Tag: Bailey’s Big 3

July 29, 2015

Life is like a Spartan Race. No, seriously. Let me explain. On June 5, 2015 I participated in the annual Spartan Sprint at Edelweiss Ski Resort. Being a relatively fit individual, I felt I was pretty prepared for the upcoming 5 km obstacle course race. Spartan was to be conquered and I was going to be the conqueror. I was so confident that my plan was to yell “SPARTA” at the top of my lungs using a deep Gerard Butler-like voice while performing air kicks victoriously over the finish line.

Why was I so foolishly confident?

 Three days a week I work out across at the gym doing some form of weight training at the discretion of my trainer. I run three days a week with a good friend of mine for at least a distance of 5km. I also play beach volleyball in a league every Wednesday night. I like to think I am a fairly active person. I can squat, lunge, jump, sprint, burpee, crawl, climb, push and pull.

Spartan had nothing on me, right? Well, here’s the thing about the Spartan Race. You have to run UP the ski-hill at Edelweiss TWICE. Emphasis on the word, UP. Ski hills are not meant to be run UP, they are meant to be skied DOWN. The ascension up the mountain literally kicked my ass!! I was not used to keeping my heart rate so elevated. This resulted in nausea and feelings of pukey-ness. Not a great start for this aspiring conqueror. Let’s just say I cursed gravity quite a bit during this pesky obstacle course!

 

So alas, here are 3 life lessons I learned (or, probably already knew but effectively ignored) while completing the Spartan Sprint.

spartan race 2015 bails

  1. No matter how prepared you feel you might be, sometimes you just aren’t. That’s life. And it’s ok! You can’t be prepared ALL the time. Sometimes you need to get your ass-kicked to remind you that there is still work to be done.
  1. Sometimes winning is just seeing it through. Instead of me yelling “SPARTA” at the top of my lungs while performing air kicks victoriously over the finish line, I hauled my tired, muddy butt over the finish line in a zombie, pain-induced state. But I finished, and it was AWESOME!
  1. You’re better than you think you are. Although the mountain kicked my butt, the obstacles did not. The obstacles actually served as a much needed break from running UP the ski-hill. And the feeling of being strong is one of the best feelings EVER. Just check out my game face captured in this photo of me after I dominated the gymnast-like rings. Clearly I was high-fiving myself in my mind! My body is capable, and that’s pretty cool!

 

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey

 

April 29, 2015

It is the last weekend of April and as you know, the theme of April is “Letting Go”. I thought it would be a great opportunity to talk about some of my bad habits because physiotherapists are people too! In the spirit of starting fresh this coming May, here are some of MY bad habits which some of you may relate too! And try not to hold them against me! Haha

1) Chewing my nails. Disgusting, I know. I don’t even know I’m doing it. I’m pretty sure I chewed my nails in the womb, that’s how bad this habit is. Have I tried to quit? Yes. Have I been successful? Not even a little bit. So if anyone has any suggestions on how to quit, leave a comment!

What have I tried? Well my parents offered me $1000.nail biting meme00 to quit for a whole 12 months when I was much younger. I was able to go about 8 months before my nerves got the best of me. I was participating in a cross-country race in The Grove located in my hometown of Arnprior, ON. Fortunately (or, unfortunately) I won the race, but lost the war when it came to my nails. It just took one race and my nails were GONE! I have also tried using that disgusting stuff that makes your nails taste terrible, and guess what? I got USED to the taste and just kept on biting. Biting and biting and BITING. Now, I have no nerve endings left in my fingers for me to even feel pain! Talk about hopeless!

2) Slouching. Ironically, I’m the self-proclaimed posture police when it comes to my clients. I’m especially strict when it comes to my clients who sit at a desk all day! Slouching can lead to loads of dysfunction in your neck and shoulders. Take my shoulder for instance: My poor right shoulder has been getting quite “ouchie” over the last few months. This is because I tend to sit/stand with my shoulders in a forward, rounded position. I am also right hand dominant, making me more inclined to use my right hand for essentially EVERYTHING. Because my shoulders have been creeping forward, the back of my right shoulder has gotten pathologically tight. As a result, my ability to put my hand behind my back is restricted and painful. Overhead movements can be often uncomfortable.

