First of all, what is chronic pain? Chronic pain is pain that last 3-6 months or longer. Recovering from chronic pain is very different that recovering from acute pain, which is new pain that is typically, but not always, associated with an injury or incident. Here are some of the key factors to consider when you are trying to get out of a chronic pain cycle.

1. Pain Education: Understanding how pain works in your body, brain and nervous system will help you to understand what is happening in your body. Pain does not necessarily mean you are causing damage to your tissues, which can be a hard concept to accept. When you begin a new exercise routine or activity, you will likely experience pain. The initial increase in pain is not damage. It is a warning signal from a sensitized nervous system, a response that has become automated but is not accurate or helpful. Increases in pain are always expected when you first start a new movement, activity or routine. The key is changing your beliefs about the pain, learning where to start, how much to do and acquiring some tools to regulate your overactive nervous system. These tools can help you take control and minimize or eliminate the pain you experience.
2. Safety: Start with movements that feel safe. Fear is a big factor when dealing with chronic pain, even if you aren’t aware of it. Practice asking yourself, “Is this safe?”, and consider modifying the movement if you don’t feel safe. This could mean having your hand on the wall for support, using a smaller range of motion, or performing the movement more slowly. It is important that you start with movements that you believe will not damage your body. This may be a very small movement or not very much activity to begin with, and that’s okay. Slow and steady wins the race, as they say.
3. How Much Is Enough: Continue the movement or activity as long as you feel you won’t regret it later. This can be difficult to determine, so start with a less is more approach and go from there. If you find that the consequences of the movement outweigh the benefits, and especially if there is a significant increase in pain after or during each movement, back off or stop. Take a breathing break. If it’s possible to stick to pain free ranges of motion, do so. If not, try to stick to minimally painful movements.
4. Breathe: Ensure you breathe calmly while you are moving or exercising. Relaxed breath or deep breath can calm you down and stimulate your parasympathetic nervous system which governs your rest and digest mode. Try taking a break between each movement or exercise as well, to breathe and relax. This can help to down regulate your sensitization.
5. Relaxation: Try to keep your muscle tone and tension as low as possible while you move. This might be hard. Remember that less is more and by being tense while you move you might be using too much effort to complete the movement.
6. Dividing Attention: If you are hypervigilant or pay a lot of attention to your pain during activities, try to divide your attention and focus on something else while you move. For example you’re your shoulder is the problem, focus on how your feet feel. If you tend to ignore your pain, try paying more attention to it.

At Remedy Wellness Centre, our massage therapists, acupuncturists, chiropractor and athletic therapist have completed educational courses through Pain BC and other continued education venues. By staying up to date on most recent research and treatment approaches for treating chronic pain, we can help you achieve balance and get back to doing the things you love. We also offer Registered Clinical Counselling with a unique focus on chronic pain treatment and management.
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If you are suffering with chronic pain, please come see us so we can get you started on a path to feeling better today.

When we first jump into the chaos of getting in shape or just improving our level of fitness, it can be appear to be a daunting and intimidating journey.  To be a healthier version of yourself you generally need to change what you eat, how much your move and how you make a lot of different decisions.  Physical transformation is exceptionally difficult because first, you must sacrifice things you are accustomed to and enjoy in some way (usually less than healthy lifestyles and foods) while initially gaining very little discernable benefits.   I will be writing on this specific challenge next month; however, for this month’s article, I’ll be focussing on the bigger challenge.  The reality that most people have few examples in their social circle or family of significant lasting and healthy change in health and wellbeing.   This is why testimonials or before and after pictures are used so heavily in the billion-dollar weight loss industry.  Look at person X, they are just like you and they did this 5 minutes work out or took a miracle pill/shake and now they are exactly like you want to be and it was easy.  Except it’s not and almost all of these examples are less than honest.   However, it is not a lost cause.  But it might require a mindset change and the ability to look outside of the experiences you and your network of friends and family have had with health and fitness.   If you are fortunate enough to know people that have succeeded in the kind of fitness and lifestyle changes you want to make, look closely at all the things you have in common (both good and bad) and recognise that they probably started out very similar to you with the same challenges and opportunities.  Then model what you can on their experience and lean on them for help because they have walked the same path as you and achieved what you are working towards.


