Learn How Volunteering Can Benefit Your Career

The phone in the clinic rings from a number you’ve never seen before. 

You answer, assuming it’s someone looking to book in for an appointment, and then you hear the same pitch you’ve heard a thousand times: 

“Would you be willing to donate your time, or a gift certificate to our charity, or upcoming cause”? 

We’ve all had those calls, and usually, the person on the other end has the best of intentions, and it’s usually a good cause. 

However, with many requests per year coming in, at what point do you say no, and at what point is volunteering your time worth it?

This is certainly an individual decision that you have to make, but I think there’s value in volunteering your time, especially if you’re new in practice. 

Is Volunteering Worth It?

I should preface this by letting you know my bias to this is yes; however, it should be done selectively. 

I would not be where I am in my career(s) today if it wasn’t for volunteering, and all the volunteer work I’ve done has lent itself to each of my careers. 

For those of you who may be new to this blog, in addition to being an RMT, I’m also a full-time firefighter, so I’m fortunate to have two great careers. 

However, I didn’t always have both as a career. 

I spent 16 years as a volunteer firefighter before getting hired full-time last year with my present department. 

The cool thing is that much of the experience I gained as a volunteer not only helped me get the career job, it’s also been pivotal in my career as an RMT and continues to be. 

Back in 2009 when I was still a student, I knew I wanted to be involved in sport as a therapist, so I approached our local Junior A hockey club and had a chat with their head Athletic Therapist to see if I could come in and volunteer some time with them to get some experience as a student. 

When I told him my background as a first-aid guy and firefighter, he looked at me and said, “Oh so you’ve seen some stuff!” and then invited me to come and start at the next game. 

So, volunteer experience in one area helped me get my foot in the door to another part of my career that still serves me today. 

Another thing that happened was back in 2010, our regulatory body came out and put the rule in place that every RMT in British Columbia had to be certified in First Aid to maintain their license. 

It was also around that time that my fire chief approached me and wanted me to become one of the First Responder instructors for the department. As a result, I became a Red Cross First Aid instructor and have taught First Aid and First Responder courses to RMT’s and Athletic Therapists all across BC. This makes up a pretty big part of my brand and business today, and I have even been fortunate enough to teach courses to the Vancouver Whitecaps medical staff. 

When I look at the seven years I spent with that Junior Hockey team, while it wasn’t a paid position, there were several other ways in which it paid off. 

The team chiropractor became a referral source for me in the clinic for the following ten years. In fact, I can remember when I first graduated, there were weeks where half of the people who came to see me were referrals from him. 

Many of the staff members would also come to see me, refer friends and family to me, and some still come and see me today. 

This volunteer work also helped establish me in the community as a “sports therapy” guy, and many patients over the years came to see me because of that reputation. 

During my time with the team, I was fortunate enough also to mentor some Athletic Therapy and Kinesiology students who were getting their practicum hours. Many of those connections are still in place today and have helped me become known as a First Responder instructor in the Athletic Therapy community because of those students. 

One student even convinced the clinic he was working at to contact me and hire me to work in their clinic when they were looking for an RMT, and I spent six years working at that clinic. 

Funny enough, one of those students went on to be a chiropractor and just recently contacted me wanting to refer some of his patients who were moving to this area. 

Once again this volunteer experience lead into more opportunities. 

Because of the experience I gained working there, this was my foot in the door to get hired by Hockey Canada, and have been able to work and travel with them over the past six years. 

As a result of working with them and the connections I’ve made with the other healthcare professionals, this has opened up other sports opportunities. 

One of the Physio’s brought me in to do some work with rowing Canada. One of the doctors recently brought me in to be a “biosecurity officer” for the FIBA Basketball Olympic trials. In addition, this has also given me the opportunity to travel to places like Russia and Slovakia that I would not have gotten otherwise. 

Now it’s also important to mention that while volunteering has given me many opportunities, a crucial part of this is also building relationships with people along the way. 

This is an important aspect of any part of our business, whether you’re volunteering or not. I was exposed to many people who later gave me opportunities because of the relationship I built with them through volunteering. 

Here is a bit of an overview of how volunteering has lead to more opportunities within each of my careers.

