As the initial inflammatory response starts to subside within the first few days, and the clean up has occurred, then we  have to start laying down new tissue. This is what I equate to framing the house.  It takes organization. 

Cells in our bodies that are able to divide will regenerate. Some tissues are better at rebuilding than others.

The skin is great at repair, while some of our organs are not so great.

 

 

Before we start to rebuild we need to make sure that the plumbing is intact.

 We need to repair and re-establish any torn blood vessels.

 

 

 

 

 

 

 You don’t heal well without blood flow to the area.  That is why smokers have a more difficult time with healing.  The blood flow is compromised. 

 

THE FIRST 2-5 DAYS

The repair or rebuilding stage starts within the first two to five days post injury (overlapping with the inflammation stage).  By the end of one week the rebuilding should be the primary thing happening at the work site.  The debris should be all clean up.  The rebuilding takes up to two –four weeks on average.  

 

The repair stage requires fibroblasts, which are cells that reframe the tissue.  Basically we start to lay stronger material over that initial chicken wire that we put over the hole in our fence.  Except that our fencing material is called  connective tissue which comes in the form of collagen. 

  

 

 

 

 

At the start of the repair stage the collagen is weaker (typically type III collagen) and more vulnerable to re-injury during this stage of healing.  This is for up to 3 weekspost injury.  There is research out that suggests that anti-inflammatories of the corticosteroid type (which are most other than asprin, ibuprofen or Tylenol), interfere with the collagen formation resulting in a weaker collagenstructure.  Typically our soft tissues, including mature scar tissue is made up of type I collagen. We want the connective tissue to be aligned properly so it is once again strong and supportive. 

 

  

STRETCHING THE AREA WITHOUT REBREAKING THE NEW TISSUE

Care is needed not to re-injure the tissue during these initial stages (typically 1-3 weeks depending on the injury and the tissue).  Some movement is required however to help with the re-organization and strengthening of the new tissue (material) as it gets laid down.  If the injured area is not moved (because of fear, pain, or casting) then the new tissue remains disorganized and has adhesions that prevent movement.  What I think of here is a mass of spaghetti that has not been rinsed.  It is stuck together and breaks easily if you try to pull it apart.

  

  

 

  

  

  

  

 

 

 

 

SCAR TISSUE FORMATION – WE NEED IT

Scar tissue formation (fibrosis) occurs when there is extensive tissue damage or the structure of the tissue that was damaged is complicated and difficult to reconstruct.  While scar tissue can be up to 90% as strong as normal healthy tissue, it generally is less in terms of the volume of the tissue that it has replaced.  The scar tissue is meant to contract to pull the edges of the wound together. 

Basically, trying to heal without this happening would be like trying to mend a tear in your shirt without pulling the two edges together. This leads to contracturesand constriction of the structure that was injured (it is tighter and harder to stretch resulting in loss of mobility or movement). 

During the repair stage you still need to protect the injured area but avoiding the aggravating activities (those thatincrease pain and swelling).  You also need to start using the injured area to “the edge of pain”. It is not a no pain no gain mentality. We need movement to help re-align and strengthen the tissue, but pain should still be the guide.

Gentle is the key.

  

  

 

 

 

 

 

 

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

HOW THE BODY HEALS

Part 1 – Inflammation

As a physical therapist, I was taught to look at the physical aspects of an injury. 

What was happening at the cellular level when the injury occurred? 

When tissue is damaged, there’s an inflammatory response in the body.

This is the first stage of healing.

And it’s a much needed stage not to be overlooked.

It begs the question, however, if it’s so important why are we instructed to:

1. Rest (avoid aggravating activities)
2. Ice (15 minutes every hour is recommended. Make sure to wrap the ice in a towel)
3. Compress: (if able)
4. Elevate the injured area

Well, it’s because we want control over how much inflammation occurs.  The more inflammation and swelling, the more potential for tissue damage to surrounding tissues. 

Research now supports if you ice a sprained ankle right away, the recovery time is shortened. There’s also evidence that supports chilling the body after a heart attack to minimize further damage, and relieving pressure in the brain after brain injuries, all works in helping with a more complete recovery.

