Physiotherapy Treatment: My philosophy

Physiotherapy is not unique to me, and in many aspects, I don't consider myself unique to physiotherapy. My treatment philosophy is simple; I think my patients are important, what's important to them is important, and keeping their bodies and minds engaged in those activities is important. It fuels their happiness, which is a critical pillar to the human experience. Losing the ability to partake in our favourite activities due to injury or illness can be devastating. I've watched it happen, and I've experienced it personally. With my physiotherapy treatment philosophy, I identify each person’s unique valued activities, and do everything possible to get them back to doing what they love. 

Since 2008, I have been providing physiotherapy services to Ottawa's downtown core. This is an interesting subset of the city's population, made up almost entirely of Government of Canada public servants, plus a handful of large and small operation white-collar businesses.  As a group, they typically age between 30 and 60, have a university-level education (often with more than one degree), and are in the most exciting part of their career.  They come from all over the world and have a variety of special talents and interests.  They are encouraged to prioritize their health, and most of them do. Ottawa is an active city, and people balance their professional pursuits with whatever physical challenge they love doing. I have treated people with all kinds of interests: triathlon, rock climbing, dragon boating, CrossFit, power lifting, ultimate frisbee, football, dodgeball, fencing, and ski racing just to name a few. The list is as interesting and varied as the people that comprise it. However, most of this crew is in the busiest part of their personal and professional lives, and time is valuable. They tend to walk into my office only once an injury or pain has stopped them from doing what they love, whatever that may be.

It is from this consistent story that I developed my physiotherapy practices and processes. My first goal is to establish a connection with each client and understand their priorities. With this information, we outline a treatment pathway. Is their recreational activity the stress reliever that balances their life? Are they training for an event or race they don't want to miss, even if they have to complete it in some pain? Will they do anything to get back to their previous activities, or are they ready to give up one sport and replace it with another?  Often there are various paths we can take during treatment, and it is important to understand and accommodate the person's specific priorities, as these are ultimately what push someone to seek help in the first place. 

The next step is to establish a meaningful change. This involves altering symptoms or pain to improve at least one aspect of the person’s life. These are typically daily life sort of things that may have been limited, such as bending forward to put on socks, sleeping on their favourite side, or sitting through dinner with their family.  Early progress confirms we are on the right path. Initial change typically happens with a manual therapy or dry needling technique, or the right home exercises. I try to establish change quickly, within the first session or two.

I prescribe a lot of home exercises for my patients, encouraging them to play an active roll in their recovery. This is an important part of rehabilitation. I believe to live your best life, you need to take action. I help facilitate this process by establishing the plan, but it is ultimately the patient who makes it happen. 

Throughout the rehabilitation process, I am continually evaluating the individual's movement, with the goal of optimizing movement patterns and establishing a base level of function and fitness. It is important for my patients to commit to their plan and finish their rehab. However, this is easier said than done. People are busy, and rehab takes time. This is especially difficult when the initial pain is gone, but there is still work to be done to improve movement, strength, muscle imbalances, or body conditioning (all things that cause injury in the first place). If this final step is not complete, the individual is more likely to relapse. This is how people can end up with the same injury over and over, and why I encourage my patients to make their health a priority and finish their rehabilitation.  It is self-care in its true form, and it's important.

I love what I do, and I hope that is evident to everyone I have had the pleasure of working with. I am grateful for  the brilliant physiotherapists I mentored under during the early stages of my career. I owe much of my manual therapy and clinical reasoning skills to these individuals. To them, I am forever in debt. I am also thankful for everyone who has taken the time to read my random spattering of blog posts. But most of all I need to thank my patients. You are seriously the best part of my job. One of the silver linings to being a physiotherapist is the one-on-one conversations I get to have free of devices, screens, and distractions - the way interactions were meant to be had. I love getting to know people. I feel everyone has a story to tell and I find that fascinating. Thanks to everyone who has put their trust in me, opened their lives, and shared their stories.  YOU are the biggest reason I love my job. 

When can I start exercise after an injury?

You're injured. Don’t worry it happens. You are pretty much guaranteed to experience injury at some point if you live an active lifestyle. Don’t let it discourage you though.  The benefits of exercise far outweigh the detriments of being inactive. Let’s assume you played it smart and took some time off training to rest and recover. But how do you know when it’s safe to start training after an injury? There is no specific timeline for this, but there are some simple guidelines to get you back to the activities you love.  I’ll cover two points here: how to safely return to activity, and how to know if you have ‘overdone’ it.