 

 

The Professional Side

This blog is one of the professional volunteer things I do. 

In the last few years, writing and promoting this blog has led to opportunities where I profit off it by teaching courses. However, it was strictly a volunteer project for many years and a chance for me to learn more about research and our profession. 

But, it led me to sit on the board of directors of the RMTBC for five years, which again was another great learning opportunity. 

While I’m a big proponent for volunteering, I understand there are those in the profession who are against it and believe we should never work for “free”. 

To a certain extent, I agree, but when I look back, there were so many of those volunteer experiences that, in the long run, made me more money than if I had never done it. 

Something essential to consider is many who think we should not volunteer are also willing to jump into Facebook groups and ask questions of their colleagues for advice. In such instances like this, you ask your colleagues to “volunteer” their time to answer your questions. While this is part of professional courtesy (and should be encouraged), shouldn’t you compensate those colleagues for their time if you believe we shouldn’t volunteer? And wouldn’t it be the same if you’re sending private DM’s or emails for their professional opinion on something? 

These are clearly all things you have to take into consideration for your business. If you’re a new grad and debating whether it’s worth taking the time to volunteer on something you’re really passionate about in the profession, give it a try, the long term rewards you can reap will be worth it. As time goes on and you get more experience, then you can start being more choosy about where and when you volunteer your time should you decide to do so.

Here’s a LINK to Tanner Thompson’s podcast I was on last week talking about the value of volunteering and getting involved in sport.

 

Finger Reset After Dislocation

3 Weeks after a DIP Dislocation in a gymnastics injury, swelling, pain, and weakness remained in the PIP more than DIP of that digit. She was unable to grip or hang/swing on bars without pain. In order to restore threat free grip, compression plus lateral rotation held enabled full pain-free passive end range flexion of the PIP. For the DIP, which was also limited in flexion, end range repeated extension restored pain-free flexion. Just a little experimentation and you can easily find desensitizing repeated loading strategies. She was prescribed to do these resets hourly and gradually work on grip strength.

[UPDATE]: Just followed up, after 4 days of the reset and grip strengthening, she was able to complete a bars routine and prior she was unable to even hang from the bar. Swelling is down, but still present, and grip strengthening needs to continue.

What a Pain in the Groin!

 

I watch a lot of hockey….like A LOT of hockey.  It seems like every offseason there are at least a handful of players having surgery for femoral acetabular impingement (FAI), “hernia” repairs and/or abdominal “tears.”

Whenever there is a huge increase in certain procedures, I’m always a little suspect whether it’s just the latest trendy thing to be done or truly necessary.  In June of 2018, the Journal of Orthopedic Sports Physical Therapy even dedicated their whole issue to FAI occurrence and treatment. 

It was an interesting issue that didn’t just address FAI, but a large number of complex groin pain.  I realized much is the same as it was 20 years ago, but the understanding of the concurrent injury has improved.

What’s In A Name? 

Complex and difficult to treat groin pain has gone by a lot of names over the years. Gilmore’s Groin, Sports Hernia, Core Muscle Injury, Athletic Pubalgia.  All these different terms complicate literature searches and lead to poorly defined anatomy definitions.

It is now agreed upon to leave the term “hernia” behind because the injury usually involves the various structures that compromise the pubic and abdominal aponeurosis, but rarely a deficiency of the posterior wall. 

The literature also doesn’t agree whether surgical intervention or conservative treatment is best. These patients may seek you out for pain management or while waiting for a diagnosis.

Who’s At Risk?

Males are at higher risk than females due to the narrow pubic arch angle.  As well as athletes that involve high frequency of deceleration and acceleration particularly with cutting/pivoting such as ice hockey, soccer, rugby, and our military personnel.

71% can relate the pain to a reproducible, specific activity that usually involves hyperextension of the trunk and hip hyperabduction.  And there is a high incident with a co-existing FAI. Athletes with limited ROM due to FAI will rely more on trunk extension and the pivot point of the pubic symphysis perhaps making them more at risk to develop tears of the aponeurosis. Repetitive pelvic motion against a fixed extremity with decreased range due to CAM or Pincer lesions may result in rectus abdominus sheath and oblique muscle fiber injuries (Strosberg et al 2016). Studies have shown if the athlete has their abdominal/groin tear repaired, but not FAI, only 25% return to sport.

