Intro to Body Loops
Sunday March 11, 2018, 2-4pm Six – Nine Months
Sunday March 18, 2018, 2-4pm Nine -13 Months
Sunday March 25, 2018, 2-4pm
Synergy Sports Medicine
235 Wallace Avenue
Cost: $150 + HST
The Body Loop, developed by Diane Bruni, will be used while exploring developmental movement patterns which are hardwired into our central nervous systems. Developmental movements range from baby pose to quadruped to squatting to walking.The Body Loop will be used to enhance proprioception, provide support and increase muscle recruitment.
SUITABLE FOR: Movement Coaches, Psychotherapists, Holistic Health Experts
Learn about cutting edge and easily accessible nervous system regulation tools that Jane Clapp has curated for movement coaches, psychotherapists, holistic health experts and anyone interested in improving self-regulation. Discover the long term impact of chronic stress and trauma on physiology and neuroplasticity and walk away with new practical body based interventions for personal transformation and better self care while being exposed to traumatic stress in others. Learn how nervous system dysregulation affects physical and mental health, when to meditate and when to move, and many tools that you can begin to use now.
The Alexander Technique is a simple and practical method for improving ease and freedom of movement. An Alexander teacher uses gentle hands on guidance to direct a student to a non-habitual experience of effortless movement and coordination. Through this moment to moment process of awareness, we learn to apply the Alexander Technique to the activities of our lives, either for performance (singing, dancing, making music) or any daily activity such as exercise, public speaking, working at a computer, or daily tasks. In this workshop, we will work with simple activities that the participants would like to explore.
Lower back, hip, sacroiliac joint problems ? Pelvic and core stabilization is easier than you think ! Learn the Franklin Method bone rhythms that automatically engage your core.This workshop is suitable for movement teachers, patients of Synergy or anyone wanting to learn how their pelvis and hips move.
In this workshop you will experience:
Pelvic exercises for strength, endurance & flexibility
How to release tension in your lower back and pelvis
Dynamic core training and dynamic posture
How to restore strength & stability to your pelvic floor
It can be daunting to undergo such a sudden change in your care after being used to in-person visits likely your whole life!
Having worked with patients virtually over the past month or so, I wanted to share personal experiences that may help clarify what to expect in a virtual session, and dispel 5 common concerns (many of these were shared to me personally by patients) that may have you hesitating to try virtual physiotherapy.
1. The technology sounds too complicated.
Joining our virtual care sessions takes exactly one click! We go through the process of creating a profile for you and setting up the video calling software behind the scenes. When your appointment time rolls around, the process is as simple as clicking on a link in your email to be instantly connected to your physiotherapist.
2. It isn’t possible to accurately assess or measure anything without a hands-on session.
The reality is that the special tests we use our hands for can be helpful at pinpointing or provoking your pain, but they only make up a small portion of our diagnostic skills. We come to a better understanding of your problem by hearing your story, watching you move, and if needed, have you press and poke where it hurts.
3. I need manual therapy to get better.
The benefits of manual therapy to your recovery are undeniable. Luckily, there are plenty of self-release/self-massage techniques using household objects like tennis balls that you can use to manage tight and sore areas. While they may not replace how hands-on treatment feels, it can be a great way to get the quick relief you need to help you move forward with your recovery plan.
4. I don’t have any equipment at home.
It can be tough to adjust to a lack of exercise equipment, especially if you’re used to a full selection of weights and machines at the gym. The good news is that your body can be strengthened, stretched and mobilized with little to no equipment. Also, we have strong research that suggests you can maintain or even enhance muscle growth at much lower weights or loads than what you’re used to, if the exercises you do are sufficiently challenging and are repeated for long enough. Your physiotherapist can help put together the right program to help meet those requirements.
5. I already have a hard time getting my exercises done at home.
Here’s a simple counterpoint: what better way to help you find ways to get you on your recovery plan than to have someone walk you through your exercises from the comfort of your home – where your equipment is within arm’s reach and with real-time feedback on exactly how to do your exercises to perfection?
If you’re still unsure about if virtual physiotherapy is right for you, our physiotherapist Samy Shash is offering a FREE 10-minute demo sessions. You will have the opportunity to see how the software works and get any remaining questions answered!
To claim yours simply give the clinic a ring at (416) 551-8715!
Do you wake up with a stiff and sore back? Maybe you find your back getting tight while sitting at your desk trying to finish all that work that’s piled up? Does bending down to play with your kids or pet your dog seem like a risky pursuit? If so, you are one of the 80% of people on this earth that suffers from back pain at some point in their life.
Despite all the research that’s gone into it, lower back pain continues to be a health epidemic. Just have a look at these statistics:
In any given six-month period, five in 10 Canadians suffer low back pain¹
Up to 85% of working people can expect to experience low back pain during their lifetime²
In Canada, the low back pain-related estimate of the medical costs ranges between 6 and 12 billion dollars annually³
So now that we know how common lower back pain is, why do we get it and how can we fix it?
So, here’s the deal, all the clinicians at Synergy Sports Medicine on the Danforth are first class all the way. BUT they cannot always tell you exactly why you have lower back pain. They can, however, work with you to fix it! Despite what some fad blog may tell you, lower back pain is complex and can have multiple causes. Some may develop lower back pain from sitting too long at the desk, others may get it from playing a sport after not having done so in ages. In those instances, both too much and too little physical activity caused the same annoying result… back pain!
We do know that we are more sedentary than ever as a population. We sit in the morning to get to work, we often sit for hours at a time while at work, we sit to get home and then we sit some more to watch Netflix. After that we lay down and go to bed and do it all over again the next day. Our spine is designed for movement, it craves it! Why else do you think we have 7 moveable neck bones, 12 in our mid back and 5 big ones in our lower back. If we didn’t want our spines to move, we’d have one long solid bone here – we really were built to move! We have a lot of joints connecting all those bones that feel best when moved. If the spine stays in static positions for too long, the joints and synovial fluid inside the joints gets stiff leading to lower back pain. As the saying goes “Motion is Lotion”
Now, there are many other causes of back pain that would need a whole other plan of care. For example, you may have a disc herniation that’s causing shooting pain from your back down into your leg and even into your foot. Synergy Sports Medicine sees these types of patients daily and knows exactly how to manage them.
Fixing lower back pain involves 3 key components
A thorough and detailed history where your unique story is heard:
We want to know all about you and your pain. How did it start? What have you found makes it better or worse? What is your pain limiting you from doing? And most importantly, what are your goals for coming to see us? Some people want to avoid taking medication that just covers the pain, while others want to get back to playing golf pain-free. Knowing your goals is paramount to a successful result.
Doing a proper physical examination: Your therapist at Synergy Sports Medicine on the Danforth will conduct an exam to pinpoint some of the structural issues that might be contributing to your pain. They may do a neurological scan, assess range of motion and strength, watch how you move in certain directions, feel for tight/stiff joints and muscles all to figure out why you have pain.
3) Getting the most appropriate care for your specific condition: This may involve hands-on manual therapy where the joints of your back are stretched and mobilized to ease tension. It may also involve soft tissue massage and stretching of your entire spine, hips, legs, ankles etc. Of course, what can never be forgotten is the stuff your therapist shows you exactly what you can be doing to get your back pain recovery sped right up! Making sure to complete the home exercises only serves you speed up the process and helps prevent it from coming back. This is where we give you the power to take control of your pain!
