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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.

 

How Can Massage Help Runners?

Some runners swear by it, others say it’s a waste of money. The fact that most elite runners have regular massage suggests there must be something in it, but how valuable a tool is it for recreational runners? Is there any evidence it reduces injury or increases performance? Let’s take a look…

What Does Massage Do?

The most commonly proposed benefits of massage are:

  • Massage helps flush away lactic acid
  • Massage improves circulation
  • Massage breaks down muscle/fascia adhesions.

It may therefore come as a surprise to hear that none of these are supported by research. In fact, the application of a little basic science suggests that such claims are either unlikely or simply not true.

What?” …I hear you shout. “So all that time & money I’ve invested has been for nothing?

No, hold on to your horses – I am a big fan of massage, I have after all taught it for several years. There is no doubt in my mind that it can help runners, just not in the way you think, and probably not as much as you may have been lead to believe.

Flushing Myths

Modern research has made it quite clear that muscle soreness is not caused by lactic acid build-up. Lactic acid (or more accurately ‘lactate’) actually clears from the bloodstream the moment you stop running, so the idea that massage helps ‘flush it out’ makes no sense.

How about flushing out toxins? Well, in all honesty, despite a lot of therapists using that as a reason, no one can actually say what these ‘toxins’ actually are. It’s an idea that sounds good but is certainly not scientifically based.

Linked with these flushing myths is the idea that massage ‘improves circulation’. Despite this being a very common claim, any increase in circulation would actually be minimal. Circulation increases when you raise metabolic demand; in other words, getting on and off the massage couch a few times will increase circulation far more than receiving a massage.

Breaking Down Knots


Ok, stay with me. Remember, I am a fan of massage and will get to the benefits soon. We just have to clear up the misconceptions first. Many runners put up with (and even expect) considerable discomfort during a sports massage in the belief that the therapist is applying the required force to break down ‘knots’ or ‘scar tissue’.

This idea is once again a myth; surgeons use scalpels to cut through scar tissue, so the belief that pressure from a thumb or elbow could break it down is obviously misplaced.

If your muscles feel more relaxed or lengthened after a sports massage, fantastic. But it’s not because the therapist has managed to force physical changes in your body’s tissues. It’s actually quite scary to think that a human being could do that with their bare hands.

How Does Massage Help Then?


So, what does massage do then? Studies show that massage after exercise can reduce the intensity of post-exercise soreness, so what is happening? Some of you may already be asking ‘why does it matter how it works, as long as it does?’

The answer to that question is as follows: if we know how something works, we can tweak it to make it work even better. If you (and your therapist) truly believe that the deep tissue massage is ‘breaking down scar tissue’, you will both be happy to put up with considerable pain, with shouts of “this hurts like hell but I know it’s necessary” and “no pain, no gain!”

Though there is a lot about pain that we do not yet understand, what we do know is that allowing a therapist to pummel you can actually lead to a delay in recovery. Pain is an output from a nervous system that is essentially trying to protect you from real or perceived damage. Trying to fight pain doesn’t make sense because all you’ll ultimately do is wind the nervous system up even more and cause it to output even more pain.

This is why stress, poor nutrition, lack of food, etc. can all increase pain. They all cause the nervous system to feel more vulnerable. And this is where we now reveal the most likely mechanism behind massage… it relaxes the nervous system

Relaxing The Nervous System


Studies show that massage can reduce both depression & anxiety. It relaxes the nervous system, removing threat and giving it less reason to output pain or restrict movement. This is why after a suitably deep massage we often feel less pain and can move more freely. The effect will not necessarily last forever (we have all seen how the initial pain often returns after a few days) but it can be a way to speed up recovery, allowing us to train more intensely without increasing the risk of overload and injury. We all enjoy a firm massage but putting up with too high a pressure runs the risk of doing the opposite.

Conclusion

Massage can help runners, just probably not for the reasons traditionally given. By relaxing the nervous system (as opposed to winding it up), massage can aid recovery, allowing you to train vigorously without increasing the risk of injury. The skill of the massage therapist, therefore, lies in applying a suitable amount of pressure at the right time. Talk of ‘breaking down scar tissue’ or ‘realigning tissues’ is outdated and can lead to runners putting up with unnecessary pain that can actually delay recovery.

 

Also, if you missed it, we had Matt on the podcast last week, give it a listen here: “Helping Runners With Matt Phillips” 

Understanding Headache Types To Help Manage Concussions

Since Sidney Crosby sat out an NHL season, the word “concussion” took on a whole new meaning. The number of research papers grew exponentially and awareness for the injury increased in popularity in both mainstream media and medicine.

For many of us, this is was not a surprise. For years medical professionals have been aware that a concussion is in fact an injury, a brain injury.

A concussion is defined by the Ontario Neurotrauma Foundation as, “a complex pathophysiological process affecting the brain, induced by biomechanical forces”. While this definition offers a general overview of the condition, it does not outline the potential list of symptoms, treatments, and presentations involved in this incredibly complex injury.

