Every patient should be approached scientifically. Using our understanding of anatomy, physiology and the best available scientific research we are able to approach each and every case in a way that gives us objective information and provides you with the best possible treatment. If you require more than just physiotherapy, we are able to use this information to provide other healthcare providers with valuable information. In this way, there are no dead ends with physiotherapy; if physiotherapy isn't your last stop on the road to recovery, it should at the very least be a very important stepping-stone for you.
What is happening to me? Why am I injured?
We often have a good understanding of what is happening but keep in mind: Some cases have more "layers" to them. There can be multiple sources of pain and multiple contributing factors to an ongoing issue. In these cases, systematic treatment is invaluable. Depending on the problem, it can help us deduce what factors are more strongly contributing and where to focus our efforts.
Not all injuries are a result of a one-time incident; when this is the case, it is usually very easy to explain what happened! Most of the cases I see are a result of many different factors. While to a patient the injury appeared all of a sudden out of nowhere, in many cases it was an injury in the making for a long period of time.
Placed at the top for a reason. Physiotherapists are well known for providing therapeutic exercises. Properly chosen exercises with the correct parameters have the best scientific evidence for long term improvements and resolution of injuries. Examples of exercise are:
- Strength training
- Stretching & self-myofascial release techniques
- Aerobic exercise
- Motor control training (helping you learn / re-learn how to use your body--wake up some muscles and start using them!)
- Nerve gliding exercises / neurodynamics
Exercise has never worked for me in the past
Just so you know, my treatments consist of more than exercise! I hear this a lot though and there are so many variables at play that it is impossible for me to know why exercise didn't help you. All I can say is that while exercise on its own can be therapeutic, for it to influence your pain and injuries in a positive way they need to be chosen appropriately, employed at the right time, and progressed/adapted as needed.
What is so special about exercise?
Exercise is the only way to create structural changes to our tissues and retrain our body's movement patterns. There is the odd exception to this rule, but this is true for the most part. Is needling going to make your tendon stronger? No. Is a joint mobilization going to permanently improve postural changes that have developed over years and years? No. These "passive techniques" like needling (as described below) are wonderful and powerful tools that can make a huge difference. They are more powerful when combined with therapeutic exercise. Will the same exercises work for everyone? Definitely not. A lot goes into choosing the appropriate therapeutic exercise!
Manual therapy basically means any form of hands-on treatment. This includes but is certainly not limited to:
- Soft tissue massage
- Joint mobilizations (wiggling your joints around to improve movement!)
- Joint manipulations (usually known for the audible pop/crack followed by pain relief)
- Muscle Release Techniques / Myofascial Release Techniques (very broad category with many "patented" and well known treatment techniques)
- Muscle Energy Techniques (contracting and relaxing your muscles in specific ways to help release tension)
Intramuscular Stimulation (IMS)
The use of acupuncture needles to release myofascial trigger points (muscle knots) that are the source of pain and movement dysfunction. This is a powerful technique that provides many people with relief (both short and long term) and can help us get you back in action.
Training / Activity Modifications
For athletes a lot of injuries come from errors in training. If it isn't a sports related injury, there are many day-to-day activities that can be modified that can be contributing or are the direct cause of your injury. It is important that we figure these things out to prevent the same problem from happening again!
If you are the type that likes to understand everything that is happening in as much detail as possible, then I might be your guy. There is a lot that I don't know and that we as physiotherapists do not know. I can tell you the possibilities, the unknown and what is for certain. Many of my patients find relief in simply understanding what is happening to them. I enjoy explaining things and when I can't do a good enough job, I can point you in the right direction!
If I can't do it myself, we can do it as a team! Physiotherapy should not be a dead-end for patients. A lot of valuable information is gathered throughout the course of treatment. This information can be used in other places to help you in other ways. If I'm unable to help a patient, your time was not wasted. There are other options out there for you and we would have gathered valuable information that will help you elsewhere.
Physiotherapists can refer directly to physiatrists, who are medical doctors who specialize in many of the same areas that physiotherapists work. In addition to being able to assess you injuries, refer to other branches of medicine, prescribe medication, request imaging and much more, physiatrists can perform:
- EMG/Nerve Conduction Studies
- Ultrasound guided procedures
- Fluoroscopy guided procedures
- Injections of spine
- Discography, Disc Decompression and Vertebroplasy/Kyphoplasty
- Nerve Stimulators, Blocks and Ablation procedures—Peripheral and Spinal
- Injections of joints
- Spasticity Treatment (Phenol and Botulinum toxin injections, intrathecal baclofen pump trial and implants)
- Nerve and Muscle Biopsy
- Manual Medicine/Osteopathic Treatment
- Prosthetics and Orthotics
- Complementary-alternative medicine (i.e. acupuncture, etc.)
- Disability/impairment assessment
- Medicolegal consulting
List derived from American Academy of Physical Medicine and Rehabilitation
Physiotherapists usually work closely with sports medicine doctors. Please note, sports medicine physicians treat everyone, not just athletes. The list below is only a brief summary of what sports medicine offers. As a physiotherapist, I usually work with sports medicine physicians during the treatment and management of more complex injuries. A sports medicine physician can fill in the gaps and help you to receive the most comprehensive treatment possible. They also work closely with other physicians who may also be able to help you!
Sports Medicine can help with:
- Injury and illness prevention.
- Diagnosis and management of acute, wear-and-tear and overuse joint and muscle problems.
- Treatment of exercise-related medical problems such as concussion, asthma, diabetes, heart conditions and osteoarthritis.
- Perform diagnostic ultrasounds and ultrasound-guided therapeutic injections including corticosteroids, viscosupplementation and platelet-rich plasma (PRP).
- Recommend exercise and physical activity for maintaining general health and prevention and treatment of chronic medical conditions like high blood pressure,
heart disease, diabetes, and bone health.
- Care for sport teams including pre-participation medical assessments, travel medicine, environmental issues, anti-doping, mental health, athletes with disabilities and sporting event medical coverage.
- Communicating with coaches, teammates, teachers, parents and officials as required for patient athletes.
Physiotherapy should work closely with your family physician. If you don't have one, then we can refer you to any walk-in physician for similar treatment. The roles of family physicians are far reaching. They can play a very important role in management and prescription of medications for pain and chronic diseases that could be hindering progress. Your family physician is also able to refer you to other branches of medicine including neurology, orthopaedic surgery and rheumatology. In some cases we may require imaging, in which case we usually refer you to your family doctor.