Conclusion
If lower back pain is something that is ruining your life and taking you away from the activities you enjoy you owe it to yourself to get it looked at by a trained professional. Physiotherapists understand how debilitating lower back pain can be. They seek to figure out what’s causing your pain instead of just treating symptoms that will just come back again and again if the underlying issue isn’t addressed. If your goals are to reduce the need for medication, get more mobile, and enjoy the activities you love than seeking the help of a therapist at Synergy Sports Medicine on the Danforth would be a wise decision.
[1] GBD 2015 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet. 2016 Oct 8;388(10053):1545-1602.
[2] Hoy D, Bain C, Williams G, March L, Brooks P, Blyth F, Woolf A, Vos T, Buchbinder R. A systematic review of the global prevalence of low back pain. Arthritis Rheum. 2012 Jun;64(6):2028-37. doi: 10.1002/art.34347. Epub 2012 Jan 9. Review.
[3] André E. Bussières, et. al. Spinal Manipulative Therapy and Other Conservative Treatments for Low Back Pain: A Guideline From the Canadian Chiropractic Guideline Initiative, Journal of Manipulative and Physiological Therapeutics, May 2018. Page 266 Citation number 23. https://www.jmptonline.org/article/S0161-4754(17)30236-1/pdf
Yoga may not be a high-impact sport, but that doesn’t mean injuries don’t happen. Here’s some tips on how to have a safe practice.
Here’s the truth about yoga injuries
If you love yoga, you probably practice because it makes that tightness in your neck go away, loosens up your lower back and makes your limbs feel longer and looser. But like any other type of activity or sport — injuries can happen. A 2008 study out of Finland found that, among 300 yoga studios regulars surveyed, there were 1.18 injuries for every 1,000 hours of practice. And in a 2012 survey of 2,500 practitioners in Australia, 2.4 percent had a yoga-caused injury over the previous year. Those are low rates, for certain, but bumps, bruises, sprains and worse do happen. “Fortunately, most of these injuries are not serous, and they are preventable,” says Dr. Raza Awan, a sports medicine doctor whose Toronto clinic, Synergy Sports Medicine & Rehabilitation, has designed an injury prevention program to train yoga teachers.
How to stay safe?
First step in avoiding pain: stop trying to be great at yoga. “The number one cause of injuries is the ego,” says Awan. Avoid looking around the room to see if you’re acing the pose compared to others. When you push your body into a new pose and it hurts, stop. Read class descriptions and, if you’re new, you don’t join an advanced class. Other yoga injuries occur due to overuse of the muscles involved. So take it easy on retreats, during a 30-day yoga challenge or when you suddenly go from doing one class a week to four. (On a budget? Here are 4 tips for practicing yoga at home.) So what exactly can get injured during yoga? Read on to find out the five most common injuries and what you can do to prevent them.
How to avoid yoga injuries: Knee tears
It’s unlikely that you’ll injure yourself serious enough to require surgery, but a knee tear will slow you down for a few weeks. It can happen if you let the knee twist out of alignment when doing pigeon pose, warrior poses or half lotus. Mike Chapman, owner of Breathe Into Motion Studio in Cambridge, Ont., and a certified personal trainer, says moving from the hip while keeping the knee bend often prevents these injuries. Do all the prep poses before moving into something like half lotus and use props during pigeon to support the knee. Here are 10 signs your body and mind wants to practice yoga.
How to avoid yoga injuries: Hamstring pulls
Ironically, if you work too hard to protect your lower back — yet push deeply into a forward bend — you can pull your hamstring muscle up near your buttocks. Awan says people who go very deep into forward bends tend to do this. Instead, pull back. But also, breathe into the entire length of the hamstring along the back of the leg to be sure you’re stretching it all. Make sure you know this insider trick on how to stay motivated while practicing at home.
How to avoid yoga injuries: Wrist strains
All that time in downward dog can really do a number on your wrists — particularly if you have carpal tunnel or have tender wrists from computer work. Your body alignment during downward dog, arm balances and handstand also has to be near perfect. “You need to bear weight on the proper part of the hand,” says Chapman. Make sure your fingers are evenly spread and that both your index finger and the heel of your hand are pushing into the mat. Awan suggests rolling up the mat or using a towel to raise the wrists as well: having the fingers on a downward tilt can take the pressure off. Check out how yoga helped maintain her symptoms of rheumatoid arthritis.
How to avoid yoga injuries: Neck injuries
Neck injuries are probably the scariest area to harm — and it does take time to heal. Chapman says going into full wheel and resting on the top of the head before going up into the pose is a dangerous move, as much of the body weight is on the neck. Be cautious in headstand, plough and shoulder stand that you’re not putting too much weight on your neck. Also, in poses like camel and upward dog, you can fling your neck too far back without support. When putting pressure on your neck in an inversion, try to better distribute your weight, putting more of it on your arms. Prioritize neck safety over goals such as putting your feet to the floor in plough. The good news is, yoga is one of the safest exercises out there. (Awan says he once heard that the injury rate is comparable to that of gardening.) But you still need to be aware in every class of any pain and be mindful of your body’s limits. Find the right class for your level, with an experienced teacher who thinks about safety just as must as testing your limits. “It’s so important to get the right instruction,” says Chapman. And here are some fitness myths that can seriously damage your health.Download PDF Version
By Doug Smith | Sports Reporter Fri., June 6, 2014
SAN ANTONIO—Cramping is an issue that’s dogged LeBron James for a decade now; he takes the liquids and swallows the pills and does whatever he’s told to do and every now and then it gets to be too much.
And as he lay on the court at the AT&T Center in the dying minutes of Game 1 of the NBA finals, basically unable to move, it was as if an old enemy had come to visit at the most inopportune time.
“Basically, my body said, ‘OK, enough jumping for you for the night, you’ve had enough,’” James said Friday, about 18 hours after his cramp-induced departure played such a significant role in the Miami Heat’s 110-95 loss to the San Antonio Spurs to open the league championship series. “Nothing I could do about it.”
It wasn’t for lack of trying, though.
James said he drank as many liquids as he could (“I mean, I hydrated as much as I could to the point where your stomach feels like it just can’t take any more,” he said), changed his sweat-soaked uniform at halftime, and iced down his neck and body as frequently as possible. Heat coach Erik Spoelstra said James took “seven cramping pills” in a failed attempt to head off the issue.
But James said he knew early in the game that trouble was afoot.
“I noticed it in warmups . . . I actually sat on the scorer’s table for 10 minutes and stopped warming up, so I could cool down a little bit,” he said.
“I really started to feel it in the second quarter and I never really change my uniform, but at halftime I changed my whole uniform and in the third quarter I came out with, I believe, eight minutes to go in the third. And I usually play the whole third quarter, so I knew the conditions was a little extreme for me personally.”
Unfortunately for James, the answer isn’t as simple as taking a chug of some sponsor-prescribed Powerade and even the best advice comes with a pretty big caveat: an exact theory on why cramping occurs is still elusive.
“The theory on electrolyte loss and dehydration is not conclusively proven,” says Dr. Raza Awan, a sports medicine specialist at Synergy Sports Medicine and Rehabilitation in Toronto. “There’s a lot of controversy right now in the literature.”
The most common alternative to the dehydration theory is muscle fatigue, Awan says. Simply put, too many back-to-back games with practices in between can force your muscles to involuntarily contract or cramp. “That’s why you often see it in the finals or the last 15 minutes or so of a match,” he says.
