Med Student Tutorials

Earlier this week, my business partner and myself were lucky enough to take part in a tutorial for 4th year medical students from UBC. This tutorial took place in the same medical building that one of our clinics is in, the Gordon & Leslie Diamond Health Care Centre, as UBC operates out of the second floor and has teaching opportunities throughout the building.

Medical School prepares their doctors to be very effective at screening assessments, looking out for serious spinal pathologies, such as cancer, vascular conditions, fractures, etc... Assessment of the non-specific mechanical back pain, which makes up almost 70% of these cases, is not so well covered. During the tutorial we went over a very straight forward case study, answering questions as we went along. Following the case study we were able to share our treatment approach and techniques with the group. This was fun for me and hopefully beneficial for the students.

Some of the main points we discussed:

- the importance of a full biomechanical assessment
- the importance of appropriate exercise for long term success
- nutritional concerns
- core stabilization
- manual therapy
- intramuscular needling
- psychosocial apsects involved in chronic pain
- the lack of evidence for many of the modalities historically used
- how physiotherapy specialization typically occurs post grad.
- how to look up Physiotherapists in BC via our PABC directory

These interdisciplinary tutorials are something that I will try to be a part of every year.

Harry

The Power of Youth

Many of us, somewhat jokingly, attribute our injuries to "old age". We can't always use this as an excuse for injuring ourselves, as most injuries can be avoided with proper training, but there are some age-related changes to be aware of.

Clinically, we can see a notable difference in injury extent, rehab and recovery time amongst athletes of varying ages. The 18-year olds may not always commit fully to their rehab, they may stay out too late and ingest the wrong things, but they still seem to bounce back quickly. This approach does not work so well for the athletes over 30.

Now before you groan and say "over 30?!?! ...that's it?", let me explain. Physiologically speaking, we can measure things such as bone density, which typically peaks in your early twenties. Skeletal muscle mass also peaks around this time (in the absence of any training). It follows that many other physiological processes, such as soft tissue healing, also begins to slow past this time. We see this reflected clinically as well. My oldest current patient is 92, and she tells me I'm silly for considering 30 plus as "older".

This doesn't mean hope is lost for the ancient "over 30" crew. But simply, that to stay healthy, there must be greater focus on proper training (both mentally and physically) and diet. Any older athlete who is competitive at the elite level of their sport must be commited to this. This is how we can counter some of the effects of aging. Truly 95% of injuries are preventable with the proper training, and we can't just chalk things up to old age and unavoidable accidents.

Aside: My son, 10 months old, had a hernia repair surgery last week, and was bouncing up and down the following day. Ah, youth.

Harry

"Sports" Injuries

People often want to classify whether they have a sports injury or not. Our culture has us believe that the sports injury is somehow more heroic or justified. Sometimes, the "sports injury" I see in the clinic is actually more work-related than you might think.

For example, I might see someone in the clinic who strained a hip adductor (groin) while playing hockey one Saturday night. In truth, their adductors and hip flexors were likely tight and weak (especially in the extended position) from hours of sitting behind a desk, Monday thru Friday. Feeling that tearing sensation during a big stride while accelerating on the ice was the result, but the root cause was actually well off the ice. The injury stemmed from weakness, tightness, muscle imbalances, poor trunk dissociation and faulty biomechanics.

So when you pick yourself up after you hurt yourself on the field, don't just look at your immediate surroundings and situation to find the cause of your injury. Look at the typical daily activities and postures you find yourself in for more answers.

Harry

Supporting Our Athletes

I wrote this post down a while back, but never got around to posting it. The incident is old news, but the point (no pun intended) is valid.

There was an unfortunate show of poor sportsmanship, by one of our Canadian fencers at the 2008 Olympics. No need to mention her name again or describe her actions. Her outburst was by no means justified, but I can easily see some of the external factors she had to deal with. The positive side effect of all this was that, through her post-competition interview, the masses were able to learn what an elite athlete has to go through when her country can’t adequately fund her sport. To continue at the elite level, she had to live and train abroad if she wished to continue at the world level.

