What does Pain mean to you

What does pain mean to you?

Pain is always a very difficult topic to discuss. So many people describe pain in different ways and pain itself and the idea of what it truly is, how its perceived and what we should do when we experience, especially in terms of injuries or activity, seems to change on a regular basis. For a long time therapists use to chase the pain finding the symptoms of pain, leading to initial short term improvements but never caused the pain to fully leave or the true cause to be chased down and dealt with. We as humans became heavily dependent on getting rid of pain so we could function long enough to compete or just get through the day. this lead to many people suffering in the long term, with tissues being damaged and movement patterns leading to injuries merely being ignored instead of changed.  The international association for the study of pain describe pain as “An unpleasant sensory and emotional experience associated or as a result of actual or potential tissue damage”.

In certain sports they have become dependent on the idea of deal with the pain to allow an individual to compete for a long enough period and then to essentially come off injured. American Football is the worst culprit for this and still continues to chase the symptoms instead of the cause.  Sadly leading to the abuse of NSAIDS, painkillers normally injected into an affected area but the overuse of which can cause tissue degeneration. Other sports have already moved away from such methods but often we find ourselves stuck in a situation where we have an athlete asking to play and willing to push through an injury, coaches balancing their want for player safety and need to produce results and therapists stuck between the want of their patient and the knowledge of what is truly occurring to them and what will occur with further stress.

People often want a quick solution and don’t want the hassle of consistent or prolonged rehab or activity when a quick solution of masking the pain will allow them to do the same. America alone spends $323 billion dollar in 2015 on pain medication with it likely to increase to $450 billion by 2021. Obviously this includes individuals taking pain medication for conditions that cannot be cured through rehabilitation and activity but a huge sum of this money is towards people suffering chronic but curable pain as well acute pain due to musculoskeletal injuries or tension.  Looking then to the entire world the money spent on short term relief of pain is astronomical in comparison to the price of what rehabilitation or increased levels of activity cost in the long run. 

The issue with always masking or reducing pain is that pain is not always a bad thing. Pain normally allows for us to find the cause or the issue or the reason behind injuries. It also allows us to prevent ourselves from returning to a position where our tissues cannot, at that time, deal with the loading asked of them.  Pain is a way for your body to protect itself by trying to force us out of positions or activities that is causing damage or this sensation to be produced. Pain not only causes physical changes but mental as both are interlinked to a level where we often cannot control it. Pain will lead to physical change which will lead to mental changes in the form of a change in movement patterns and the reaction to fear. This is often an unconscious factor but often leads to prolonged changes in the way we function. We can also become over saturated with pain meaning we can become hypersensitive to it or almost numb to its presence, both as bad as the other in functional terms.

Pain can illicit a response from several systems including the motor, endocrine, sympathetic nervous and immune system.  Pain also does not always mean tissue damage in the sense of an injury.  For muscle and tissue to correctly develop it has to be broken down and built up, with the correct loading for more avascular tissues. Pain is also exceedingly selective with pain producing a different  response or level of pain depending on its cause or placement of injury depending on the activities of each person e.g. knee pain in an Olympic weight lifter vs a musician. Our body has specific healing phases with each tissue type having a different time-frame of healing. Masking the pain or introducing exterior stimuli to reduce pain before these stages are complete to an excessive level can cause issues where a premature return to activity occurs several times causing chronic problems.

Our biggest issue stems from a mixture of refusing to spend the time needed on correct rehab to produce long standing results and our lives revolving around excessively sedentary lifestyles. We only need to be active in the correct manor for short periods each day but we find it difficult to entertain the idea of it. Time seems to be the real killer with us normally not having the patience or willingness to give time over to what seems hard to make things easy in the long run, instead doing what is easy and maintaining what is wrong for the long run.

Physio v ATT

The Difference Betweeen a Physiotherapist & an Athletic Therapist

My qualification is a B.Sc in Athletic Therapy and Training, meaning I am an Athletic Rehabilitation Therapist. There is often confusion as to what I do when I describe this to people. I often get called a physio, physiotherapist, sports physio, sports therapist, physical therapist or a massage therapist. I am in fact none of these things and an accumulation of skills from all of these things. Athletic Therapists or (AT’s) are not widely known even within athletic and sports circles in a country such as Ireland. This is very different in countries where Athletic therapists are better known and more widely implemented especially in America, Canada and Australia. It is a mixture of people perceiving what I do and making a connection to something like physiotherapy, which is widely known and spoken of.  Yet, when people hear I’m not a physio the uncertainty sets it. It’s concerning when people ask which course I did “was it the 6-week course or the 12-week course you did to become a stretch therapist?” I actually spent 5 years in university and thousands of hours in clinics and pitchside being overviewed and assessed on practising my skills and knowledge.