INFLAMMATION (stage one of healing)

The process begins when blood comes in contact with our collagen (the connective tissues in the body). The body sets into motion a series of events designed to:

1. Stabilize the body and prevent further bleeding (stimulation of clotting factors)

2. Eliminate tissue damage

3. Stimulate repair

The initial response to injury is blood vessel constriction (5 to 10 minutes) followed by vasodilatation. We also see a lying down of fibrin (cross linking fibres or a natural bandage) over the wounded area. 

This would be like laying down a chicken wire over a hole in a chain-linked fence. It will help keep what’s inside from escaping or what’s on the outside wanting to get in from getting in – kind of like chickens in a hen house, with a sly raccoon lingering outside. 

CHEMICAL RESPONSE TO CLEAN UP

We have what are called mast cells located in our tissues. These cells when triggered release mediators (histamine and tumour necrosing factor or TNF) that start the inflammation process. Histamine triggers blood vessel dilation (vasodilatation) and increased permeability of the blood vessels, which allows more blood flow to the area and cells to get through the cell walls to the injured tissue better. When it comes to increased permeability, I think about it as making the doorway bigger to let the big guys out to help with the recovery response. 

INFECTION PROTECTION

These mediators call to action white blood cells called lukocytes which help defend against infection. These little guys travel to the injured area via the blood stream. I’ve often related this as calling 911 when you need an ambulance and getting not only the ambulance, but firefighters and police arriving at the scene. 

A tissue injury can make tissues look like a tornado ripped through your muscle or whatever soft tissue (ligament, tendon, muscles) that’s been injured. The emergency response team shows up and starts to co-ordinate the cleanup effort.

Another type of white blood cell called neutrophiles is predominating at the wound site for the first couple of days. These neutrophiles break down debris and bacteria (that can contribute to infection) and kill bacteria (using free radicals) and also cleanse the wound. Once these guys are done their job the monocytes (50 per cent is stored in the spleen as reserves) which become macrophages when they leave the blood stream at the injured site. These are the “big eater” cells in our bodies. Their role is to surround, break down and digest the neutrophiles.

I’ve always considered these guys the Pac-Men of the body (for those who grew up in the 1980s).  These macrophages also stimulate other lymphocyte immune cells in the body which will attack any foreign substances that may be in the area.

Macrophages are very important in wound healing. These are protein derived and attracted to the injured site by growth factor.

On a side note, one of the reported benefits of IMS (intramuscular stimulation) is the release of platelet derived growth factor, which can help stimulate tissue repair. 

The macrophage is a key player in moving the healing from inflammation to repair, but good repair occurs in the absence of macrophages (presence of macrophages delays wound contracture).  

There is also the release of cytokines, whose role is to control the function of other cells (like a messenger). These guys influence the leukocytes involved in inflammation and repair.

SIGNS OF INFLAMMATION

1. Redness: This is from the dilation of blood vessels in the area that’s required to help bring increased blood flow (carrying all the required white blood cells) to the site of injury. 

2. Warmth: From the increased blood flow to the area in addition to the release of certain chemical mediators.

3. Swelling: Otherwise known as edema occurs when fluid (exudates) accumulates outside of the blood vessels.

Contained within the edema or exudates includes substances that help with clotting (to prevent the spread of infection throughout the body), and antibodies that will attack foreign substances that might be present. 

4. Pain: associated with inflammation occurs because of pressure on pain sensitive structures, in addition to certain inflammatory chemical mediators in the system (serotonin, prostaglandins, bradykinin). 

Now that I’ve mentioned prostaglandins, you might as well know these are fatty acids in the body (unlike the lukocytes which are protein derived), that are responsible for increased permeability of the blood vessels (letting certain cells leave the artery which carries blood away from the heart, into the injured area). 

These fatty acids also help with clotting and create pain and warmth at the injured site. 

When you take an anti-inflammatory, you’re stopping the production of prostaglandins. 

Bradykinin (of the kinin system) contributes to pain and itching associated with inflammation. Its role in the inflammation process is thought to be in the control of the blood vessels.

SUMMARY

We need the inflammation response to happen in our bodies after an injury, but it needs to be contained. So continue to rest, ice, compress, and elevate as much as you can to help with the recovery process. 

Too much of a good thing can sometimes not be such a good thing.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

I recently received a lengthy email from someone filling me in on their back problems going back eight years.