I feel that Canada has failed her more than she may have diminished our image, as the larger issue was our Country’s support (or lack thereof) of amateur sport. I’m proud that we are improving by leaps and bounds in this department, through projects such as the “Own the Podium”. And I don’t think we have to (or are even able to) dump endless resources into it like some countries do, as there are more important social issues to address. I just hope we continue seeing the value of amateur sport long after the hype (and funding) of 2010 has passed.

It’s very difficult to quantify the effect in monetary terms, but the effects are many. Our athletes can inspire us in many facets of life, promoting health and fitness, which in turn prevents many other health issues, and through competition they can bring the world together where common ground and mutual respect can grow.

Harry

The (not so secret) Olympic Equation

I remember back when I was watching the opening ceremonies, I bet my wife that China would end up with 49 gold medals. In the end it was 51 with some gymnastics controversy, so I’m going to pretend I was bang-on (kidding). The U.S. won the overall medal count which was also no surprise to most people... but how do they do it? The U.S. is said to be the most overweight , sedentary and unhealthy countries in the world. We (Canadians) like to think we are so active and healthy, but childhood obesity is steadily increasing for many years now.

So what’s the equation for Olympic success?

POPULATION SIZE + FUNDING + the athletes = Olympic Success

Joking aside, I realize I’m not the first person to come up with this, as almost anyone involved with sports at any level is aware of this. I just felt the urge to write it down. And it’s because of this reality, that I am most inspired by the Olympic athletes that make it with very little support.

My Apologies

There is not much out there that bothers me more than a dormant website or blog. I, however, am guilty of both. For that I apologize, and will now be updating online every 2 weeks. Truly, I have a whole word document entitled “blogstuff” that is full of great half-finished posts, but I find my biggest challenge is making them concise. I tend to get carried away and go on and on when discussing topics I care about (as I’m sure my patients will attest to).

So now, my excuse...

My partner and I have been running Envision Physiotherapy together for 5 months now, and things are going great! We’ve received a lot of attention in the physiotherapy community, and the clinic has been getting busier every month. I’m truly enjoying the longer appointment times working one-on-one with my clients. The downfall, of course, is that I have neglected my online duties, but...

My promise...

I will be able to get back on top of things as I’m taking 3 days off (my first days off in 6 months) to work on the website, blog, and my latest magazine article.

Thanks for your patience

Harry

"Real" Physio

A few years ago I was in Italy with the ski team, and we had just returned from some time off back home. One of my athletes, JP, comes into my hotel room for physio treatment (for his knee - ACL reconstruction) and says “finally, it’s good to have real physio again”. I asked him what he meant by real physio, because he was set up with some very skilled physios back home. He told me he meant a physio that actually spent some time with him, instead of “seeing me for 5 min. and then hooking me up to some machine”.

Combating this unfortunate reputation built by some members of my profession was one of the main reasons I decided to open my clinic and operate the way I do. 30 or 60 minute appointments, hands-on, one-on-one care. In talking to some of my colleagues with similar approaches, with the kind of results we are seeing, we would never dream of returning to that unfortunate “classic” system.

Many clinics will advertise 20 minute appointments as a progression from the old days of treatment, but very few operate on the 30-60 min format like we do.

Harry

Vancouver Triathlon World Chmapionships 2008

Well, the weather may not be perfect for this weekend, but if you want to see some inspiring performances, make your way downtown (specifically English Bay, the West End and Stanley Park) to watch the Vancouver Triathlon World Championships. I'm going to be working Sat. & Sun at the medical tent (along with other Sports Physios, doctors and nurses) as well as follow the performances of some of my patients.

To find out more go to triathlonvancouver.com or to get a quick idea on what the event is like, check out this video on youtube regarding last years event.

the Team Approach

When I was working the National ski team, one aspect that I enjoyed the most was the true team approach. Every single staff member, from coaches, doctors, technicians and media personnel worked together with myself to do what was best for the athlete. Every decision was based on this.

Once I returned to clinic work after 3 years of this, I was disheartened with the lack of teamwork from the practitioners within the community. There are professionals out there who believe they have all the answers and disregard any other options. This is especially bothersome when they employ unsupported techniques and are not backed up by qualifications and experience (but that’s a whole other story). This approach is not worthy of an elite athlete and it’s not worthy of the average person.