This is not always a bad thing, more a frustrating thing. Many people ask me “does it really matter?”, and I normally ask them “would you like to be called your title or something close to your title”. Many therapists and qualifications share similar skills, client bases and even places of work. The difference is normally found in our backgrounds, where we learned our skills and they were intended for. Physiotherapists learn in a clinical or hospital setting often attending people who are post-op, suffer from age, disease or extreme injury-related conditions which has affected their physical capability to properly function. Physios normally have to attend individuals who start at a point where slow and steady state rehab is needed. Many physios then go on and learn in greater detail either through placement or further education to deal in more fast based scenarios such as acute injuries incurred by athletes or active members of the population.

Athletic Rehabilitation Therapists are the reverse. We learn in a fast based environment where there is often a shortage of time and excess of individuals such as teams or athletes attending clinics where their aim is to return to activity with the framework to complete most everyday tasks still being intact. AT’s then often learn the slower based and one on one skills later on in their training and in further clinic work when they can better dictate their hours. Both of our aims are the same but it is often controlled by the patients we care for and the environment in which we practice. We learn almost in reverse of each other and we often take differing approaches to the way in which we attempt to rehab our patients. I find that we often show our differences in the way in which we push our clients, this can either be slow with low activity or controlled with a more intensive form of rehab.

It is understandable as to why so many people misunderstand, all the varying therapists and qualifications that are out there. We share the same body of knowledge for most common complaints from patients, we share patients and a competitive environment. What really differentiates us is individual therapists and how they implement their care and knowledge and to whom. I have worked on competitive athletes and people who would, with pride, describe themselves as weekend warriors. I’ve helped people post-op, chronic and acute injuries, musculoskeletal, neural and articular, and the only real difference I think anyone should ever worry about is whether they are going to someone they think can handle the issues you have and that they have the confidence to either take it on with the best of their abilities or has the same amount of confidence to say its beyond their ability to help. As such there are very few differences other than the general public’s knowledge of one profession over the other. This is then something that AT’s themselves must change.

As perfectly stated by the Canadian Athletic Therapists Association; “The treatment varies but the objective doesn’t: an Athletic Therapist’s goal is to help clients return to their usual activities, whether that means playing competitive sports or walking to the mailbox and back”.

New Therapies from Old Ideas

In our modern world the old and the new seem to inter mingle and over take one another as we see them with fads and waves of interest, fashion and ideas. This is very much true when it comes to the way in which we view how to treat patients. What is currently in fashion, what are the therapies currently used or being studied. We often see these first hand from professional athletes or at major events like the Olympics or World games. What are the athletes currently receiving for their rehab or their pre-event work. This can be clearly shown when we see therapies like cupping or kinesio tape which were around for many years especially cupping, originally an Asian treatment, making their big world showing at the Olympics and suddenly becoming the new “It” therapy.

As such, are the therapies used or wanted, implemented like a popularity contest, with the fashionable and cool person winning even without knowing for sure what it is they do. This can often lead to therapies evolving and becoming more stream lined and specific such as the therapy dry needling, coming from the Asian medical practice of acupuncture. It seemed to work for centuries but not exactly for the reasons described. Does that mean that all therapies possibly have a sell by date before they are either updated and brought forward or left to the way side.

We often see this being heavily influenced by where our school of thought lies. Western medicine for nearly a century has implemented the R.I.C.E method of Rest, Ice, Compress and Elevate to treat initial injuries and for early stage rehab. Whereas Eastern medicine often implements the use of stimuli to injured or affected areas to hopefully cause increased levels of healing. So who is right? Well neither can 100% claim that their way is without a doubt the best, it is purely based off where a therapist received their training. Many therapists will learn new methods, ideas and therapies to keep themselves up to date and relevant. So no therapist who has practiced for a long enough period is the exact same as they were when they first entered the industry.

An article I recently read put it somewhat into perspective that fad therapies often come and go due to initial popularity and exposure but they mainly end up being contained by the school of thought they come from. Which is why when therapies such as cupping, dry needling and the many different forms of soft tissue therapies that become long term and major therapies within both bodies of medicine, it is a pretty major thing,

https://newsstand.google.com/articles/CAIiEGOf56AyetebYcZ4FsuiE5wqGAgEKg8IACoHCAowy-2kCjCw_3cwjs7sAQ

The reason behind many therapies ability to reduce pain have yet to be scientifically shown, such as the term “trigger points”. A trigger point has never been shown to actually occur in enough pieces of literature to be a definitive reason behind pain or reduced mobility, but I can find them and release them somehow in patients. Sometimes we practice things that are not fully backed or that we don’t quite know why they are helpful and yet we use them regularly and we can see that they are beneficial. So unless its somehow a placebo effect present in most people or sometimes we implement different methods of treatment without needing to know why they are effective as long as they don’t cause harm. Maybe this means the way we view rehab needs to slightly change from everything being rock solid truths. Yet maybe we also need to better educate those who come to us in what exactly the methods we use do so that rehab becomes less of a popularity contest where we case what people want and provide a wide enough spectrum of treatments from several schools of thought.