Before we get into these, it is important to note that you want to be out of the inflammatory stage of tissue healing before beginning a progressive return to activity.  This initial stage of healing is very recognizable with its constant, unrelenting pain.  It typically lasts from 3-14 days, though this can vary.  If you are ever in doubt of your stage of tissue healing, or your body’s ability to being a progressive return to activity after an injury, consult a health care professional.

Guidelines for return to exercise

When you are ready to start training after an injury, there are three guidelines to avoid doing too much too fast. These guidelines apply to all activities, even things that you may not have considered physical activity prior to your injury, think getting groceries, mowing the lawn, or cleaning the house. They will also apply to activities you are doing as stepping stones to your usual workouts (example: biking with the goal to get back to running).

1. Don’t add more than one new activity, or exercise at a time.  This includes everything that you have been modifying or avoiding because of your injury.  Pick one that seems gentle to start, try it, and monitor the effects. If it goes well, pick another one and repeat.

2. Take a day off in between workouts to evaluate the effects on your body.  If you have ever pushed a muscle group to its limits, you will have felt the two day soreness known as DOMS or Delayed Onset Muscle Soreness. DOMS is felt one or two days after a hard workout. Considering this delayed effect, it is best to take it easy two days after introducing a new activity. This will allow you a chance to fully evaluate its impact on your body before you try adding another one. It’s the safest way to make sure you don’t do too much too fast, which can cause relapse or reinjury.

3. Don’t change more than one variable at a time.  Such variables include frequency of the activity in days per week or times per day, intensity, duration of the workout session, and type of activity (including how many exercises you are doing at once).  Example: let's say you started with running 20 minutes easy, 2 times in one week.  You were happy with how it went, so you want to increase your training next week. Considering these return to sport guidelines, you have a decision to make. The next week you could: run 25 minutes 2 times, run 20 minutes a little harder, run 20 minutes at the same intensity 3 times, or run an easy 20 minutes 2 times plus an additional 15 minutes swimming as a third workout. In most cases, which scenario you pick is often up to you, and will depend largely on what is most important to you.  Would you be happier running less frequent but a bit harder because it is killing you to run super slow? Or would you be happier running a bit longer or more frequently. If your health care provider has left it up to you, you get to follow your heart. 

How to know you have “overdone it”

This part is usually pretty easy. Your body will tell you when you are overdoing it, just monitor for these signs:

1. Pain during the activity. When you start back to an activity, don’t expect to feel no pain at your injured area. It’s OK if you do feel a bit sore. This is a sign the injury is being stressed in a good way, which promotes tissue healing.  But don’t let the pain get very high, no more than 2 out of 10  (0 being I feel nothing, 10 being very extreme pain). If the pain starts to get more than a 2/10, stop, you are done being active for the day.

2. Pain after the activity. Let’s say you felt nothing during activity, but you started to feel the pain after. Again, that’s OK as along as it doesn’t last more than 20 to 30 minutes, and the pain doesn’t get too intense (think more like a 3 or 4/10).  If the pain settles down quickly, then we would still consider the activity a success, and you could proceed with your slow progressions back to activity as in point #3 above.  If the pain lasts longer, becomes more intense, or gets worse as the day goes on, then you overdid it. Take a couple days to recover, then decrease one of the variables from point #3 above, and try again.

3. Stiffness the next morning.  In this instance, you may not have felt any pain during or after your activity, but the injured area is tight or stiff when you get out of bed the next morning. Morning tightness or stiffness is a sign that you stresses the injured area. This is required for strengthening the injured tissues, so some morning stiffness is acceptable up to 15 minutes. Anything longer than that is a sign you overdid it the day before, which will including your hobbies, work, and regular household tasks. Often what happens when a person starts feeling better after an injury is that they don’t just start back to their workouts, they start back to their life, and the combination can occasionally be too much. If this happens, take a couple days to rest and try again.  It could also be helpful to keep an activity log to know exactly how much you did each day so you can look back and modify as needed.