Now we come to the heart of the problem for many.  What to do if you feel alone in this battle?  What if making all the changes and sacrifices are just too difficult and you do not feel up to the challenge?  To start with, you are going to have to find ammunition, but of a different kind of calibre than some of you might be used to.  For psychologist Alfred Bandura, “the most effective way of developing a strong sense of efficacy is through mastery experiences.”  Performing any task successfully strengthens our sense of self-efficacy and the bigger the success the more we are emboldened by it.  Succeeding at difficult, daunting and challenging tasks is like a power up or boost to our own personal sense of efficacy (the idea that we can be successful in creating change), even if it is in a different avenue.  The first reaction when you feel intimidated or that you are failing to meet the challenge of your new fitness and health regime, should be to make a mental list of the big things you have accomplished in your life.  The bigger, more bad ass and hard earned the result, the better.  These don’t have to be fitness related and frankly for those starting out, they probably aren’t going to be.  Start with your proudest accomplishments, military or civil service, past sports success, charitable work or community involvement, with successfully raising children an often neglected source of awesomeness.  Stack all of those great things you’ve done on top of each other and by the time you are done, you should hopefully have built up a large arsenal of difficult and challenging things you are proud of.  Use this list as a touchstone for when things get tough.  Say to yourself, “I did x, y and z which were incredibly difficult, and they didn’t stop me, break me or defeat me.”  Then, when you struggle to eat breakfast, exercise regularly or plan your eating, recognise that these things can’t beat you either.  They are not much of a challenge compared to what you have already achieved.  If you build up this ammunition as you slowly work towards improvement, physical or otherwise, there is nothing you won’t be able to take down.
 
James McDonald is a certified Athletic Therapist and Strength and Conditioning coach, experienced in working with wide variety of clientele.   From recreation level runners and MMA fighters, and from Pro Hockey players to amateur Quidditch players, he loves to work with anyone and everyone he can help.  So, if you need to get healthy or be better at what you love to do, FREE individual consultation sessions as well as one on one treatment sessions can be booked online with Remedy Wellness.
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This is the first in a series of articles on common problems, of the aches and pains, that active people regularly put up with and alternative solutions that an Athletic Therapist can suggest given our background in working with both active individuals and elite performers.  As a clinician and coach with extensive experience in high-level sports including work with Hockey Canada, in the Western Hockey league and multiple provincial and national level programs in a variety of different sports, I can help someone see things most would miss.  The perspective I can offer as an Athletic Therapist is different from other professions and will help you fully understand your injury or limitation and how we can work together to help you move, play and feel better.

Today’s example is one I’m sure that any person working in an office or sedentary industry can easily relate to.  Perhaps it shows up in the mid afternoon or during an especially long commute home. It is that nagging pain in your upper back, just near your shoulder blade.  Your first instinct is you try to reach around and massage it, but you can’t quite get it and besides you look like your giving yourself a one arm hug while sitting in the Colwood crawl.  You try rolling your shoulder around and maybe you find a position where it’s manageable, but you just end up looking like a turtle.  While a little bit of self massage, a few Advil or a glass of wine when you get home might help a bit, really what’s going on is a battle for stability around your shoulder and you are the main casualty. 

The two combatants in this situation are potentially the Rhomboids (they are located around where you feel the discomfort in your upper back) and the Pectoralis Minor situated where your chest and the front of your shoulder meet, just under the much large Pectoralis Major.  Many of us spend a large amount of time sitting at work and mouse or slumped over our phone and generally not moving enough.  When this happens, the front of our chest tends to move into a tightened position and the pec minor gets the signal to remain shortened and contracted to help stabilise our shoulder blade (scapula) and this can lead to a shoulder shrug like motion and a forward rounding of our shoulder. 

