Tagged: physio

So You’re Injured – Now What?

Any active person has had it happen.  You are doing whatever activity you enjoy and suddenly feel a bit of a pull, cramp, sharp pain or something not quite right.  Hopefully you’re smart enough to stop what you are doing and not push through the pain to complete whatever you are doing, but maybe not.

Then the inflammatory feeling starts kicking in.  Your tissue will feel full, there may be lingering low level pain or sometimes acute high level pain when you move.  Sometimes you can’t move without your body telling you not to through a jolt of pain.  Often this is a bit indicator of the severity of whatever injury has happened.

So you realize that this is beyond a simple pull, mild strain or simple fatigue.  You’ve done something that may require intervention and some sort of attention.  You’ve injured yourself.

First things first: if you have acute high level pain and can’t move a limb or joint please GO TO A HOSPITAL.  You will wait a while because musculo-skeletal injuries aren’t triaged as a priority but at least you will likely get some imaging immediately.  There may also be things going on underneath the surface you have no idea about so better safe than sorry.

injured

If that’s not the case, what is your next step.  Well, there is a simple routine that you should follow, and it can be done in this order:

Care

This is what you do immediately.  The biggest thing to do with any injury is STOP MOVING IT.  Don’t stretch it right away, don’t think that you can “push through the pain”.  You will make things worse.  Stop what you’re doing.  Your body is very intelligent and is already doing what it needs to in order to start fixing things.  Give it a chance and don’t make things worse.

Don’t ignore pain.  Pain is a signal saying “QUIT IT”.  Your body is literally telling you to stop what you’re doing just like taking your hand off a hot stove.  Once you have stopped moving, the next step is…

Evaluation

Some questions to ask yourself:

  • Is the pain acute with movement or does it come and go, for example it stiffens up during sleep or is painful at different times of day?
  • Is my strength compromised for certain movements, ie can I not pick something up, reach over my head or extend my leg without a problem?
  • Is there soft tissue damage?  Swelling is one thing, but bruising typically means a much more severe trauma that requires attention faster.

The more you have information, the easier the next step will be because you can figure out which practitioner to see first and not waste your time.  Have a soft tissue problem?  Massage might be best?  A serious joint issue?  Maybe an osteopath or chiropractor (more on this later in the article).  Arming yourself with answers and figuring things out on your own can be valuable in not wasting your time.  That leads us to…

Diagnosis

This does NOT mean going to someone like me and asking them what it is, because I have no authority to diagnose anything even with my years of experience.  What is does mean is going to someone with the words Doctor in front of their name and ideally getting some testing and/or imaging.  I always tell my clients to push for imaging because ultrasound and x-ray can reveal things simple testing cannot.  If MRIs were more easily accessible that would be my default for many things.  For those of you in Canada, remember that some provinces (ie Quebec for those of us in Ottawa) do allow paid MRI’s – you just have to pay for it.

As much as I appreciate the access to General Practitioners or walk in clinics, regular MD’s have little to no experience with bone and joint injuries and often will suggest exactly what I just said anyway, so don’t waste your time.  And if a GP does give you a “maybe it’s this” diagnosis please get it confirmed by someone with experience and ideally imaging as I said.

Be proactive – once you have a diagnosis, learn everything about it that you can.  It will not only educate you on what the injury is, hopefully it will make you realize WHY it happened and how to prevent it in the future.  Often during my initial consultation I have found that clients have never had their injury properly explained to them by anyone and have no idea what happened to them and why.  Knowing the why is very important for any recovery model.  And that allows me to discuss…

sports-massage-therapy

Recovery

After you have a diagnosis, depending where you get it the first suggestion is always physiotherapy.  It’s covered under benefits, didn’t you know?  The only problem is that there are lots of other ways to treat an injury and in my experience physio yields the worst results overall for my clients and others I have spoken to.  If I was going to suggest the order you should look into things and why, here’s my list.  Again, not to knock any practitioners – there are lots of good and bad ones out there – this is simply my experience in dealing with all of them frequently.

#1: Osteopath.  These people frequently have had experience in another modality and decided to move into osteopathy.  From an assessment and treatment perspective the results from these practitioners seems to be consistent, and they don’t ask to see patients frequently.

