We are now a few months into the new year and this is the time that the majority of people have fallen short of their goals set in the early mornings of New Years Eve. Perhaps the goals were not realistic. Perhaps the goals were too much too soon. Perhaps the goals were not properly planned or executed.
As we have talked about many times both in the clinic and in these BLOGS, setting small and attainable goals are what is important. It doesn’t have to be important to anyone but yourself. This is not to impress anyone, or to post cool pictures on social media. It can be a slippery slope when you are injured to make excuses for where you are at (or not at). Have a bigger goal, and then create mini steps to get there. Maybe your first goal is just to sit down and create a list of goals….
Setting achievable goals will help to keep you motivated and focused. What are your 2020 goals?

Here is what the MotionWorx team says (so we can be accountable too!):

• “Cycle the Okanagan Rail Trail from Lake Country to Vernon”
• “Compete in a few Brazilian Jiu Jitsu competitions”
• “Find time for activities that I have not done in a few years including cross country skiing, tennis, rollerblading and rock climbing”
• “Become stronger with more regular training/gym sessions to be able to play tennis again without injuring my shoulder, and to improve my golf swing”
• “Continue to explore more of the wonderful hiking trails around the Okanagan”
• “Participate in more trail and road races. They are a good motivator to train and it is fun to push myself once in awhile. There are many great trail races in the Okanagan to choose from throughout the year”
• “Be more consistent with exercise…even if it is 10 minutes. Creating the habit forms the foundation”
• “Explore more of Kelowna with outdoor activities….become a tourist again”

The post Stay on Top of Those Goals for 2020! appeared first on MotionWorx Physiotherapy.

This weekend I re-learned a valuable lesson in the importance in patience. I had the yearly trip up to Big White with my family which fit 7 adults, 3 kids, a newborn, and 3 dogs into 1 house. Chaos personified if I have ever seen it…but I’d have it no other way. With so much going on, it can be hard to take time to focus on yourself…so I made a promise that I would make sure that I would find time to snowboard, and enjoy every minute of it. The thing is, as much as I love snowboarding, I am a snob. I would rather not go at all, then go on a day without powder. Many epic days in the snow have spoiled me….and here in lies the rub. I am staying up at Big White for 4 days, and the weather is sub-par.

The first day we get there (Friday) it is a beautiful blue sky and is nice and warm. There is a lot of activity on the hill, but we are getting settled into our lodging. People were posting online about how beautiful the conditions were, and how there have only been a handful of clear days this year. Looking forward into the weather forecast, the following day was supposed to be colder and not bring any new snow …Did I miss the timing of my day to go snowboarding?

True to the weather guys prediction…As I wake up Saturday morning- no new snow, and cold as heck (read: all that nice snow from Friday is now solid ice). So I decided to spend the day relaxing while the kids were in lessons. Turns out the weather guy was only correct until 11am. Then it once again got beautiful out, but by then I had mentally moved on to spending time with family and prepping for dinner etc. Super important, but definitely not snowboarding….and the weather prediction for the following day was to be cold, minimal snow and windy. Very windy.

Sure enough, this was the worst day of the lot so far. This was definitely a no go for any form of fun snowboarding, unless you are looking to use the wind to sail to the west coast. Seriously…it was that bad….and so it all came down to going snowboarding on the following day…or not at all.

As I was going to bed that final night, I looked back at all the fun things we had done as a family, and will cherish many of the memories forever. It was fantastic. Many of these memories that I was involved in clearly happened because of the fact I was present in what was happening and not thinking about my missed time snowboarding. I had resigned to the fact that I was not going to ride that day, and had put all my focus back into what mattered at that moment. The conditions were garbage anyways, so why waste mental space and time on something that really wouldn’t have been worth it. I think the key thing here was not forcing the issue. When you always tend to focus on others (job, kids, family) sometimes you can feel lost in the shuffle, and then try to force it when you are trying to spend time on yourself. Perhaps not listening to the proverbial weatherman.

In returning to sports, I definitely see patients with a lack of patience. Maybe it’s not my place to say, but I see people forcing the issue to get back to sports for one reason or another. I’m sure those reasons are even valid, but what I’m suggesting is the time just may not be right. I see them do all the right steps in terms of doing rehab, working on other parts of themselves, but there is that innate drive to get back to “the old them”. I’m not sure if it’s the ego talking, or just a goal to overcome adversity and prove to themselves that they are healed. Forcing the issue in either of these situations can lend itself to failure…which has more of a negative impact on mental health, then perhaps waiting for an extra day, week, or month. To be clear, waiting does not mean sitting around doing nothing…in fact it is the exact opposite. It should be doing everything else to clear obstacles and excuses so that when the right time does arrive, there is nothing holding you back, and you can then be present in the moment when you are attempting to achieve your focused goal. Set yourself up for success!