​Summer is here and many of us are out in the garden. For many of us, the long winter months are spent in anticipation and planning for award winning gardens. However, few of us have spent much time getting ourselves into shape for the coming season. With gardening growing in popularity, we see more injuries than ever seen before. Here are some safety tips to help you prevent injury and enjoy your time outdoors.
 
Gardening is like any other activity. A proper active warm up is needed to prepare the body for the positions and muscle work involved that will help avoid the aches and pains that are normally felt afterward.

• Your active warm up should include exercises that increase blood flow to the muscles as well as raise your heart rate.
• Try a short walk, marching on the spot, some jumping jacks or arm circles. Use movements that involve bending, reaching over head and out in front.
• Maintain good body mechanics: bend your knees and use the larger muscles of your legs rather than the smaller ones in your back for lifting. Keep your shoulders back and down, rather than allowing them to roll forward and up toward your ears, to avoid straining your shoulders, upper and mid back.

Visit your local gardening store for tools that allow ergonomically correct posture. One will find everything from shovels to small hand tools as well as specialty handles available for all. Use a wheel barrow to move heavy items when possible. When lifting, one should tighten their core muscles, while lifting with your legs. Imagine your abdominals are a girdle that is tightening around you, bringing your belly button closer to your spine. Remember to breath while lifting and avoid using your back to lift up the object.
 
Some Tips to help avoid injury while gardening
 
1)  While planting, weeding or harvesting your garden, it's best to squat down or kneel on a kneeling pad instead of bending forward at the waist.
 
2)  When digging, insert the shovel head vertically into the ground and step on the blade, lifting small amounts of dirt at a time.
 
3)  When shovel ling, push from the end of the handle and shift your weight forward from your back leg while keeping your knees bent and core tight.
 
4)  Using a hoe or rake, step into the movement instead of bending forward and just using your arms.
 
5)  When cutting the lawn, keep your arms close to your side and walk with the lawn mover.
 
6) Plan frequent stretching breaks – stand and lean backwards with your hands on your hips. As well reach over head and rotate your head side to side. Shoulder rolls to relax the muscles between the shoulder blades.
 
7) Plan frequent changes in position to minimize soreness.

8) Spread the work out over a couple of days or weekends. Don't try to get it all done in one day.

 
If you are stiff and sore from your day, try some of the following:
 
 1) Go for a walk to increase blood flow to your muscles which will help with the removal of built up lactic acid which causes soreness
 
 2) Stretch after your day in the garden, holding each position for 30sec- 1min
 
 3) Apply ice for 15-20 min to a sore area which will help with pain relieve and reducing inflammation
 
 4) Take a rest giving your body time to recover
 
 
The most common injuries we see after a weekend of gardening are lower back pain and shoulder pain.
If you have over done it and your aches and pains just won`t go away, contact us to find the most appropriate treatment method.

Sunscreen: It's important to protect your skin from over exposure to the sun, including both UVA and UVB rays, but have you thought about protecting yourself from the harmful ingredients in most sunscreens?

Here is a list of 12 toxic ingredients to avoid when choosing sunscreen, and any other beauty/hygiene products:

BHA and BHT
Coal tar dyes: p-phenylenediamine and colours listed as
"CI" followed by a five digit number
DEA-related ingredients
Formaldehyde-releasing preservatives
Parabens
Parfum (a.k.a. fragrance)
Parfum (a.k.a. fragrance)
Sodium laureth sulfate
Siloxanes
Petrolatum
PEG compounds
Dibutyl phthalate

For more information on the harmful effects of these ingredients visit:
The David Suzuki Foundation Website

A strain injury is a tear in the connective tissue, usually either muscle, fascia, ligament or combination thereof, as a result of overstretching the area. Muscles are more prone to strain injuries during an eccentric contraction (muscle is lengthening with resistance) versus a concentric contraction (muscle is shortening with resistance).  Tendons are less vascularized (less circulation) which makes them more prone to rupture/tearing at the area of least blood supply; usually the middle or at the musculotendinous junction (where the muscle attaches to the tendon).
 