James said he has gone through a battery of tests over the years in an attempt to find out why he’s more prone to crippling cramps than many other players. None of them have come back with any conclusive answers so he’ll do what he does and hope for better timing.
It’s one thing to cramp up in some meaningless regular-season game; it’s quite something else to have it happen in the NBA finals with about three minutes left in a two-point game.
“It hasn’t happened a lot in my career, it’s just so happened it happened twice in the NBA finals and we all remember that,” said James, who added that he was sore Friday but fully expects to play in Sunday’s Game 2. “It happened in the OKC series (in 2012) and it happened last night. So, bad timing on my part.”
James was criticized by some on Friday for not playing through the pain with so much on the line. But a series of cramps — James said multiple muscles tried to shut down — for an NBA player are like nothing a regular human would endure.
“Zumba classes don’t count,” said James’ teammate Shane Battier.
Said Miami coach Erik Spoelstra: “It’s like trying to play, you know, an NBA basketball game in a hot yoga environment — it’s not ideal. We’re not making excuses for it, we’re trying to adapt on the fly and it was at an extreme level and he was competing at an extremely high level.
The only other answer would have been to pace himself, and he doesn’t have that in his DNA.”
‘Overwhelming evidence’ arthroscopic surgery ineffective for arthritic knees, expert panel says
CBC News · Posted: May 11, 2017 Physiotherapy and weight loss are likely more effective than arthroscopic surgery for knee problems stemming from osteoarthritis. An international expert panel says a common, minimally invasive surgery is largely useless for knee problems stemming from arthritis. Yet most arthroscopic knee surgeries in Canada are performed for this common condition. The panel of physicians, physiotherapists, academics and patients reviewed 13 randomized trials with control groups and found patients who underwent the procedure had the same outcomes as those who didn’t. Arthroscopic knee surgery involves sending a tiny camera called an arthroscope through an incision in the knee, allowing surgeons to look inside and use small instruments to cut tissue. “It’s not helping people in the long run.” – Dr Reed Siemieniuk McMaster University’s Dr. Reed Siemieniuk, who chaired the panel, said the ease of the procedure makes it an attractive option for physicians who want to alleviate their patients’ chronic knee pain. “It’s minimally invasive. It generally has low risk. But that said, if it’s not helping people in the long run, then even small risks can become important when it’s so common.”
$31M in health-care spending
Siemieniuk said arthroscopic surgery has been shown to be effective in only a small subset of patients such as those who’ve had a sports injury or experienced sudden knee trauma from an accident. But the panel’s research found that in Ontario alone, of the 27,000 people who had the procedure on their knees in 2013, about 90 per cent were due to arthritis. With an average cost of $1,300 per procedure, the figures suggests $31 million in health-care spending that likely had no long-term benefit to the patient. Evidence that arthroscopic surgery is ineffective for arthritis began emerging a decade ago, yet physicians continued to recommend it to their patients to treat secondary problems stemming from the condition such as meniscus tears, sudden pain or clicking and catching of the knee.
No easy answers
In its new clinical guidelines published in The BMJ (formerly British Medical Journal), Siemieniuk and the rest of the panel recommend against arthroscopy for these symptoms. He said there are no easy answers for chronic knee pain. Arthroscopic knee surgery: Why it may not help you “The first few steps are weight loss, physical therapy and painkillers, whether injections or topical creams. But long term, people with arthritis and chronic knee pain eventually go on to needing knee replacement surgery.” Siemieniuk said it is up to health policymakers and physicians to decide how to discourage needless arthroscopic knee surgery as the guidelines are just that.
Every time I cue my clients to engage their pelvic floors, I find myself doing it along with them. I’ve been engaging my pelvic floor like mad since my daughter was born over ten years ago, but I
recently discovered that all those kegels were doing nothing for what I lovingly refer to as ‘leaky lady syndrome’ AKA stress incontinence.
Then last month, I had the good fortune of meeting Michelle Fraser (referred to as Fraser in her circles), Orthopaedic and Pelvic Health Physiotherapist, certified yoga instructor and Rehabilitation Director at Synergy Sports Medicine. We were discussing treatment protocol regarding one of her patients, (one of my clients) and in that conversation I realized I had a lot to learn about the ins and outs of the pelvic floor and, more specifically, I had a lot to learn about my own.
So I booked an appointment. What better way to help my clients then to learn through my own body? She performed an internal exam to assess my pelvic floor muscular imbalances and within
a few minutes, I found out why I was suffering from stress incontinence even though I had a relatively strong pelvic floor. I was given a set of very specific and finely tuned exercises including
a breathing exercise that taught me how to fully relax my pelvic floor, something I clearly had forgotten how to do in all my manic kegelling.
What blew my mind is how ultimately simple my issue was and yet, so many women like me don’t get the help we need. In fact, I even trained one male gynaecologist who insisted pelvic floor
exercises were a waste of time and only surgery could really fix stress incontinence. What!?
I interviewed Fraser to share a bit of what I learned. This is what she had to say:
What’s your biggest pet peeve about how kegels or pelvic floor exercises are coached?
What makes me most sad is that so many men and women’s quality of life could be significantly changed with relatively simple treatment…so my pet peeve is that so few people know about pelvic
health physiotherapy! Doctors, obstetricians, gynaecologists, urologists midwives — their patients could benefit so much from pelvic health physiotherapy. Our responsibility is to continue to educate these health care professionals, as well as the general population, about this type of work. The most understanding seems to be anecdotal reports from patients/ clients/ friends…so spreading the word in the manner that we are doing (an article based upon a personal experience) is perfect!
Can people do more harm than good in doing a kegel/pelvic floor exercise the wrong way?
Yes. When I assess muscle function of the pelvic floor, I am checking to see whether muscles are working optimally, and if they are not, whether they are weak, too tense, too short, or not working
in a coordinated fashion with other muscles. Let’s say that, in one’s pelvic floor, one muscle is overused while an adjacent muscle is weak. If a general pelvic floor exercise is performed, such as a general kegel, the muscle that is already overused will come in, while the muscle that is weak may not. Therefore, the muscle that is overused may become painful because it is being overused even more, while the weak muscle may not catch up. This may lead to the difference in strength between the two becoming even more significant, worsening the patient’s condition. Ideally, overused muscles would be taught to relax, and pelvic floor strengthening exercises designed specifically for the weak muscles would be performed.
What types of major issues have you seen corrected for people who sought proper treatment with you?
other urinary symptoms (nocturia (getting up at night to urinate)
Hesitancy (unable to start the stream)
Pelvic, hip and low back pain
Sexual dysfunction due to pain that is not being able to participate in sexual activity due to pain
Rectus diastasis: separation of the abdominal wall, usually due to pregnancy
constipation
Mild bladder prolapse
Why do you think so many women are dealing with pelvic floor issues nowadays?
Our society teaches women to multi-task, to be “super-mom”and that “stronger is better.” Many of my patients benefit from the opposite of this — they benefit from softening, stopping and taking a breath, listening to their bodies, and not pushing through discomfort in order to reach unattainable goals. The conditions listed above are often due to too much tension in the body, rather than a
need to strengthen.
Also, there is a false notion in our society that it is “normal” to have symptoms such as urinary incontinence after childbirth — perhaps it is common, but it is not “normal” — and a pelvic health
physiotherapist can help to resolve these symptoms.
When your baby bump is causing back pain, there are plenty of things you can do to feel better without taking over-the-counter pain killers.
