Articles Of The Week February 4, 2018

First off, a challenge. Do you ever demand things of your patients? They could be polite demands, but they’re still demands (we may be doing it without realizing it). We have to be careful with our communication when talking to patients and this article will help you with that.

Clinical Challenge I” – Cory Blickenstaff

A link between depression and low back pain? Well, there is a link but it’s probably not the way you think. While there is a link, there are probably more factors at play.

“Twin Studies Lend New Insights Into Link Between Depression And Back Pain” – Dr. Marina Pinherio

It turns out the struggle around evidence-based treatment isn’t isolated within manual therapy. Mental health therapists are facing some of the same issues, and it’s surprising the similarities between our professions.

“Looking For Evidence That Therapy Works” – N.Y. Times

I’m sure we all know someone, whether a patient, family member or friend who has suffered a stroke. Turns out some new research shows the brain can rewire itself to unused areas as part of recovery. 

“Stroke: Can The Brain Rewire Itself To Aid Recovery?” – Medical News Today

With some debate online this week, some therapists were calling themselves “healers”. In turn, we found this post which shows we are the “helpers”, the patient is actually the “healer”.

“I Am A Massage Therapist, Not A Healer” – Tania Velasquez

 

Travelling In Sport As A Massage Therapist

 

When I decided to go back to school to be a Massage Therapist, the one thing that made me decide on this new profession was the chance to work with athletes and sports teams.

The whole idea of working with teams always had a certain lure to me, getting to be part of that team environment always seemed more appealing than strictly working in a clinic.

While in college I was lucky enough to start working with our local Junior A hockey club and continued working with them for seven years, even being the head trainer and medical director for one season. During that season, I did some travel with the team to other parts of the province and got the feel of what it’s like to be on the road with a team, dealing with transport, setting up dressing rooms, loading and reloading the bus with equipment and all the other issues that happen on the road.

Because of putting in the time volunteering with that team, some other great opportunities have come my way. I got to spend a year working with our Rugby 7’s men’s national team, and in 2016 I got my first opportunity to work with our national women’s development program in hockey.

Since working with the women’s development program, I’ve had two opportunities to travel internationally with them. I thought I knew the work and effort it takes to work with a team from my past experience, but working and travelling internationally takes on a whole other level of work and work ethic to be successful.

I know many of our readers are interested in this type of work, so I’ll try to outline what an average couple of days looks like work-wise, so you’ll know what you’re getting into if this is your chosen area of interest.

Daily Schedule

While I’m sure it’s different for every sport and probably every venue, it takes a ton of work to get things set up at hotels, dressing rooms, and whatever venue you are using to help the athletes throughout a tournament.

You aren’t doing strictly massage therapy when you’re on the road, you’re helping out wherever is needed, plus covering some aspects you may not have thought of (keep in mind this is just three days of a three-week trip).

Pretournament Game

5:00 amLight snack

5:30 amAthlete exercise routine  

6:00 amTeam meetings/presentations

6:30 amTeam practice/dryland

7:00 amRegular breakfast

7:30 amMorning session with S&C coach

7:45 – 9:10amPractice session for some athletes  

10:00am – 12:00pmPhysio & Massage Therapy treatments

1:30 pmPregame Meal

3:10 pmAthletes and coaches meeting

3:45 pmDryland warmup

4:30 pmOn ice warmup for both teams

5:00 pmGame time

5:10 pmAthlete cool down  

8:20 pmDinner

9:00 pmStaff meeting

Travel Day

5:00 amLight snack

5:30 amAthlete exercise routine

5:45 amTeam meetings/presentations

6:30 amBreakfast

6:50 amAthletes and coaches meeting

7:15 amDryland warmup

8:00am – 9:15amTeam practice

9:30 amAthlete cooldown 

9:30 am – 10:15 amHelp equipment manager pack up the dressing room and load all equipment on the bus

10:30 amLunch

12:15 pmLoad all team luggage on the bus

12:30 pmLeave for airport

1:45 pmCheck all baggage and equipment in through airport security

5:05 pmFlight leaves

6:30 amLand for connecting flight

10:10amConnecting flight departs

3:25 pmLand in destination, collect luggage, load bus

6:00 pmCheck into hotel

6:30 pmDinner

7:00 pmAll support staff (medical, logistics, equipment manager etc) set up athletes dressing room, medical room, and all associated equipment.