Thankfully, I work with a great team who is able to help me restore my passive accessory movement back to normal. Even though I’m a physiotherapist, sometimes you just need another set of eyes and hands to help resolve some of your issues!

3) Don’t wait! Procrastinate now! Take this post for instance: My boss likes me to post things every Wednesday morning. Heaven forbid I try to have something written BEFORE Wednesday! I like to think I thrive under the pressure of having a deadline. Realistically though, instead of “thriving” I often find myself stressed! There is enough stress in the world without procrastination. My goal in May is to try and set aside some time each day to do something productive (i.e. study for my Level 3 Manual Therapy Course). A half hour is nothing in the grand scheme of things. Maybe my goal should be to de-activate Pinterest? I’m sure I’d get a lot of my life back after doing that!

Keeping it real everyone! With the warm weather approaching, now is the time to make those much needed changes to better yourself! I’m going to try, so should you!

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training and has really really REALLY short nails.  More about Bailey here.

Bailey

 

April 17, 2015

So the theme of April at Whole Therapy is “letting go.” I struggled with coming up with a blog topic to compliment this theme. This past week, however, I came across this article on the web and thought to myself, Eureka!  This is my teachable, “letting go” moment!

I want to preface by saying that medical imaging technology has developed into something amazing. The amount of stuff we can see without actually cutting into the body is phenomenal. Sounds morbid, I know, but it’s true! Medical imaging can be very valuable in identifying serious medical conditions such as fractures, dislocations, etc. That being said, it is often difficult to discern what findings on imaging are related to natural aging processes or rather a pain-provoking injury? Words like arthritis, degenerative discs, disc bulges, tendon tears all sound very scary! And the fact that they sound scary is a problem in itself. They can create fear- a lot of fear. But, what if I told you that the above are all minor findings and do not really add much value to your plan of care?

Confused? Let me clarify. Mrs. A came to see me at the clinic for a “MRIdisc herniation.” On my subjective intake, I asked Mrs. A about her pain. Mrs. A had NO PAIN. Confused, I asked Mrs. A about her ability to perform her day-to-day activities. Mrs. A had NO DIFFICULTIES performing any of her day-to-day activities. Now very confused, I asked Mrs. A about this suspected “disc herniation.” Mrs. A had a hysterectomy in which she had some complications. She had to undergo repeat CT Scans to make sure all was well and healing appropriately. It just so happened that a disc bulge was seen as an incidental finding on one of these CT scans. Nervous about this finding, Mrs. A sought out physiotherapy to treat her disc herniation, for which she had no pain, no loss of function and for all purposes, NO impairment!

The fact is, arthritis, degenerative discs, disc bulges and tendon tears are usually just a natural result of aging against gravity. Don’t believe me? Check out this recent article (2015!) summarizing a cross-sectional study looking at abnormal findings on MRI in the cervical spine (a.k.a. neck) in 1211 asymptomatic people (a.k.a. NONE of the 1211 people had ANY neck pain). You can find it here: http://europepmc.org/abstract/med/25584950\

Three things you should know about neck imaging:

  1. Everyone has disc bulges. This study found that 87.6% of the 1211 had disc bulges and no neck pain. So for every 10 people, 8.76 of them have disc bulges! And remember, none of these people had any pain!
  2. You even have disc bulges in your 20s. They found that 73.3% and 78.0% of males and females in their 20s had disc bulging. Yep, even your 20 something co-worker who barely seems out of the womb probably has a disc bulge.
  3. A small percentage of people even have spinal cord compression and no pain! Sounds unbelievable eh? But 5.3% of people, generally over the age of 50, had evidence of spinal cord compression with no pain. That’s not to say that the compression shouldn’t be monitored, but it goes to show you that the perception of pain is a lot more complicated then we may give it credit for!