I believe that my ideas were first challenged when on placement when the fully qualified Athletic Therapist in charge of me asked me as question.  We had spent a little while assessing patients with him asking me anatomy questions, which had me sweating to like good in front of this person. Eventually we went out to cover the game and he asked me what I thought about different therapies I was learning about, especially modalities and if they were any use at all. I then said that I thought R.I.C.E was the “most effective rehab”. He laughed and then asked me “So should you put ice onto an effected area straight away even though ice will reduce pain but slow the repair phases possibly causing issues later if its over used like it normally is”. After hearing this I was quit for a solid half an hour because I couldn’t answer him and my 2nd year college mind couldn’t yet comprehend the idea that “wait that cant be right”.

So after years I’ve come to the conclusion that I still do not have a conclusion and that each and every individual must be taken as an independent case and that any therapy be they strange, tried and tested, old, revamped or the simple thing you skipped because it was simple I believe that having predetermined methods and schools of thoughts cant really work anymore.

Trying to Set Up a Business

Recently I have been trying to find myself a place to start my work out of. This is always a difficult scenario for anyone hoping to start working for themselves. We spend so long becoming experts in our own fields, while learning this and taking instruction from others, that we often don’t learn more practical skills such as how to do taxes, how to sort our accounts and how to approach setting up a business. Sometimes we become so single minded that we often forget that we aren’t going to simply be able to apply to a single workplace and get that job we want or be able to find the perfect place to set ourselves up with the right number of clients and atmosphere in the area.

Starting a business starts with a lot smaller scale work which I actually find much harder. Setting up various contact pieces such as a website, Facebook page and getting in contact with people, handing out leaflets and business cards. So essentially social aspects and foundations to the business itself. I am not the best when it comes to going in to people and chatting to them about business. Not the actual talking aspect but the part in which you initiate the conversation or send off that first message. This is the same for many people who also find these interactions difficult.

Starting this has really made me far more aware of how much more I still have to learn. Dealing with patients and their injuries is now my normality. Dealing with having to find a space to work out of, put funds together to pay for it, pay for necessary equipment, getting a business card put together and printed, advertising and then keeping track of all that while sorting out insurance and deciding what type of business I should become not so much. These were not things that were going through my head as I walked up a small flight of stairs to receive my degree. I had ideas of having a small holiday and the apply to a couple of clinics and teams and start off from there. That didn’t quite play out the way it did in my head. If you are lucky and skilled enough to find work in an established clinic, you are definitely in a good place and your work probably reflects that you deserve it as well. If you haven’t then its a case of finding out exactly where you stand in this industry and what you do with yourself and that’s a big question.

I had never initially intended to go off and try to set myself up from the beginning. I did not think I needed business cards, a website or anything that would be something for myself. I imagined a few years of working in a fairly safe position, working hard and then maybe going off on my own and after a few years of learning everything I needed be able to set myself up hassle free. I was fairly naive when I see it written in front of me. People told me various different things like “It’ll all happen in time” or “Don’t worry these things sort themselves”, these are not phrases that build confidence. Then someone who is now my business partner and pretty much does all the hard slog to allow me actually do what I want to do simply asked me”Why aren’t you setting up your own space and work for yourself”. It was such a blunt and harmless question but I couldn’t think of an answer that didn’t revolve around “Well people normally work for someone established first and then try and sort themselves out”, except that’s what I thought and I was wrong, as much as that pains my ego.

So here I am attempting to establish myself as a real adult, I mean therapist. With my own space and equipment, with all the social media pieces and contact foundations and I still haven’t really started as many people have already told me, who understand how business really is, that “You never stop, you never finish, you merely keep growing or you fail”. Hearing that actually makes me nervous far more than I ever thought because the idea of failing seems horrible but realistically how would anyone learn if they didn’t fail and try again. Or as my business partner said “If you fail when you’re this small at least not that many people will notice”, which made them laugh and nearly made me hyper ventilate. So here I am panicking over things I shouldn’t and then not even being worried about the actual work itself. I am probably going to end up making everyone a nervous wreck around me until I actually have that very first patient and then after that I’ll be hooked.