BY ALEX MLYNEK
During pregnancy, that bowling ball, a.k.a. baby, inside your uterus changes your whole centre of gravity, which results in your pelvis arahifting forward. This can lead to a common form of back pain known as pelvic girdle pain (PGP), which spans from the middle lower back area all the way around to your hips and pubic bone, says Sarah Mickeler, chiropractor and founder of West End Mamas, a clinic in Toronto that specializes in pre- and postnatal care.
At the same time, in order to compensate for this forward shift in their pelvis, many women naturally lean backward, which increases the curve of their lower back, potentially leading to low-back pain. Ouch!
All of this can add up to a lot of aches and pains, but the good news is there are a number of ways to prevent and treat it. “Pregnancy does not have to hurt,” says Mickeler. Here are some ways to find relief from pregnancy-related back pain.
1. Exercise the pain away
Staying mobile can really help with back pain as it keeps your muscles from getting too tight, says Cynthia Rebong, a midwife at Midwifery Care North Don River Valley and a yoga and Pilates instructor. Some forms of phsycial activity can become uncomfortable during pregnancy, but Rebong recommends swimming as a pregnancy-friendly way to keep moving.
Mickeler suggests focusing on your glutes when you exercise. “We have this anterior shift in the pelvis, and now we’re tucking our butt under, so our butt’s getting really tight, and super, super weak,” she explains. And weak glutes can wreak havoc with your lower back because they force other muscles, like your hip flexors, to do the work for them. Mickeler says exercises like squats, lunges, glute kickbacks or bridges can all help support your posture by strengthening not only your glutes but your back, hamstrings and calves, which will help prevent back pain.
If you already have low-back pain, manual osteopathic practitioner Riki Richter, co-owner of Synergy Sports Medicine and Rehabilitation in Toronto, recommends doing squats against a wall, which will give you support at the same time as minimizing that lower back bend. She also suggests cat pose, which will help keep that low-back area flexible. And if you have pain around the dimples in your low back, butt, hips or pubic bone, choose fitness classes that don’t involve forward bending, as that can be painful, says Mickeler.
2. Try pelvic floor physiotherapy
Another contributor to back pain is overly tight pelvic muscles. A pelvic floor physiotherapist can help you work on those internal muscles by doing what’s basically a massage of your pelvic floor through your vagina. This type of treatment has added benefits, too, as Mickeler says it can reduce the incidence of tearing during delivery, and give you a head start for recovery after your baby is born.
A pelvic floor physiotherapist can also assess the shape of what’s called your deep core, which consists of your pelvic floor, your diaphragm, your transverse abdominis and a muscle in your lower back. Mickeler explains that if one part of your deep core isn’t working well, it can mean that other parts of your body will have to compensate, which may lead to pain. Aside from working internally, pelvic floor physiotherapists can also use exercise- and rehab-based techniques to help with low-back pain.
3. Practise deep breathing
Sometimes belaboured breathing during pregnancy can contribute to back pain. “When we’re pregnant, because our organs get squished up from the weight and the size of the baby, we tend to have diaphragms that don’t function properly,” says Mickeler. This can lead to your rib cage not moving as well as it should, which can contribute to back pain, she says. Using proper breathing techniques can help keep your rib cage moving properly. Mickeler suggests practising what’s called core breath, where your ribs go out and up on the inhale, and in and down on the exhale.
Richter explains that this directed deep breathing is also important because super-slow silent inhales through the nose will help get the breath into your side ribcage and lower and middle back, helping to release tightness in those muscles.
Dr. Raza Awan suggests three ways we can get moving at work.
Office workers, beware. Did you know we spend three-quarters of our waking hours sitting or lying down? All that time on our derrières negatively affects our health, stresses out the heart, expands our waistline and increases the risk of diabetes, cancer and high blood pressure. Researchers have dubbed these ill effects as “sitting disease.”
Toronto physiatrist Dr. Raza Awan has seen an increase in joint and muscular pain as a result of our penchant for a sedentary lifestyle and isn’t surprised by the connection to other health conditions. “When you sit for long periods of time, the way your body metabolizes fat and sugar changes,” explains Awan.
The good news? Sitting disease is preventable. Here are three ways to reduce your time on your behind!
Take a stand. Stand while talking on the phone or reading a report. “If you aren’t typing, you can get up,” says Awan. Programmable apps like, such as BreakTaker remind us to stand every 20 to 30 minutes.
Try a moving station. Treadmill desks offer the flexibility of working while moving at one to two miles per hour —enough to get the heart rate up but not too fast to distract from work.
Swap out the office chair for a stability ball. Sitting atop it helps improve posture and strengthen abs, legs and back muscles.
From The Mindful Strength Podcast with Kathryn Bruni-Young
Riki is an Osteopathic Manual Practitioner, Pilates rehabilitative specialist, and a deep source of knowledge on the interconnectedness of anatomy, breath, movement, and more as it relates to our complex body systems. Riki also has a host of other trainings, is continuously researching and educating and co-runs a unique clinic in Toronto’s West end called Synergy Sports Medicine. As Riki’s practice is rooted in body science, this episode is highly technical and focuses in on the core, pelvic floor, breathing, strength, and mobility. We explore how Riki’s ideas and anatomical inclusions of core have changed over the years, take deep dive into breath/core connection, how to breath and feel breath in the body, where that breath should be directed in specific proportion, diaphragmatic breathing, and squatting. Learn some ins and outs of hyper-mobility, mobility in general, and joint congruency, as well as some examples of what Riki’s strengthening and rehabilitative protocols might incorporate and look like. Kathryn and Riki also chat about closed kinetic chain movement, specifically Dynamic Neuromuscular Stabilization (DNS) with mention of The Franklin Method and the overarching importance of continued education, keeping an open mind and staying curious to evolve with science and information of body, mind, injury, movement and rehabilitation. More at KathrynBruniYoung.com
Carpal tunnel is more than just a pain in the butt your hand — the painful, throbbing sensation can restrict movement from the tip of your fingers to past your elbow.
While doctors can’t say for certain that there is a way to prevent carpal tunnel, there are ways to reduce pain and even postpone or eliminate the need for surgery.
In the video above, physiotherapist Jesse Awenus shows us three simple exercises you can do at your desk to soothe carpal tunnel pain.
here is no singular cause for carpal tunnel, but researchers say many factors can lead to the condition, including gender, pre-existing medical conditions and workplace conditions.
“Repetitive actions like clicking on a mouse and typing all day can create tension in the muscles of the wrist, which place pressure on a nerve in the wrist, causing pain and numbness into the hand,” says Awenus. “Just like muscles, nerves also need to be able to move and stretch. If they get stuck or pinched, it will produce pain.”
You don’t have to play tennis to experience the agony of tennis elbow. The painful tendon inflammation caused by overuse of forearm muscles can be caused by all sorts of repetitive activities like typing, painting, knitting, gardening, and even weightlifting.
In this week’s episode of Fit Bites, physiotherapist Jeese Awenus shares three easy exercises to fight tennis elbow.
Starting with a simple wrist extensor stretch, Awenus demonstrates how you can relieve tension and increase mobility by placing light pressure on the back of your extended hand while it is bent at the wrist with fingers pointing down. Even a deep self-massage can help eliminate stiffness and tenderness.
Light exercises are one of many treatments for tennis elbow, and experts also recommend icing the elbow to reduce pain and swelling as well as taking anti-inflammatories like ibuprofen or, for more intense pain, painkillers or steroid injections for instant relief. However, aside from strengthening the muscles, most treatments only offer temporary relief.