Pain in itself is a complicated construct. I’m not trying to undermine anyone’s pain experience, but it is important to recognize that the scary-sounding results on imaging may not be so scary at all. Giving these words power over your life, however, has been shown to lead to more doctor’s visits, more pain, more disability, and a poorer quality of life. The only way to overcome this is to let go of the power we give these words and understand that they are probably just a natural result of aging! Don’t worry, you’re going to be just fine!

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey

 

 

 

 

 

April 8, 2015

shin splints

If you have been reading my blog, my goal was to initially complete a series on needling in the profession of physiotherapy. Don’t worry folks, I still plan on completing that series! It’s just on pause for now. I have chosen to stray from my previous plan and look at a common problem that plagues many runners, because as we all know, April showers bring May flowers, and a boat-load of running injuries! Also, my boss wanted me to do a blog on running. Since she is of course, my BOSS, I figured I should make like a good employee and write about shin splints!

Shin splints is a funny diagnosis. It’s a funny diagnosis because shin splints is typically used as a catch-all term to describe shin pain. In fact, shin splints is defined by the American Academy of Orthopaedic Surgeons as “pain along the inner edge of the shinbone (tibia)”. So in a nut shell, shin splints = shin pain. This makes its diagnosis confusing. Imagine this typical made-up conversation:

              Hello doctor, I have pain in the inner, lower portion of my legs after running.

              That is easy! You have shin splints!

              Oh, that answers EVERYTHING. I have shin splints!

But I just told you that shin splints = shin pain. See the problem here? Shin splints doesn’t actually tell me what’s causing your pain! Here are three reasons you may develop shin pain, also known as the notorious shin splints.

1) Medial tibial stress syndrome. This is also known as “too much, too soon” syndrome. MTSS is typically the result of overloading the tibia with biomechanical inefficiencies. This can lead to periostitis, an inflammation of the membrane (a.k.a. periosteum) covering the bone. Ever wonder why it feels like your bone is bruised? Muscular imbalances commonly seen in the tibialis anterior, tibialis posterior and soleus muscle in combination with excessive pronation often puts too much stress on that poor tibia bone. As a result, the tibia bends and bows more than it should. This pulls on the connective tissue attaching to the bone itself. More pulling = more inflammation = more periostitis = more pain. Addressing the biomechanical inefficiencies while decreasing excessive load is key in making sure this bad guy goes away! It usually presents as a dull, diffuse ache along the bone of the tibia.

2) Compartment syndrome. Compartment syndrome is the compression of nerves, blood vessels, and muscles inside a closed space, or compartment, surrounded by a sheet of fascia. There are four different compartments in the lower leg. In order to understand compartment syndrome, you need to understand the role of fascia. Fascia is connective tissue, which attaches, stabilizes, encloses, and separates muscles and other internal organs. It is literally EVERYWHERE in the body. It also does not like to expand very much. As a result, if a compartment in the lower leg swells beyond the stretching capability of the fascia, pressure inside the compartment can increase and increase, and INCREASE. This is serious and can cause tissue death due to the compression of blood vessels (lack of oxygen). If you are experiencing extreme tightness, burning, pins and needles and/or temporary paralysis with running, PLEASE STOP and seek a medical opinion!

3) Tibial stress fracture. A stress fracture is exactly what it sounds like, a fracture or crack in the bone. It is the consequence of the tibia failing mechanically due to repetitive submaximal stress. It is also known as “too much, too soon, too late” syndrome. But Bailey, I’m only running. This is a submaximal stress! How can I get a fracture?! Well, repetitive submaximal stress can cause an imbalance in your body’s ability to resorb bone and form bone. In this case, there is more bone resorption then formation. So even the smallest, most microscopic crack in a bone can progress and worsen under repetitive, submaximal stress. With tibial stress fractures, a runner will experience very localized tenderness directly on the bone. You may even feel a bony anomaly under your finger. Unlike MTSS, you will probably experience pain immediately when you start running in a very point-specific spot. If you suspect a fracture, PLEASE STOP and seek a medical opinion!