Yet if I could give anyone who wants to open up their own clinic or some form of work revolving around health care, look into how businesses actually function, look into social media and how to talk to people and if possible find someone patient enough to help and put up with you because and speaking from experience you will freak out and only afterwards will you wonder why. Im still not really in a position to give advice as I am pretty much as big a noob at all this as there could be but its a case of swallowing all that ego and fear and being ok with a few set backs as long as you keep moving foraward.

The Importance of Communication with Patients

Recently I attended the Coaching Masterclass event held in Dublin City University. Coaching itself is not something I wish to do as a profession but the premise behind good quality coaching can help with dealing with patients and receiving the best quality effort from them.

Often coaches, therapists and others, who would be perceived to be in a position of authority and care, can fail to communicate to the people that come to them.  As professionals in our fields we often talk to athletes or patients and tell them what to do. Not always necessarily listening to their own views and difficulties on the matter. We often lose ourselves in the idea that we know best and that doggedly persevering through any form of set back or failure without making changes will work.

This is of course is a selfish ideal that we can all fall in to. Thinking we know best and that if others just listen to you and do as you say, well then of course they will improve. Sadly this is not true for most. We have seen now for years that not every form of learning will suit each person, “One size fits all” does not always apply.  Within the event better ways to communicate and understand athletes as well as people in general were presented by coaches, sports scientists, sports psychologists and experts of human behavior.

We sometimes act like most people will improve at a steady and homogeneous rate. This is often a trap that health care providers fall in to with set backs and slow progress stumping many of us purely because “Well why wouldn’t it be working”.  Its the exact same way in which we look at performance. We often look at the potential in individuals and we can see where they could end up, but just as many of the people speaking at the event made reference to, you can have the greatest car in the world but it will only drive as well as the person behind the wheel.  Simple example but it holds true to anyone trying to come back from injury or improve their performance. Your body has all the capability in the world, but the effort you put into it and the decisions you make are what determines the outcome.

We normally see this in private when a person can perform to a high standard with ques and a presence to guide them step by step. Adversely we see them falter and become unsure in an open environment with unknowns and the fear of return to play. As such we need to be able to communicate with our athletes/patients in a manner that allows them to grow as an individual with the necessary skills to not only return to general activity but excel in it. These individuals must not be afraid of stumbles and failures as they will be what allows them to grow.

We all want those we aid to grow more and more but each individual is different and cannot always fall under broad methods of training or learning. We cannot merely tell them what to do at every given period. We need to instill in them to ability to return from injury and know the way to prevent re-injury. This can be difficult as most people are in a rush and want to be told what they need to do, step by step. Challenging them while aiding their physical return to play may be what is truly necessary in the long run for player health and longevity within a sport. Knowing the ques for the best result and describe where an individual truly both mentally and physically are also necessary.

Performance as well as the rate a person progresses in their rehab is seen as 90% preparation. If we do not adequately challenge people with factors relatable to their sports or general activities and merely cater to their ability to complete abitrary tasks away from a true to life scenario then we are merely setting them up for a fall. Rehab must become something where the patient, those involved with them and ourselves all share a common goal in mind that we all strive to achieve, a “shared mental model”. This system where we strengthen not just a person physically but also mentally is where we make people return and become even better than they were as staying the same in their position means they aren’t getting better. This responsibility given to the individual will hopefully make them try harder and make them more open to try methods on their return to full health and continuous improvement in their performance, be it on the field of in every day life.

 

The Fear of Re-Injury Stopping Return to Activity and Perforamance

A topic that often doesn’t get discussed very often is the psychological aspects of returning from and injury. Whether it be returning to sport or just everyday activities and work depending on the level, type or location of injury many people will struggle to return to normality issue free. I don’t just mean people struggling with debilitating issues mentally regarding their return to health but many people will have times where the struggle mentally in recovery.

Injuries are something that can suddenly shake our attitudes and confidence which in itself is an unsettling feeling for most. We all very much feel that we can just bounce back and if you can all the better. Sadly at times the road to recovery is slow and an uphill struggle. The grind to return is at times monotonous and frustrating especially severely acute or long term chronic issues. I think many people do not give themselves enough credit for the efforts they put in their attempts to recover. We often see athletes and the injuries they go through and we belittle the issues we have ourselves. Its true athletes normally receive far worse types and degrees of injuries but many athletes will have several major injuries and returns to play in their career while having a well developed support system that to them, unless very serious, its just another speed bump in their business.