Returning to activities after an injury is often a slow process. Exercise your patience along with your body.  Remember, setbacks happen. It is seldom a linear progression. Don’t let this deter you from your goals.  Ultimately, persistence pays off and you will get back to doing what you love.

Video Blog: How to properly lift a canoe without hurting your back

Amy Fahlman, a CAMPT-Certified physiotherapist, talks about how backcountry canoe camping is an excellent way to decrease stress and improve your mental health. However, if you don't lift a canoe properly you risk back injuries or making an existing back issue worse.

Physio In Your Pocket: Rolling the Foot to Relieve Foot Pain during CrossFit

Amy Fahlman, a CAMPT-Certified physiotherapist, talks about one of her passions CrossFit and how Plantar Fasciitis, foot pain, or foot cramping is a common condition as a result. In this video, Amy explains how to properly roll the foot to help relieve CrossFit foot pain and camping.

Video Blog: Shoulder Pain and CrossFit

Amy Fahlman, a CAMPT-Certified physiotherapist, talks about one of her passions CrossFit and shoulder pain or shoulder strain that may result. In this video, Amy will explain why CrossFit shoulder injuries can happen and how physiotherapy, manual therapy and exercise can help. 

First Adventure Race Recap: All the things not to do.

My husband and I recently completed our first adventure race – consisting of a combination of mountain biking, canoeing, and trail running (aka bushwhacking), all done while orienteering your own route through the wilderness with only a map and compass.  The objective is to find as many checkpoints as possible before the time cap.  For our first race we chose an 8 hour event hosted by Raid Pulse.

As you can imagine, with adventure racing there are a few more variables to consider than your standard road race.  We learned a lot through this experience, mostly how to improve for the next race.  So for anyone considering making the leap into adventure racing, here are 6 rules to nail your first and following adventure races because as you will experience, it is very addictive.

Top 6 things not to do in an adventure race:

1. Don’t move until you know where you are on the map.  This is perhaps the cardinal rue of adventure racing.  We were warned of its importance several times by more experienced racers.  But we of course were caught up in the race atmosphere, got moving too fast,  didn’t follow the rule, and ended up lost in the woods.  Having to backtrack to a point that you know where you are not only wastes time, but is exhausting and frustrating.  Don’t test your partnership this way.  Follow the rule.  Find where you are on the map, then get going.

2. Don’t follow other people.  At some point it’s going to seem like a good idea to follow other racers you come across, especially if you are second guessing your location.  Don’t …. just don’t.  They might be lost too.  Or worse, they may know exactly where they are but are faster and more experienced.  Follow someone like that and before you know it they are way out of sight.  If you didn’t know where you were then, now you are really lost. See rule #1, and just try to ignore everyone else.

3. Don’t underestimate mental fatigue.  Part of the reason we chose this race was because we knew we could handle the distances for each discipline.  However, when the whole thing was over we agreed this was the hardest thing we have ever done in a single day (and we have done some pretty challenging things).  The physicality of the race could not account for our level of fatigue.  It requires a lot of extra energy to stay focused, making decisions, and checking navigation.  This is an extra element to consider when you are training and racing.

4. Don’t skip eating because you don’t feel hungry.  It’s very easy to get caught up in the race and head out of transitions zones too quickly instead of taking the time to properly refuel before moving on.  Your body won’t often feel hunger during the race,  but you are at risk of ‘hitting a wall’ and becoming unable to continue if you don’t get enough calories.  Poor nutrition can also cause muscle cramps or electrolyte imbalances, which can turn into an injury or something more serious without much warning. In addition to needing calories for the physical challenge, your brain needs calories to stay focused.  Eat.  It’s a long race.  You will need it.

5. Don’t move too quickly.  You probably don’t routinely do as many hours of physical activity as the race requires.  It’s easy to get caught up in the race atmosphere and try to run up a hill when you should really just slow down and walk.  Pacing your body to handle long durations of physical activity is an exercise in restraint.  You want to make sure you will make the finish line, as it could be a while before someone comes and rescues you from the bush, so don’t empty your tank too soon.

6. The bugs are bad.  Don’t freak out.  During an adventure race it is not uncommon to find yourself bushwhacking a course though the back country.  This is where you will encounter the highest concentration of bugs you are likely to have ever experienced. Try to remain calm, it will only promote you ignoring the other 5 rules.  We will have bug nets to put over our heads for the next race.