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey

 

 

 

March 25, 2015

AcupunctureSorry for my absence on Whole Therapy’s social media for all of my devout followers (If you are reading this at all, THANK YOU very much!). I was in Cuba for a WHOLE WEEK vacationing from thinking. I’m back though and ready to educate poison all of your minds!

It’s Wednesday and I’ve noticed that I’ve been performing a lot more needling techniques over the last week (with quite a bit of success!). This has inspired me. I feel like writing a series of blogs on the use of needling techniques in the practice of physiotherapy. Today’s goal is to clarify some misconceptions I commonly see in the public’s eyes. In future posts, I’ll look at its utility as an adjunct therapy, because contrary to what some of my client’s might think, I do not enjoy stabbing people with needles just for the fun of it (I will NEVER admit that the masochistic side of me loves seeing that angry, little hypertonic muscle twitch, wink wink).

So here is blog 1 of my needling series!

  1. First of all, I am NOT an acupuncturist. I am a registered physiotherapist who has taken extensive post-graduate course work in order to implement needling techniques as an adjunct therapy in my practice. What does this mean? This means I treat musculoskeletal injuries using acupuncture. I am NOT qualified to treat infertility, digestive issues, silence your nagging spouse, etc using acupuncture. That is outside the scope of practice for physiotherapists. For those types of health concerns, you need to go see a Doctor of Chinese Medicine or your family doctor.
  1. If you’re not an acupuncturist, why are YOU allowed to perform acupuncture then? Physiotherapists who have been trained in Canada now undergo six years of intense training in human anatomy and physiology. Six LONG years! Therefore, the Regulated Health Profession Act (RHPA) provides physiotherapists the authority to perform needling techniques provided we complete the appropriate post-graduate course work to use needling safely (even MORE training). What does this mean? The Regulated Health Profession Act has complete confidence in our ability to use acupuncture. This is because we KNOW the human body. We are little encyclopedias of bones and muscles. We’re pretty much obsessed with the human body (on the cusp of being neurotic). Rest assure, we are knowledgeable and safe!
  1. What schooling do physiotherapists need to take in order to perform acupuncture? There are many post-graduate courses that offer training in acupuncture. I completed two acupuncture and dry needling series with Meridian Health Education (total of 5 courses). Other notable programs include McMaster University’s Acupuncture Program, the Advanced Physical Education Institute, Ontario College of Traditional Chinese Medicine, etc. Feel free to enquire as to what your therapist’s educational background is with regards to needling. It is also the law to roster with the Ontario College of Physiotherapists. This means that if you search us up on our Regulatory College website, it shows that we are rostered to perform acupuncture (and the College knows about it). This is really important! If we do not roster, we can get into big trouble! It’s the public’s right to know that our regulatory body is aware of the skills we are qualified to do. And if your therapist isn’t rostered, STOP. They may not have the expertise we pride ourselves on having (BAD, BAD, BAD).

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey

February 18, 2015

Cheese Clip Art  Anyone who knows me knows I like inserting my quirky attitude into educational sessions.      Here are some of my favourite cheesy phrases.

  1. Motion is lotion. Correct, AND it rhymes! Many joint surfaces depend on movement for nutrition. Your articular cartilage, discs and menisci get nourishment indirectly by the movement of synovial fluid. They key word being MOVEMENT. If things remain stagnant, you’re depriving your joints of the much needed nourishment they need to heal and stay nice and lubricated. “But it hurts when I bend and straighten my knee.” Well, you may be setting yourself up for a much nastier condition in the future. Movement also controls for inflammation by re-distributing fluid throughout the joint surface, it keeps your muscles activating like they should and maintains your available ROM. These are all good things for a speedy recovery!

