The article below was conceived and written entirely by a past patient of York Rehab. We did not solicit the article nor has the patient received any compensation or special privilege for the submission of this piece. His motivation to write this article was because his treatment outcome has been life-changing and he wants to share his story so that others suffering a similar fate are aware of the possibilities for healing. We are immensely grateful for this individual’s thoughtfulness and his time spent to produce this article, especially without the need for recognition or reward.
I’ve wanted to share my experience for a while but had not discovered an outlet until now – thank you York Rehab for allowing me a platform! Here goes: A friend (and soccer teammate) of mine recently turned the corner on a year of suffering from an injury. Feeling unqualified to share my opinion while I observed his situation, I bit my tongue only gently offering suggestions on what he might consider re-evaluating with his treatment approach. My advice was usually politely dismissed, and understandably so given my untrained perspective was different from his surgeon’s. When his lack of recovery reached a point where he was getting ready to give up playing soccer (a game he loves so much), he was then willing to listen and try anything. I won’t provide any specifics of his injury and experience, that’s his story to share. But I told him about McKenzie Therapy, which he had never heard of (as is the case with most people). The short story was that after a year of debilitating pain, one visit to a trained McKenzie physiotherapist reduced his pain by almost 70%, allowed him to return to play within a week and restored hope that recovery was possible. Helping my friend led me to want to help others by sharing my own story. Although not related to McKenzie Therapy (a treatment approach I’ve significantly benefited from many times), it’s another type of treatment that changed my life in an unimaginable way. I want my story out there to let people know about the possibilities of healing from long-term and chronic ailments.
Now my story. I’ll start with some background information. First off, I should quantify my reference to “soccer career”. I’m not a professional, I don’t make a living playing soccer, I play the game for its pure enjoyment (for over 4 decades). It has been and will continue to be an important part of my life until my very end. Let me add that although I may watch the occasional game on TV, my interest and love for the sport lies in my ability to get on a field and play. If I never see another professional league game for the rest of my life, no sweat…if something happens that prevents me from playing soccer, my life would feel like it’s over. And that’s the direction things were heading about 4 years ago, leading up to my visit to Glenn Woodland (a chiropodist at York Rehab).
My problems started about 2 years prior to my first meeting with Glenn (Chiropodist at York Rehab). I had been really struggling with recovery after my weekly soccer game. The typical minor muscle and joint pain from my once-a-week calling on underused body parts like knees, ankles, and quads had been manageable in the past, but a new problem was surfacing…Achilles pain and it was escalating. Initially, I assumed the cause was from the ankle braces that I had been wearing for the past 15 years to protect me from chronically rolling my ankle during play. A result of loose ligaments from repeatedly spraining my ankles when I was younger. I figured the brace was the culprit because it was rubbing on my Achilles in the area the pain was originating. I began to become more concerned when the pain began to limit my ability to play and the post-game recovery process which consisted of 2 days of waddling around like a penguin to minimize the pain coming from my throbbing Achilles. My self-imposed number of days between games which I set to 3 days to allow for the usual recovery was becoming insufficient.
As my pain continued, my thinking changed from the ankle bracing being the culprit. Maybe the progressing pain and discomfort was something that simply came with age. The pain was starting to become more intense and drag on for days and the thought of taking some time away from the game started to surface. That became a very depressing thought! My wife sensing my panic with the thought of having to stop playing the game I love suggested I go see a chiropodist. Maybe orthotics could help she said. I then remembered a teammate of mine from 15 years ago had Achilles issues, got orthotics and his problems went away. I knew of orthotics but always figured it was for someone who had inherently bad foot design issues. I always considered myself more of an athlete (all in my head) with a perfectly aligned body and would never need to rely on devices like orthotics to correct my movement.