Left untreated, tennis elbow can worsen, making it difficult to complete everyday tasks like lifting a cup or shaking hands. Surgery may be required for symptoms that surpass a year in duration including rest and treatment.
In our series Fit Bites, we look to fitness and well-being experts for three exercises to relieve common pains and ailments. What condition would you like to see us tackle next? Shoot us an email at [email protected] or let us know in the comments below.
Some injuries can take months, even years to heal. Patience and a well-rounded approach can increase your chances of a successful return to running.
by Tania Haas Published in Canadian Running Magazine, March/April 2012
One month before my first marathon, the 2010 New York City race, I was the fittest I had ever been. The momentum was building. Since I gained entry by lottery, I felt luck was on my side. That changed, however, when I heard something crack near my right knee when I got up from a chair. It didn’t hurt, so I ignored it and chalked it up to tired muscles. Then, a day later, 2K into a slow run, my right leg suddenly gave up. I tried to run it out, but my leg didn’t respond.
Days later, I learned the name for this symptom. Runners call it “dead leg”, and the cause was a severe case of Iliotibial Band Syndrome, also known as ITBS. My chiropractor referred me to a physical therapist who said, yes, I can do the marathon, if I downed several anti-inflammatories, strapped on a custom-made knee brace and drastically changed my race-day expectations. I eventually decided not to risk further injury and I reluctantly pulled out. Instead of running with the crowds through New York’s five boroughs, I entered the five stages of grief.
My doctor told me I had to rest and do nothing for a while. It was tough to digest, and I insisted that doing nothing was not an option. A sports medicine specialist agreed that I need to take time off. He told me the injury wouldn’t be permanent, and when ready, I could start building up stronger muscles around the knee. The process could take six months to a year. I had to be patient. Start slow, he advised.
At first, I denied the injury. Two minutes into the run, I would often turn around and limp home. I got angry at my typical training mistakes. Why did I overtrain? This was followed by stretches of bargaining, depression and finally, acceptance. After six months of grieving, I set my first post-injury race goal: a sprint triathlon in July. Kate Hays, a psychologist who specializes in sport and performance psychology, tells her patients to consider biking, swimming and other activities after sustaining an injury. “Often an injury is an opportunity to cross-train, find other ways to use your body that is also pleasurable,” says Hays. “And it often extends your running that much longer.”
With a goal in mind, I turned to professionals to make sure I trained properly this time around. My chiropractor, Rosty Serebryany, created an extensive post-injury strategy. It included Active Release Technique, Graston technique and acupuncture to help heal the weakness and pain in the iliotibial band. Then he gave me a series of specific rehabilitation exercises, geared to strengthen my weaker muscles. “Exercises for the ITB help increase strength and size of the muscle, which help with the recovery process. A stronger and larger ITB can more easily repel ground reaction and shearing forces that results from running,” Serebryany says. While I worked on strengthening my muscles, I needed an outlet to calm my mind, so I turned to yoga.
Riki Richter, who incorporates rehabilitative yoga and pilates in her classes, helped me work on strengthening weak areas and stretching tight spots. “I assess the person and try and remove any misalignments or limitations in the healing process,” says Richter, pilates and yoga director at Synergy Sports Medicine in Toronto. “Common issues I find with runners are a pelvic torque and foot issues. I treat these {conditions} using techniques in order to bring balance.”
When I was strong enough to train, I asked a good friend, Karla Bruning, to be my triathlon partner. She has a strong record of getting back into shape, even after suffering her own devastating injury. Bruning had a non-cancerous bone tumour removed from her leg in her mid-20s and used running initially as a form of therapy. She’s now 33 years old and has run four marathons since the operation. “Training with a friend is fun and motivating, whether you’re physically training together or emotionally training together,” Bruning says. “You have someone to inspire you and encourage you and commiserate with you, and then someone to share the experience of the race
with.”
Bruning and I cross-trained together, and we finished the Tri Sport Canada Peterborough Sprint Triathlon only minutes apart, last July. While I still think about running the New York City Marathon, my focus right now is enjoying a brisk 5K. As the saying goes, the journey of a thousand miles begins with a single step. And when it’s a pain-free step, the journey is much, much sweeter.
**Tania Haas is a freelance writer, yoga-enthusiast and sprint triathlete based in Toronto**
Troubled by controversial claims that yoga can wreck your body, Kat Tantock takes a cold hard look at the practice she loves
Diane Fereig thought she would be doing her body a favour when she got an unlimited yoga pass for just $50 a month. A 28-year-old student in Toronto at the time, she wanted an antidote for long days spent sitting and stressing. She went to the physically demanding Ashtanga classes five days a week until one day, while doing downward dog, she fell and dislocated her shoulder.
Back then she blamed her sweaty palms, but these days Fereig, now a yoga therapist helping people in Toronto and Montreal improve their health through yoga, understands there were other factors at play. First she says, her ego got in the way: “I hadn’t learned yet to go at my own pace instead of trying to keep up with the class.” Second, she now realizes she’d been downward-dogging wrong the whole time, straining her shoulders, and her teacher, tasked with handling too large a class, failed to notice.
As a yoga devotee for 16 years and now a teacher myself, I’m a true believer in the practice benefits: It helped me conquer a teenage back injury and, more recently, rehabbed a nasty knee sprain that left me limping for weeks. o when I first read the recent New York Times Magazine article alleging a silent epidemic of yoga injuries (excerpted from journalist William J. Broad’s book, The Science of Yoga), my knee-jerk reaction was to brush off the anecdotes of over-the-top behaviour – like the guy who sat on his knees for hours at a time – as outliers, people who made dumb decisions and got the injuries they deserved.
But then I realized that aside from those drastic cases, Broad was calling attention to real problems. After all, I know first-hand how challenging it is for teachers to guide students into even basic alignments. When taking classes I often spot students doing off-kilter poses, or exerting themselves so hard I fear they’ll have an aneurysm right then and there – never mind develop subtle injuries such as the nagging pain in my left shoulder when I overdo sun salutations.
Yoga isn’t hockey, anf getting beat up shouldn’t be part of the package. But the truth is, many people are doing moves they shouldn’t be – and getting hurt in the process.
An Injury Epidemic?
It’s hard to pinpoint how many people get hurt doing yoga. In the U.S., the Consumer Product Safety Commission counted more than 7,000 injuries treated in doctor’s offices and ERs in 2010 – mainly overstretching and repetitive strain in the neck, shoulders, spine, and legs.
By Lisa Evans Special to the Star
Tues., April 9, 2013
The office might not seem like a hazardous workplace, but over time sitting in front of your computer can weaken muscles leading to chronic back pain, repetitive strain injuries in the shoulders, elbows, wrists and forearms and hand tendinitis.
As a writer, my computer is my livelihood, but at the age of 30, I have developed three of these issues. Unable to give up my computer, I searched for a solution. That’s how I came upon Computer Fit, a yoga- and Pilates based program offered through Synergy Sports Medicine & Rehabilitation, located just north of Bloor St. W. and Lansdowne Ave. It uses breathing techniques and exercises to address computer-related injuries.
Dr. Raza Awan liked the rehab potential of yoga and Pilates and worked with instructors to modify movements from fitness exercises to rehabilitation drills, keeping core strength as the basis of the movements to address office-related injuries.
“We see neck pain from computer use particularly with women who returned to work after pregnancy. Their abs and core aren’t strong so they’re getting neck tension because of poor posture,” Dr. Raza Awan says. Similarly, forearm pain can come from the body compensating for weak shoulders.