As research continues, the fact remains Massage Therapists continue to play an integral role in concussion management. With increased involvement, there is a need for a better understanding of how to serve patients in their recovery process. This article hopes to provide education on common trends within the concussion community and how the massage therapist can improve patient outcomes.

Acute concussions, with early diagnoses and intervention, result in very favourable patient outcomes. In fact, research shows that 85%-90 of concussions will resolve within 7-10 days. Of the remaining 15%, recovery times range from weeks to years in length.

A common question asked during this period is “how much complete rest should a patient take?” During the most recent consensus statement on concussion, in Berlin, experts concluded complete rest should not exceed 24-48 hours, at which time patients can begin a tailored return to activities protocol. During the acute phase of the injury, symptoms that take priority include post-concussive headache, sleep hygiene, and accompanying or emerging mood disorder.

Massage Therapists are often called upon to help manage the above symptoms, with headache being the most common. As such, the importance of headache recognition by the massage therapist plays an integral role in patient recovery.

The most common type of headache suffered after a concussion is a tension headache. Tension headaches originate in the autonomic nervous system and are perpetuated by the metabolic crisis of a brain injury. Tension headaches are typically bi-lateral, “stabbing or throbbing” in nature, and aggravated by increased physical exertion, or cognitive stress beyond a patient’s threshold. Tension headaches lend themselves to treatments that are focused on relaxation, with the primary goal of decreasing the sympathetic nervous system’s effect on post-concussion symptoms.

The second most common type of headache suffered is a cervicogenic headache. Cervicogenic headaches are typical uni-lateral, consistent to one side of the neck, head, or face, and recreated by neck movement and/or palpation. These headaches are typically caused by the associated whiplash injury that accompanies a concussion. A cervicogenic headache requires a treatment whose goals include improving range of motion, tissue tone, and quality.

It’s important to note that tension headaches can often be misclassified as a cervicogenic headache. This may be the most important understanding for massage therapists treating concussion populations. Aggressive treatments without an understanding of headache type may lend themselves to increasing the patient’s symptoms.

Outside of clinical skills, the most valuable thing to offer patients is education. This includes dispelling the myths that exist within the concussion community. Exercise previously thought to be negative now plays an important role in the recovery process. Leddy et al. have done extensive research on sub symptom threshold exercise and its benefit on patient recovery.

The world of rehabilitative therapy offers both vestibular and ocular rehabilitation to help patients manage a multitude of symptoms and return them to pre-injury status. While these methods still require more rigorous research, early case studies show promise in their role in patient management.

Concussion is a scary word. As Massage Therapists involved more than ever in the recovery process it’s important to offer patients support. Re-assure them that there is plenty of new evidence to help their recovery. Search your community to provide patients with resources and most importantly be aware of current advancements in research to provide the best patient outcomes possible.

References

1. Ontario Neurotrauma Foundation. (2018, May) Guidelines for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms 3rd Edition. www.braininjuryguidelines.org
2. McCory et al. Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin (2016) Br J Sports Med. 51, 838-847. doi:10.1136/bjsports-2017-097699
3. Harmon et al. American Medical Society for Sports Medicine position statement on concussion in sport  (2019) Br J Sports Med. 53, 213-225. doi:10.1136/bjsports-2018-100338
4. Giza et al. The New Neurometabolic Cascade of Concussion (2014) Neurosurgery. 75 Suppl 4:S24-33. doi: 10.1227/NEU.000000000000050
5. Leddy et al. The Role of Controlled Exercise in Concussion Management (2016) PM R. 8,3, S91-S100. doi: 10.1016/j.pmrj.2015.10.017
6. The International Classification of Headache Disorders 3rd Edition (2018) Cephalgia. 38, 1, 1-211. DOI: 10.1177/0333102417738202
7. Reiley et al. How to diagnose cervicogenic dizziness. (2017) Archives of Physiotherapy. 7:12:1-12. DOI 10.1186/s40945-017-0040-x
8. Brandt et al. The dizzy patient: don’t forget disorders of the central vestibular system. (2017) Nat Rev Neurol. 13(6):352-362. doi: 10.1038/nrneurol.2017.58
9. Ellis et al. Vestibule-ocular dysfunction in paediatric sports-related concussion. (2015) J Neurosurg Pediatr. (3):248-55. doi: 10.3171/2015.1.PEDS14524
10. Leddy et al. Exercise is Medicine for Concussion. (2018) Curr Sports Med Rep. (8):262-270. doi: 10.1249/JSR.0000000000000505
11. Leddy et al. Early Subthreshold Aerobic Exercises for Sport-Related Concussion – a randomized clinical trial. (2019) JAMA Pediatr. 173(4):319-325. doi: 10.1001/jamapediatrics.2018.4397
12. Teel et al. Randomized Controlled Trial Evaluating Aerobic Training and Common Sport-Related Concussion Outcomes in Healthy Participants. (2018) J Athl Train. 53(12):1156-1165. doi: 10.4085/1062-6050-7-18

 

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

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