So, my wife’s suggestion brought me to Glenn’s clinic for an appointment. His assessment began with observation and minor contact of the affected area…he noticed how swollen my Achilles was, how sensitive they were to mild contact (as they had been for 15 plus years), and how bumpy (scaring) they felt below the skin from the recurring trauma due to the demands of playing soccer. He then started to focus intensely on the design and movement of my legs and feet and measuring parts of them with instruments I’d never seen before. He took stock of:
This data gathering process led him to a few conclusions all of which he shared with me in detail to ensure I understood his reasoning.
Although Glenn felt that orthotics would help, he wanted to test how I would respond to some adjustments to my current footwear. So, he hand-crafted some temporary inserts on the spot for me to use in my shoes for the next two weeks (he had me bring in the 2 pairs of shoes that I’d wear the most during that time: running and soccer). I left Glenn’s Chiropody clinic with my inserts, slightly hopeful of pain relief but still full of skepticism that a solution to my pain and injury rested in a couple small pieces of cork (the material the inserts were made of). What happened over the next several days was pretty miraculous.
Fast forward to 3 months later and regularly using my actual pair of orthotics. I was able to jog and play soccer twice a week with no issue and no pain whatsoever. Playing without my ankle supports has allowed me to play like I’m 15 years younger – my mobility, agility and speed have both improved immensely. And no longer does it take me 15 minutes to suit up to play – lacing up my ankle braces was always a hassle. I’m ready for play in 2 minutes…it’s a new lease on life. And the Achilles pain is gone…so is the swelling and tenderness. I haven’t been able to touch my Achilles for decades because they were so tender.
It’s been two years and my ankle and Achilles situation has permanently changed for the better. After a lifetime of wearing out my soles on the outside edge (since I was a kid!) it no longer happens! I thought I’d be playing soccer with ankle braces for the rest of my life, but I don’t need them anymore. I don’t even carry any in my gear bag just in case. Ankle exercises and the mere fact that I’m not restricting my ankle’s mobility has allowed my ankles to strengthen nicely. There are other small changes that are actually big things to me. Like the fact that I can put up my legs on a table or ottoman and cross them so that my Achilles rests on the front part of my ankle without me wincing in pain. I’m also playing soccer as I did 20 years ago because my ankles are no longer restricted, the mobility and agility that I once knew are back – things I thought were lost as I age. I also wake up the next morning after a game and can simply walk (no more wobbling to avoid pain). I never imagined that a small shoe device could do so much for me – they have made the inconceivable possible. By sharing my little story, I hope others who are suffering from chronic pain take a small step forward and visit a chiropodist (or physiotherapist if the pain is elsewhere). I must include “physiotherapist” because I’ve had a couple of life-changing recovery experiences with one as well. I am motivated to share my story because like many people I assumed your body slows down and falls apart with age – but I’ve learned that it’s the other way around. Your body falls apart because you slow down as you age – simply put, don’t slow down. Walk, run, and play forever because if you stop using it you will lose it.
Thank you, Glenn!
We’ve been in business for more than 20 years offering chiropody, massage and physiotherapy treatment to patients within the town of Newmarket and surrounding areas. We pride ourselves on our approach to treatment that is 100% patient focused. Our policy has always been that for every Physio appointment, the patient is seen exclusively by a Physiotherapist for the entire visit. This ensures the patient’s comfort, movement and progress are exclusively observed by the therapist. Some clinics use physio assistants during patient visits…a strategy that sometimes frees up the Physiotherapist to see another patient or two at the same time – we believe treatment is more effective when our therapist stays with one patient for their entire visit. This allows the therapist to directly monitor patient’s progress by directly observing how the patient feels as they receive treatment and are directly accessible when invariably the patient has a question. Our goal in caring for our patients is that we treat them effectively and fast…we aim to minimize your time with us. This patient-centric approach only works if we have therapists who truly care about the patient.
We are very fortunate to have such caring staff. So much so that their care often extends beyond our four walls. Here’s an awesome example of that. Meet Fiona, one of our physios who has been with us for several years. She’s a licensed physiotherapist who also has a diploma in Mechanical Diagnosis and Therapy – a title possessed by less than 30 therapists in Canada. Fiona will be traveling to Peru (August 2018) with a team MDT trained therapists to participate in a humanitarian effort that will assemble a pop-up clinic to offer treatment to locals for several days. This program is aimed at providing quality MDT care to underserved areas around the world.
