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Articles Of The Week February 11, 2018

February 10, 2018/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy, Pain/by Jamie Johnston

Like so many things in our industry, there is lots of confusion around youth strength training. Does it improve health? effect bone growth? is it even appropriate? Some great information in this article covering those questions and many others.

“Youth Strength Training” – Mario Chavez

Chronic disease is a massive expense on our healthcare system, and yet there doesn’t seem to be much done to prevent it. So how can we start to change things to start making prevention a regular part of our healthcare systems?

“An Ounce Of Prevention Is Worth A Pound Of Cure” – Jarod Hall

Quite often I have patients and colleagues ask where to get good information on pain. Well, Lissanthea Taylor is stepping up with this great resource she is developing. There will be lots of information on pain so that we can give accurate information to others.

“Where’s The Good Information About Pain?” – Lissanthea Taylor

Do you know the difference between Varus and Valgus? This post will help to give you a better understanding of the differences between the two and what can contribute to it. One of the things I like about the article is how the author points out that someone may have this kind of condition, but not experience any pain, so it may not even need treatment.

“Valgus, Varus, Vargus…What Is It?” – Whitney Lowe

Being in business for yourself is hard work! It seems there is a never-ending list of things that have to get done and we’re constantly hustling to accomplish more. But could we be more successful if we hustled less? Here are four tips on how to do just that.

“How Not To Hustle Your Way To Success: 4 Tips For Aspiring Entrepreneurs” – MeiMei Fox

Three Reasons It Matters Why A Treatment Works

February 5, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy, Pain/by Todd Hargrove

Why exactly does someone feel better after a massage? Or acupuncture? Or foam rolling? Or a chiropractic adjustment, or wearing K-tape, or doing mobility drills, or a hamstring stretch?

There are some good answers to these questions, and the interesting thing I’d like to point out in this post is that quite often, the therapist doesn’t know them. Or even care about them! Or maybe the therapist has heard the good answers, but prefers alternative bad answers that are far less plausible given the current state of relevant science.

Speaking of bad explanations: Foam rolling probably doesn’t work by breaking adhesions or melting fascia. Chiropractic manipulation doesn’t put joints that are “out” back “in.” Deep tissue massage doesn’t get rid of toxins or “muscle knots.” Acupuncture doesn’t access special points or meridians – putting the needles in random places works just as well. Some sham surgeries work just as well the real thing. Motor control exercises often work to reduce pain even though motor control hasn’t changed.

None of this means that the above treatments can’t work to make someone feel better. It just means they don’t work in the manner advertised. And no this doesn’t mean that everything is just placebo (that’s a confusing word without a clear meaning.)

In general, it seems that therapists have a strong bias towards the idea they are fixing “issues in the tissues.” And they tend to ignore issues in the more complex systems in the body – nervous, immune, autonomic – which are very sensitive to even minor inputs and have a great influence over how we move and feel. Maybe this is because these systems are less visible, or tangible, or just not what practitioners learned about when they were in school.

I was trained as a Rolfer and taught that Rolfing works by changing fascia. So when people got up from the table and said they felt taller, or looser, or had less pain, this was because their fascia had somehow changed for the better.

After doing some research about the deformability of fascia in response to manual pressure, I decided this was not a good explanation for our observations. A better explanation would involve the nervous system, which is constantly adjusting muscle tension, movement patterns, perception, and pain sensitivity in response to new sensory information, including the highly novel sensory information caused by bodywork.

Of course, it’s kind of a bummer to learn that a central premise of your education is incorrect. But the good news is that this doesn’t mean people can’t be helped with your treatment. That is a completely separate issue. So my attitude was – OK, it’s not about the fascia, but that doesn’t mean I can’t help people.

But for many Rolfers, it just has to be about the fascia. And for chiros, it has to be about the subluxation, and for Reiki practitioners, it has to be about energy, and for others, it needs to be about posture, or core strength, or muscle imbalances, or movement patterns.

And of course, many others will say: “I don’t care how the treatment works, I just know that it works does so who cares why?”

Here’s three reasons why it’s important to know why your treatment works.

1. If You Know How Something Works, You Can Make It Work Better

This should be obvious. If you know where the target is, it’s easier to hit the bullseye.

Let’s assume that stretching or massage works to create better range of motion by getting the muscles to relax. (Reasonable enough, right? And supported by research!)

But if you think that it works by forcefully breaking adhesions or physically lengthening tissues you might lose focus on whether your clients are staying relaxed.

When I work on someone I always ask “how does that feel?” Here’s a common response from clients who think it’s all about the fascia: “Don’t worry about me, I have a very high pain tolerance, just do what you have to do.”

And I will think to myself: “Well, I need to know how you feel because that is one of the main targets for this work.” But if my target was breaking up fascia or muscle knots then indeed I wouldn’t care how they felt. And I wouldn’t do as good of a job.

2. Unintended Consequences

Imagine someone with neck pain goes to the chiropractor, is told their neck is “out”, gets cracked to put it back “in”, and then immediately feels much better. What’s the harm if they think that pain relief came from some form of realignment?