2. End-range is everything. So anyone who has seen me in action knows I am an end-range queen! End-range, end-range, end-range. The magic happens at end-range. This is because many powerful, neurophysiological effects occur at end-range. Receptors in our tissues, known as mechanoreceptors, are activated with end-range stimulation. This stimulates larger nerve fibers which consequently inhibit smaller nerve fibers (a.k.a. as YOUR pain fibers). End-range stimulation literally decreases pain and muscle spasm. Some say it hits the re-start button on the nervous system! Don’t believe me? Many of the bigger physiotherapy treatment techniques depend on end-range. This includes McKenzie, Mulligan and even Active Release Technique. End-range is so powerful that a rapid responder can get immediate relief from pain using an end-range protocol. Yep, like magic.

3. My rule of thumb… I get a lot of questions as to when someone should start an activity again. It’s a hard question a lot of the time (It also doesn’t help that people are generally excited to get back to whatever activity they have restricted, haha). My rule of thumb is that if you are sore upwards of 2 hours after an activity, you did TOO much. An inflammatory response was initiated telling me the activity was too provocative. Now your tissues are mad again. However, if you are sore for a few minutes following an activity with quick symptom resolution, chances are you didn’t cause harm or initiate another inflammatory response. You’re probably in the clear! This also goes for the home exercise program as well (for all those keeners out there doing double or triple the amount they should be!). More is not necessarily “more”, so to speak. You wouldn’t do bicep curls 5x a day, would you?!

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey

 

February 12, 2015

danger ice

Anyone who knows me knows I am a big believer in staying up-to-date on the most current literature and eating icing on cake. It’s important to know when the scientific community supports the crazy things we get our clients to do in clinic. I think it is also important to stay on top of controversial topics. So prepare yourself for the controversial topic of… ICING!

RICE (Rest. Ice. Compression. Elevation) has been perpetuated as the gold standard for acute injury management. You would have a difficult time finding someone who hasn’t used RICE in the management of some sort of ache or pain at some point in their life. It has been proposed that RICE will help limit the amount of inflammation in an area, allowing you to return to normal faster. Is this actually the case though?

Here are 3 beliefs you may want to reconsider when it comes to the application of icing. This information is solely meant o make you think critically on why we do what we have always done.

  1. Swelling is really bad and can prevent a speedy recovery. When we first injure a tissue, there is an initial vasodilation (opening of the blood vessels) to allow blood and white blood cells to enter the area. Their job is to help begin the initial cleanup of the area. So, the easiest way for the white blood cells to get to the injured tissue is through the swelling! Swelling also increases our sensitivity to pain, reduces movement and progresses the inflammatory response. This is all in an effort to keep us from further injuring ourselves.  How can the body come up with an appropriate plan of care if we continue to subject the injured tissue to forces it isn’t ready to handle?! We have evolved to swell. Maybe our evolution regarding swelling isn’t necessarily wrong?
  2. Ice will prevent excessive swelling. Well, maybe not. What if I told you that icing may actually increase fluid in the affected area? It has even been hypothesized that icing an injury may restrict lymphatic flow and promote fluid build-up. The natural swelling process isn’t bad, but excessive swelling is! Our lymphatic system is responsible for getting rid of the excess fluid in the area. Long periods of icing may increase permeability in our lymphatic system. This means fluid has an easier time leaking out of the vessels into the injured area! This makes clean-up nice and sluggish. Icing also has been shown to temporarily reduce skeletal muscle activity. We need the squeezing of our muscles to assist the lymphatic system in pumping out excessive fluid.
  3. Icing improves the body’s capability of healing itself. A pilot study by Takagi et al 2011 wanted to see how icing affected injured skeletal muscle in rats (obviously we can’t just start hurting humans for the sake of science!). A specific muscle group of the rats was crushed using forceps. The rats were then divided into 2 groups: one group iced the muscle group and the other group did not. The rats were then sacrificed (muffle tears) and their muscles were investigated. The icing group had significantly less regeneration of healthy muscle tissue. The regenerated tissue also had abnormal collagen formation, making it overall weaker compared to normal collagen. There were also fewer cells in the area, known as macrophages, cleaning up the injured and necrotic tissue.

