The phrase “no pain, no gain” would probably be the leading misconception about pain that I hear – live by this slogan at your own risk. Why? Because first and foremost, pain is a protector. Pain is a wonderful and fascinating perception that helps to keep us out of danger. I can certainly sympathise that when you’re experiencing persistent or intense pain, its hard to see it as “wonderful” or “fascinating” but it truly is a remarkable defence mechanism that we possess. When you step on a nail, twist your knee or tweak your back, what comes to your defence first? The simple answer is pain. It’s your first warning of actual or even potential tissue damage. Yes, that’s correct – “potential” tissue damage, meaning your body is smart enough to tell you to withdraw from danger before the damage is done. Wow! When tissue damage does occur, such as a strained ligament, tendon or muscle, your body sends all its best healing products to the area in the form of ‘inflammation’. The brilliance of inflammation is that it increases the sensitivity of the danger detectors (receptors) in the damaged area, which send more danger messages to the brain where they are processed and a pain experience can result. What do you think of that? Essentially, your body doesn’t just heal you with inflammation but it also tells you about it through the feeling of pain as a way of changing your behavior, allowing the area to rest and heal more effectively.
If you understand that the experience of pain is a critical response when the body feels threatened or in danger, then you will see how the slogan “no pain, no gain” will quickly lead you astray. Instead, us ‘pain geeks’ like to encourage the slogan – “know pain or no gain”, meaning that if you understand why you are experiencing pain and what it means, you are more likely to adopt the appropriate behaviour to encourage recovery.
The story of pain can get rather complex but equally as fascinating. Like any of our body systems, our defence systems can sometimes get a bit carried away and malfunction. This is often the case in the event of persistent pain – a story that will have to wait for another time. Until then, remember “know pain or no gain”.
Nick Black is a registered Physiotherapist at Sun City Physiotherapy Winfield.
BODY ROLLING: A new way to enhance flexibility and well being.
How often do you get a tight area in your back that you’d love to get rid of? Or a tense band in your buttock or hamstring that has plagued you for weeks? Have you noticed that your shoulders round forward, and you’re tight across the back of your shoulders? The nagging tight spots we feel can be the result of restricted mobility or adhesions in fascia, the elastic web of connective tissue that surrounds and connects muscles.
There is a technique to improve flexibility that is easy, inexpensive and works extremely well in conjunction with stretching to improve myofascial mobility. It’s called Body Rolling, and it’s a powerful self-treatment tool using a firm 5” diameter ball. It is similar to using foam rollers, which are popular in gyms. Because of its size and compressibility, it is useful in areas other tools can’t reach.
Body Rolling techniques combine the relaxing effects of massage with the toning effects of exercise. Working with your own body weight, the exercises ease movement by loosening the muscles and their surrounding fascia, with the benefits of a deep self-massage. It can take as little as 10 minutes to work a specific area, and you can do it at your convenience. Working an entire region or chain of muscles gives the best results, since fascia is connected in long tracts that can span more than one joint.
The techniques of Body Rolling can: free adhesions in the connective tissue sheath that wraps around muscles and lies between muscle fibres; help muscles lengthen; improve muscle flexibility and tone thereby improving range of motion and shock absorption in the joints; improve circulation; and assist in correction of faulty posture
People with an active lifestyle often come in to see a physiotherapist with unexplained pain in a muscle, tendon or joint. Physiotherapists look at posture, movement and perform selective tissue tension testing to determine the problem. As a physiotherapist, I use many tools, such as manual therapy, exercise and soft tissue releases to improve freedom of movement.
With exercise that is highly repetitive in nature such as running, cycling, rowing, racquet sports, fascia surrounding the working muscles tends to be loaded in one direction and can subsequently shorten. Movement patterns and normal posture can be altered, which can lead to injury and pain. Learning to use Body Rolling, and stretching along planes of movement, rather than spot-treating tight areas can free things up most effectively.
People working at a desk job every day tend to develop shortening in certain muscle groups– typically the pectoral muscles, the hip flexors, and the hamstring muscles. Over time, this can result in adaptive shortening. The price tag of a desk job can be poor posture, aches and pains at the end of the workday. Activity breaks and Body Rolling can help.
Hip osteoarthritis is a common condition that involves the degeneration of the articular cartilage of the hip joint. If you have this condition and are noticing an increase in pain and a decrease in physical function you may be wondering what treatment options are available to you.
With osteoarthritis of the hip you may feel a constant ache localized to the groin and side of your hip and sometimes extending into the front of your thigh and knee. The hip often feels stiff, especially first thing in the morning when you get out of bed and it can make activities of daily living much more painful including standing, walking and stairs. It can also make it difficult to put your socks on, get into and out of your car and even get on and off of the toilet.
Stiffness, pain and having difficulty with many previously easy daily activities may lead you to want to do less physical activity. The trouble is, not moving will often lead to weakness, further stiffness and general deconditioning.
A physiotherapist can help design a treatment program with a focus on decreasing pain, increasing range of motion and flexibility, improving core stability, gaining muscle strength and endurance and improving general conditioning. Other functional goals often include improving walking pattern, speed and distance, ability to go up and down stairs without pain and better control going from sit to stand.