So what happened with me being OK with the possibility of not snowboarding, and putting off going out in far less than ideal conditions? I woke up looking out the window throughout the night to heavy snowfall, and in the morning was treated to 30cm of fluffy snowfall. Boom.
It was an amazing day of riding fresh tracks. I met an 86 year old with a perma-grin beating people half his age down the hill. Everywhere I went I heard people laughing and high-fiving over the “best run ever”.
For those of you that had patience this weekend…High Five.

When I was done, I walked back to the cabin where we were staying and realized the vast amount of snow that had to be cleared for us to be able to get our vehicle out. I look around and see a small scoop shovel…I think to myself “Self, you got to have fun, and this is a little bit of work to pay for the fun you had…no biggy”. I set to work clearing an ENORMOUS amount of snow (think knee high x 30 SUVs)…and JUST as I finished shoveling for well over an hour, a massive CAT with chains and snowplow attachment showed up to finish the job.

Perhaps, I should have been more patient…

The post The Value Of Patience appeared first on MotionWorx Physiotherapy.

So you have just been injured. Welcome to the club. The club no one wants to be a part of.

Was it caused by some other persons error that wasn’t following the rules? Were you just not paying attention? Did we get the goal? Can I still play?….Often these can be the first thoughts that go through our heads when we get injured. In fact, the last one that can enter the mind is ” Am I OK?”.
Once that thought jumps into our heads, sometimes it will never leave. When things are slow to progress, it can feel like it will never get better. Dreadful thought.

After we have assessed the damage to our best ability (some people when injured are more capable than others at this), we carry on and then have to make some important decisions about the best course of action after an injury, or as I like to call it: Damage Control.
The funny thing about damage control is that, while it’s important to deal with any emergent situation (fractures, open wounds, concussions etc.), the vast majority of poor decisions that happen for less scary injuries, can often lead to prolonged or worsened conditions, if only due to the fact that they are poorly handled early on.

THE MOST IMPORTANT THING YOU CAN DO WITH ANY INJURY IS GET A PROPER AND THOROUGH DIAGNOSIS. This seems obvious enough, but what often happens, is the injured person gets thrown off the correct path towards a diagnosis due to subtle, but powerful, “Red Herrings”. A Red Herring in an injury is when a person focuses on the pain, not the cause of the pain. This can be due to the unrelenting nature of the pain, the emotional attachment to the injury, or the masking nature of the injury itself (such as a low back nerve injury that feels like pain in the leg or foot).
The reason that a proper diagnosis is KEY to tackling an injury is that if done correctly, should put all possible related diagnoses on the table, and come to the final diagnosis (or differential diagnosis of a few similar ones) by exclusion. The nature of this is important to shed the fears of the patient towards more ominous potential injuries, when a simple injury is just not being treated correctly. By removing fear, a patient can then better look at “Is the pain I’m feeling directly from something I did wrong?” or “Is this injury more serious than I thought?”, versus “Will this ever get better?” or “poor me! I can’t do anything!”

Here is a real life common example of decision making early in an injury… Young Timmy is playing soccer and reaches out for the ball with his foot, and feels a pain in the back of the thigh. There is a lot of pain, but no swelling or bruising. Timmy sits off the field and puts ice on his hamstring, and stretches it out as it is going into bouts of spasm (both ice and stretching weirdly seemed to make it sore afterwards). The next day there is still no bruising, but misguided young Timmy is unable to reach his leg out in front to walk, and has pain all down the back of the leg. Timmys Mom tells him to take some ibuprofen and continue to stretch.
The following day Timmy has pain into his glut region (and in the previous areas) and is getting numbness in his foot.
So where did they go wrong?
The best question to that is when did they go wrong? Immediately.
In this case, Timmy’s injury is commonly thought of as a hamstring strain. Except when it isn’t. In the case of a hamstring injury (please see upcoming BLOG on stretching post acute injuries), Timmy did what most people will instinctively do, even if it is incorrect- stretch a tight muscle after an acute injury.
In this case, the injury was a traction injury to the sciatic nerve, which lives anatomically under the hamstring. The hamstring will be the last anatomical structure left to protect it in an outstretched position, and will “throw itself on the sword” to protect that valuable sciatic nerve. The muscle is tight either because it itself is injured, and is trying to auto-splint itself, or the sciatic nerve was injured in a traction fashion, and the hamstring is tight in attempt to prevent further stretching to the nerve. Either way, stretching was not a good decision in an acute injury.
On a side note, acute nerve injuries do not tend to react well to traction forces, compression forces, cold temperatures, or vibrational forces. It is easy to see how stretching and cooling an acute nerve injury would make things worse (even just for a short duration). If an injured person does not listen to these important signs, they could continually irritate the nerve, and then grow frustrated when it does not heal as expected.