We asked Fiona a few questions about her trip.
Why did you get involved with this initiative?
I am passionate about MDT and travel – this is a great way to merge both. Being able to share my knowledge of MDT as an evidence-based approach for the benefit of underprivileged individuals is quite rewarding. At the heart of the method is how we educate patients to treat themselves to continue to self-manage their symptoms should they recur –MDT is not well known to Peruvians… the same holds true even in right here in Toronto, Canada!
Have you done any other humanitarian efforts before?
It wasn’t quite a humanitarian effort per-se, but I did travel to Iqaluit, NU in the Canadian Arctic. I arranged a leave of absence, to allow me the opportunity to work for the Government of Nunavut for six-weeks in April/May of 2017. There I was able to use MDT to assist with offering evidence-based care, while also while also significantly reducing their outpatient orthopaedic wait list.
So, this will be a lengthy trip to allow you to treat patients over an extended period of time, how are you affording it?
If you count 18+ hours of travel with three layovers, then yes it’ll be lengthy. But in reality, the trip will actually be relatively short. We are aiming that each patient will receive an assessment and follow-up visit during our time in Peru. What allows us to do this is the potential for rapid and lasting change with the use of McKenzie MDT.
Are you going with a big team?
This year will mark the largest group of clinicians gathered together for Mechanical Care Everywhere. A total of 11 of us from four different countries will participate. While those numbers appears relatively small, eight of those clinicians participating are Diploma Level. That’s amazing! But let me put it into perspective: To date there are 450 Diploma Level clinicians worldwide…eight of them will be represented on this trip! Within Canada there are 30 Diploma Level clinicians…York Rehab has 2 of them!
Why choose Peru as the destination?
Jason Ward (PT), the founder of Mechanical Care Everywhere has visited this area before and has connections there to assist with an effort of this magnitude.
It’s probably going to be an expensive trip – who is sponsoring you guys?
None of the participants received any funding for this trip – we have all paid out of our own pocket for air travel, accommodation, food and the costs associated with the 4-day clinic. Friends, family members, colleagues and various branches of the McKenzie Institute International have provided donations to Mechanical Care Everywhere to assist with offsetting some costs like the following:
If you want to learn more about the project you can check out the MCE website: www.mechanicalcareforum.com/mce
So this will be a series of trips so you can do follow-up visits right?
If we return to Peru again it will be a separate initiative. For this trip, our goal is to assess each patient and complete a follow-up visit during our brief time in Peru. At the heart of the method is how we educate patients to treat themselves to continue to self-manage long after we have returned home.
How is it that MDT can offer such fast results?
Mechanical Diagnosis and Treatment (MDT) is a safe, structured and evidence-based system used to assess and treat patients. The system can be applied to the spine and/or extremities. As MDT therapists, our greatest skill lies in our assessment, where we use the information collected from how a patient feels (symptoms) and how a patient moves (mechanics) to classify them into a particular group. From there, we can then match our treatment approach with the particular classification. Patients receive a program designed specifically for them, emphasizing active involvement, education, self-management and prevention of recurrence. With continual assessment and re-assessment of the patient (often less than 6 sessions), results are achieved fast, decreasing the financial burden on patients.
Once you leave Peru, how will you know if the trip is a success?
Following our 3-hour educational workshop with the local Peruvian physicians and physiotherapists, we will offer the opportunity for those interested to observe with us during our clinic days as an added learning opportunity. Thereafter, we will also network with these clinicians to encourage their learning remotely through the many forms of social media. This way, education will continue long after we have returned home.
I’d also like to share a story of MCE Founder Jason Ward – last year he had a woman waiting in line to see him specifically. She was offered the opportunity to be assessed by one of the other therapists, but declined; content to wait for Jason himself. Jason remembered her as a patient from the previous year. This woman waited hours in line to thank Jason for his assistance the year prior. She has been continuing with her exercises since Jason’s last visit and has remained pain-free as a result. Now THAT is proof in the pudding!
