Posts made in July 2016

When Physiotherapy is Not Helping

We see patients who have been referred to us for lack of progression with their physiotherapy program performed elsewhere. Generally you should notice an improvement in your condition over any two-week period. No improvement over two weeks indicates that there may be something wrong with your program. Here is a checklist we use to determine why you may not have seen improvement in your condition with your current physical rehabilitation program.

Did the you have a specific diagnosis? Who made the diagnosis, a sports medicine doctor or physical therapist? Was your diagnosis based on any special tests such as x-rays ultrasound or MRI?

How often did you attend therapy and for how long? Did you perform the required exercises appropriately and with the prescribed frequency?

Does your program include hands on treatment and exercises or only passive modalities such as ultrasound, interferential current, laser and some exercises? Were you treated by a registered therapist or a physiotherapy assistant?

Did you refrain from activities that aggravate your condition?

Without a diagnosis only symptoms are being treated. By not performing the prescribed exercises you most likely will not progress. If you do not have a comprehensive physiotherapy program including hands on treatment your treatment may be lacking essential components. By participating in aggravating activities you are setting back your recovery.

If your physiotherapy program has not resulted in an improvement of your condition a review  of these factors and your condition is recommended.


Getting Down to the Root Cause

Ever wonder why many medical organizations and associations use the symbol of a snake on a staff for their logo? If you check the Bible in Numbers 21-9 you will see that G-d told Moses to make a fiery serpent and put in on a pole to heal those who had been bitten by snakes in the desert sent to punish them for complaining of their situation.  They would be healed by looking at the snake.   These individuals were bitten because they acted in an evil way by complaining about their condition in the desert.  Evil speech is often associated with the snake.  Why would a copper snake heal the condition associated with it?

 Well the lesson here is that when you are sick or injured you have to connect with root cause to completely heal from the condition and prevent recurrences. Getting to the root cause of sports medicine problems is essential for physiotherapy and other treatment interventions such as custom foot orthotics and custom made or over the counter braces to work effectively.

At the Toronto Centre for Sports Medicine, we are often assessing patients who have not responded to programs of physical rehabilitation or who have received orthotics or braces at other facilities . The most common reason for lack of response is that the  underlying cause was not dealt with initially. Many people come to us without a diagnosis despite having had extensive treatment and interventions.

The story of the snake on the pole and the use of this symbol by many medical organizations reminds us to always search for the underlying cause as the best approach to treating an illness.

Treat the patient not the MRI

While teaching a medical student today I had the opportunity to demonstrate how one should never treat findings noted on investigations such as radiographs (x-rays), ultrasound or MRI unless they correspond with the patient’s history and clinical findings.

A patient referred for a meniscal tear of the knee confirmed by MRI with the request to help manage their knee pain until the surgeon could see her in 5 months. As required we  took a detailed history and performed a comprehensive physical exam. The patient had significant tightness of the soft tissues around the knee cap causing restricted knee flexion range which could mimic a meniscal tear. Standard tests for meniscal tearing were negative. After performing some techniques used by physiotherapists to release the tight knee cap the patient had much less pain with walking and could flex the knee to a greater extend and with less pain. This patient benefited greatly from a sports medicine consultation and has been directed to have physiotherapy for the knee. I suggested that the surgeon’s appointment be kept for now but most likely will not be needed.

The patient was very happy and the medical student learned a great lesson.

Your path to recovery with sports medicine

Sports medicine embodies the concept of optimizing your function no matter what level of functioning you are at currently. This is accomplished by identifying and dealing with the underlying cause of your problem.  The next step is setting up the appropriate building blocks to provide you with the strength and flexibility of mind and body to achieve full recovery and prevent recurrences. Tapping into your own body’s resources for healing and improvement is the general guide for treatment provided by various professionals including sports medicine doctors, physiotherapists and massage therapists.