While this scenario seems drastic, it is very common on some level with many different injuries. This can be further perpetuated by a rushed timeline (such as an upcoming competition or strict coach/parent). It cannot be stressed enough that emotion is very powerful in influencing the injured person to make poor/rash/desperate/anxiety or fear-driven decisions. WHEN YOU ARE ABLE TO TAKE EMOTION OUT OF THE DECISION PROCESS, YOU WILL ALWAYS MAKE THE CORRECT CHOICE. The best way to do this is to educate yourself (hopefully from a thorough diagnosis, not just Dr. Google) so as to best decide WHERE IS THE BATTLE that you have to focus on- and solve it correctly, before you move on to the next battle.
Think of it as you need to finish kindergarten before you can move on to grade one, and so forth, before you graduate high school. Sometimes, you may have to go back a few steps and do them correctly before getting back on track, as injury healing is not always a linear path.

A very important aspect of this process is to not let pain be your guide as an indicator of whether or not the injury is actually improving and ready to go (SEE BLOG ON PAIN). Just because something FEELS better, doesn’t mean it is better. You may just be amazing at compensating and working around the pain, and possibly creating another problem. The key again, is to get a proper objective indicator of how you are doing at that moment (strength, timing, range of motion), and then gauge your progress and direction from there. This is where your trusted physiotherapist, chiropractor, doctor, massage therapist (or other), can be an invaluable guide on your journey to getting back to your regular (or better) self.

When medical professionals are initially assessing your injury (or your progress for that matter), the first thing to rule out is the presence of anatomical dysfunction (such as a fracture, cartilage damage or an actual tear on the muscle). Once that is ruled out, the next thing they should be screening for is the presence of a nerve injury (compression or traction injury) causing weakness and/or impairment in the periphery. Both of these complications can cause the muscles in the body to do some pretty crazy things, and can lead you down the wrong path towards success in your injury management.
The next thing to screen for is the presence of joint hypermobility (too much movement) or hypomobility (too little movement). This again, can cause your body to move differently, and thus inappropriately load the injury, or other parts of the body attempting to help you continue to move around “normally”.
Finally, they should be screening for biomechanical strength, control, movement patterns, and timing. This is commonly what people associate with physiotherapy and the homework they are given to do at home (or in the gym with a kinesiologist).
If for some reason the gains in strength are not being made, we have to readdress WHERE IS THE BATTLE? and perhaps look at: Did we miss an underlying nerve injury?, What are the other patterns of weakness present? Are there any compensatory patterns?, Was the homework done properly? Has the injury been overloaded in daily activities? Are there any underlying emotional or psychological factors slowing down or masking the progress?

So if you are finding yourself frustrated with your injury, make sure you slow down and try to analyze where things are going wrong, rather than just stating that things aren’t getting better, or worse, just focusing on the pain. This is a great time to talk with a trusted healthcare practitioner and have them thoroughly assess where you are at, and to help guide you. Make sure to explain any concerns you have with your current plan, and discuss what things seem to help or hurt your injury. The more information you provide to your healthcare practitioner, the better they can help figure out where WHERE IS THE BATTLE that is important to fight at that time, and they can then help set a realistic plan to help you achieve your goals.

Keep at it… Educate. Rehabilitate. Dominate.

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While babies haven’t developed an ability to have an intellectual discussion with mom on the merits of breast feeding, they are very clear when they are hungry.  The key is to understand that they ARE speaking to you, and that if YOU pay attention, you can sort the problem out and make sure the little tyke is happy and healthy.

Picture an injured body. Would you let it continue to send pain signals to your brain without trying to figure out why it is sore? Is something damaged? Weak? Nerve Injury? Workout too hard? Or would you just take pain medication and ignore the problem?

While the body hasn’t developed clear language to communicate with the brain on specifically what is wrong, it is VERY clear that there is SOMETHING wrong. This language is pain (and other subtle cues that likely were given beforehand). While there are many different types of pain, it is clear that pain does not equal harm.