He had a disc problem in his lower back that called for surgery. He was looking for a therapist who would take someone on with chronic back issues. 

Past therapies he endured included passive modalities such as TENS and ultrasound. He said he has an exercise routine but isn’t consistent with it. When he exercises, his back flares up.

WHERE TO START?

During a typical physiotherapy assessment, I start by looking at the alignment of the body. Is the pelvis resting properly, and what is the mid- to upper-back doing? The muscles of our bodies are both short (cross only one joint) and long (cross more than one joint). In our backs we have muscles that cross several spinal segments.

What is happening at the hips and mid-back? Even our shoulder can effect what’s going on in our lower back.

The lower back is not meant to twist. Twisting comes from the hips and mid-back. If these are tight, twisting happens in the lower back. The result then is a breakdown of the joint stabilizing system and discs. 

BALANCING THE MUSCLES

The best treatment technique I have come across for releasing tight muscles is Intramuscular Stimulation (IMS www.istop.org). If there are tissue adhesions and fascial tightness in conjunction with tight, ropy, reactive, shortened bands of muscles, then the addition of massage therapy techniques, with stretching is hugely beneficial.

MOBLIZING THE JOINTS

If there’s a joint that’s stiff or stuck (not moving or hypomobile), mobilization and/or manipulative techniques are useful to get it unstuck. 

RETRAINING THE SYSTEM

Once the system/body is properly aligned with more normal muscle tension (not over-reacting to all your movements and activities) then I look at re-training the system (re-programming) it to work at its best.

DID YOU KNOW?

We tend to run on autopilot most of the time? We only use about five per cent of our conscious brain throughout the day. Most of what we do runs off of our subconscious programming. 

Re-training your muscles takes concentration and repetition (in other words time and dedication). 

It’s like when you first get behind the wheel of a car. You need to focus on what you’re doing at all times and thinking about every move. 

It’s like learning to walk again after a brain injury or stroke. It can be done but you have to do the work. 

It’s not just about going back to the gym, starting back into running or taking up boot camp. You will just run those old, automatic brain patterns when you do these activities. 

NANCY MCNEIL is a local personal trainer (www.forever-fit.ca) who runs a back fit class that was developed in conjunction with me. The focus is on re-training the core from the inside out. You start by finding your inner core muscles, then progressively work on more challenging core exercises. The goal is to be able to engage the inner core muscles while doing certain movements without the compensatory muscles kicking in. 

I also refer my clients to Pilates instructors or a Somatics group (www.appliedsomatics.com)  in town to help with supervised muscle re-training exercises.

SELF CARE

When it comes to care of the body, it does not matter whether it’s the back, shoulder, knee, hip, elbow or neck, it requires work on your part. The therapist is there to assist while you release certain muscles or joints that need releasing. A client (you) can take a pro-active approach and do self release or massage techniques and stretching. The therapist can show you exercises that will be most beneficial for re-training and strengthening, but we can’t do them for you. 

We can advise you what activities you should avoid and when, but we can’t keep tabs on you at all times.

It’s your body and the only one you get in this lifetime. Help it last a lifetime by giving it the maintenance it needs. 

Give it a rest when it needs it and fuel so it can function optimally and heal well.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

As a kid I was always very active. Growing up in Ontario afforded me many opportunities for skating and outdoor rinks were everywhere, and lucky for me my neighbour Jack had one. I was skating by age two. When the ice melted, we switched gears to road hockey.

Organized sports started for me around age eight. There was softball in the spring, soccer in the summer, and hockey in the fall/winter months. 

With this bundle of activities, not forgetting the wipe-outs off my bike, there were bound to be a few injuries here and there.  As kids though, we tend to be able to just let our injuries heal and get on with life. 

What I didn’t realize then, was I was developing tight ropy bands in my muscles that would eventually make it harder and harder to stretch.

FORGET ABOUT IT

I do remember having a conversation with my mother and telling her about pain I was having during an activity. The response I believe was, “if it hurts, don’t do it.” 

This is all well and good, but it doesn’t always solve the underlying issue. There are four progressive stages of an overuse injury such as tendonitis. 

