Articles Of The Week October 7, 2018

October 6, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

It’s great to see that some major outlets are starting to share sensible information. This article about back pain is great and actually shares some quality knowledge. Movement for back pain is probably the best medicine we can use and this article agrees!

“Babying Your Back May Delay Healing” – Harvard Women’s Health Watch

I’m absolutely honoured that this guy has been following me from early on, and I’ve been following him. The beauty is how he’s started doing videos. He’s an absolute pro when it comes to runners, so if you work with that population, make sure you follow this guy, cause he’s an absolute PRO!

“How Stretching Can Delay Recovery” – Matt Phillips

I refer to Bronnie a lot, cause she puts out great stuff. How’s your assessment, is it time to change? Well, it might be, give this post a read and decide for yourself.

“From The Particular To The General – Clinical Reasoning In The Real World” – Bronnie Lennox Thompson

“Ergonomics do not have a firm basis in science.” How many patients do you have, who have been told their ergonomics need to be fixed to get rid ‘of pain!? Well, you may want to share this article with them.

“A Difficult Position: Experts Question Whether Ergonomics Holds Up” – Liam Mannix

This one comes from one of my favourite massage therapy people, so you’d better listen up! If you’re debating going out on your own, or just debating starting your own business, Rajam has some great advice for you, and I suggest you heed it!

“How To Start A Massage Therapy Business” – Rajam Roose

Why Do Isometrics Work So Well?

October 1, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy, Pain, Therapeutic Exercise/by Erson Religioso

A question I often get asked is “Why do isometrics work well to isolate pain?” I started adding isometrics to improve pain during motion and pain and end range with active and passive testing.

They work great! Forget “muscle energy technique” and other theories. They are too mechanical. I go over the reason why isometrics work well as a compliment to manual therapy and repeated loading strategies.

Articles Of The Week September 30, 2018

September 28, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

Sometimes when we treat patients who are dealing with chronic pain it can be difficult to come up with appropriate home care for them as they are often afraid to move. What about if we took a totally different approach and gave them directions to find joy?

“Finding Joy” – Devra Joy

We’ve been putting up lots of posts on tissue loading lately as it’s a VERY important part of helping patients rehab injuries and overcoming pain. This is a great post with videos of exercises for platar surface foot pain.

“Midfoot Mobility – Toe Extension – Strength” – Jeff Cubos

This is another one of those “try looking outside the box” kind of articles. It comes from a medical doctor’s approach of using poetry to connect with and creating a real connection to help his patients.

“Expanding The Time We Have With Patients Through Poetry” – Rafael Campo

Last week Readers Digest put out an article about 14 exercises you should never do after the age of 50 (I think they’ve since changed the title). The physical therapist in this youtube video disagrees and so do we!

“5 Exercises You Can (And Often Should) Do at Any Age| A Physical Therapist Explains Why!” – Ryan Smith

This is another video which shows for one the importance of tissue loading with tendionpathies and also how the motor cortex of the brain is involved. It also shows creative ways of using a metronome to effectively tailor an exercise session for the patient.

“How The Brain Is Involved In Tendon Pain” – Ebonie Rio

5 Tissue Loading Progressions To Help With Hip Pain

September 24, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy, Therapeutic Exercise/by Jamie Johnston

Not too long ago we went over the different phases of tissue healing and how to start properly loading the tissues to promote healing and help get our patients stronger. This is ALWAYS a great way to reinforce the manual therapy you do with your patients on the table and can also be a way to start the treatment.

If someone comes in who is having some S.I. Joint pain, Glute pain, or just pain in the posterior hip, in general, this is a good way to start getting them moving again. Quite often when a patient is dealing with pain, they become afraid to move because they associate pain with the movement.

This is where doing a solid intake interview (remember to rule out red flags) is important to listen to your patient and let them be heard regarding their pain. All too often patients feel like no one will actually listen to them and rush to get into a treatment, rather than listening to what they are fearful about, or acknowledging that their pain is real.

However, if you can get the person into a different plane of movement and apply some graded exposure techniques you’ll find they become less fearful and start to move more. Even if the movement is just a minor increase each time, it can make a huge difference for the patient.

This video shows just one way to do some graded exposure, but I would encourage you to try some different movements to instil that feeling of safety with your patients. Remember, pain is a protection mechanism and sometimes we just need to send signals to the brain to show that movements are safe again.