Pain is the equivalent to a fire alarm. It is telling the people that there is smoke/fire/burnt supper. All the alarm knows is its job is to tell the people to investigate the source, and then either take the burnt pizza out of the oven, or in more serious cases- get out of the house and call the fire department. The Alarm is NOT the problem. More importantly, if you had a fire, and chose to ignore the alarm, there may be dire consequences.

So while there is absolutely a time a place to take medication to control the pain or more importantly bring it to a reasonable amount, it is an important message that many people chose to not listen to, and that may lead them to unknowingly do too much, thus, perpetuating the cycle. An important time to manage pain levels is especially true at night- poor sleep will lower ones pain tolerance, which again feeds the cycle.

While pain can be scary, when you realize what increases pain, and what decreases pain (physically, not with chemical intake) it helps you narrow the field of what is safe to do and therefore allows you to safely continue to move your body, in addition to educate yourself about your body.

One piece of advice that I will end with is that injuries can be a great way to focus on ourselves, perhaps learn what we did wrong, and make decisions moving forward that can prevent the injury coming back, make us a stronger well-rounded athlete, or to just further teach us about our body…If nothing else, it can make us a better version of ourselves when we come out the other side.

“A knight in shining armor is a man who has never had his metal truly tested” -Unknown-

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Sit up straight! (Seriously…try it. Right now. Sit up straight. Just do it for me)

This is one of the thousands of cues that you will hear parents tell their kids before they give up to the unrelenting nature of gravity and seemingly uncaring slouching of their children. Poor posture however, is by no means limited to just indifferent teenagers. As physiotherapists, we deal with a myriad of issues that directly relate to posture, and its importance in rehabilitation. I read a great article a few years back that noted that while the human head weighs approximately 8-10 pounds, when leaning forward at a 45 degree angle the stress at the base of the neck is equivalent to 50 pounds of force (significantly higher forces at higher angles). And that’s only 45 degrees! Think about that next time you are scrolling through your facebook/Instagram feed hunched over like Golum just found his precious ring.

Whether we are dealing with an upper extremity nerve injury stemming from bad posture, post MVA whiplash, low back pain, TMJ dysfunction, or headaches (to name a few) or are looking to get stronger in the gym, look more confident for that new job, or get taller to get on that special ride at Disneyland, all are directly affected by poor posture.

So why the heck don’t we all just sit up and stay that way? If you were one of the few people that tried to sit up from my prompt at the start of this, are you now? (Ever notice how when you say the word posture, people in the room sit up?- or maybe that’s just a byproduct of my profession….)
If I asked you to lift your arm out to shoulder height and keep it there all day, could you? If this is not something that you have been working up to, is this a realistic expectation (or just painful)? Do learn-to-run programs start with having someone just go and do the marathon, or do they work up to it and train for it?

In my experience, people approach posture as a all or nothing task. As in, Sit Up Straight. If they are not up straight, that is a FAIL. What if we took the approach of NOT being in the problem position being the focus, and any consistent amount of time working TOWARDS proper is a WIN.

The truth is, people are not meant to sit for prolonged periods, especially focused on a screen that pulls our attention away from the many signals that our body says to our brain about load, stress or even pain- FAIL. People are meant to MOVE their muscles. So, when people ask me what the ideal posture is for sitting, it is easy to spout off the rules of sitting ergonomics- but the reality is that anything upright that is not passively resting on your joints for prolonged periods is a WIN. Are standing desks the answer? Only if you change your positions frequently and use your hip/core muscles appropriately…not standing locked out on one hip, looking like the teenager with too much attitude. OMG Becky!

So what can we do?

Yes, it is important to try and sit tall. When sitting, this can be accomplished by trying to get off your tailbone, and sit…on your sit bones (shocking). This will bring your pelvis into a more neutral position. It’s also important to try and be as tall through the back of your head as possible- think of someone pulling the hair on the back of your head up to the sky. Lastly, think about gently squeezing your shoulder blades together, or sticking your sternum out a bit, looking proud.

If the goal is to succeed, there is no point trying to hold this all day, as previously mentioned. Focus on doing lots of a little- like doing interval training for your posture. This is accomplished by finding a cue that you do ON A REGULAR BASIS. Examples of this are:

• Every time a commercial comes on TV while watching shows, posture up for duration of commercials (no fast forwarding!)
• Every time you are at red light/stop sign, posture up for duration of car being still (no blowing through lights/signs!)
• Every time you get a text message, posture up for duration of messaging (no cutting off friendships)
  • Note: Good text posture can be achieved by resting elbows ON your ribs to hold you upright. No more setting phone in lap, causing your head to creep overtop causing the slouch.

That’s it. Start there. And succeed. Get a WIN and posture up.

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