However, if both are repaired 89% return to sport (Larson et al 2014).

What Do I Need To Look For? 

We are not going to diagnosis an athlete with FAI or athletic pubalgia.

But what if our athlete comes to us with groin pain and we aren’t sure if it’s something muscular to treat? 

What makes this diagnosis difficult is there is no great test or exam that is specific for these injuries.  And studies have shown that there are potentially 17 different structure that can be involved!  Common Hallmark Signs include:

  • Deep going or lower abdominal pain
  • Pain exacerbated by very specific sports activity that is relieved by rest
  • Palpable tenderness over a conjoined tendon or rectus abdominus insertion near pubic tubercle
  • Pain with resisted abdominal curl up
  • Pain with resisted hip abduction at 0, 45 and 90 degrees of hip flexion

And of course, if your patient isn’t responding to treatment, it’s always time to investigate further.

To Treat Or Not To Treat?  

Most guidelines agree to always treat conservatively.

However, only 27% of athletes return long term to sport with conservative treatment.

Also, the length of a conservative treatment trial is somewhat controversial and inconsistent.  Nature of injury, level of performance of the athlete and length of time before return to pre-injury play all need to be considered when deciding how long to have a trial of conservative treatment.

I think back to my college athletic training days and I realize there were quite a few “sports hernia” surgeries being done.  So maybe this isn’t a new trend after all! However, it’s always good to remind myself of signs and symptoms and anatomy so we all make sure we are treating our patients effectively. It will, of course, be crucial for you to do your own assessment and use your critical thinking on how to progress with treatment, along with how to manage it as a conservative treatment as recommended. But at least after this hockey season is done, I’ll have my own answers as to how necessary the treatments on my favourtie players are.

 

References:

Cohen B, Kleinhenz D, Schiller J, Tabaddor R. Understanding Athletic Pubalgia: A Review. Rhode Island Medical Journal (2013)[serial online]. October 4, 2016;99(10):31-35.

Copperthite K. Athletic Pubalgia, Part 1: Anatomy and Diagnosis. Athletic Therapy Today[serial online]. September 2010;15(5):4-

Harris-Hayes M, Steger-May K, van Dillen LR, Schootman M, Salsich GB, Czuppon S, Clohisy JC, Commean PK, Hillen TJ, Sahrmann SA, Mueller MJ. Reduced Hip Adduction Is Associated With Improved Function After Movement-Pattern Training in Young People With Chronic Hip Joint Pain.  J Orthop Sports Phys Ther. 2018 Apr;48(4):316-324. doi: 10.2519/jospt.2018.7810. Epub 2018 Mar 16.

Heerey J, Risberg MA, Magnus J, Moksnes H, Ødegaard T, Crossley K, Kemp JL.  Impairment-Based Rehabilitation Following Hip Arthroscopy: Postoperative Protocol for the HIP ARThroscopy International Randomized Controlled Trial.  J Orthop Sports Phys Ther. 2018 Apr;48(4):336-342. doi:10.2519/jospt.2018.8002.

Hopkins J, Brown W, Lee C. Sports Hernia: Definition, Evaluation, and Treatment. JBJS Reviews[serial online]. September 2017;5(9):e6

Larson CM. Sports Hernia/Athletic Pubalgia: Evaluation and Management. Sports Health. 2014;6(2):139-144. doi: 10.1177/1941738114523557

Munegato D, Bigoni M, Gridavilla G, Olmi S, Cesana G, Zatti G. Sports hernia and femoroacetabular impingement in athletes: A systematic review. World Journal Of Clinical Cases[serial online]. September 16, 2015;3(9):823-8

Strosberg D, Ellis T, Renton D. The Role of Femoroacetabular Impingement in Core Muscle Injury/Athletic Pubalgia: Diagnosis and Management. Frontiers In Surgery[serial online]. February 12, 2016;3:6.

Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, HÖlmich P.  Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management.  J Orthop Sports Phys Ther. 2018 Apr;48(4):239-249. doi: 10.2519/jospt.2018.7850. Epub 2018 Ma

Altered Skin Colour And Circulation, Result Of Massage Or Nervous System?