The pressure of work can also be a factor. “stress gets into your neck and shoulders,” he says. During the class, they use breathing techniques to reduce that stress, derived from yoga and Pilates. Strengthening the core and shoulders also helps with prevention. Yoga and Pilates moves can also help stretch out the back, chest, neck and leg muscles.
Proper ergonomics is also important; strength and stretching can’t make up for a bad chair or a low computer screen.
After I took a class, under instructor Riki Richter, my back felt stronger and I stood taller. Best of all? My forearms didn’t scream while I typed this article.
Five moves that will counteract a day at your desk.
Posture corrector
Sitting with your feet planted on the floor, inhale using the diaphragm and lift your breastbone towards the ceiling. Draw the bottom of shoulder blades together and elongate the crown of head to the ceiling.
Neck stretch
Place your hand under one side of your chair, lean your body to the opposite side letting your neck fall, then bend your chin toward your shoulder to feel a pull.
Place a one-inch rubber ball on your desk. With your forearm perpendicular to your torso, roll the ball under your forearm. The rubber ball acts like a foam roller for your forearms to loosen the muscles.
Hamstring stretch
Sitting on the edge of chair, extend one leg in front so the heel is touching the ground, flex the foot and bend forward slightly at the hips, keeping the pelvis stable.
Hip opener
Sitting with your feet planted on the floor, cross one ankle to the opposite knee and bend forward slightly at the hips until you feel the stretch.
Yoga is a good form of exercise, but experts warn it can lead to serious hip injuries in some women.
Dr. Raza Awan, a sports injury specialist in Toronto who uses yoga for rehabilitation, started tracking yoga injuries after noticing there wasn’t much published data.
If someone is too flexible and gets into the end range of a pose without good support and muscle stability, it can cause wear and tear on joints, Awan said.
While injuries to the lower back, knees and wrists are more common, hip injuries can be more significant and need surgery, he told CBC’s Kim Brunhuber.
“There’s a rim of cartilage inside the socket portion that can become torn,” he demonstrated with a model of a hip, the body’s largest ball-and-socket joint. “That can lead to surgery because the cartilage doesn’t heal well typically. If you continue to have cartilage loss, you’ll get arthritis, and this may lead to hip replacement or an artificial hip.”
Riki Richter has been teaching yoga for 14 years and has taught anatomy and injury prevention to aspiring yoga instructors.
Richter said women complain of hip pain after yoga classes, often those who are “hypermobile” with ligaments that are much looser than average. Its not necessarily newcomers to yoga she sees injured, but sometimes yoga teachers.
“It’s that their body can go into a very extreme range of motion and it doesn’t feel like anything. So for something like a hip issue, they can deeply fold without actually fine-tuning any of the rotations and really cause some problems.”
It’s hard to back people out of going deeper all the time, Richter said. Pain signals injury with the knee but people need to be cognizant of hurting their hip joint when twisting it excessively without even knowing.
Richter’s prevention tips include:
Take classes with an experienced teacher who looks for injury.
Monitor your own body to make sure you’re not feeling discomfort.
Watch for any kind of “catching” in the hip or feeling a little tentative to weight bearing after a class.
Cristina Gonzalez has been practising yoga for 18 years and attends Richter’s small classes. Gonzalez said she tends to be hypermobile and despite injuries to her shoulder and hip, Gonzalez continues to enjoy the self-reflection that yoga offers.
“Yoga helped me to understand my body better, or at least I thought so at the time,” Gonzalez said. “I’ve injured myself quite a bit thinking something felt good or feeling like I was going deeper.”
With files from CBC’s Kim Brunhuber and Marijka Hurko
The CrossFit workout trend of heavy weightlifting and short but intense intervals of cardio can be difficult for rookies lacking proper form or who are overly competitive, a sports medicine doctor and coach say.
The strength and conditional program is used by elite and everyday athletes. Proper training is key to reduce the risk of injury for workouts that combine high intensity cardio, weightlifting and gymnastics routines that change daily, with exercises from the Olympics and military boot camp.
Moves include a gymnastic pullup where the body swings up onto an overhead bar or bringing the toes up to a bar in a dynamic fashion.
When considering injuries, there’s an important distinction between CrossFit the fitness program that caters to everyone and Crossfit the competitive sport, said Nic Martin, head coach at a Reebok CrossFit in Toronto.
“Often times people who you know are just looking for that general fitness are getting injured because they’re doing things their bodies aren’t ready for,” Martin said.
Dr. Raza Awan, medical director at Synergy Sports Medicine & Rehabilitation in Toronto, enrolled in a month-long CrossFit program after noticing patients were coming in with injuries after participating. Awan said he got “amazing results,” a sense of the demands of the exercises and how they could lead to injury.
The most common CrossFit injuries Awan sees in his clinic are:
Lumbar disc injuries to the back from doing heavy squats or heavy deadlifts.
Shoulder and rotator cuff injuries from push ups or other overhead activities.
Knee injuries from a lot of skipping, box jumps, heavy squats and lunges.
“Unless someone has a background in athletics or weightlifting, they may not know how to do some of the moves,” Awan cautioned. “I think if people exercise with good form and technique, a lot of the exercises are very sound exercises.”
Squats, lunges, pushups and pullups are all functional activities the people need to do in everyday life, he said.
“It’s just that when you add in the competitive environment and the fact that there’s a time pressure to get done, a lot of people will lose their form and technique and become sloppy.”
Heather Kidd used to play lacrosse and was a varsity athlete. Kidd started doing CrossFit last November. After doing overhead lifts, she noticed a pinching pain in the shoulder that didn’t go away.
When you add in the competitive environment and the fact that there’s a time pressure to get done, a lot of people will lose their form and technique and become sloppy.– Dr. Raza Awan
“It was supported where I was at to continue to go and be active but not necessarily doing something that was going to affect that problem area,” Kidd said of her post-recovery workouts. “I’ve sort of retired from the ‘win at all costs’ attitude.”
Dr. Mark Linder is a family doctor and emergency physician who has been doing CrossFit since November. Linder used to go to the gym to work on biceps and triceps. He likes that CrossFit uses the whole body because he wants to prevent injury when playing sports.
“There’s no push to kill yourself. In fact, there’s a great deal of encouragement to pace yourself,” Linder said.
Trainers teach newcomers proper technique at foundations programs, offer dynamic warm ups and check members’ technique, Martin said. The athletes also need to be proactive about avoiding injury by coming in early or staying later to work on mobility if they have a particular issue, he added.
“I think we need to realize there’s injuries in any sport,” Martin said. “There’s injuries in any physical activity but it’s really important to make sure that you’re taking the [preventive] steps as an athlete.”
By Isabel TeotonioEducation Reporter Fri., March 22, 2013
After a sudden move during a tennis match triggered a slipped disc in his back, Dr. Raza Awan found himself in excruciating pain. It radiated from his lower back down his left leg.
Awan, a rehabilitation medicine specialist, sought help from the city’s best physiotherapist, chiropractor, osteopath, acupuncturist and massage therapist. Nothing worked.
“I was desperate,” he says, recalling the injury eight years ago. “I even went to a woman who was humming on my chest.”
Doctors wanted to operate, but Awan refused. On the suggestion of a patient, he tried Pilates and yoga.
Finally, he found relief. Pilates treated the sciatica and yoga eased chronic neck pain from years of playing sports and sitting in front of a computer.