We are having a lot of fun sharing our adventure race experience with others, almost as much fun as we had during the race.  Though I can definitely say it would have been a smoother race experience if we had followed these rules, I have only great things to say about the event itself.  Raid Pulse did an excellent job with the event logistics, and their super friendly staff was very supportive, answering all our questions before and after the race.  Plus we couldn’t ask for better weather!  I would recommend adventure racing to anyone interested, you are guaranteed to have an unforgettable experience. 

Running shoes and Rehabilitation: A Personal Account

A common question I get from both experienced and novice runners is which shoes should they be using.  As with most things related to physiotherapy, the answer is, it depends.  It depends on a lot of things including: running form, training regimens, goals, and injuries.  Yes it can matter which type of shoe you are running in to get you through an injury.  I am going to share with you my personal experience of why my last three pairs of running shoes have been quite different styles, and why I changed to a different style of shoe to rehab an injury. 

First it should be said that it doesn’t matter which shoes you are in if you have poor running technique.  No shoe will be able to make up for the risks with improper form.  Bottom line is that if you are running with poor form you are going to experience some pain eventually.  For a quick adjustment in running technique check out my blog “ONE EASY CHANGE TO RUNNING TECHNIQUE CAN PREVENT INJURIES”.  For a more detailed look, contact a physiotherapist or other health care professional that specializes in running and can do a run technique analysis for you.

Now, back to the shoes. 

A few years back I decided to make the long transition into minimalist shoes. After trying a few different kinds and finding they weren’t holding up against long distances on asphalt, I ended up in Inov-8’s Road-X 233 (see the first shoes in the image above).  These shoes had a slightly more rigid base, and the structure was a bit more sturdy than a true minimalist shoe.  Without this being a shoe review, I loved these shoes and ran in them without incident.

Fast forward to about a year later.  By this time I had been doing CrossFit about six months and had recently bought a pair of lifting shoes.  (Lifting shoes are designed for Olympic lifting.  They have a large amount of stability with a big height difference between the heel and toes). My technique doing Olympic lifts was not so good and even in the new lifting shoes, I was often too far forward balanced on my toes instead of on my heels (note to all novice CrossFit athletes, get your weight back on your heels, it saves you grief in the long term).  This put a lot of stress on my calves and shins and I developed shin splints, which made it very painful to run.  This is why I bought the Saucony Zealot Iso shoes (second shoes in image).  These shoes are VERY spongy, but have a snug fit lacing system. The spongy soles helped a lot with the shin splint pain through shock absorption when striking the ground on each step. They also have an exaggerated toe off motion (helps the foot roll forward to decrease the amount of push required from the calf). This helped minimize the amount of work my lower legs had to do while running.  It would have been better if the shoe had a higher drop (height difference between the toe and heel, in this particular shoes = 4mm) as this would take more strain off my hind leg, but they seemed to work well enough for my purpose and allowed me enough relief to keep running short distances (4-7 km) while I rehabilitated my shin splints.

The spongy material of the Saucony’s worked well for what I needed, but broke down much quicker than I expected so it wasn’t long before they were too loose and feeling almost wobbly, thus I needed a new pair. My shin splints were thankfully gone, but I did like the feel of Saucony’s.  I started looking for something more firm than that, but still spongy and with a more durable sole.  I still have some work to do on my Achilles and calf mobility, and I wasn’t prepared to go through the slow transition down to a minimalist shoe, so I needed a shoe with a medium drop.  So what I was essentially looking for was a hybrid between the previous two shoes. This is how I ended up in the New Balance Fresh Foam Zante V3. This shoe is a neutral support, light weight, a medium foam with a more rigid sole, and a 6mm drop heel to toe.  I would have liked a more durable material for the sole as I think these will also wear down before their time, but I have done a handful of runs in them and so far they are without issue.

So shoes can make a difference when it comes to an injury, but it depends on your individual situation.  If you are dealing with an injury, or just getting over one, you might consider changing shoes as your needs change. If ever in doubt, ask a physiotherapist that has some experience with running injuries to help make the right decision for you.

Feel free to message me with your questions, or post them through social media. 

For additional tips on injury prevention and rehabilitation on all things running, CrossFit, outdoor adventure and travel, follow me on YouTube, Facebook or Instagram.