I know this is controversial. I am only suggesting that one consider some of the newer theories out there surrounding the efficacy of icing. When it doubt, go talk to your health care professional!

Here is the link to the original article by Bahram Jam, PT: http://aptei.com/articles/pdf/Ice-NSAIDs-Paper.pdf

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey

 

January 28, 2015

So you went over on your ankle. Now, a black and blue softball currently resides where your ankle used to live. It’s painful, swollen, hot and difficult to walk on. When is this going to get better?!

This is probably the most frequently asked question I get as a physiotherapist. Generally speaking, a moderate sprain/strain can take upwards of 8+ weeks to resolve. HOLY CRAP! 8 WEEKS?! Yes, 8 weeks, give or take. I cannot expedite the body’s ability to heal tissue (I wish I could just place my hands on someone and heal them, I would make a lot of money!). I can merely help create an environment in your tissues conducive to healing. So if you have a swollen, black and blue body part, chances are it’s going to take 8+ weeks to heal itself (And compared to the 20 odd years it took you to become an adult, 8 weeks is pretty fantastic!). Understanding what happens during these 8 weeks, however, can really help prevent re-injury and decrease your risk of things becoming chronic.  

1. Inflammatory phase (3-5 days)

There is not much we can do during this initial phase short of resting, elevating and compressing the affected area. Trauma to your tissues (also known as collagen) cause bleeding. Fluid and other cells (your body’s knights in shining armor) travel to the area to help assess the damage that has been done. The pressure from the fluid, in addition to the chemical soup now residing in the injured area, stimulates nerve endings causing more pain.

Pain limits function. And from an evolutionary standpoint this makes sense. The brain needs to assess the area to figure out what it needs to do to heal itself. It doesn’t want you walking on that sprained ankle, you might hurt it some more! So get those crutches ready and take it easy for those 3-5 days, you have my permission!

2. Repair Phase (3-21 days)

Remember those knights and shining armor I talked about in the inflammatory phase? Well these cells initiate a chemical response which causes blood clotting to stop the bleeding. Fibroblasts also make their presence known in this blood clot. Fibroblasts are cells in your body which essentially act like little carpenters. They come in and help build new tissue. Unfortunately in this stage, Type 3 collagen is laid down. This type of collagen is very weak and has little tensile strength. Its goal is to essentially help plug up the injury!

It’s important to recognize that this new tissue is really weak. Your injury may start feeling a lot better in the next 2-3 weeks. It doesn’t take much to tear this new tissue. Tearing this plug will only bring you back to the inflammatory phase, starting the 8 week process all over again! Re-tearing the tissue over and over again can cause disrepair, which can leave you with an ugly chronic issue.

3. Re-modeling phase (21+ days)

This phase can last up to a year if the injury was severe enough. In this phase, the weak Type 3 collagen is replaced by much stronger Type 1 collagen. Type 1 collage has a lot more tensile strength and makes the tissue more resilient. Type 1 collagen is still not as strong as the surrounding tissue, however, due to its plug-like nature. Most of our tissues are composed of parallel fibers which oppose the forces we put through them. The new tissue is literally a shredded-wheat of fibers, all criss-crossed in a haphazard formation.

In this phase, we can start aligning the fibers in the optimal parallel formation using controlled stretching and strengthening. We also need to work on other important things, but I can’t give it all away in one post! Haha!

Source: http://www.physioroom.com/injuries/supplements/ligaments2.php

Bailey Gresham is a registered physiotherapist for Whole Therapy. She specializes in manual therapy and movement-based therapy. She likes bridging the gap between rehabilitation and performance training.  More about Bailey here.

Bailey