Hi ya’ll! I know many of our readers struggle with either short-term injuries or long-term injuries, aches, pains.
Having gone through a major injury myself (due to long-term wear and tear), I wanted to write something to provide some sort of guidance for those who can’t come in and physically see us.
Sometimes you feel like you’ve tried it all.
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Pre-injury – Body Mechanics
Background on my Injury
It took me years of exercise, sports, and weight-training before I realized that there was a lack of rotation in one of my hips. Overtime it was leading to wear and tear in my knee, as the knee aims to make up or as I say in my practice “steal mobility” in order to keep up with activity
I was training for the marathon for months. I was pleased with the gradual progression from running 10k to 21k. Felt amazing throughout except some knee inflammation after my long runs (15km plus).
It was the day of the race when my body finally said – NO MORE
I had 1km left to the run, when suddenly I finally let myself stop running… and BOOM… or POP I should say.
Good thing emergency medics were everywhere.
Finally, my body could not compensate or hold on any more. I broke my femur at the 20km mark during the half marathon (freak accident, this doesn’t just happen)!
Usually people break their femur from a collision or impact related incident (or old age). I was 27 at the time and super active (maybe too active – stay tuned for that article later).
I underwent emergency surgery (as a femur breakage can be fatal (bone can severe the femoral artery).
Post-surgery to insert a rod into my leg, I went through TONS of tests for hormones, bone density, bone cancer, everything came back clear.
Hindsight is always 20/20
Now it was up to me to figure out WHAT THE, WHY THE, HOW THE…do you break the biggest/densest bone in your body?
The body will aim to correct dysfunctions on it’s own if they are not dealt with. Initial signs and symptoms are simple – DISCOMFORT. Anything that’s uncomfortable enough to catch your attention. If you feel it, you feel it. DON’T IGNORE.
The problem is we all have different levels of Pain Tolerance, so those with higher pain tolerances will fight the good fight… but you can’t say the signs weren’t all there can ya? Hindsight is always 20/20.
When you do feel it, you find a way to self-manage. For some it’s taking a few “days off,” booking a Massage Therapy appointment, or doing what you know will help relieve the discomfort.
For me – I foam rolled, massage, muscle release, iced, “took it easy” for a couple days (BTW – “taking it easy” has got to be the worst advice I’ve heard. Fine if there is an overall plan for therapy… but if the plan is to “take it easy” and that’s IT?! Please go get a second opinion)
See blog on: When Doctors Tell Their Patients not to Exercise
For some they may pop a muscle relaxer or an anti-flammatory. Fine every now and then, but don’t kid yourself.
So here we go, here is a list of treatments I have endured, and my recommendations. BTW this whole experience has made me the Kinesiologist/Personal Trainer/Health Coach I am today that can help so many people with their struggles…so actually wouldn’t trade a single minute of it!
Pain Killers
Acetominophen (Tylenol) / Advil (Ibuprofen) Acetylsalicylic acid (Asprin)
These OTC pills will manage pain temporarily. I understand there is a time and place for these in efforts to manage pain; however, our bodies have very powerful healing mechanisms. As soon as our nocireceptors sense pain in the body, they immediately send signals to the brain whereby multiple chain reactions occur. The reactions that occur are to send the repair cells to their job. When painkillers are taken, this healing process is primarily halted. Lastly, our pain thresholds are increased giving a false sense of pain-relief. All these, along with the effect that any pharmaceutical has on your gut bacteria were enough for me to only use on semi-extreme circumstances. I used them post-surgery but never during training.
Muscle Relaxers
Personally never used these. I believe they may be used for short-term use if you experience muscle spasms. Some muscle relaxers work on the brain and spinal cord, and some work on the muscle themselves. Do your research beforehand
Self-treatments
Ice and Compress (R.I.C.E)
The BEST injury management strategies. Ice and compression help support the healing process. Ice helps to decrease inflammation and temporarily partially numb nocireceptors. Medium compression great for any swelling around joints to clear our edema. Ice: 15 mins, 15 mins off
Heat
Also one of my absolute favourites, but not to be abused. This was learned early on as I was talking with a good friend of mine Shivani, who is a Registered Massage Therapist. She told me heat is a great therapy however the length of time applied for is crucial to be aware of. Applying heat to the same area for too long can also be counterproductive, therefore she suggested moving around the heat source to different areas of your body.