9:10 pm Staff meeting (time depending on dressing room setup completion)

Pre-competition

8:15 amBreakfast

8:45 amAthlete and coaches meeting

9:30 amDryland warmup

10:00 am – 11:45 amPractice

12:00 pmAthlete cool down

12:40 pmLunch

1:15 pmTeam meetings/presentations

2:00 pm – 4:00 pmPhysio and Massage Therapy treatments

4:30 pmLight meal

5:30 pmDryland warmup

6:00 pm – 7:15pmPractice

7:25 pmAthlete cool down

8:30 pmDinner

9:00 pm – 10:00 pmTreatment window for Physio and Massage

10:10 pmStaff meeting

Gameday

7:15 amBreakfast

7:45 am – Athlete and coaches meeting

8:15 amDryland warmup

9:00 am – 9:45 amPregame Skate

9:55 amAthlete cool down

11:00 amLight lunch

12:00 pm – 2:00 pmPhysio and Massage Therapy treatments

3:30 pmPregame Meal

4:50 pmAthlete and coaches meeting

5:45 pmDryland warmup

6:30 pmOn ice warmup for both teams

7:00 pmGame time

9:10 pmAthlete cool down

10:30 pmDinner

11:00pmStaff meeting

So when you look through this schedule, everywhere it talks about dryland warmup, athlete cool down, and practices, at least one member of the medical team is expected to be in attendance. Typically one member attends while the other therapist tends to some other tasks like filling game water bottles, getting ice, making up ice bags, or helping the equipment manager if needed (essentially doing the background work that isn’t typically thought about). Sometimes the practices and warmups etc. overlap each other depending on how the schedule is set, so you could be covering one practice and another medical staff member is covering the other one.  

During game times I would go up and help the video coach by shooting video during the game, while the physiotherapist is on the bench. Essentially everyone has a job description, so each members time is utilized and productive. 

If you’ve followed this blog for very long, you’ve seen articles stressing the need for us as a profession to be certified in First Aid training. In sports, it’s even more important to be trained as a First Responder. In cases like this, anytime there is an emergency with one of the athletes, the Massage Therapist is part of the emergency action plan and is expected to take part in the injury or emergency, whether it’s on the ice, or off. 

I can’t stress enough how important it is to get this training if working in sports is your interest!

The Team Within The Team

All of the staff are literally another team, within a sports team, it’s not just about the athletes working together.

As I mentioned before, you could be tasked with some menial work (filling water bottles etc.) while another member of the medical staff is working directly with the athletes at a warm up or cool down.

You can’t have an ego about this! 

Even if you work with a team at home and you’re the head trainer, that may not be your role when you travel with a national team. They will have a specific job description for you, and it’s important you adhere to it. There are some really long days where you could be setting up a dressing room, or loading equipment for travel (and not actually do any massage), while the coaches are doing their prep work, logistics are organizing travel, and other members are filling the role for whatever their responsibility is.

But just like the athletes who may be playing a smaller role on the team than they play at home, everyone comes together as a team to accomplish a goal. EVERYONE is filing a different role than they are used to. There will be days you get frustrated, you’ll be tired, and maybe even annoyed with other staff members. But part of being on a team is the ability to put that aside, come together, and work for the benefit of the athlete, it’s about them, not you. 

However, if you are willing to work, put your ego aside and do this kind of work, the benefits are phenomenal. The friendships you’ll make, the pride of not only helping the athletes performance but also representing your country (or whatever organization you’re working with) is incomparable. Plus, you may even end up with a cool picture and a medal at the end of it all.

 

Articles Of The Week December 31, 2017

We have to be careful when loading certain injuries like a fracture or complete tendon tears. However, with muscle and tendon injuries the evidence is showing that loading early is beneficial, and a little bit of pain isn’t a reason to back off. 

“Starting Rehab Early Can Speed Recovery From Muscle Injuries: Study” – The Globe And Mail

 

This is a great article (however I think I connect with it because I used to be that guy!). Manual therapy is great, but we don’t need to crush tissues or use heavy weighted force to ‘release’ tissue. We need a more logical way to work, and this article helps us understand that. 


“Should We Crush Tissue?” – Mitch Hauschildt

 

This one is actually a video from David Butler on assessment of the upper and lower limb. It’s great information and can be implemented in your clinical setting right away.

“NOI Neurodynamics” – David Butler

 

We are all business people, so it’s just as important to learn about business as it is therapy. This article shows how recognizing a pattern and reacting to it differently can change a bad habit and create new positive ones.

“How Your Patterns Can Kill Your Business – The Solution Is Not So Simple” – Alley Jean

 

I’m sure we’ve all helped a patient in our practice who has dealt with a concussion. Whether from a car accident, a fall, or from playing sports, concussions can be difficult to deal with. For this reason, some parents are pulling their kids from sports because they’re afraid of them getting a concussion. But what about all of the other things sports do for kids? Here are 5 reasons why they should still be in sports:

“5 Reasons Kids Should Play Sports” – Complete Concussion Management

 

Change is hard, change within an entire industry is even harder! However, this post goes on to discuss why manual therapy needs to change, and why the change is important.