Causes of Strain Injuries:

• Sudden Overstretching
• Extreme Contraction of the muscle against heavy resistance
• Warming up before an activity or sport decreases the likelihood of straining tissue. Other factors that can contribute include:
• Inflexibility
• Fatigue
• Poor form
• Repetitive overuse
• Muscle imbalance
• History of previous strain

 
Levels of Strain Severity
 
Grade 1, Mild or First Degree Strain: minor tear to the musculotendinous unit with minimal discomfort when contracting or stretching the area. Symptoms include:

• Mild Swelling, Heat, Bruising may be present
• Point Tenderness
• Minimal Loss of Strength or Range of Motion
• Able to Continue with Sport/Activity

Grade 2, Moderate or Second Degree Strain: the degree of tearing can be several fibres to the majority of the fibres. You would have difficulty continuing with your sport or activity due to weakness, reflex inhibition and pain.

• Snapping sound when injury occurred
• Moderate swelling, heat, hematoma and bruising
• Palpable gap in tissue
• Moderate point tenderness
• Moderate pain when stretching or contracting the affected muscle
• Moderate loss of strength and range of motion

Grade 3, Severe or Third Degree Strain: Complete rupture of the muscle/ligament or an avulsion fracture (the tendon and muscle fibres remain intact but break a piece of bone off the limb). Continuing with any sport or activity is not possible due to pain, muscle weakness and inhibition. This type of injury must be surgically repaired and followed with physiotherapy and massage to rehabilitate the tissue.

• Snapping sensation/sound when injury occurred
• Swelling, heat, hematoma and bruising
• Palpable and possibly visible gap in tissue. Muscle may bunch up due to spasmodic contractions
• Severe pain with immediate loss of strength and range of motion

 
A period of total inactivity after a strain injury is not recommended as the affected muscles will shorten, restricting range of motion, and atrophy which will weaken the area. If the injury is not treated with some sort of soft tissue mobilization it will develop adhesions. Chronic inflammation from micro-tearing during the healing phase can also occur.
If you continue to overuse a muscle that has been strained, without giving it adequate time to heal, the area will be prone to repeated strains. It is possible to strain any muscle but the most frequently strained areas are:

• Hamstrings (usually in the middle of the muscle belly or at the musculotendinous attachment on the ischial tuberosity/just below the bum)
• Quadriceps /Thighs
• Gastrocnemius / Calves (usually at the musculotendinous junction or the Achilles attachment on the heel.)
• Adductors /Inner Thigh/ Groin Muscle (usually in the middle of the muscle belly or at the musculotendinous attachment on the ischial tuberosity/just below the groin)
• Erector Spinae (Parallel to Spine)
• Iliopsoas (Deep Postural Muscle and Hip Flexor)
• Rotator Cuff
• Biceps (usually in the muscle belly or at the shoulder attachment)
• Whiplash: strain of several neck muscles that may include the scalenes, levator scapulae, posterior cervical muscles, infrahyoids, suprahyoids and longus colli)

Massage Therapy, Physiotherapy or Athletic Therapy can not only identify the level of injury, but can be very beneficial in:

• Speeding up healing time
• Preventing development of adhesions around the scar
• Regaining strength and mobility
• Regaining range of motion

Ultimately the goal is to return to your sport/activity as soon as possible. Identifying the factors that may have contributed to the injury in the first place is key in preventing it from reoccurring. We can recommend some sport specific and personalized exercises to help you stay injury free after your rehabilitation.

Scar tissue is the result of an injury and the inflammatory process that follows. It is the collagen based tissue that your body replaces damaged tissue with. It will only be about 80% as strong as the original tissue (skin, ligament, tendon, muscle, nerve or fascia). Scars result from wounds, burns, musculoskeletal injuries, inflammatory arthritides and osteoarthritis. Anything that prolongs the healing process can result in scar tissue production.
 