Once you’ve done some treatment, this is a way to start loading the tissue.

During the acute phase (the first 24-48 hours) these isometrics would be most appropriate. As you can see there is some movement as the patient loads and pushes up into the glute bridge, but once they are there have them hold the contraction at the top of the range for 20-45 seconds (depending on their tolerance) and gradually add a little bit more time to the contraction as they build strength.

Once your patient can confidently do the exercises in the video above, see if they can handle doing the same exercise, one hip at a time.

These are still an isometric load, we’re just building more strength on each side by removing the assistance of the opposite hip.

Once the patient can do the single leg isometric exercises, you can start to add more difficulty by using an eccentric load, as they are now in the proliferative phase of healing and it’s safe to start adding more load.

In this case, we are going to provide stability for the patient by coming up into the bridge using both hips, but then applying the eccentric load to only one side. This way if the patient is feeling weak or unable to do a full range, the opposite hip is there to provide safety in case the movement feels like it’s too much at any point.

Now as we progress hopefully your patient is going through the ranges in a more pain-free movement as you’ve been doing great treatments and appropriately loading the tissue.

If by their third or fourth visit they can do the above eccentric exercises, you can start to apply concentric loads. By this point they have probably reached the remodelling phase of healing, so we can start to be a little more aggressive, but still need to stay within the patient’s pain tolerance.

Takeaways

Remember that your patient may be fearful of movement due to their experiences with pain, this is where using graded exposure to the movement is the most beneficial.
Encourage the patient that movement is a good thing, even if they are a bit sore from it the next day. If they haven’t been moving for a while, some discomfort the next day will be normal, just like going to the gym for the first time after a long absence.
As important as your communication with the patient is, their communication and feedback are far more important, listen to their concerns and address them appropriately.
Educate on how a little bit of pain during movement is okay, just remind them not to overdo it.

Articles Of The Week September 23, 2018

September 22, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

All of us deal with patients experiencing back pain. The question is, can we do better? Well, while this post is coming from a “training” perspective, the message in it is quite applicable to us as therapists, and I think we can do a better job.

“How To Train Clients With Low Back Pain” – Ellie Somers

Well, when this lady speaks, we listen. Laura has been an advocate and educator for massage therapy for quite some time and has decided to make one of her courses for free. If you’re interested in, already dealing with, or are just curious about treating people with cancer, here is a free course you should take.

“The Ethics Of Working With People With Cancer” – Laura Allen

Once or twice, we may have talked about the biopsychosocial approach around here :). So, this article is great. It actually chronicles the history of the approach and is well worth the read.

“Everything Old Is New Again, On A History Of The Biopsychosocial Model” – Tim Cocks

I’ve had some patients come in and say: “can we just not talk at all during the session?” Everyone is different and everyone likes different things. Some patients want to unload and talk during the entire treatment, others enjoy the silence. So, what do we do if our patient does not want to talk at all? This post has some good advice and approaches on how to handle that.

“Talk Or No Talk During Massage” – Raechel Haller

For those of us who work in sport, this is always a great topic, and great to see more research is being done. We used to tell athletes to sit in a dark room for the first little bit when dealing with a concussion, that has since been proven negative. However, there are new things underway that show activity is of more help.

“New Active Rehabilitation Program For Treating Concussion Being Tested” – University Of Alberta

Making Win-Win Decisions And The Value Of Relationships

September 17, 2018/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

In the past, we’ve had several posts talking about the importance of building relationships and business.

While this is a crucial part of the therapeutic relationship with our patients, it’s just as important in our communication and in building our practice with other practitioners.

However, not everyone sees this or treats it with the importance they should.

With this post, I’ll go into why it’s important and two different circumstances where this has made a massive difference in my life, and in my practice. If spending time building relationships with patients and other practitioners aren’t something you’ve been focusing on, I suggest you start.

Here are two examples where this has helped me in the past two years.

The Job

Back in 2009, it was my third term of massage therapy college.

I knew from the start, I wanted to work with athletes and teams. I was fortunate enough to have a friend from my hometown playing for our local Junior A hockey team, so I asked if they had a Massage Therapist working with them. They didn’t, so he helped get me in touch with their head trainer, and my start in hockey as a therapist began.

The first game I was introduced to the team chiropractor, he instantly started getting players to get treatment from me. I was astounded at how supportive the medical staff was.