Thanks for taking the time to share a bit about this initiative Fiona. Have a great trip!
We are so proud of Fiona.
This two-day course focuses information critical to the assessment and treatment of patients dominated by Nociceptive Pain Mechanisms involving the peripheral nerve. The Peripheral Neurogenic Pain Mechanism (PNPM) requires specific neurodynamic mechanical exercise prescriptions as well as pain science education about peripheral nerves and the pain alarm system. Outlining Chapter Five and Six of “A World of Hurt: A Guide to Classifying Pain,” pain clinicians will learn how to assess and classify neurogenic nociceptive pain mechanisms as either “trapped,” “tight,” or “sensitive” utilizing neurodynamic evaluation testing and clinical reasoning. This course assists identifying neural entrapments, dysfunctions and/or the beginning signs of central sensitivity in both the upper, lower body and spine. This pain science course provides interventions in patient education for neurogenic conditions and specific prescriptive neurodynamic exercises for each neurogenic mechanical problem. This course includes an active manual therapy workshop for common upper and lower body neural entrapment sites and local tissue treatments. The workshop is dedicated to both active neurodynamic exercise progression and passive neurodynamic testing, in addition to manual therapy. Video, paper cases and live patient demonstrations (when available) will aid application to each clinician’s practice by understanding the importance of the specific “words” and “moves” necessary to reverse neurogenic mechanical nociceptive pain mechanisms.
WHO SHOULD ATTEND
Physical and Occupational Therapists, Chiropractors, Osteopaths, Physical Therapist Assistants, Occupational Therapy Assistants, Medical Doctors, Psychologists, Athletic Trainers, Massage Therapists, Personal Trainers, and any other practitioners who are involved in treating musculoskeletal pain and prescribing exercise.
At the conclusion of this course, participants should be able to:
Course Fee: (Canadian dollars)
$550.00 (early registration received on/before July 31, 2018)
$600.00 (registration received on/before August 23, 2018)
FACULTY (Course Instructors)
Annie O’Connor, PT, OCS, Cert. MDT, is Corporate Director of the Musculoskeletal Practice and Clinical Manager of the River Forest Outpatient Center at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. Annie has co-authored 2018, Pain Mechanism Classification Chapter, Rehabilitation of The Spine: A Patient Center Approach, Liebenson C (3 ed). Wolters Kluwer Philadelphia publisher. She has co-authored 2017, Therapeutic Exercise Chapter, Orthopedic Knowledge Update Spine 5, American Academy for Orthopedic Surgeons publisher. This chapter specifically is dedicated to helping Medical Doctors understand pain mechanism classification and the importance in therapeutic exercise selection. She has co-authored 2015 book “A World of Hurt: A Guide to Classifying Pain” and September 2016 Journal Article in JMMT “Validation of a pain mechanism classification system (PMCS) in physical therapy practice.” Both publications offer a research supported “paradigm shift” in managing Musculoskeletal Pain promoting effective and efficient outcomes with significant cost savings. She is an Orthopedic Clinical Specialist (OCS) of the American Physical Therapy Association and has a Certification in Mechanical Diagnosis and Therapy in the McKenzie Method (Cert. MDT). She lectures nationally and internationally on musculoskeletal pain mechanism classification and intervention, neurodynamic evaluation and treatment, mechanical diagnosis and therapy of spine and extremities, kinetic chain evaluation, functional manual therapy and exercise prescription. She was instrumental in establishing the Pain Mechanism Classification System approach for musculoskeletal pain at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago. She is a member of American Physical Therapy Association in the orthopedic section and canine special interest group, the North American Spine Society (NASS), and McKenzie Institute. She serves on the 10X25 tactile coalition task force to reduce spine related disability by 10% in year 2025 sponsored by the Spine Foundation a national group of the NASS. She continues to treat orthopedic, neurological patients, and canines with musculoskeletal pain to achieve the best life possible.
