness, mobility & health.

That said, as I said above, there are some patients that will be flared up regardless of how gentle you proceed with things. Again these people likely need more help in other areas (i.e. psychosocial factors, sleep management) to help with decreasing pain.

5) How great vacations are … when you actually take them

2018 was the first year out of physio school where I took all of my vacation days. Some of these were spent with family & friends and some were spent travelling across Ontario. As much as I enjoy working hard it’s great to take some restorative time and to catch up with friends – something that gets neglected in the pursuit of selfish goals.

 6) Sometimes you just gotta say “no” and set boundaries

Having a lot of great professional opportunities can be both a blessing and a curse. It’s a blessing in the sense that people value your work & your opinion – plus some of these come with financial benefit. But it can also be a curse as it’s very easy to get overloaded & overburdened.

Over the course of this year I’ve had to, for the sake of my own mental sanity & energy levels, say no to some big opportunities with some big names in the field. As someone who wants to help as many people as possible – that hurt. But it was something I had to do to take care of myself first.

Below is a list of my five most viewed articles of 2018 on this site….

3 – My Journey With A Learning Disability, Anxiety and Depression: Finding Strength & Confidence – I wrote this article in honour of #bellletstalkday and had no idea how well it would be received. Thank you.

2 – The McGill Method: Common Misconceptions – Co-authored with Dr. Stuart McGill

I wish you all a Merry Christmas and a fun, safe and happy holiday season with friends & family. Thanks for reading and I will see you in 2019!!!

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