#2: Massage Therapist.  With the disclaimer that this is for soft tissue injuries only, a good massage therapist can help with things like scar tissue, blood flow to improve tissue and relieving stiffness and immobility.  This should be included with any recovery plan.

#3: Chiropractic – Again, with the disclaimer that this does NOT mean back cracking or neck cracking.  A good chiropractor who knows other treatment protocols like ART or myofasical release, or even relieving nerve entrapment are usually your best bet.

The thing with chiropractors is that a lot of them are salespeople who try to lock you into long term treatment plans where you see them three times a week – please don’t fall for this and if it is suggested, find another practitioner.  This generally doesn’t have any interest in your recovery, it has interest in your wallet and benefit plan.  If you need to see a practitioner three times a week they need to justify it.

#4: Physiotherapy.   Again, there are good physios out there.  The problem is that in my experience they are few and far between.  Look for someone who doesn’t use outdated methods, someone who will actually spend time with you individually (not hook you up to a machine and walk away or leave you with an assistant), and who will progress you session to session properly.

How long does it take for proper recovery?  The general rule for serious soft tissue injuries is 6-12 weeks, more serious damage like tendons and ligaments can be up to 3-6 months. Anything requiring surgical intervention can be 6-12 months.  This is not carved in stone, but it will give you some perspective in that you need to assume that this is a long term fix and not a temporary thing.

In my opinion surgery should always be a last resort.  It is done when there is no other option for restoring tissue.  Full tears, severe arthritis, and things like broken joints often carry this load and it is totally necessary.  If you have the option, see how well you can get first without it and then see about surgery if all else fails.  Realize that if you meet with a surgeon, they are going to likely push for an operation – that’s their job.  You have options, consider them all wisely before making a decision that can affect your body for the rest of your life.

As a final note, the number one thing I see that causes injuries to recur is that the person rushed back into exercise and doesn’t do what they need to do to fully recover.  This just makes things worse and more often than not will result in a worse injury down the road.  Listen to your body and ease back into exercise.  Sometimes my clients have to start off ridiculously easy and it drives them crazy, but it takes time for recovery and having a guided path is absolutely essential.

 

 

So you’re hurt – there are lots of options for you to pursue and the good news is an injury doesn’t have to be the end of the world.  If I told you the laundry list of injuries I’ve had (including a disc herniation and multiple tears in various places) you would be surprised – but I can still move easily and lift heavy things without a problem.  Be smart, apply things properly and keep moving forward.

If you liked this article feel free to SHARE it on Facebook and follow me on Twitter @strengthottawa.  And of course if you have any questions you can contact me at any time via phone or email.  Stay mobile!

I Am A Healer – There, I Said It.

Years ago I had a client who had torn his rotator cuff during a simple movement.  The funny thing was, he didn’t even know it until he got an MRI on the area.  He had come to me with some shoulder pain and I did what I do and strengthened the area, thinking he had simple tendonitis and it resolved in a few months and he went back to regular lifting.

The “holy crap” moment came when he got the results of his MRI, and his orthopedic surgeon said that he actually had a full tear in part of his rotator cuff.  What the surgeon also said was that his shoulder was so perfectly strengthened to within millimeters of the tear that his shoulder could function without a problem even though he had an injury that should have required surgery.

Over the years I’ve had many examples of this type of thing within my practice.  Hip replacement?  Golfing within four months.  Achilles tendonitis?  Took four weeks.  Massive spinal trauma due to getting hit by a truck twenty years prior?  Resolved issues and can perform at work and home without issue.  Four herniated discs?  Skating and lifting things again within six months.  Powerlifter with a chronic hip issue that wouldn’t allow her past parallel?  Competed in provincials several months later.  I had a woman come in with a diagnosed tennis elbow she had for over a year and resolved that in 40 minutes by popping it back into place.  She’s still good months later.  Bodybuilders who have shoulder issues?  Retrained and fine after a couple of weeks.

I actually got an email a few months ago from a client with two knees that were essentially destroyed due to lack of cartilage I worked with three years ago – who said she is still walking 20 miles a week and her knees are totally fine.

Here’s the funny thing – sometimes I still feel like I don’t know what I’m doing.  I know a lot about the body and how it responds to force and how to strengthen things really effectively.  This is simply a confidence issue stemming from years of bullying and neglect at home where I had to fight to prove that I was good at anything and even then got ignored so gave up a lot.