Melissa Watson, MSPT, Cert. MDT, received her Master’s in Physical Therapy and her Bachelor’s in Exercise Physiology from Ohio University. Melissa practices at the Shirley Ryan Ability Lab formerly known as the Rehabilitation Institute of Chicago Willowbrook Outpatient Center with 16 years of clinical experience in neurological rehabilitation. Melissa has been helping to lead RIC’s Clinical Ladder Program for over 7 years where she mentors other clinicians on their professional and clinical development. She is a certified clinical instructor and consistently mentors students in clinical practice. She is practicing clinically in the Day Rehabilitation setting with an interest in musculoskeletal pain and applying both MDT and pain classification principles within the neurological population for pain and spasticity. She is currently leading a Day Rehab Pain Group Committee where she is mentoring other Day Rehab clinicians on running pain groups that are focusing on pain education and active care treatment for patients with centrally dominated pain throughout 6 sites of care and facilitating a standard for education through Inpatient clinicians. She is certified in Mechanical Diagnosis and Treatment – McKenzie Method. She has been training the Pain Mechanism Classification System outlined in the book “A World of Hurt: A Guide to Classifying Pain” for last 3 years and uses both sub grouping methods exclusively in her neurological clinical practice to guide patient education and exercise prescription to facilitate functional return.
Financial: The presenters will receive an honorarium and expenses for teaching this course.
Nonfinancial: The presenters have no relevant financial relationships to disclose.
Course Book: “A World of Hurt: A Guide to Classifying Pain”
Groin injuries are a common injury amongst active people, as well as those unlucky enough to strain the area by falling, tripping, or getting their leg caught on something. It is usually characterized by pain along the inner thigh where the muscles are thought to have been over-stretched. It also has a reputation for being a “difficult” injury to recover from, although this reputation is somewhat undeserved. Sometimes the nature of the injury is incorrectly assumed from the beginning, which can lead to ineffective treatments and prolonged pain. Groin pain following a strain can result from several different injury mechanisms, each of which requires a different management approach.
Groin or inner thigh pain can be a manifestation of a hip joint problem. The hip is a ball and socket joint that is lined with cartilage and surrounded by other supportive soft tissue for protection. Sometimes when the groin is “strained”, the soft tissue can become pinched and cause pain. The resulting pain comes from compression of this tissue by normal hip movements. Usually, though, the hip can be “unlocked” by moving it in the proper direction, which can be found under the supervision of a well-trained physiotherapist, and relief of pain will quickly follow.
Another possibility is that the ligaments and tendons of the groin take the majority of the force rather than the muscles themselves. These tissues have notoriously poor blood supplies and so don’t receive the nutrients and support needed for good quality healing. Therefore, they can remain painful for weeks or even months if the proper intervention is not undertaken. However, they are quite responsive to tension or resistive forces, and with a specific exercise program, they can be remodeled slowly to decrease the pain and regain the strength. This does require discipline, as the changes will occur slowly over a number of weeks, but should ultimately result in recovery.
When a groin strain primarily affects the muscular tissues, which is what most people assume groin injuries to be, healing will usually proceed over a number of weeks, because of the aforementioned good blood supply. As long as the muscles are not over-stressed during this healing period, and movement and strength are gradually regained as the symptoms allow, the recovery will proceed uneventfully.
For all the different injury mechanisms listed above, once full movement and strength of the area have been attained, treatment will focus on recovering a level of function required by the person’s work or athletic activities. For example, a physiotherapist can guide a tennis player to safely progress and return to running, cutting, lateral movements, and lunging, all of which are necessary components of the sport.
In summary, the crux of the matter with groin injuries is to determine what kind of problem it is. To say you have a “groin injury” on its own does not say enough for a healthcare professional to be able to treat it effectively; they have to be able to understand it on a deeper level to direct the appropriate treatment. The physiotherapists at York Rehab possess the assessment skills necessary to diagnose such injuries and help you to recover as efficiently and effectively as possible.