Maybe in the short term, there is no harm, but false beliefs have a mischievous way of eventually causing problems in the long term.

Let’s say the neck pain comes back. The client thinks her neck must be “out” again so she needs another crack. So she overlooks other potential solutions like exercise, rest, or gentle movement. If the neck pain continues, she might eventually develop the pathological belief that her neck is fragile and unstable. This can have a nocebo effect – creating further pain and avoidance of healthy movement.

I have seen many clients with similar misconceptions, and this has cost them significant time, money, anxiety, and confusion.

And I’m not just talking about the clients of chiropractors.

I have seen yoga people who are always stretching; Pilates people always stabilizing; corrective exercisers looking for microscopic muscle imbalances; joint mobility fans perpetually mobilizing, as if their joints need a constant bath in synovial fluid, or will start knitting themselves together with some sort of fascial “fuzz” after just a few minutes of stasis. Rust never sleeps!

All these pathological behaviours ultimately stem from false beliefs about why certain therapies have worked for them in the past. These beliefs cluster around the idea that they have corrected “issues in the tissues” as opposed to temporarily adjusting the sensitivity of the nervous system.

The bottom line is that false beliefs, no matter how small, are like viruses – they multiply, get passed to others, mutate to form superbugs, and can eventually cause disease. Don’t spread them, people!

3. The Truth Matters

The truth has inherent value, even when its practical application is not immediately obvious. Knowledge is always powerful – for you, your clients, and the whole community.

We don’t yet know exactly why people have chronic pain and the best ways to treat it.

Even though that knowledge hasn’t been created yet, that doesn’t mean it’s useless to learn more. Every step away from misinformation and confusion is a step in the direction of the truth.

Let’s face it. The truth is good and ignorance sucks. Here’s some quotes from smart people to prove it.

“All evils are caused by lack of knowledge.”

–David Deustch

“I think it’s much more interesting to live not knowing than to have answers which might be wrong.”

— Richard Feynman

“It ain’t what you don’t know that gets you into trouble. It’s what you know for sure that just ain’t so.”

— Mark Twain

“The truth will set you free, but first it will piss you off.”

–Joe Klaas

Many thanks to my readers and members of my social media community who are thinkers, skeptics, and unafraid to follow where the evidence leads.

Articles Of The Week February 4, 2018

February 3, 2018/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

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

January 29, 2018/in Massage, Massage Clinic, Massage Therapist, Massage Therapy, Sport Massage/by Jamie Johnston

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 am – Light snack

5:30 am – Athlete exercise routine

6:00 am – Team meetings/presentations

6:30 am – Team practice/dryland

7:00 am – Regular breakfast

7:30 am – Morning session with S&C coach

7:45 – 9:10am – Practice session for some athletes

10:00am – 12:00pm – Physio & Massage Therapy treatments

1:30 pm – Pregame Meal

3:10 pm – Athletes and coaches meeting

3:45 pm – Dryland warmup

4:30 pm – On ice warmup for both teams

5:00 pm – Game time

5:10 pm – Athlete cool down

8:20 pm – Dinner

9:00 pm – Staff meeting

Travel Day

5:00 am – Light snack

5:30 am – Athlete exercise routine

5:45 am – Team meetings/presentations

6:30 am – Breakfast

6:50 am – Athletes and coaches meeting

7:15 am – Dryland warmup

8:00am – 9:15am – Team practice

9:30 am – Athlete cooldown

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

10:30 am – Lunch

12:15 pm – Load all team luggage on the bus

12:30 pm – Leave for airport

1:45 pm – Check all baggage and equipment in through airport security

5:05 pm – Flight leaves

6:30 am – Land for connecting flight

10:10am – Connecting flight departs

3:25 pm – Land in destination, collect luggage, load bus

6:00 pm – Check into hotel

6:30 pm – Dinner

7:00 pm – All 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 am – Breakfast

8:45 am – Athlete and coaches meeting

9:30 am – Dryland warmup

10:00 am – 11:45 am – Practice

12:00 pm – Athlete cool down

12:40 pm – Lunch

1:15 pm – Team meetings/presentations

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

4:30 pm – Light meal

5:30 pm – Dryland warmup

6:00 pm – 7:15pm – Practice

7:25 pm – Athlete cool down

8:30 pm – Dinner

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

10:10 pm – Staff meeting

Gameday

7:15 am – Breakfast

7:45 am – Athlete and coaches meeting

8:15 am – Dryland warmup

9:00 am – 9:45 am – Pregame Skate

9:55 am – Athlete cool down

11:00 am – Light lunch

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

3:30 pm – Pregame Meal

4:50 pm – Athlete and coaches meeting

5:45 pm – Dryland warmup

6:30 pm – On ice warmup for both teams

7:00 pm – Game time

9:10 pm – Athlete cool down

10:30 pm – Dinner

11:00pm – Staff 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

December 30, 2017/1 Comment/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

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

December 23, 2017/in Business, Massage, Massage Clinic, Massage Therapist, Massage Therapy/by Jamie Johnston

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