1. PAIN DURING USE

This is your body’s first signal something isn’t right. Perhaps there’s a muscle imbalance, or you’ve overworked a muscle and it’s tight and tired. The pain calls it quits if you stop the activity, but comes on again when you start the activity back up.  

WORDS OF ADVICE: This is the time to contact a therapist for help.

2. PAIN DURING USE AND FOR A FEW HOURS AFTER ACTIVITY

This is a signal it’s getting worse. There’s more tissue damage happening and likely some inflammation. 

 3. PAIN THAT LINGERS FOR THE REST OF THE DAY BUT IS GONE BY THE MORNING

Not good.

 4. PAIN THAT’S STILL THERE THE NEXT DAY

Even worse! This is never a good sign. What happens when you get to this stage is you may have to stop doing the activity for a prolonged period of time and will likely require more intensive and prolonged treatment (I know… but please don’t shoot the messenger).

What does this mean for you? Well, it’s a more costly recovery, not only for the cost of treatment sessions, but often the pain starts to interfere in other areas of your life, such as work. 

WHY DO AN ACTIVITY THAT HURTS?

Therapists understand you don’t want to stop doing activities you love to do, or that you don’t want to (or financially can’t) stop, like working. It may be easy to give up vacuuming, doing the dishes, or laundry and if you’re fortunate enough, someone else in the house will take these jobs on for you. It’s much harder, though to give up your green thumb, store away the tennis racquet or hockey gear, or say goodbye to running or bootcamps.

These are activities that invigorate you and are a huge part of your social sphere… I know. 

Would it not be better, though to give these activities up for 3 to 6 weeks while you receive treatment for the injured area and perhaps other areas contributing to the out-of-balance muscles, rather then giving them up for 3 to 6 months? 

Sometimes in the case of shin splints that have progressed to stress fractures, you will be off for a year, and perhaps not able to return to that activity ever again. 

When it hurts, don’t do it works to take the pain away, but you might be missing an opportunity to find out why it hurts when you’re participating in that activity and get to the root of the issue. 

AN OUNCE OF PREVENTION IS WORTH A POUND OF CURE

My mother wasn’t wrong. Doing the painful activity can make it worse.

The part she left out, however, was to go see someone who can help discover why you’re getting the pain when you do the activity, so you can one day do it pain free.

Also keep in mind: don’t wait until you’re getting the pain at rest as well, be proactive with your health, and it will save you in the long run.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

What happens to the tissues in our bodies when we use them? 

How do they get stronger? Why do they get injured? 

How do they recover so we can exercise the next day? 

Why am I sore a day or two after tough exercise? Why do my legs burn when I’m  exercising? 

How can I recover better? 

I know… lots of questions jumbled together all at once, but it’s a pretty typical train-of-thought scenario I’d like to unravel.

TISSUE INJURY

I heard Dr. Paul Watson speak early on in my years as a physiotherapist. Something he said I have never forgotten was,  “Exercise is controlled injury.” 

When we use our bodies, especially when we use them to play at higher intensity, the tissues actually get what are called microtears, or little tears in them. This creates an inflammatory response. When you experience enough of these tears, you will experience  pain for a day or two after exercising (DOMS or Delayed Onset Muscle Soreness). Contrary to what some believe, this is not Lactic Acid build-up in the muscles.

THE BURNING PAIN

Lactic acid builds in the muscles as a product of the anaerobic system (which is the system our body uses to create energy during short burst activities such as sprinting). Our bodies are able, when trained, to use this lactic acid as an energy source. It’s the build up of lactic acid that creates that fretted burning sensation.

WOLFE’S LAW

What doesn’t kill you will make you stronger. Okay, this is not Wolfe’s Law, but it’s close. When we stress our tissues, our bodies respond by making the areas under stress stronger. This is why we exercise.  

BREAKDOWN

If you were to take a piece of plastic and bend/stress it back and forth in the same spot over and over, eventually it would weaken, then crack and finally snap. Unlike the plastic, when you stress your tissues, they have the ability to recover. 

However, this does take time. If you stress the tissue again before it’s fully recovered, it will gradually reach the point on the STRESS STRAIN CURVE that it snaps.

OVER-TRAINING

This is the biggest cause of injury that I tend to see in my practice. 

TOO MUCH, TOO SOON, TOO HARD, TOO FAST. 