Most would not argue with the statement that 80-90% of people who start a New Year’s resolution at the beginning of January are probably not going to make it to February. Most resolutions are meant to improve people’s lives and make them happier, so it’s sad that so many people give up on their dreams so prematurely. There are varying reasons that can explain the failure to keep resolutions but some of the more common ones are connected to setting too many goals at once, making your goals too general or making them too big. Whether you’ve consciously or unconsciously abandoned your resolutions after only a few weeks of trying, the good news is you don’t have to wait until next January to make another attempt. March is the perfect time to pick yourself up, dust off and give it another go. Here are a few things that can help you make your second shot at your desired life change more permanent.
First, Look at the Data
If you’ve failed at keeping up your January resolutions, you’ve now accumulated useful data. Between when you started and when you quit, you can likely pull some information that can show you what worked with your attempt and what didn’t. Taking a closer can help you to figure out what things you can do differently so that you don’t repeat failure a second time. For example, maybe your resolution was to start exercising regularly (5 days a week), but you were only able to exercise 3 evenings the first week, then 1 evening each of the next two weeks. That data would show evening exercise didn’t fit well with your schedule. So on a second attempt at the resolution, exercising first thing in the morning would be a better plan.
Figure out what’s REALLY Important to You
People sometimes decide on resolutions for superficial reasons and a deeper look can uncover that a particular resolution may not really matter to you. You might have a resolution to stop eating chocolate – but upon closer inspection you discover that what you really want to do is start eating healthier as a whole. Deciding to focus on only eliminating chocolate from your diet wouldn’t yield you the type of results you want because you could simply replace one less than ideal food choice with another.
Be Specific with Your Goal Setting
Break down your goal into specific parts so you know exactly what you need to do, and when you plan to do it. The wrong way to approach a resolution like incorporating more exercise into your routine would be to say “I’m going to exercise more this year”. When you’re that vague, it allows you the flexibility to interpret “…exercise more…” any way you want – i.e. I exercised twice this month, hopefully I’ll exercise more next month. It may not unfold exactly that way but you get the gist. Instead, be specific on how you are going to integrate exercise into your routine, i.e. I’m going to do yoga four times a week on Mon, Wed, Fri and Sat first thing in the morning. By listing specific steps, you’ll know when you’re not keeping up and that you might need to address something in order to stay on track with your goal. Choose the SMART method for goal setting:
Don’t Do Too Much at Once
There’s an endless list of things one would want to change about themselves but trying to make many changes at once is usually difficult. Start with one goal and once you have built some momentum with maintaining it, only then should you consider working on another goal at the same time.
Create Accountability for Yourself
Don’t keep your goals hidden, share what you want to accomplish with someone close to you. You’ll be more committed when you know someone is watching. And invite them to inquire about your progress. When you know someone is going to check up on you, it’s added incentive for you to keep up with your efforts so you have results to communicate when you’re asked: “How are things going?”
Measure and Celebrate
Keep track of your progress, whether by journaling or marking progress on a calendar. A visual record of your progress helps you maintain momentum because it allows you to see how much you’ve already done. And identify milestones so that you can have mini celebrations along the way. If you need to lose 20lbs, it’s much better to celebrate each time you lose 5 than waiting to celebrate only after you’ve lost the full 20.
And Finally, Lighten Up!
Making a change is not easy, especially if it’s a significant change. There will be moments of discomfort and times when you just won’t do what you are supposed to do. If you have a moment of weakness and stumble, don’t use that as an excuse to quit – no one is perfect, failure along the way is normal. Also, accept that your goal won’t always be exciting and fun to tackle and that you may often not want to complete your task(s). Most of the time you probably won’t feel like doing what you should be doing – recognize that motivation won’t always accompany you. Despite the absence of motivation, do what you need to do anyway. Focus on developing the simple habits that will get you going, i.e. if you need to get in a morning run – just focus on getting your shoes on, and once those laces are tied what follows will be automatic.