At my new practice, restoring this open interdisciplinary communication is one of our primary goals. We work together with the doctors within our practice, personal trainers, strength & conditioning coaches, select chiropractors, massage therapists and you.

Regardless of who you see, ensure they are willing to communicate with other team members (doctors, coaches, etc...) and that they are well qualified to do what they claim to.

Harry

I'm famous! (joke)

This is just some fun news, nothing important.

Some of the pictures from our Envision Physiotherapy website, made it onto the cover of the new physio directory. I know my modelling career wouldn't have taken off, because, as you can see from the picture they used on the BC Physio website, my back is turned.

Oh well, I guess I'll have to keep my day job.

New Physiotherapy Clinic!

Brent Stevenson and myself (Harry Toor) are opening another Envision Physiotherapy clinic at the “Gordon & Leslie Diamond Health Centre” at Oak & 12th in Vancouver, BC.

The Diamond Health Centre is a world class medical facility that brings together Vancouver General Hospital’s outpatient care services – including specialty clinics, along with medical education, physician teaching clinics and research – at one site. We will be affiliated with the doctors of West Coast Family Practice, which include Dr. G. Ayling, Dr L. Bootsman, Dr. A. Harpur, Dr. C. Harvey and Dr. M. Sweeny. West Coast Family Practice and ourselves, Envision Physiotherapy, were fortunate enough to be the only non VGH practitioners invited into this amazing facility.


So what is special about our approach with Envision Physiotherapy?

Envision is a unique One-on-One Physiotherapy service, with the focus on quality of care. Appointments will be 30 or 60 minutes long in a private treatment rooms with a highly trained physiotherapist. Assessments are extremely detailed and specific to the client’s pain, profession or sport. Treatments consist of manual therapy to first correct joint alignment and muscle imbalances, then specific muscle control exercises are prescribed to prevent any re-occurrences and to optimize their sport performance.

So how can you reach us at this new clinic?


Our receptionist, Leah is available M-F at (604)737-0799 to take your call. The clinic is located on the 3rd floor of the Diamond Health Centre at 2775 Laurel St. There is ample underground pay parking, as well as meter parking on the street, but keep in mind the streets are often quite busy.

I’ll be at the new clinic Tues/Thurs, Brent will be there Weds/Fri and we will share Mondays. To learn more about the clinic, go to our Envision Physiotherapy website.

We open our doors March 3rd, 2008!

What Happened to Treloar Physiotherapy?

For those of you who don't know, Treloar Physiotherapy is one of the larger, well respected clinics in Vancouver. Where is Treloar Physiotherapy? They are at 686 Broadway, the same building as the (now infamous) Taco Del Mar. The recent bomb blast at this business has affected the overall condition of the building so for the time being, Treloar physiotherapists are not able to function out of their current location. Instead, many neighboring physiotherapy clinics have arranged for some of Treloar's physios work within their offices.

Both the clinics I practice out of (West 4th & Envision) have made such arrangements with Treloar, even though we have been extremely busy. One patient asked me, "Isn't that weird? Aren't they your competition?". I never thought of it like that because what many people don't realize is that we are a fairly close knit group. All physios with similar expertise, take the same courses, atted the same conferences, or work at the same sporting events. It is very unlikely that any like therapists would let their colleagues suffer at mercy of some uncontrollable events. It's nice to be part of a profession that is not only concerned with helping our clients, but to helping our professional community as well.

Harry

New Practice!

Finally,

after 9 years of work as a physiotherapist, I'm taking the plunge and opening a new practice with fellow physiotherapist, Brent Stevenson. We are opening another branch of his Envision Physiotherapy Clinic at the Diamond Health Center on Oak & 12th in Vancouver BC. We will be working at this world class health center with the doctors of Westcoast Family Practice, of whom I will introduce to you later.

Brent and I are on the same page with regards to our approach to physical therapy. We are both passionate about our profession, extremely focused on continuing education, and we both opt for the one-on-one treatment approach. We will spend the next week ironing out the details, which I will share with you next week. The clinic will be up and running by March 3rd, 2008.

Harry