We are all guilty of it. We don’t want to give up doing the activity we love. We want to run every day to help keep the weight off (or so we can eat whatever we like when we like). We tend not to listen to our bodies. 

But like a newborn child who’s hungry, if we don’t pay attention, it gets louder.   

RECOVERY

There is a lot of information out there on how to help your tissues recover so you can keep on track without injury. One of the best ways though is to rest the tissues as needed. The old gym routine where you work the upper body one day and the lower another, then perhaps do some core work the third makes sense. 

I love ice hockey. This involves a lot of work for my legs. I also was a runner and cyclist (also leg work). When I went to the gym then, I did not work my legs at all. No squats, lunges, stair running, jumping. Instead I stretched my legs and focused on my upper body and core. 

YOU ARE WHAT YOU EAT

Our cells are made up of proteins, carbohydrates, fat and water. So why would we not replenish these right away to help with healing? 

After a hockey game, I go for the protein right away (I use a whey protein powder in water). And, what I’ve discovered is my legs are better able to play four games in a weekend tournament when I do this. Last year I occasionally played back to back games (three hours of hockey). Having water with electrolytes on the bench and my protein drink afterwards helped in my recovery. Again there is a lot of information out there on what quantities to ingest for your body size and metabolism. It really is trying things out to know what works best for you. 

SLEEP

When we exercise, we’re stressing our system. The more we stress it, the more sleep we need. I read in a triathlon magazine professionals training for an Ironman will sleep upwards of 12 hours a day. How many people training for these big events are really able to get that kind of sleep while holding down a full-time job and having a family? When we sleep, our bodies process cortisol, the stress hormone that wreaks havoc on our bodies.

WORDS OF ADVICE

1. Listen to your body. If you’re experiencing more pain each time you exercise STOP. 

Your ego really doesn’t have your best interest in mind, despite what it may be telling you. 

2. Cross train. Who knows you might have fun trying something else.

3. Eat a well-balanced diet and drink adequate amounts of water.

4. Get a good nights sleep (watch how much stimulation you get before bed). Dr. Bill Code told me the quality of sleep during the hours before midnight is better than what you get afterwards (it has to do with the hormones released then). I’ve been trying to have my lights out by 10:30 p.m. (after reading for 30 minutes) and I find I’m better rested, even if I wake up at 4 a.m.

IF YOU’RE MOTIVATED:

More on the anaerobic system: http://www.youtube.com/watch?v=uCmNQQWlrc0

Dr. Bill Code’s website: http://www.drbillcode.com/ 

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

ARE YOU OUT?

How many times I’ve heard a client say: “I have one leg shorter than the other,” I can’t count.

Or there’s, “my hips are out and the therapist tugs on my leg to fix it.”

What exactly are us therapists doing when we pull your leg? What we’re up to is actually a form of manipulation that’s supposed to target the sacroiliac joint (SIJ), where the tailbone (sacrum) meets the pelvis, wing-like bones (innominants). 

I will admit this was a technique I used frequently to help correct my client’s pelvis misalignments. 

I’ve even had it done to my own. The trouble with this is when clients tell me they need to keep having it done, because it keeps going out. 

WHY ARE YOU OUT? 

The pelvis (sacrum or tailbone and the pelvic bones or innominants) has two forms of stability. 

1. STATIC STABILITY, which comes from the shape of the bones and how snugly they fit together as well as the tough ligaments like duct tape holding them firmly in place.

2. DYNAMIC STABILITY, which comes from the muscles and how they pull on the pelvic bones. 

WHAT MUSCLES?

Muscles can have an effect on your pelvis including the muscles at the front of the thigh (quadriceps, tensor fascia lata), the inner thigh muscles, the back of the thigh muscles (hamstrings), the buttock or gluteal muscles, the back muscles, and even some of the shoulder muscles (the lattissimus dorsi, which is a huge muscle coming from the front of the shoulder down into the lower back). 

CHECKING THE PELVIS

I check the alignment of the pelvis on most of my clients who come in for an assessment. 

I had one client who came in for a calf strain as she was training for a half-marathon.  After releasing the calf tightness and following the line of muscle tension up the hamstring to the pelvis, I soon discovered she had significant muscle tightness and stiffness in the left upper thoracic spine (mid-back between the shoulder blades). 