This is often accomplished through a combination of education, manual therapy and exercise. An exercise program is often extremely beneficial to help improve physical function and decrease pain. A physiotherapist is an excellent resource to put together a safe and effective home exercise program for you to perform daily at home or at your local gym. Also, if you enjoy swimming, bring this up with your physiotherapist as aquatic exercise is a great form of treatment for hip osteoarthritis.
Other possible physiotherapy treatments that may be effective for some individuals with arthritis of the hip include: acupuncture, massage, heat on the muscles around the hip, ice, TENS, supportive footwear and/or a gait aid such as a cane or walking poles. It is important to talk with your doctor about your arthritis to discuss other treatments that may be beneficial to help manage your symptoms. Certain medications may be helpful, but it is important to bring this up with your doctor to be sure they are appropriate for you. Also, if you are overweight, a weight management program can be extremely beneficial to decrease the stress on your joints. Since nutrition plays a crucial role in weight management, it is important to have this discussion with your doctor.
A small portion of individuals with hip osteoarthritis will eventually opt to have a total hip replacement. This is often the case when symptoms are progressively getting worse and significantly limiting activities of daily living. If you have had a total hip replacement a physiotherapist guided post-operative hip strengthening program is ideal in order to decrease pain, improve your hip function and return to your active lifestyle.
Krista Smith is a Registered Physiotherapist and associate at Sun City Physiotherapy’s downtown, St. Paul Street location. She can be contacted at 250-861-8056 or email [email protected]
Optimal bone health is a serious consideration in people approaching mid-life. It is common knowledge that bones become more brittle as we age. What may be less recognized are the factors we can control through exercise and nutrition in the first half of adult life that have a direct effect on prevention of osteoporosis.
Osteoporosis is a disease characterized with a loss in bone mass and deterioration in the sturdiness of bone structure. This is associated with the increased risk of fractures, particularly in the hip, wrist and spine. It is prevalent in the older population. If you are a woman, you have a 50% lifetime risk of a fracture from osteoporosis. Bone loss is an insidious process. In the early stages it is called “osteopenia” It can occur when an arm or leg is casted after a frracture. A loss in bone mineral density (BMD) can accelerated after taking steroid medications or with certain autoimmune disorders or diabetes.
Reduced levels of estrogen after menopause accelerate bone loss. However, it is well- established that if a woman in her 40’s and 50’s exercises regularly and has good nutritional habits, she can diminish her post-menopausal bone density loss substantially. Osteoporosis is optional!
How does exercise affect bone health? Bone is a living tissue. Bone cells, called osteophytes, have the ability to act like strain gauges and adapt to the amount of stress placed on them. Regular weight bearing exercise or strength training is essential to maintaining healthy bone. Resistance training improves muscle mass and strength and can increase spine and hip bone density. It is essential that the exercises chosen are safe and appropriate for the individual. Physiotherapists assess posture, understand risk factors and can advise which exercises are best for those with osteoporosis.
As a preventative measure and for those with mild osteopenia, high and medium impact exercise such as soccer, tennis, activities such as skipping and step-ups can stimulate healthy bone cells to produce a stronger bony matrix and increase BMD.
For individuals with moderate osteoporosis, weight bearing exercise and moderate impact exercises are appropriate, high impact exercise is not. Strength training exercises should target the specific areas affected. Balance exercises and fall prevention awareness are important, as falls can result in fractures, which are painful and can take much longer to heal than with normal bone. Working with a physiotherapist with specific knowledge about osteoporosis to set up an exercise program is highly recommended. Check with your physician before beginning a strenuous exercise program.
Attention to postural alignment during strength training is important. Certain exercises place too much strain on the midback area and can increase the rounding, or kyphosis in this area. For example, repeated curl-ups for abdominal strengthening, or swinging kettle balls with arms extended should be avoided.
Why does nutrition play such an important role in prevention of bone mineral density loss? Bones are important warehouses for calcium and other important minerals needed for cellular function. If our diet is low in calcium, the body borrows it from our bones. If it’s not restored, a net deficit in minerals can result in reduced BMD. In order to maintain optimal bone health, sufficient amounts of Calcium, Magnesium, Vitamin D are recommended.
As a physiotherapist, I assess and treat injuries that occur in the workplace. These can be sudden (acute), or gradually over time (overuse). Overuse injuries come from repeated stresses that cause micro-damage of muscles, ligaments, or joints. Over time the micro-damage turns larger, and pain and weaknesses become apparent. Overuse injuries are quite common, difficult to diagnose, but relatively easy to prevent.
Any job comes with some degree of risk of injury. Knowing what your risks are, and working together with your employer or organization to minimize these risks is important for keeping your body happy and work-ready.
When possible, look at your work environment to see if anything is within your control to be changed. I will use physiotherapy as an example: There are times when I can modify my environment in order to make a task easier on my body. I can raise and lower the treatment table, or my stool on which I’m sitting, or in some cases I can use equipment that is ergonomically friendly.