When applied at the right time, massage therapy techniques can be beneficial in reducing scar tissue formation and breaking down adhesions after they’ve formed. Scar tissue forms during the inflammatory process, so by decreasing inflammation and swelling during the acute phase, the amount of scar tissue produced can be reduced as well. RMT’s use gentle lymphatic drainage techniques and cryotherapy (cold therapy) on acute injuries which encourages excess fluid to move back into the lymphatic system. Once the scar has mostly healed, typically two weeks after surgery you can start doing some self massage techniques. Wait until the sutures have been removed and all scabs have fallen off by themselves. Be gentle. You may discover that the area is quite sensitive and deeper is not necessarily better. If you're unsure where to start, come in for an appointment and one of our RMT's will be happy to show you how. We are big on patient education and empowering our patients to use self care techniques.
 
Adhesions and contractures can lead to postural dysfunctions, joint pain, tension and muscle pain. Abdominal scars, such as c-section and appendix removal scars, can have a negative effect on your digestion and reproductive system and even cause lower back pain. Hypersensitive scars can be desensitized with tactile stimulation.
 
Types of Scar Tissue:
 
Contracture: shortening of the connective tissue to the point where it cannot fully lengthen or relax and reduces range of motion.
 
Adhesions: occur when there is reduced range of motion at a joint over a period of time. This allows cross links to form among collagen fibres which further reduces the range of motions. This occurs mostly with postural dysfunctions or immobilization of a limb.
 
Scar Adhesions: occur after an injury when your body has produced new collagen fibres during the inflammatory process. These adhesions occur between fascial tissue, muscles, skin, tendons, even between whole groups of muscles. They don’t allow each tissue type to move independently, as they should, but rather as one solid unit. There’s a feeling of tension and discomfort, pain in some cases and reduced range of motion. Adhesions and Scar Adhesions can be broken down with myofascial release and other massage therapy techniques.
 
Fibrotic Adhesions: occur where there is chronic inflammation and can lead to extreme restriction in range of motion. These types require more aggressive techniques.
 
Irreversible Contracture: fibrotic tissue or bone replaces muscle or connective tissue. Can only by reversed with surgical intervention. An example would be a “pump bump” or bone deposit at the Achilles tendon attachment on the heal.
 
Hypertrophic Scarring: an overgrowth of connective tissue that remains within the boundaries of the wound and is mostly associated with burns. These may be surgically removed or skin grafted.
 
Keloid: overgrowth of connective tissue that does not remain within the boundaries of the wound. Result from an imbalance between collagen synthesis and breakdown within the wound. Keloids do not respond well to surgery.

Musculoskeletal Injury is a broad term for any injury to the soft tissues, joints or bones. It encompasses everything from sprain and strain injuries to dislocations and whiplash. Regardless of the diagnosis, the end treatment goal is to promote tissue healing/scarring/regeneration, regain full pain free range of motion to any affected joints and full strength and mobility to all affected tissues. Such injuries can be assessed, diagnosed and treated with Athletic Therapy, Physiotherapy, Osteopathy or Massage Therapy. If you are uncertain which would be best for you, please call or email with your questions. We are happy to point you in the right direction.
 
Inflammation is the body’s immediate way of telling us that there’s tissue damage and that your immune system is already hard at work making repairs. Depending on the severity, you may see and feel edema/swelling/bruising around the injury and typically an associated pain response. Pain is meant to stop you from continuing with any activities that could cause further injury. For active people and athletes, it’s important to learn the difference between “feeling the burn” and pushing through pain that is causing tissue damage. Never take pain medications before a workout/sport/activity as this increases the likelihood of aggravating an existing injury and/or the occurrence of new injuries.

The Pain Threshold: your nervous system is an all or nothing threshold system. You can have tissue damage and inflammation that you don't notice until you go above your pain threshold line. Have you ever experienced pain after doing something pretty insignificant, like "all I did was bend over to pick up that thing and my back went out" or "I just stepped funny and now I can hardly walk." You were probably hovering just below your threshold and whatever you did was enough to push you over and now you're in pain. On the other end of recovery, people will sometimes return to activity too soon because they're below the threshold zone and think they're fine. The tissue may not be completely healed yet, it's just healed enough that it's not triggering your pain sensors. Return to activity needs to be slow and gradual to prevent re-injury.