The stiffness was one-sided, so I asked if she had ever been in a car accident (one where because of the shoulder strap crossing over one shoulder only, there may have been a twisting trauma). 

In fact, she had…20 years ago. 

IS THE PELVIS STUCK OR IS IT JUST MUSCLE?

One of the things I learnt from physiotherapist Dianne Lee http://dianelee.ca/ (be sure to check her website for more educational information) is how to better determine what muscles might be contributing to the problem at the pelvis.

Why are you out? This is the question I ask myself. So, I feel how the joint itself is sliding and gliding. Sometimes I feel a stiffness like I am pushing against a brick wall (the joint itself is stuck). Other times (which is actually most of the time) I feel a resistance that resembles trying to push against a mattress spring. This to me is indicative of a tense muscle causing the joint to lose its mobility. In any case, the treatment technique is different. 

With the stiff joint, I will manipulate it (which might be tugging on your leg). With restriction from muscles, I use Intramuscular Stimulation (IMS) http://istop.org/.

COMMON TRAINING ERRORS

One of the biggest training mistakes I see is over-working of the quadriceps (front thigh muscles).  People run, bike, play hockey, then go to the gym and blast the quadriceps more with squats, squat jumps and lunges. 

Tension in the quadriceps builds and has the tendency to pull the pelvis bone (wing innominant) forwards. This then puts strain on the back opposite (antagonistic) muscles, the hamstrings, which can then contribute to a hamstring strain or pull. 

You can see what I’m getting at. It’s all about muscle balance.

DO I NEED STABILITY EXERCISES?

In my honest opinion, everyone can benefit from exercises that focus on stability around the pelvis. It connects the lower half to the upper half. 

There are people who have injured the strong ligaments (after childbirth is one example) that support the pelvis and need to work on regaining the muscle stability. 

There are specific tests we can do to determine if you will benefit from these exercises and if you need extra support (core shorts are what I use).  

When retraining the pelvic muscles, PT Dianne Lee distinguishes the inner core from the outer core. 

Hold tight for more on this in my next blog entry.

So for now, if you are someone who continually needs to have his/her leg tugged on to re-align the pelvis, it’s time to look at whether the SIJ is too loose and needing extra stability or whether it’s a matter of muscle imbalances around the hip and pelvis (or up at the shoulder) that need to be released and stretched. 

It’s time to look for the why (see my earlier blog on our “bullies”) rather than treating the symptom (victim).

IF YOU’RE MOTIVATED:

Read more from physiotherapist Dianne Lee: http://dianelee.ca/

Find out more about IMS: www.istop.org/

Read Wendy’s earlier blog on discovering our bullies: http://bit.ly/qjUCY0

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

I was out kayaking yesterday morning bright and early from 6 to 8 a.m. 

One of the things that happens when I’m out without anyone around on a calm day is my mind will think. But it’s not the wounded up thinking that happens when I’m at work, trying to keep to a schedule. It’s more a meditative type.

WINDING UP

We live in such a fast-paced society now a days. We get up and rush to get ready for work. You have to get your children ready for school before getting yourself ready. Some mornings I’m just getting myself out the door on time, so it’s hard to imagine adding children to the equation. I’d have to get up earlier ( isn’t 4:30 a.m. early enough?) or substitute journaling and meditation (which contradicts my self care plan). 

So maybe you do what my friend did and consider home-schooling your children. 

She doesn’t have to rush in the mornings unless she’s scheduled an appointment. 

UNWINDING

Kayaking slows things down. It’s meditative in nature (pardon the pun) but it’s nature that I love the most. I listened to the seagulls rising with the sun. I had two sea otters pop up in front of my kayak and stare inquisitively. I sat still for over 10 minutes and watched a heron patiently wait for its breakfast – waiting patiently (very Tao). 

The rhythmic nature of the paddling got me thinking about an information session I just listened to on pain management. It’s about 45 minutes, so only follow the link (at the bottom of this post) if you have 45 minutes. 

IF YOU DON’T, HERE’S A SUMMARY

1. We can change pain by shifting our beliefs and attitudes towards pain and people suffering with pain (by removing the barriers).