The experience changed how he practices medicine. He’s proof, he says, that when doctors get injured, they become better doctors.
Awan, now the medical director of Synergy Sports Medicine and Rehabilitation, has designed a rehab model that incorporates yoga and Pilates.
The sports medicine clinic is among Toronto’s first to fully integrate yoga into its rehab model — something that would’ve been seen as “unorthodox” a decade ago, Awan says. Now, more than 250 doctors refer people to his clinic, including neurologists whose patients have severe headaches triggered by neck pain.
Western medicine has loosened up, with a growing number of doctors prescribing yoga to ease and treat illness and prevent injury. The increase has happened as the sciencific evidence continues to mount showing the health benefits of yoga.
Many of the studies are pilot studies of have small sample sizes. Experts say more randomized controlled trials, the gold standard in research, are needed. But still, the research is compelling.
Yoga is prescribed for musculoskeletal disorders, such as carpal tunnel syndrome, osteoporosis, arthritis and back pain. It helps those living with chronic conditions such as HIV and cancer better cope with the disease. And for those with multiple sclerosis or Parkinson’s disease, it can ease chronic pain, reduce blood pressure and improve posture and balance.
The proven mood booster and stress reliever is also used to treat psychological issues, such as anxiety and depression, and to help fight addiction.
Research even suggests yoga’s stress-busting capabilities can slow the biological clock on a cellular level, according to The Science of Yoga: The Risks and the Rewards by U.S. science writer William Broad. Scientists have discovered telomeres, which sit at the ends of chromosomes, get shorter as cells divide and age. One thing that erodes telomeres is stress.
Broad, a The New York Times Pulitzer-prize winning journalist at The New York Times, notes yoga’s flexing poses and slow breathing stimulate the vagus, one of the most important nerves in the body. The nerve regulates the body’s immune system and its response in fighting illness, including inflammation.
By Isabel Teotonio | Education Reporter
Tues., April 30, 2013
Get in shape before tackling a new sport. Learn proper technique. And don’t overuse your muscles. That’s what Dr. Raza Awan, a sports medicine doctor and rehab medicine specialist, suggests to his patients.
“When you’re young you can get away with playing sports to keep fit,” says the medical director of Synergy Sports Medicine and Rehabilitation.
“But when you’re older, you have to keep fit in order to play sports.” Before diving into a sport, he recommends pre-habilitation — seeing a physiotherapist to learn the demands of the sport and address any imbalances or weaknesses in the body.
When you’re on the field, use proper form. And don’t play the same sport on consecutive days, because muscle overuse can result in injury, says Awan, who encourages patients to cross-train instead.
The Star spoke with Awan about the most common injuries at his clinic and what usually causes them.
When injured, he says, stop doing anything that aggravates the pain and focus on recovery, which takes about six to eight weeks for these injuries, except ankle sprains, which heal in three to six weeks. Instead, try one of the alternatives to stay fit without causing further harm.
Tennis elbow
Cause: Racquet sports, fencing and weightlifting. Symptoms: A dull ache on the outside of the elbow, and sharp pain from grabbing something, such as a coffee cup.
Treatment: Relieve pain and inflammation with the RICE method: Rest, Ice, Compress and Elevate. A forearm strap will relieve pressure from the elbow. Acupuncture can reduce pain, physiotherapy will help stretch and strengthen forearm muscles and steroid injections help acute inflammation.
Alternatives: Anything that doesn’t involve a power grip, such as cycling, running or swimming.
Rotator cuff tendinitis
Cause: Overhead sports, such as tennis, volleyball, swimming, baseball and weight lifting. Weight lifters who focus on their chest and bicep muscles and neglect the back — sometimes referred to as having a Cadillac in the front, Volkswagen in the back — can cause an imbalance in the shoulder that results in rotator cuff problems.
Symptoms: A dull pain in the shoulder or upper arm when reaching up or sharp pain when lifting something heavy. Sleeping on the affected side can exacerbate the pain.
Treatment: Physiotherapy can strengthen the shoulder and shoulder blades. Injected steroids may also help.
Cause: These two are often related. Runner’s knee involves softening of the cartilage behind the kneecap, while jumper’s knee is inflammation of the tendon below the kneecap. Causes include running, basketball, volleyball and soccer. Women who suddenly take up exercise are susceptible to this type of injury because they often have weak hip muscles, which causes an imbalance in the
knees.
Symptoms: A dull ache around the front of the kneecap, or a sharp pain below the kneecap. Pain intensifies when the knee is bent and under pressure, such as when going up and down stairs.
Treatment: Physiotherapy stretches and strengthens the knee and hip areas. You can use a knee brace to help the kneecap track properly.
Alternatives: Swimming, core exercises or upper-body weight training.
Ankle sprain
Cause: Sports where you jump and change directions suddenly, such as basketball, volleyball, soccer, football and tennis.
Symptoms: As the ankle twists, you may feel a snap or a pop. Within days, there is swelling on the outer ankle and/or bruising, often accompanied by pain. (If you can’t put weight on the foot or are limping, you might have a broken bone.)
Treatment: The RICE method is key. Physiotherapy reduces swelling and increases range of motion. An ankle brace or crutches may be recommended. Because the ankle ligament usually heals in a lengthened position, it can be loose and easily sprain again, so it’s key to build strength and single-leg balance.
Alternatives: Sports with little ankle motion such as cycling, swimming, upperbody weight training and core exercises.
Achilles tendinitis
Cause: Running and sports with lots of running, such as soccer and basketball. Symptoms: A dull ache at the back of the ankle that worsens with activity, such as climbing stairs. (A really sharp pain — often described by patients as being whacked with a two-by-four — may signal a tear.)
Treatment: A heel lift in the shoe can prevent the tendon from stretching. Rehabilitation involves stretching out the back of the leg, especially the calf and the hamstring. Sometimes, orthotics can provide arch support.
Lets face it, going through the community based level system run through the Orthopaedic Division or through either Western’s or the newly formed McMaster masters program in Manual and Manipulative Therapy is tough. These are structured programs that require many months of study, practice, exams, and mentorship. Let’s also not forget all the associated course/tuition fees and lost income from time away from work to finish these programs. I finished my advanced diploma in 2015 and it took me about 5 years to get through it all. I recall having to say no to many weekend getaways during the summer of my advanced exam as I would be at home hunched over my desk studying anatomy, biomechanics, pathology, and everything else the people reading this know all too well about. It was quite the onerous process to say the least.
So why do we do this to ourselves? What posses a physiotherapist to take on this extra burden after already completing 6+ years of university study to become a registered physiotherapist. While I’m sure this answer differs for many, I think it comes down to a few key concepts. First off, physiotherapists by nature have a thirst for knowledge and betterment. I know this because year after year the Allied Health Professional Fund (AHPF) in Ontario consistently states that we as physiotherapists use up our funding much quicker than every other listed profession combined! (We sure do like our continuing education). We strive to do better for our patients and figure out exactly why we fail to help a portion of the patients who seek us out. Second, physiotherapists love a good challenge. Despite all our bitching and moaning about the process of becoming an FCAMPT, we enjoy the ride and the community it builds for us both professionally and socially. I can’t tell you how many amazing physiotherapists I wouldn’t have otherwise known had I not done all my levels. The professional networking at these courses cannot be understated.
Other reasons for gaining fellowship may include increased status within the profession, monetary gain from clinics/bosses who provide additional payment for course completion, and for self satisfaction. I’m sure people reading this have their own reasons for taking a level course or doing another masters program.