 

This is one of those topics that inevitably comes up on a regular basis.

The last time I taught our course on pain science and therapeutic exercise, there was some resistance to the idea that massage therapy does not increase circulation and last week there were some big discussions on the topic on one of the massage groups on facebook.

This was a harsh reality for me when I realized we don’t have any effect on circulation and I remember the day in college when I started to question it (I’d love to say it was because I was some sort of forward-thinking genius, but I digress). I was working with a hockey team and one of the players had an episode in the summer which required him to be on blood thinners. I was super worried that if I did any massage I’d have an adverse effect on him, so I approached one of my teachers to ask if massage was contraindicated and what I should do as I was worried about the increase of circulation with his condition.

My teacher simply looked at me and said: “you’re not going to increase his circulation any more than him playing hockey!”

It was like a light bulb of astonishment went off, I wish I had a picture of my face.

Now, surely that story can be taken anecdotally if you choose to, so the question will remain: “what does the research say?”

Heart Rate And The SNS

I remember in college while working in the student clinic, part of each treatment we had to develop three goals prior to treatment to be reviewed by one of the clinic supervisors.

Most of the time my goals would look something like this (they got more specific as school progressed):

  1. Increase circulation.
  2. Decrease SNS firing.
  3. Patient education.

I think the reasoning behind “decreasing the sympathetic nervous system firing” was more to just a way of saying we calmed the patient’s stressors down and essentially helped them relax. As we know the SNS is responsible for our “fight or flight” response, which is essentially used when we are scared because we’re being chased by a bear or something. In order to have a “fight or flight” response, it would require our heart to start pumping hard and feed blood to the necessary parts of our body to get us moving and run from the said bear.

One of the assessment tools we would use to prove whether we actually had an effect on the patients SNS was to check their pulse before and after treatment to see if there was a change. Inevitably their pulse rate would be slower post-treatment than it was prior to treatment, thus justifying how we “relaxed” our patient.

So how in the world did I think I could simultaneously increase circulation, while both decreasing sympathetic nervous system activity? My assessment was literally proving me wrong. The sad part is I only thought of this example last week, at no point during my education did I ever question this, I just habitually put them as goals.

One thing we know for sure (and we’ve written about it before, you can read it here), is that massage therapy can help with hypertension and actually decreasing blood pressure. Some articles argue this entirely depends on the type and depth of massage technique used. One study showed using trigger point therapy and sports massage actually increased BP, however, the article wisely ackn0wledged this was due to the pain caused during a trigger point treatment. In this case, the treatment would be causing a sympathetic nervous system reaction to withdraw from pain, thus temporarily increasing blood pressure.

With everything we know about modern pain science and the knowledge around old theory of trigger point therapy, I hope we aren’t going in and causing pain with our patients anymore, as we know it’s not effective. In turn, it’s also not a technique we should use to fight the argument about an increase in circulation. As far as sports massage causing an increase, we’ll get to that in a bit. 

Sport Massage 

In the sport massage world, there has been a long time practice of using tapotement techniques to help with warm-up and increase blood flow before a competition.

While this can be an effective way of helping an athlete warm-up, there is probably more of a psychological aspect to it than anything about bringing circulation to a specific body part or tissue (this may be part of the reason that a typical warm-up involving exercise is always recommended before seeing a therapist to assist with warmup).

There is also the argument about doing a “leg flush” post-competition to help clear out lactic acid as part of recovery.

While there are several studies showing that blood flow is increased with massage (to help prove the above theories), most of the methods used to try and prove this theory wasn’t very reliable. However, more recent studies have shown that massage has little effect on arterial blood flow.

There were theories that reported a 50% increase in circulation after a vigorous massage, but later studies (which used somewhat unreliable measurement tools) showed not only smaller increases, but some showed no increase at all.

The above-cited study actually did tests post-exercise to see if massage would still have any effect when it comes to circulation. They used one group who would take regular rest post-exercise and one group who would receive massage. There was no significant difference between the two groups on femoral artery blood flow and massage performed on the quadriceps.