Other times, the environment is not ideal, but also not in our power to modify. This is when you need to think of your body mechanics– the way you use your body to perform a task. Here are some general tips, from head to toe, of ways you can keep good body mechanics. This list is not exhaustive so it is important to consider each task you have to do individually, and what risks may be involved.
Head and neck: a common posture that is a big no-no is the forward head posture where the chin juts forward and hinging occurs about one vertebra in the lower neck. Any time you are in an upright position, keep a nice gentle chin tuck, with the back of your neck long.
Upper body: the other common poor posture is the rounded shoulder posture. When in this position too long, the muscles in the front of the chest get tight, and muscles in the back get long and weak. Also avoid hunching your upper back, which can also contribute to a forward head posture. Keep your shoulders pulled back, with your chest open and proud.
Arms: working repetitively above shoulder height can put you at risk of an injury called ‘impingement’ in the shoulder. When it is possible, avoid having your hands overhead, or above shoulder height, especially if lifting. This can mean using a step if you’re trying to reach high, or finding ways to better position yourself around your task. Avoid repetitive reaching away from the body; if it is possible, put your body closer to where you’re working.
Hands and fingers: if your job involves a lot of bending of your wrist or fingers, gripping or grasping, it is important to stretch those tired muscles, and to strengthen the opposing muscle groups to balance it out. If you work at a computer, look to see what your wrist position is at the keyboard or the mouse. Ideally, they shouldn’t be bent up toward you too far, and the bottom of your wrist shouldn’t sit on a hard surface for a prolonged time.
Low back: Lifting techniques and proper sitting posture can make a big difference in low back pain! If you sit a lot, try to support the normal curve of your spine either through a ‘lumbar support’ or a rolled towel. For those who lift during the work day, remember the following important points. Keep the load you’re lifting close to your body. If what you are lifting is below waist height get into a lunge, or a squat position and stick your bottom out like you’re going to sit in a chair. This helps to preserve a ‘neutral spine’ – which is slightly arched. Lastly with regards to lifts, or picking anything up / putting anything down of any weight, avoid twisting and bending simultaneously.
Legs and feet: avoid twisting your body when you have a foot, or both, planted. Wear footwear that is supportive, and appropriate for your job. If you have been prescribed orthotics, ensure you wear them while working, to help support your feet and legs. If sitting, change up your position: try not to sit all your time with legs crossed, and if you do cross your legs, try to balance how long each is the leg on top.
If you do notice new pain or weakness, attend to it as soon as possible. While many injuries require 4-8 weeks to heal at the level of the tissue (although you may return to some functions during that period), this time frame can be made longer if the injury doesn’t have a chance to heal, or if it gets re-aggravated. Be conscious of what you feel, what your job demands are, what may have caused it, and how that risk can be minimized. Seek help when help is needed, be it through your work’s first aid service, or a health professional.
Across Canada, during the month of May there will be promotion of the profession of physiotherapy. Meanwhile, across Canada during the month of May, many people will be asking the question of “What is physiotherapy, anyway?” With National Physiotherapy Month nearing, I felt this would be a great time to answer that very question, and others that I have been asked from friends, family, and clients.
Questions such as:
What is physiotherapy?
What do you do?
Who gets physiotherapy?
Where can you work?
How long did you have to go to school?
My dad, while I was undergoing my studies, once asked, “So, you’ll be cracking backs then?”
In short, physiotherapy is the assessment, diagnosis, and treatment of pain, injuries, and a broad range of chronic conditions. It is delivered in a number of ways including soft-tissue techniques (i.e. massage), hands-on manual therapy, modalities, and the most fun (for us) – exercises. Physiotherapy is often a complement with other health professions to help decrease pain, and optimize strength, function and overall well-being.
To become a physiotherapist in Canada now, an undergraduate degree must be completed, followed by a two-year Master of Science degree. The latter involves extensive hands-on practice both in class and in placement settings. The schooling doesn’t end there! Physiotherapists are committed to life-long learning, taking further education to improve current, or gain new, skills. (So to answer my dad’s question: yes, after courses and a specified number of hours of training, physiotherapists can ‘crack’ backs. Although we prefer to use the term ‘manipulate’.)
Physiotherapy isn’t limited to people with acute injuries – the service is also provided for people with heart disease, stroke, amputations, chronic pain, and lung disease, to name a few conditions. All ages and abilities can be treated: from pediatrics to geriatrics and everything in between. Physiotherapy can also be proactive, by promoting healthy living and avoidance of injuries and illness.
There are many settings in which physiotherapists work. The most commonly thought-of environments are the clinic or hospital. Physiotherapy is also provided in retirement residences, long term care facilities, hospices, community health centres, in home, in the work place, on the sports field, and in schools.
When looking at how many systems of the body can be treated with physiotherapy, and all the different environments in which it can be delivered, it is understandable for there to be some mystery around the subject. I hope this was helpful in understanding what the profession is. For further information, you can visit the website for the Canadian Physiotherapy Association (www.physiotherapy.ca), and the BC division (www.bcphysio.org). To learn more about National Physiotherapy Month check out www.npmcanada.ca, where you can find information, take a survey, or thank a physiotherapist. Although, seeing people feeling and functioning better is the best ‘thanks’ of all!