“Embrace Change” – Eric Purves

 

Articles Of The Week December 24, 2017

We all know how important movement is, but what about the quality of movement? Well, there are a few things to look at in this regard, and Greg Lehman has some arguments around pain, movement and quality of movement. 

“Why I Put Strength On Dysfunction” – Greg Lehman

How good are you at listening to your patients? There are times where a patients recovery could be held up because they are blaming the scenario that put them in pain. But if a person feels they have been heard, they may have less of a reason to hang on to that blame. 

“The Blame Game” – Alison Sim

As humans, we have many different behaviours. Did you know we also have pain behaviours? These behaviours can influence your patients response to pain, so there may be a way for us to help them if we understand this better.

“One Way Of Using A Biopshychosocial Framework In Pain Management – II” – Bronnie Thompson

I’m sure we’ve all heard (and some of us have preached) about not letting your knee go past your toes with certain exercises, in an effort to have great form. But what about when the intent of any given exercise changes? Here’s a great article looking at the mechanics of a split squat and how its intent and thus form can change. 

“The Split Squat And The Knee Over Toe Conundrum” – Michael Gouldon

This one is important, not just for our loved ones, but also for our patients. There may be cues you pick up on with your patients, where their loved ones may not. Its important for all of us to be able to recognize warning signs of dementia, so this article should help. 

“5 Early Signs Of Dementia (And Why Everyone Should Know Them)” – Jamie Wiles

Treatment Tips: An Easy Way To Achieve Posterior Pelvic Tilt

 

As I teach, there are certain concepts/techniques which are self-explanatory, while others have nuances which make them harder to convey, both in the classroom as well as once the therapist is back in their clinic. In the past, I’ve sent out Treatment Tips, but the printed word and still photos only go so far. Recently I had another photo shoot to provide updated content for the new Upper Body and Lower Body Foundations in Myofascial Release Seminars as well as the renamed Myofascial Release for Neck, Voice, and Swallowing Disorders Seminar and we shot a dozen or so short sequence videos. Here is the first one and excuse the first-time-editor-mistakes.

Though not a mandatory aspect of lower back/abdominal/pelvis manual therapy/myofascial release, increasing posterior pelvic rotation and applying light lumbosacral traction often changes the dynamics while treating.

My preference, and what I teach, is manual sacral traction applied in supine with the opposite hand on the lower abdominal region.

I beg and plead with therapists to try this method, but I know that placing a hand under their sacral area by placing the arm between the legs is too much of a boundary issue. I get it. So over the past few years, I devised a “cheater’s” method of accomplishing sacral traction/posterior pelvic tilting without the need to place a hand under the sacrum. Watch the video to see what I mean:

 

Pretty easy, right? If you add a piece of Dycem under the sacrum beforehand, you have an even better-felt sense for the patient. You can find more treatment tips over at Foundations in Myofascial Release Seminars.

Articles Of The Week December 17, 2017

If I’ve heard this once in life, I’ve heard it a thousand times, (Work Smarter, Not Harder!) however, this is the first time I’ve heard it from a fellow therapist. And what’s cool, is that it’s from one of my heroes in this profession. She’s one of the few who will tell it like it is (and honestly, when I first started following her, she pissed me off but I realized she’s pretty amazing), which is rare for us. So take her words to heart!

“How Massage Therapists Can Work Smarter, Instead Of Harder” – Alice Sanvito

I’m sure we all have patients who are dealing with fibromyalgia. For me, I sometimes wonder what advice to give as far as home care. This article comes straight from someone with the condition and gives some sound advice for this holiday season that you could share with your patients.

“Banish The Word Should For The Holidays” – Christine Lynch

Rajam Roose gives some quality advice on client retention and building relationships in this post. I promise if you even do one of the things she recommends you will see a return on your investment, because if we’ve said it once, we’ve said it 1,000 times, building relationships is crucial in this business.

“Retain Your Massage Clients” – Rajam Roose

This one is a conversation piece. A conversation with Lorimer Moseley so you can understand the difference between pain science education, and understanding pain science. And let’s be honest, anything with Lorimer in it is worth reading.

“Lorimer Moseley WOW Chat: Pain Science Education Vs. Understanding Pain. What’s The Difference?” – Shelly Prosko

This is a great post on pain and why it persists. Everything Rachel writes in this post, you could easily use as an explanation to your patients. Please give it a read and use the info she has shared, and talk to your patients about what meaningful touch is!

“Why Does Pain Persist?” – Rachael Scott