When you need a physiotherapist

Most people over the age of 30 can relate to experiencing random pain when doing a certain movement.  Maybe it’s when you bend down to tie your shoes, checking your blind spot while driving, or pouring your morning coffee.  Stranger yet, it seems to have started for no apparent reason.  You didn’t slip and fall.  You didn’t hurt yourself.  You didn’t even do anything different than you usually do.  Yet sure enough, there it is and it doesn’t seem to be getting any better.   Well you are not alone, and I know exactly what to do about it.

This is when you should see a physiotherapist (or physical therapist if you prefer as they are different titles for the same profession).   You may have always wondered what a physiotherapist does, but never had a reason to look into it further.  Physiotherapists will analyze the cause of your pain and work to resolve it.  Our goal is to help you recover from an injury and give you tips to prevent it from coming back.  This is best achieved by identifying problems with your movement.  We then work to solve these movement issues with techniques such as hands-on therapy to reduce stiffness and improve mobility, and a personalized exercise program to improve strength and flexibility where you may be lacking.  Think of a physiotherapist as a movement analyst.  Our job is to resolve your pain issues and keep you active in the things you love doing.

So why might you see a physiotherapist?  When your back hurts while sitting, your shoulder hurts too much to sleep on your side, you sprain an ankle, or your knee is causing pain when you run.  These are just a few common examples, and there are many more aches, pains, and injuries physiotherapists treat.  By the way, it’s never too late or too early to see a physiotherapist.  There is good research to say you are likely to require less pain medication, fewer trips to your family doctor, and fewer treatments sessions from a physiotherapist if you start within the first month of your pain; however, you are always likely to benefit from consulting a physiotherapist regarding your movement problems. 

Maybe you aren’t sure if you should see a physiotherapist or another health care provider.  It’s not uncommon to see both a physiotherapist and massage therapist, or a physiotherapist and a chiropractor at the same time.  These are just a few possible combinations of health care practitioners you may decide to have as part of your health care team.  It is important to note you can over-treat a problem so ask your health care provider if it makes sense to see more than one practitioner at the same time.

Here is what a few other professionals said about referring their clients to physiotherapy:

“I believe a referral to a trusted physiotherapist that is willing to cooperate is critical in the case of a client who has a previous injury or developed one. To make sure that I am doing the right thing, at the end of the day I am a Strength coach/personal trainer and not a rehab specialist, the scope must be understood despite all the confusion out there nowadays of “I know it all” trainers. Working in cooperation maximizes the safety and efficiency in a client’s training and progress. Two horses pull a cart faster than the sum of both horses’ power. The client will also recognize your care as a coach and appreciates your initiative.”

                                                                                    - Hussain Samhat, Personal Trainer

 “As clients go through their own healing and treatment processes, I have found it extremely helpful to refer them to a physiotherapist for concurrent treatment. The combination of techniques and treatments consistently result in the client receiving more variety of homecare exercises, wider range of treatment protocols, and often a shorter recovery time. The use of physiotherapy in conjunction with registered massage therapy treatments helps to address all angles of a clients injury or condition thoroughly.``

                                                                                                   - Elise-Marie Walsh, B.A. Kin, R.M.T.

“Coaching competitive and recreational athletes in CrossFit, physiotherapy comes up often in conversation. Whether to ensure longevity in the sport by having regular ‘check-ups’ to make sure everything is running smoothly, or to know what could be improved to reach your fitness goals faster and safer (and making sure we're not just constantly aggravating an old injury). I know that reaching out to a physiotherapist is essential to maximize results and improve your training experience.”

                                                                                                       - Simon Buteau, Crossfit Coach

"I have worked along side Physiotherapists for 15 years, and have learned to really respect and value their opinions and skills when it comes to patient care.  If my client's progress becomes static, or I feel she could use further assessment, a very detailed exercise program, or benefit from modalities or specialties the Physios in my office possess, I do not hesitate to refer to my colleagues. I often have physiotherapy treatment myself, and have had great results as well."
                                                                                                       - April Magnan R.M.T.

You aren’t likely to require physiotherapy on a continual basis.  It is a physiotherapist’s job to help our patients and send them on their way as efficiently as possible.

So next time pain or injury is holding you back, consult a physiotherapist.  We can help you achieve your movement goals.