So what does this tell us? The only real way to increase blood flow is through movement and exercise. As our friend Alice Sanvito stated in a forum not too long ago: “If we mean there is more blood to an area, we run into another problem. The circulatory system is a closed-loop. There is a relatively fixed amount of blood. If more blood is shunted to one area, then there must be less blood somewhere else.”

The body would not let this happen, so we cannot actually alter circulation to bring more or less to any area of the body, without significant injury, which would result in shock, or blood loss.

Changes In Skin Colour

The question came up, “if we don’t increase circulation why does the skin go red!?”

Great question!, so I had to do some research on that as well.

We have all seen it in our clinic, we work on a specific area of the body and the skin changes color and gets a little bit pink, or maybe even red. Well, there are two possible mechanisms at work here, either the friction created doing, say, an effleurage stroke is irritating the skin, or a change in temperature from touch is the culprit. What about the clients you treat where the skin doesn’t change colour? Does this mean the massage is having less of an effect on them?

Well, studies show that skin friction can increase heating which causes hyperemia in the local massaged area. But the same thing happens when I put a cold pack on my arm and isn’t cold actually supposed to cause vasodilation and a decrease in circulation?

While there is a minor increase in blood flow to the capillaries of the skin, the increase in blood flow has been measured and shows that the amount is so arbitrary, there is no way it is being diverted away from local musculature. So, while this is p0ssibly a minor increase to the skin, we can’t assume we are increasing circulation to the muscle because the skin is changing colour.

As we mentioned before, what about those clients whose skin colour doesn’t change? Does this mean there is something wrong with their circulatory system, and we aren’t influencing circulation to that area? I’d venture to say no, it probably has more to do with skin sensitivity, or it’s a true measure of how minimal the circulation increase actually is.

Our friend Alice Sanvito also made a stellar point about this:

“What were we taught about the sympathetic and parasympathetic nervous systems? The sympathetic “fight or flight” nervous system diverts blood away from the skin and internal organs and towards the muscles. The parasympathetic “rest and digest” nervous system diverts blood away from the muscles and towards the internal organs and the skin. Since massage tends to relax people, it is probably safe to assume it is downregulating the sympathetic nervous system.”

Like it has been with so many other things in our career, we really have to take a step back sometimes and critically look at the things we were taught. This has been a huge learning curve for me during my career, but there is also a refreshing side to being able to give honest and logical answers to patients. While we may encounter arguments from others on these points, it’s important to keep educating ourselves and others to stay on top of current research and evidence-based practice. We’ve said it before on this blog in regards to circulation, there’s more of an increase happening by your patient walking into your clinic and getting on your table than from anything that happens during the treatment. And you know what? That’s okay because what you are doing for them on the table is FAR more important than worrying about increasing their circulation. 

 

Articles Of The Week March 11, 2018

Is yoga effective for managing chronic pain? Maybe, but then again maybe we just need to look at safe, non-threatening movement as a way to cure or manage chronic pain.

“Yoga, Mice, Pain and Your Brain” – Sarah Haag

There are some great points in this article about doing aggressive psoas work on patients, but there’s some things I don’t like about the article. To say that only those trained in visceral work should be doing this kind of work (because there’s not much evidence to say visceral manipulation is effective), is a bit of a stretch. However, I like the overall gist, that only trained professionals should be doing the work, and to be careful, there’s no need to do “aggressive” work.

“Serious Warning – If You Do Any Releases To Your Psoas or Abs, You Must Read This” – Antony Lo

Load management in athletes is an important factor in making athletes available for, and being in the best shape possible for competition. This post reviews three factors related to load management to help your athletes.

“Load Management Is Not About Decreasing Minutes” – Tim Gabbett

I love sleep, so I hate this part of the year where I lose an hour of it putting the clocks forward (why are we still doing this!?). A lack of sleep can lead to a host of health conditions and can affect brain health. Fortunately, massage therapy helps with sleep, so this could be a good article to share with your patients as another reason to get a massage!

“Why Are We So Sleep Deprived And Why Does It Matter?” – The Conversation

I’ve been asked many times if I would ever open up a practice at home and while it’s not for me, I know plenty of therapists who do. This post lays out several things to consider if you are wanting to open a home-based practice.

“Opening A Home Based Massage Business” – Allissa Haines