I find heat great for mild tightness and soreness from either being cold all day (our body tenses up), or from soreness/tightness from exercise or activity.
If you are just tight and sore from nothing really… heat will feel good but it’s just a crutch. You will find yourself in a constant cycle of needing heat to “feel better.”
Also, I used a little heat during a bulge disk injury in my back however, ICE felt 10000 times better.
Foam Rolling/ Self myo-fascial Release
Highly recommend this therapy to most people. If self-release is too intense then it is counterproductive. If this is the case in session, we would ask you to hop onto the massage table and we can apply more gentle, release work and encourage you to breathe throughout. (See more under Breathwork)
If someone doing it for you is not an option, release work can be modified to reduce intensity (by using a softer tool, and reducing the amount of pressure to the area)
In general, there is an optimal pressure and it is in your best interest to learn what you need. Many people enjoy intense pressure in which case I advise you use your breath to calm your nerves so the body doesn’t tense up even 1%. “Sucking it up” mentality really does nothing to benefit your muscles, tissues, and pain. In cases where the nervous system is fired up (emotional stress or chronic pain), a gentle release MUST be used in efforts for actual improvement and actual benefit.
When breathing is practiced throughout (while letting go with each exhale), then a slightly higher pressure can help to release muscles.
Breathwork!
There can be breathwork/breath classes that is conscious connected breathing; times which last anywhere from half an hour to 2 hours.
There can also be breath work which means practice to breathe mindfully which can be done anywhere from 1 minute to 15 minutes. The idea to practice Mindful breathing periodically is to train your body to consciously breathe (properly) throughout the day.
They both involve diaphragmatic breathing (breathing from the diaphragm) / belly breathing.
I find this to be an extremely beneficial therapy to incorporate into treatment. Refer to foam rolling/muscle release area.
Effects of Improper Breath:
- Lowered oxygen to the muscles
- Increased fatigue (physically and mentally)
- Decrease tissue repair
- Uptight nerves
- Overuse of neck and shoulder muscles (shallow breathing)
- Decreased massage on intestines (digestion issues)
Another aspect of breathing which I find is not achievable in ANY other therapy, is it can provide the ability to identify an emotional-relation contribution to pain.
What the mind feels and thinks will be directly affected/relayed in the physical body. This can be applied to short-term pain and trauma but is very apparent in long-term pain and related trauma. Our body holds psychosomatic information in our physical body.
I found this to be extremely enlightening. When my emotional stress was high, my injury pain amplified.
Again, it takes proactivity to monitor your physical pain fluctuations and tap into your emotional pain.
Emotional ‘pain’ can be from past physical trauma to repetitive thought patterns to repetitive physical tendencies. i.e . tendency to clench an area.
Breathwork is a small part of my sessions with clients (due to time) and a large part with myself. It is one of the key factors discussed in my new Health Coaching work as it is so essential to achieving optimal health.
Highly Recommend Christina Niven – Soul Spring Wellness
Passive/Table-based Treatments
Chiropractic
For my particular injury, I had amazing benefits from Chiropractic back in 2012. The method of chiro was more “new school.” I didn’t get adjusted once (mind you I was also post-surgical when I was seeking treatment). The Chiropractor I was seeing (first link below) was amazing at providing traction, stretch, and release.
In general, I found chiro to be beneficial in the beginning stages of my injury and rehab. I know there are various different types of Chiropractic treatment that don’t even involve manipulation (“cracking”). The key is to tuning in to your body, and asking your chiropractor what you can do to help the process.