Yet the fear and difficulty of injury can be intense for even those in the general public. Injuries makes us feel fragile physically and mentally where we fear hurting ourselves or re-injuring the affected area again which makes us overly cautious and, in a vicious cycle, makes us more likely to hurt ourselves.  We become nervous of the movements or actions we do that caused the injury so we limit the movement or stop that activity all together. This means our tissues become accustomed to this reduced level of activity meaning in return it takes far less force to injure ourselves. This dents our mental fortitude further and is the cause for many to give up on many new sports or activities. This fear is not something only attributed to the general public, various studies have shown that athletes at a high level express greater levels of fear even after one injury when returning to sport , with certain studies even showing that fear, due to the possibility of injury, can cause stress hormones to be released, reducing the quality of tissue; e.g. https://journals.humankinetics.com/doi/pdf/10.1123/jsr.2017-0075

https://www.ncbi.nlm.nih.gov/books/NBK278995/

Speaking from experience of returning from injury to sport, the fear of pain can be worse than experiencing the pain itself. Pain does not always means we are at risk of injury. It is the ability to educate ourselves and overcome this fear logically to allow us to return to ourselves that we all need to become far more accustomed to. Fear is natural, but overcoming that fear and not letting it control the way in which our very bodies act is one of the most important things after an injury.

This is just a very simple video showing that injuries happen and the mental aspect of returning from injury is far more important than we all think.

T-Spine Mobility and Its Importance

Your T-Spine or Thoracic spine is the largest section of our spines. It is where our ribs and spine are interconnect as well as where nearly all trunk movement pivots upon. It connects our upper and lower extremities and is a passage way for forces that go through our bodies as well as protecting the contents of the thoracic cavity.

Our T-Spines are not very mobile as they are not suppose to be, otherwise we wouldn’t be able to stand upright and the contents between or ribs and T-Spine wouldn’t be protected. At the same time movement in relation to the limbs and joints attached to the T-Spine while it moves laterally, anteriorly and expands aids to force dispersal from the upper extremities of our bodies and the transferal of forces into our lower extremities.

The movements shown in the video (by Squat University) above can help with T-Spine mobility and stability which often is neglected with the other sections of the spine being concentrated on. Spine mobility as a whole are often neglected but as can be seen in the video it is very important even in something such as olympic lifts.

T-Spine mobility is a key to helping with many other functional strengths in our bodies. It can aid in shoulder functionality and chest mobility, lumbar strength and hip mobility. Often something overlooked it can at times help with the full functionality of many other and integral parts to our bodies.

Increasing Mobility using Voodoo Bands

A somewhat controversial topic at times to due many peoples views on the use of voodoo bands in relation to improving mobility. This is often due to certain ways in which they are used or to what extent. Mobility bands or Voodoo bands originally came into practice through body building.

They were originally used to provide  an increase in pressure, to the active joint, to allow for a greater degree of movement, especially while their tissues are loaded. Within the body building world they are often also used to provide a hypertrophic effect to grow on the surrounding tissue. 

They became popular in their use amongst athletes and therapists a like. Similar to the application of pressure by an external individual in PNF the bands allow for a greater degree of movement through compression, tension and movement.  These often increase joint mobility, decrease pain, and speed up recovery through myofascial release, occlusion and reactive hyperemia, and joint centralisation.

Certain athletes can at times use the bands to increase their mobility to an unsafe degree in relation to their sport but as a whole it is often an incredibly useful way in which people can increase their mobility and reduce pain due to a reduction of tension in tissues and an ease of movement. The video shows the use of bands for ankle mobility and draining of excess fluid.

At the same time all aspects to Voodoo bands are not necessarily viable. Many use them for neural flossing but the compression itself can act more as a placebo effect reducing a persons ability to fully experience the pain. However as a whole for the benefits they can provide especially to those who are very immobile they are an essential tool.

Pigeon Stretch

Hey guys,

My first blog post on my brand new website, which was kindly brought to me by www.michellemcinerney.com. Work is still ongoing, but there’s no time like the present to recycle the past. Below might look familiar if you follow my Facebook Page. And if you don’t, click here and give us a like 🙂

Around this time of year, the holiday season, maybe peoples bodies don’t feel as good as the mood of the season itself. A lot of us are running around, driving for hours, standing and then sitting for hours on end without getting a chance to take care of ourselves. The New Year has rolled ’round and all the promises are being made.

This video (shared from @fitnessguydublin) is just a way to stretch out your glutes and piriformis, taking a little stress away from your upper legs and lower back. A solid block like the bench used can help those who don’t have the balance of range to do it in standing or on a mat. It’s quick and easy and will help those who are stuck in one position for extended periods of time, be it at a desk or sat watching Netflix.

More to follow!