I would be remiss if I said everything I learned and studied was based on solid evidence and I would be doing a disservice to my skeptical nature if I didn’t have grievances on how the program is taught. While this article isn’t a commentary on the current state of manual therapy education in Canada, I do think it’s prudent to point out that many of the pathobiomechanical models that are routinely taught within the CAMPT program don’t follow suit with emerging evidence. I distinctly recall being made to feel inept when I couldn’t feel thoracic spine passive intervertebral motion (PIVM) as well as the person instructing me. If I’m to be honest, I recall leaving class some days feeling more stupid and incapable then when I entered. It was later on in my career that I realized that was simply not the case and that there have been repeated studies concluding that identifying lesions by motion palpation are not reliable (Huijbregts et al 2002, Nyberg et al 2013, Seffinger at al 2004). I began to worry that the physiotherapist down the street from me would be better able to help a patient in pain because they were able to be more specific in their treatment selection and delivery then me.
Fortunately, I realized this was also not the case. There are now a number of studies showing similar benefits among patients receiving “therapist selected” and “randomly selected” mobilizations or manipulations. Both groups seem to show equal short-term improvements as long as they receive any form of manual intervention (Donaldson et al 2016, de Oliveira et al 2013, Chiradejnant et al 2003, Aquino et al 2009). I learned through many hours of reading research that manual therapies can be very effective for nociception reduction, but the exact mechanism for this is till up for debate. If you can keep these ideas in mind as you go through the CAMPT program, I think you will enjoy it much more.
It may seem like I’m saying that becoming an FCAMPT was a waste of time, but that couldn’t be further from the truth. The program I was taught gave me a much more solid foundation in differential diagnosis, screening for red flags and understanding anatomy at a much deeper level. I feel better off for having been through the system and I am glad I stuck through it. There are rumblings that when the new manuals come out next year there will be less emphasis on motion palpation and biomechanics and more emphasis on neuroscience education and a more current model explaining the possible reasons why our hands can help make people feel so much better. I welcome these changes and hope to see more made in the future to keep our program relevant in light of all the emerging evidence surrounding manual therapy. I am a proud FCAMPT and I encourage anyone with any questions about it to contact me. I would be happy to help in any way that I can.
Let’s say you have two people who walk into your clinic with an acute episode of back pain after they fell off their bikes in very similar ways. Their pain location is the same as is their initial pain intensity. Both seemed to have muscle strains after physical assessment. After a few sessions, patient A is doing much better…pain is down and he is well on his way to a full recovery. On the other hand, patient B seems to be doing worse…pain is not going away and it’s starting to affect other aspects of daily life. This is peculiar to you because both had very similar objective findings when they first arrived to see you and both sustained very similar injuries… what gives?!
This brief and overly simplistic story is common. The question that has been on my mind for the last several months has been what factors predispose one person to have chronic pain and another person to get better in a matter of weeks? Why do similar injuries lead to often very different outcomes despite good care? What traits or factors do different people posses that lead them down the wrong road into the land of chronic pain?
In the world of social media where rehab gurus rein supreme, I would expect that some “expert” would give an intricate pathoanatomical explanation as to why patient B didn’t get better. I might hear such things as I should assess their rolling pattern, or that a certain muscle has become inhibited in the (insert random body part here). I would be told that I need to take this or that course to learn the next “game changer” technique to be better at my job. While con-ed is great and learning from peers online has been a blessing for me, I would say that what is not talked about are the less sexy causes for pain…the stuff we can’t assess with a movement screen or strength test.
I took a course a few weeks ago by a professor out of Western University that addressed the prognostic factors that lead to chronic spinal pain. Dr. Dave Walton might not be a social medial celebrity in the world of rehab/therapy, but that’s probably because he is too busy conducting real research out of his lab, The Pain and Quality of Life Integrative Research Lab. This course, entitled “Prognosis- based approach to assessment and treatment of acute neck and low neck pain” was a 1 day seminar discussing the evidence behind the very question I ask on a daily basis….what causes chronic pain?
We talked about the roughly 25% of people who suffer an acute injury that becomes chronic and what similarities they had. For whiplash:
I find it funny that many of the more anatomical categories such as position of neck and impact direction have very little to do with the onset of chronic pain. This continues to beg the question of the relevance of biomechanics in the treatment of the chronically pained patient.
For lower back pain, the results of a large scale meta-analysis from 2010 by Chou and Shekelle, which was published in JAMA showed the following.
The most helpful components for predicting persistent disabling low back pain were maladaptive pain coping behaviours, nonorganic signs, functional impairment, general health status, and presence of psychiatric comorbidities.” — Author Credit
The other key aspect of this course was the introduction of evidence backed outcome measures for pain and disability. These are used so we can actually measure objective change in pain and disability over time without the subjective conjecture of “oh you’re getting stronger and moving much better”. Having validated measures to use such as the Brief Illness Perceptions Questionnaire, the LEFS or Neck Disability Index (NDI) are great ways of helping us get a clearer picture of the patients pain and how it specifically effects their day to day life. It also helps us understand the patients beliefs around their pain and why they think they have it and how optimistic they are about recovery. Knowing this information going into an initial assessment really helps me get a clear picture of what I need to do with the patient. Maybe they believe their doomed to lifetime pain or maybe they have very few yellow flags. Knowing this drastically changes how I communicate and even what I do with the patient on the initial visit.
Overall, my tune has changed quite a bit over my 5 years of practice in that I used to be very quick to label peoples pain as anatomy related…” your back pain is due to your locked S.I joint or you have a twisted pelvis creatIng muscle spasm”. I now cringe at thinking all the ways I scared patients and made them feel fragile and broken. As it stands now, my practice strives to rule out the bad reasons for pain (the red flags) and to find ways of modifying my patients pain to hopefully help them see that they have the ability to get better without excessive treatment. Education is a cornerstone of my practice… sometimes I think I talk TOO much to my patients about how robust their bodies are!
To hear from a physiotherapist I strive to emulate please take the time to watch this interview from Prof. Peter O’Sullivan, a world renowned expert in treating chronic pain:
Joining our virtual care sessions takes exactly one click! We go through the process of creating a profile for you and setting up the video calling software behind the scenes. When your appointment time rolls around, the process is as simple as clicking on a link in your email to be instantly connected to your physiotherapist.
The reality is that the special tests we use our hands for can be helpful at pinpointing or provoking your pain, but they only make up a small portion of our diagnostic skills. We come to a better understanding of your problem by hearing your story, watching you move, and if needed, have you press and poke where it hurts.
The benefits of manual therapy to your recovery are undeniable. Luckily, there are plenty of self-release/self-massage techniques using household objects like tennis balls that you can use to manage tight and sore areas. While they may not replace how hands-on treatment feels, it can be a great way to get the quick relief you need to help you move forward with your recovery plan.
It can be tough to adjust to a lack of exercise equipment, especially if you’re used to a full selection of weights and machines at the gym. The good news is that your body can be strengthened, stretched and mobilized with little to no equipment. Also, we have strong research that suggests you can maintain or even enhance muscle growth at much lower weights or loads than what you’re used to, if the exercises you do are sufficiently challenging and are repeated for long enough. Your physiotherapist can help put together the right program to help meet those requirements.
Here’s a simple counterpoint: what better way to help you find ways to get you on your recovery plan than to have someone walk you through your exercises from the comfort of your home – where your equipment is within arm’s reach and with real-time feedback on exactly how to do your exercises to perfection?