 
When skin, muscles, ligaments or tendons are injured/torn, your body will regenerate new connective tissue made up of collagen fibres. This is commonly called scar tissue. There are 3 phases to healing connective tissue:
 
Acute Phase: starts immediately after injury and lasts about 3-4 days. Symptoms include edema (swelling), redness, heat, pain and often loss of function depending on severity, may be accompanied by spasm and muscle guarding/tension. Possible bruising black, red, purple or blue.
 
RICE (Rest, Ice, Compress, Elevate) has been the long standing immediate treatment protocol for acute injuries. New research is suggesting that ice and use of anti-inflammatories during this phase may actually impede the body’s natural healing process. Unfortunately all the research articles we searched through had inconclusive results on this topic. https://www.ncbi.nlm.nih.gov/pubmed/22744434
 
Early Subacute Phase: starts within about 3-4 days and can continue for as long as 3-6 weeks after the injury. The symptoms of inflammation begin to reduce. Tissue damage is gradually being restored; skin and muscle heal faster (5-8 days) than tendons and ligaments (3-5 weeks). Symptoms include mild edema/swelling, warmth around the area, less painful, less muscle spasming. Bruising will likely still appear the same as in the acute phase. Pain with range of motion but to a lesser degree and reduced muscle guarding/tension.
During this phase your body is laying down new collagen, which is very fragile and susceptible to reinjury when overstretched.
 
Late Subacute Phase: Begins about 2-3 weeks into the subacute phase. Pain is significantly reduced but possible limited range of motion due to adhesions and weakness. Bruising may change to yellow, brown or green then disappears. Area is still tender to the touch.
Wound contraction and scar remodeling happen in this phase. Myofibroblast cells contract to pull the tissue cells tighter together, while reshaping and remodelling of the collagen fibres strengthens the area. Massage Therapy can be very effective in preventing the formation of adhesions during this phase, which contribute to chronic pain and reduced range of motion.
 
Chronic Phase: occurs about 6-10 weeks after the injury and can last for years. In extreme cases people can experience a permanent change to the injured area that never fully heals. The inflammation process has finished and there is likely no residual swelling/edema. There is typically pain that can be constant or intermittent, restricted range of motion and guarding/muscle tension due to adhesions. The quality of this tissue can still be positively affected with massage therapy techniques, stretching, mobility, strengthening exercises, etc. Full recovery is still possible.
 
Full Recovery: Complete return to activities with no pain and full range of motion. The new tissue/scar tissue that was laid down at the injury site will never be as strong as the original tissue (skin, muscle, tendon, ligament). In fact, it will only be about 70-80% as strong, therefore the area may always be prone to re-injury. Re-injury can be prevented by continuing with the same exercises your physiotherapist, athletic therapist, osteopath or RMT would likely have had you doing during recovery. We call this “maintenance.” If returning to the same sport or activity that the injury was related to, a “tune up” treatment every 1-3 months for the first year is ideal.
 
Factors that Affect the Healing Process

• Severity of the Injury
• Age (extreme youth and age can affect healing)
• Infection
• Nutritional Conditioning
• Pre-Existing Conditions (Diabetes, Liver or Renal Problems, Lymphedema, Carcinomas)
• Circulation to the Area
• Effects of some drugs (Steroids inhibit the inflammatory process as do immune suppressants)
• Smoking (delays healing)

                Vit C: for collagen synthesis
                Vit A: supports fibroblasts and increases collagen synthesis
                Vit E: promotes tissue healing and prevents scarring
                Zinc: required for many enzyme reactions and for production of cells
                Protein and Calorie Intake: promote the cellular process

Conclusion: the best chance you have at making a full recovery from any injury is to have it properly assessed right away. For acute sport injuries such as sprain, strain, contusion or concussion we highly recommend a consult with an athIetic therapist. It is also important to determine if there were factors such as muscle imbalance, faulty firing patterns, overuse, postural dysfunction that may have contributed to the cause of the injury in the first place.