Chiropractors I would recommend: If I haven’t seen them myself, we have mutual clients (and like what we hear)
Hafeez Merani @ Metrotown Family Chiropractic
Massage Therapy
Massage Therapy in relation to injury management – I find it to be beneficial to help manage conditions from progressing. It can also be very useful to calm the nervous system which has a large role in pain thresholds and also in fascial health. Our fascia has a large role in injury and injury management (as it overlays and intertwines with muscle like the white part of a steak).
Although I couldn’t get massage directly on my injury site, it helped me greatly to loosen up the rest of my body that tightened up (as the body does when there is injury).
As well, during my lower back bulge disk back pain (different injury few years ago), I felt a significant increase of tightness in my upper back and shoulders. Massage was great help
I also refer people to massage therapy when they haven’t been in a while, and I feel it will benefit their injury rehabilitation process. You don’t have to be injured to go for a massage. In my opinion, everyone should be getting massaged at least once a month.
Emily Smith @ Back to Wellness
Niki @ Aurora Integrative Medical
Frank Mollica @ Mainland Massage Therapy
Physiotherapy
Physiotherapy can mean so many things, it depends on your needs. Some may need pain management – IMS, acupuncture, ultrasound, muscle stimulation. Others need manual work which can be release, manipulation. You may also need strengthening – neuromuscular electrical stimulation, exercises which is where the real injury rehabilitation comes into effect.
I was lucky to have 2 great Physios. First one listed below was my recent Physio (2019). He refused to let me do treatment after treatment, and got me solutions after less than 6 sessions. I now do check-in sessions with him. My Physio post-surgery in 2012 (second one listed below) was very knowledgeable on the course of treatment and was able to communicate the appropriate windows for making strides in my rehab. For example, I had a certain window of time to work hard on achieving full leg extension. He also made me aware that NOT achieving full extension would be very detrimental to my mobility and capabilities going forward. Concurrently, we worked on physical exercises. He taught me how to do them and watched me do them.
Depending on your needs, you therapist will be able to advise. I advise people stay proactive in their injury rehabilitation. Meaning not only do what is recommended to you but also monitor your own progress, become in-tune with how your body feels, ask your therapist questions during each appointment. There should be progress in the right direction
Without proactivity, there will be an endless cycle of treatments coupled with mental frustration and emotional debilitation.
Shafeen Hirji @ Station Physiotherapy
Sunny Ma @ North Burnaby Physiotherapy
Lindsay O’Connor @ North Burnaby Physiotherapy
Florence Yip @ North Burnaby Physiotherapy
Fascial Stretch Therapy
Where to begin. This therapy has been instrumental not only in my injury rehabilitation but also in the awareness to insight into my body, mechanics, as different findings are discovered. During my FST sessions I felt a clear line of pull from the top of my right foot all the way up to my knee, hip, and up to my Diaphragm on the right side. Toward the peak of my injury I even felt my right side shoulder straining more. Studying Anatomy Trains, this made a lot of sense. Here are images of Fascial Trains that run in the body
Applying the knowledge that the body is made up of fascial trains has helped me greatly as it allowed me to look more globally into fascial interconnections and where possible compensatory patterns have manifested and have possibly been overlook in other therapies.
In addition, while Physio was greatly helping my knee and quad muscle, there had already been compensatory manifestations in other areas of my body that had taken place, up and down the chain. Due to Physiotherapy sessions being short, my Fascial Stretch Therapist was able to spend more much needed time to find areas that were in need of release.
side note: the success you experience in during Fascial Stretch Therapy (FST) is greatly reliant on the knowledge and experience of the CFST (Certified Fascial Stretch Therapist)
For me, finding the root which was actually quite simple (lack of hip rotation as mentioned in the beginning) of the injury is my answer to prevent further malalignment and further overuse as I continue with my active lifestyle.
Fascial Stretch Therapy videos on website
Fascial Stretch Therapy videos on Instagram (one of many)
Fascial Stretch Therapy videos on YouTube
Homeopathy
Haven’t done enough but from what I hear it has helped a lot of people, adults, children with prevention and treatment of ailments. If I had to comment on its application to physical pain and treatment of injuries, I believe it could be a nice complement but not a stand alone solution.