2. Learn self management.

3. Pain doesn’t always mean damage to the body (it hurts but there is no harm).

4. Pain changes everything (tissues, body chemistry, cells, emotions, thinking, breathing, posture, sense of self and relationships).

5. Number one treatment according to scientific evidence is combined cognitive behavioural therapy and exercise.

6. Chronic pain conditions are closely related to hypersensitive nervous systems.

7. Treatment programs need to take advantage of neuroplasticity.  

8. With chronic pain, the nervous system develops a Learned Helplessness.

9. The body’s image becomes distorted with chronic pain.

10. Desensitizing the nervous system, with the altered body schema/image, through visualization, meditation, rhythmic activities, breathing, yoga, touch, and/or hot or cold application.

11. Breathing: a very powerful way of calming the nervous system – practise five minutes, five times daily for four to six weeks.

12. SET GOALS – so you have something to work towards. These should be achievable with a timeframe to achieve them.

It is possible to change the nervous system

It takes time, persistence and consistent practice

IF YOU’RE MOTIVATED:

Pain management session: http://www.vimeo.com/28165279

 Neuroplasticity: http://en.wikipedia.org/wiki/Neuroplasticity

A great book on neuroplasticity: The Brain That Changes Itself by Norman Doidge, MD: http://www.normandoidge.com/normandoidge/MAIN.html

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.

Have you ever wondered why some people heal from an injury and why someone else might not? 

Have you ever wondered why you’re experiencing repetitive injuries or pain in certain areas of your body?

Wendy has been doing more and more reading on the mind-body connection. 

Some of her favourites include Carolyn Myss’s Anatomy of the Spirit, Bruce Lipton’s Biology of Belief and most recently, Louise Hay’s You Can Heal Your Life.  

MOVERS AND SHAKERS

In June, Wendy attended a Mover and Shaker’s workshop put on by Cheryl Richardson and Hayhouse. Part of the homework was to put together a book proposal and/or a 5-7 minute video with a message. 

Wendy focused on the mind-body connection in a video. To have a boo, go to the video section on our blog or search for it on YouTube under ‘Start Line Physiotherapy.’ 

Remember we are more than just our physical bodies. Our feelings and emotions can be reflected through our bodies. If we don’t listen, the volume (pain you experience) gets turned up.

I’ve recently been having to explain to clients the difference between having joints that are nice and snug versus joints that are too loose. A joint is where two bones come together. Most joints are surrounded by strong collagenous tissue called a capsule. There are also ligaments supporting the two bones that make up the joint. 

THE CUP VS SAUCER

For the average person, joints are like putting a ball into a cup. The ball can move around but is relatively stable. Some people’s joints are like the ball in the saucer that moves around too much. These (sometimes lucky) people tend to be great at stretching (head right down to the floor) and are likely into ballet or gymnastics. 

These are the loosey-goosy type people. 

OUT OF JOINT?

What I’ve noticed clinically is  with clients like me with joints snug in the socket, the tight muscles compress the joint, but they don’t seem to get pulled or pushed “out of joint.” 

I can have tight muscles and discomfort, but I’m still able to function. And as far as treatment goes, as soon as I loosen off the muscles (IMS, manual tissue mobilizations, and of course stretching), the pain goes away and it’s all good.

However, when someone has a looser joint, a single muscle that is tense, it seems they’re able to push or pull the joint out of position and mechanically move it the way it should move. 

A great example is a client who had inner knee pain for over six months before seeing me. There was no evidence of ligament damage (both knees moved too much in my opinion, which is called hypermobility). 

What I discovered was a tense ropy sartoreus muscle (longest muscle in the body coming from the front pelvic bone to the inner knee).  Once the satoreus muscle was released (with IMS) during our first session, the client experienced huge improvement and was back to normal activities (with a core and knee stability program). 

LETTING GO OR HANGING ON

For those of us with normal to tighter joints, once the ropy, reactive muscle is released, we should be stretching to help the mobility in our joints and muscles. For those who are too loose, you’ll need to commit to stabilization exercises on an ongoing basis.

Your ligaments and joints require good support from your muscles. Just ask my sister. She has spondylolithesis (one bone in her back slipped forwards on the other).

If she doesn’t do her Pilates stability exercises on a regular basis (stops for more than two weeks), her discomfort increases. 