Recently though I’ve had a bit of a mind shift.  I’ve taken a look at the success I have had over the years with clients of many shapes, sizes and ability levels and realized that while sometimes I keep putting myself down, I have actually affected and helped a ton of people in a very positive way when it comes to “fixing” injuries and getting people moving without a problem again.  I’ve also encountered some incredibly rare conditions that I have had the luck to be able to work on and gain experience with.  My brain just seems to work in line with movement and force so that I can make logical sense of things and actually get to the root of the issue.

So what’s the point of this?  I guess it is a simple statement that I’ve realized that I can embrace this skill.  It is something that I was meant to do.  Something I’m really good at and can help people with.

Last year in a course they asked us to generate something called a “sankalpa” which is a yoga word for a simple statement that you use to focus yourself and discover your inner being.  The first thing that popped into my head after thinking about it was “I am a healer”.  My other inner voice pushes that away and tells me I’m not good enough, but recently I’ve been able to shift into another way of thinking finally.

So there is is:  I am a healer.

The exciting thing about it is that there are still many avenues I can explore, directions I can take and methodologies I can learn in order to increase the level of skill I already have.  I’ve gone down a couple of those paths, but now it is time to make it a direct focus and really get into the practice (not that I wasn’t already).  It feels good to have that type of mind shift, even though it has taken a long time.

We are all on the Earth for a reason, and as much as I tried to push it away and ignore it, this is simply my calling.  I’ve known it for many years but now I’m just declaring that it is time to stop that and embrace it instead.  Expect to see some changes to the practice in the near future.

Got a problem?  Injury?  Strange condition that you want to improve?  Come at me bro.  Want to feel better, move better?  Tried everything and nothing seems to work?  Try this.  And the great thing is that it can be applied to many communities from heavy lifters who tweak something to the elderly who have been living with problems for years.

With the support of my amazing family and community and clients I know that I can make some changes that will only enhance my ability to help people and make them well physically again.  And with any luck help more people that recently thought that there was no help for them.  Wish me luck and of course, if you know of anyone that might need help please just let me know.

What Goes in My Grocery Cart?

Nutrition is obviously a hot topic these days, with everyone touting gluten free this and sugar free that.  Basically if you read enough on the internet, everything is going to kill you.  Here’s a bit of a hint – everything IS going to kill you eventually.  Really what you want to focus on is staving off the effects for as long as you possibly can and not letting yourself develop a chronic degenerative disease that might make it happen sooner.  My grandmother recently turned 100 years old, and still puts salt on things, eats butter and has two sugar cubes in her instant decaf coffee every day plus a hit of sherry once in a while.  I also share a Coke with her once a year.  She also lives an incredibly stress free lifestyle, which I think is one of the major contributors to degenerative disease today – but I digress.

While at the store this morning I thought I might post about exactly what I shop for and why, and hope that it might give you some insight into what a “fitness person” eats.  So here’s what was in my grocery cart this morning, which is pretty typical of 90% of our food intake:

Apples                  Tomatoes            Bananas               Cheese

Grapes                 Cucumber           Green Beans      Whole Wheat Wraps

Broccoli                                Strawberries      Kale                       Lactose Free Milk

Greek Yogurt     Brussels Sprouts               Oranges               Brown Rice

Peppers               Sweet Potatoes                Peppermint Tea

Tofu (we feed this to our daughter for fat and protein – and she loves it – yes, I know about soy)

Cheerios (my daughter also loves these as a treat but I eat them too for breakfast sometimes)

Total Cost:  $53 (at our local FreshCo) for enough to cover us for about four to five days.  We typically spend about $80 per week on groceries.

We get our meat from a local butcher because it is better quality – I rarely buy meat from the grocery store unless they are having a big sale on something in bulk.  Most of our meat is fish and chicken, but I also buy ground beef and sometimes a roast for convenience.  Once a week we do a slow cooker meal which covers us for 3-4 meals so it is easy for my wife to simply reheat if I am working late.