For the next seven years, that chiropractor and I worked together on the team. Once I was certified and in practice, we referred patients back and forth. A year or two into my career, I looked at the schedule and half of the people booked in with me one week were referrals he had sent.

There are patients who I’ve been seeing for the past seven years of my career (obviously only when they need it, not weekly or anything) because they were referred from that chiropractor.

About three years ago, he referred another patient to me, and the relationship building with that patient started. He spoke fondly of our chiropractor friend every time he came in. As our relationship built, I mentioned how I was a volunteer firefighter and hoped to get a career job one day. He immediately told me about one of his best friends who worked at one of the fire departments in town (and it was the department I really wanted).

Skip ahead a year and that department started a hiring process.

My patient got a hold of his buddy and said: “you gotta help this guy, he’ll fit in perfectly.”

Then the text messages started. His buddy was giving me advice on what to study, how to get ready, exactly what steps to take. As the hiring process unfolded, he texted me every step of the way with advice on what to do. The advice was invaluable and helped me with the process in ways I can’t even explain.

AND I HAD NEVER MET THE GUY! However, based on his friend’s recommendation, he was willing to help!

After volunteering for 16 years, applying to several departments, spending thousands of dollars on hiring processes, this past June, I was the first person hired off the hiring list and started a career that I worked so hard to get.

None of that wouldn’t have happened if nine years ago, I hadn’t started building a relationship with my chiropractor buddy, or with the patient he referred.

The Win-Win

Back in 2005 a good friend and I invested in a franchise business for repairing dental equipment.

Whenever people bought a franchise, they would have to go down to Oregon to receive training on how to repair the dental equipment and learn the business etc. The man who owned the parent company would always have the new franchisees attend a two-day workshop that was basically a self-improvement kind of thing.

We honestly scoffed at the idea initially, but it turned out to be a pretty good two days. One of the key messages we learned was that whenever we made decisions both personally and professionally we would always try to make the decisions a win-win. Each decision had to be made so it would always be something that would benefit us both.

We worked that business together for two years until we came to the realization it was only going to make enough money to support one of us. After some discussion, we decided he would buy me out, and that was what paid for me to go back to college to become an RMT. The decision was truly a win-win as he still runs the business, I’m clearly enjoying my career, and we’ve remained good friends ever since.

Fast forward 11 years to 2016 and I was faced with another business decision.

Do I take a chance and move on to another clinic to pursue my interest in exercise with patients, or continue with the clinic where I was given my first real chance to build a practice. Part of the difficulty for me was the stories I’d heard about people leaving clinics and there being a fight over patient clinic files between the owner and contractor. Plus the clinic owner and I had built a solid relationship and a great friendship over my five years there, how was that going to work out?

Over a three day period, I kept trying to ask her to grab a coffee or go for a drink or something so we could chat about it, but our schedules didn’t work. On the third day when I tried to arrange something, she looked at me with a smile on her face and said: “are you breaking up with me!?”

When we actually sat down and talked she said it would never be held against me for chasing after the career I wanted and to make sure and email all my patients so they knew where I was going so they could find me and book in.

Since then I’ve referred patients to her clinic, she refers patients to me and there has never been an instance where a disagreement occurred about a patient file. In fact, I still have access to all of the files for when the lawyer requests records for one of my patients.

Even better, that clinic owner refers her family members to me and comes to me for treatments herself (and yes she gave me permission to write that, so I’m not breaking confidentiality). So, when I hear those rumours (I hope they’re just rumours) about owners and contractors bickering over patient files, I can’t help but wonder WHY!?

Why is this an argument?

The patient has the right to choose where and to whom they go for their treatment, it’s not up to the practitioner or the clinic to decide that. I get there might be an instance where there is a monetary value to the file if a lawyer or insurance company etc requests the file, but it’s not so great a value that is worth ruining a relationship over. There are many patients who followed me to the new clinic when I moved and just as many who stayed behind and continued at the old clinic because all of them had the right to choose. The most important thing in that whole experience is the relationship that remained between myself and the clinic owner. Because the decisions made between us were done on a win-win basis, the patients win, both the clinic owner and I win, and our relationship has never been better. And to be honest, that relationship is far more important to me than the monetary value of a file, or whether a patient followed me.

Takeaways

The Job

The Win-Win

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