Osteopathy
Haven’t done enough but what I love about Osteopathy is it considers the big picture. Osteopathy takes into consideration the deepest of deepest occurrences that could be contributing to repetitive pain and discomfort.
Active Treatment
Kinesiology
Kinesiology, Active Rehab, Injury Rehabilitation/Corrective exercise.
Corrective exercise should be applied for everything from tight muscles to stiffness, to constant pain, radiating pain. There are multiple, multiple exercises with numerous variations that can be used in efforts to correct most injuries
Corrective Exercise – Shoulder and Neck
Corrective Exercise – Neck and Shoulder Pain
Corrective Exercise for Neck and Shoulder Tightness (advanced)
Corrective Exercise – Plantar Fasciatis
Corrective Exercise – Knee Pain / Plantar Fasciatis Pain
Corrective Exercise – Foot and Toe
Corrective Exercise – Foot and Toe Stretches
Corrective Exercise for Hip Mobility
*this is a very short list and most of these are mobility flows where as we use a combo of mobility flows with strengthening
The first step in correcting however, is figuring out primarily where the issue lies. More experienced Kinesiologists can do more than just stretch you out and go through standard exercises. Though this goes for all treatments, the therapist you see will be your mentor. Listening to what they say will be instrumental in your recovery.
With being the most active of all therapies, I notice there is sometimes getting worse before getting better. This depends on the conservativeness and knowledge of your Kinesiologist. An intuitive, educated Kinesiologist is able to decipher when a more conservative approach will be best, and when a less conservative (but appropriately coached approach) is going to serve this client best. =
Conservative or not, there has to be progress. Sometimes yes it is 2 steps forward, 1 step back, but overall the goal here is to move you to almost feeling at your best.
Best Kinesiologists in Burnaby. I’m sure there are other great Kins but I have personally only worked with my team, and I wouldn’t be where I am in my rehab without their knowledge, compassion, ability to be phenomenal coaches.
Animal Flow movements
Animal Flow is a modality of training involving primal-based movements, using only body weight. To give you an example, here are some images:
Deep Ape
In addition, it factors in that our body is made of up fascial trains. For me, this modality of exercise and stretching helped immensely.
Not only did it empower me to feel strong and do cool stuff, it was amazing to do something like a crab reach and stretch out my full superficial front line.
I found with my knee injury, EVERYTHING on my right side tightened up. From my ankle to my shoulder. This became evident during all the asymmetries felt.
Scorpion
While you may look at this and say, I can’t do that… the truth is – Animal Flow movements just require good coaching. It has been existential in helping myself and some of my clients.
Not only to stretch and strengthen the fascial trains, but to EMPOWER people to knowing that their body is not broken and they are capable to do things.
The cons with Animal Flow is it is very dependant on wrist health. I enjoy this as well because locked up tissue in the wrist and hands can be a large contributor to neck and shoulder issues.
Functional Range Conditioning / Kin Stretch
To put this into laymens terms, I am referring to exercises based on achieving proper joint laxity, joint mobility, all the while promoting you to strengthen the control your body has through joint- which helps to prevent tightness of repetitive muscles. I’m sure this explanation is sub-par compared the founders and coaches (lol) however, it is the short version.
A joint with low laxity and low neuromuscular control is a joint that is destined to develop long-term stiffness which encourages muscles around it to tighten up to protect and decrease movement in the area to prevent injury
Having a certified FRC Coach on our team has been quite a treat to say the least
This modality has been very useful to myself, and our clients (one before and after below from an FRC client with Frozen Shoulder). We often times find it is the missing link in many programs.
The downside is it is not very much fun however the results can completely change the health of joints and muscles around them, not to mention make you pain-free!
I hope this helped guide you in some way! There is only so much I can write but I have a lot more to say and I’m always here to help guide and answer further questions.
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Asma Kassam, BHK, FST, CSNA
Owner, Active Kinetix Fitness & Rehabilitation
Kinesiologist, Personal Trainer, Fascial Stretch Therapist 1, Health Coach