BALANCE

An equation for success. What’s desired (=) is  MOBILIY (+) STABILITY (-) LESS PAIN and (+) FUNCTION.

IF YOU’RE MOTIVATED:

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. We’re now on Twitter too! To book an appointment at Start Line, call the clinic at 250-746-7463.

As a physiotherapist who has always been very manual therapy oriented, the discovery of IMS (Intramuscular Stimulation) changed my practice the most. I was once told that I could get 90 per cent of people feeling better just with my skills I learnt in school, and therapeutic use of myself. But for the other 10 per cent, I would need more skill. My last preceptor (the person who guided me on my clinical student placements), told me to get my hands on as many people as possible. I know this sounds highly inappropriate but, conations aside, this was great advice.

NATURAL HEALING

When we injure ourselves, there is a natural healing process. What this means is that the damaged tissue will repair itself given enough time. Why then would anyone need to come to see a physiotherapist? What people are not always aware of is it’s not always just the tissue damage that’s the problem. 

SCAR TISSUE

There is the formation of scar tissue that if not mobilized (through movement) as it heals will get tight and scarred down. The massage therapist who was working on me the other day mentioned how tight my left buttock was. I related this to my piriformis syndrome from prior nerve irritation in the lower back. She told me it felt more like scar tissue, like someone might have after a fall.  Immediately I thought back to Grade 5 when I was trying to hang upside down with my feet in the rings, only to discover that my feet were too small as I toppled to the ground landing half on the mat and half off the mat. How could I forget the pain in my buttock at the time?  Of course being a kid, I just went on with life. 

I know the benefit of deep tissue release work to areas where there is scar tissue damage. My partially dislocated shoulder continues to improve with massage therapy to it.  Of course I am doing the work from my end as well, with stretching and strengthening work. 

MUSCLE REACTIVITY

The other thing that seems to happen with an injury is muscle tissues go into a protective shortening (most people would consider this a spasm).This protective response is controlled by our nervous system. What these bands of tissue feel like to me are ropy knots in the muscle that are tender and/or painful to light massage and do not go away fully (and may get worse) with deeper scar tissue massage work. 

THE ROARING MUSCLE

When the engine of your car is revving too high, you punch the gas and the revolutions drop.  When your computer is malfunctioning, you turn it off and turn it back on.  This is what we call rebooting. When the engine of your muscles are revving too high is when I use IMS to reboot the muscle. An acupuncture needle (more like a filament) is inserted into the muscle, and the muscle that is reactive will jump or twitch. After IMS, muscles feel very fatigued and may be sore like you have done a workout.  What I tell people is it’s like we have shut down the muscle and are rebooting it. 

REBOOT TIME

 If a client goes out and performs the aggravating activity right away while the muscle is rebooting (generally no less than 48 hours but it can take up to a week), it will become over active again. What I find is it’s not quite as bad the next time though. Nobody really wants to stop the activity they are doing (unless of course it is work or vacuuming) but sometimes if you don’t stop, treatment really just feels like maintenance, without any full resolution.  I am guilty of this, but have been better lately. 

EFFECTIVENESS

IMS is not for everyone, and there are still times that a joint needs to be mobilized (wiggled free) or manipulated, scar tissue needs to be released, the whole system needs to be relaxed.  What I have found is I perform IMS on approximately 90 per cent of my clients, and would estimate it’s effective on 90 per cent of those clients. I continue to utilized my other manual therapy skills, educate the clients, and provide exercise instruction.  I also refer to other health care practitioners. 

REBOOT YOUR BOOTIE

If you’re suffering with a pain that just won’t go away, perhaps a “sciatic” pain in the buttock or down the leg, neck and upper back tension with or without headaches, a rotator cuff shoulder impingement, achy knee joints, hip pain, consider IMS to help reboot your tight muscles, taking compression stress off the joints, or simply allowing the joints to move as they are supposed to because the muscle imbalance is no longer present.

IF YOU’RE MOTIVATED:

Make sure to check out this link: http://www.istop.org/

We’re online in every place imaginable! Surf our website www.startlinephysiotherapy.com, then be our friend by moseying on over to our Facebook or Twitter sites by hitting the link there. To book an appointment at Start Line, call the clinic at 250-746-7463.