You might notice that there’s nothing from a box or that’s frozen.  This isn’t always the case – we buy frozen fish because it is cheaper and my butcher doesn’t carry it and we buy frozen peas because they are convenient and cheaper as well.  We don’t drink pop, or any juice.  I drink coffee that I sometimes make at home but I typically buy one from Tim Horton’s 5 days a week when I’m on my way to work.  I put cream and sugar in it because it tastes better that way.  If I want a snack I’ll eat fruit, yogurt or banana chips from Bulk Barn since I’m allergic to nuts and can’t eat those.  My post long run recovery drink is chocolate milk and sometimes my wife puts it in her coffee at home.

Here’s another shocker – I don’t take supplements.  No protein shakes, no BCAA’s, nothing beyond a simple Vitamin C to help reduce the risk of illness.  I found through trial and error that protein powders don’t make my system happy and the added juice and sugar add up to a ton as well.  Not that this is necessary, but I made a decision a while ago to basically cut back on anything artificial or that has chemicals in it, which any protein powder does.  And you can tell me until you’re blue in the face how yours comes from 100% natural ingredients, but the truth is, your powder still got made in a factory with 20 others that are simply boxed and shipped to other companies and there are still fillers and additives in it.  So basically I get 80% of my nutrition from real food, and the other 20% is the occasional 1-2 times a week I grab something when I’m out.  About once every other week my wife and I order in Thai food like normal people.  I follow the 80/20 rule – if you do the right thing 80% of the time it likely makes up for the 20% that you don’t.

I also have a ten month old at home – we feed her pretty much the same stuff that we eat at this point because she loves to feed herself and imitate Mom and Dad.  She loves beans, broccoli, cauliflower, peas, tofu, brown rice pasta, and especially strawberries.  For breakfast we often make her toast with almond butter and she loves it.  She has been exposed to pretty much everything (all fish, nuts, major allergens except for honey) and has no food allergies.  She doesn’t like too much animal protein because of the texture at this stage, but she will eat fish and chicken if we hide it or if she’s hungry enough.

So there you have it – the grocery and eating habits of a not perfect personal trainer and a regular human being.  I know that nutrition is a personal choice for many people so if you want to comment, that’s fine – I just might not listen.  I’ve spoken about nutrition before, and lots of people either over complicate it or simply don’t manage their time well.  They hit the snooze button 3 times and skip breakfast.  They don’t bother making lunch at home and spend hundreds a month eating out – which also leads to unhealthy choices.  Instead of whipping something up that’s healthy and easy at home (which you can easily do in 15 minutes) they stop and pick up something packaged or fast food.  Always remember – this is a choice.  If you choose to do that, then fine, but don’t complain about it.  It is really easy to make a simple change and manage your life and time better so you can live longer and feel better.  If you’re going to make a change, don’t make it for 6 weeks or a “90 day challenge” – make it for the rest of your life and commit already.

I hope it helped – feel free to comment, subscribe and share!

4 Good Reasons to Fire Your Trainer

Due to the fact that my industry is unregulated and anyone can call themselves a trainer after taking a weekend course, it is generally filled with some pretty interesting characters.  What still amazes me to this day is the fact that people will blindly walk into a fitness centre and sometimes invest thousands of dollars, simply under the promise that they are going to lose weight, get ripped or be able to perform like a high level athlete in no time – and not even interview the person properly!  Some trainers prey on this like a lion devouring a carcass, and take advantage of people who are emotionally vulnerable as a part of their selling process.  You can see examples of this all over YouTube if you just search for “personal trainer sales”.

Other trainers will use a personal relationship to take advantage of their clientele and drop their service level – sometimes to the point of completely neglecting them and what they were hired for in the first place.  Because they now see the client as a friend, they allow themselves to forget the professional side of the equation.  Trainers generally aren’t good business people, which is why they get into an easy entry profession in the first place, and chain gyms pretty much guarantee that even a totally incompetent idiot can get clients if they just stick around for long enough.

This bothers me.  I tend to take my job as a trainer seriously, and what a lot of trainers (and clients) need to learn is that when you a trainer is affecting someone’s body in a positive or negative way they are impacting a lot more than just their physical well-being.  Also, I don’t know many people who can afford to waste $60-100 an hour and not get value for it.  I know I can’t.  Our industry is also rampant with unprofessionalism.  Trainers texting, eating, or ignoring clients to chat with other people during workouts.  Trainers who talk more than they coach.  Trainers who come in to work hung over and brag about it.  Believe it or not, this is actually common – and it really shouldn’t be.

So in a nutshell, here are some very good reasons to fire your trainer.  If you are a client reading this and can relate to one of these, fire your trainer.  Today.  If you are a trainer reading this and get fired (or have been in the past) well then odds are you should probably stop doing one of these.

1)      They don’t show up for work. 

Trainers who constantly cancel, take loads of time off and always make excuses or reschedule should be fired immediately.  You are paying someone for a service and they are supposed to be focusing on you and your results.  A trainer who no-shows for any reason in this day and age should likely be fired right away.  With texting, email, easy ways to communicate there is no excuse beyond a legitimate emergency and this should happen once in a blue moon.

I personally know a trainer who took over 65 days away from work last year and constantly cancelled sessions last minute – but then would charge his clients if they did the same thing.  That’s 13 working weeks away from his clients, and for some reason – he didn’t get fired by some of them.  Good thing he got paid up front!  As a client, don’t let your trainer use a personal relationship to abuse the fact that they are hired to do a job.

2)      When they do show up, they act like you are hanging out with a buddy. 

If you are talking more than you are working then the session probably isn’t doing you a lot of good.  A skilled trainer can maintain a conversation (if you really need them to) while you are doing movements.  Frankly, if you are resting too much because you are chatting, why are you paying that person?  Most trainers cost over a dollar a minute – make sure you are getting value for your time.  Personal training also isn’t a therapy session or a “nutrition consultation” where you pay the person to solve problems that are outside of their scope of practice.  Doing ten sets of exercise in 45 minutes isn’t going to get you very far either.  There should be a plan, and it should be executed properly.  I know that often I don’t even have time to get everything in that I want to do in an hour long session, never mind chatting.

One big test – if your trainer is talking to you about their own personal issues a lot, get rid of them.  The session should be about you and what you are accomplishing towards your fitness goals.  Be serious about your physical fitness and health and find a trainer who is too.

Oh, and if they ever pull out a cell phone during a session except to use it as a timer or they have an emergency, you might want to think about how much they respect the time they have with you.

lazy trainer

This should never, ever happen.

3)      They don’t have a plan, long term or even during a session.

“What do you want to work on today?” was a normal thing I heard when I worked at some gyms.  Um…it is your job to figure that out and tell me, that is what I’m paying you for.  Can they modify or change a workout in the moment if it is needed because you ended up moving furniture the day before and your back is sore?  If your trainer doesn’t have a plan for that workout and then moving forward odds are they really aren’t focused on getting you what you want – results.  If you tell them that you don’t want to work a particular body part because it is already tired and they give you blank stare, run for the hills.

Part of the skill as a trainer is also being able to figure out what is appropriate for that person in the moment and constantly be assessing ability.  This can change even movement to movement.  If a client comes in and hasn’t slept, didn’t eat right or has another problem and the trainer just goes ahead with a hard core circuit workout (that they have likely done with every client that day) then they are putting you at risk of injury.  Is someone who either doesn’t know better or doesn’t care worth investing in?

I actually heard of a guy who would put a daily workout on a wipe board and have every client do it that day – no matter their condition, age, size, etc.  Ridiculous.  And not worth your money.

4)      They have no experience dealing with your specific issue.

I know you have a personal relationship with your trainer and would never want to leave them, but honestly sometimes if your goals change or something happens you may need to find a new one.  An example would be a client who gets pregnant and their trainer has never worked with a pregnant woman before – is that really a good idea?  If I suddenly decided to enter a powerlifting competition and my trainer was a marathon runner that might not be a great fit.  If I seriously injure myself and my trainer has no background in that particular injury, is it really wise to hope that they learn with you as a guinea pig?

A trainer with integrity will refer out when situations like this come up, not simply wing it hoping for a good result.  Don’t be afraid to suggest that maybe they could find you someone more suited to your needs.  Likely the money you invest will get you a better result.  Personally I’m never insulted if/when this happens and I have a good network of other professionals that I can refer to.

DaveCoach

I know that sometimes I am negative on my industry, but realistically these things happen less often than you think.  Just make sure that they aren’t happening to you!  In order to improve your results, you need to make sure you are working with a top quality professional, and they are definitely out there.  Sometimes you just have to weed through them a bit before finding a good one.  Let me know if there is anything you would add to this list and feel free to comment and subscribe!