Wesley the Physio

Fresh sprain? Forget about RICE, let's try some PEACE and LOVE instead! . Rest. Ice. Compress. Elevate. We've all heard of this classic post injury strategy, and it's one size fits all type of approach to short term management of injuries. The evidence supporting this policy is limited. It's application is primarily for acute (short term) management, and ignores the latter (more important) stages of healing. . One of the main contentious talking points is whether to ice.... It has been linked to disrupting the natural inflammatory process which may lead to impaired tissue regeneration. The evidence that it improves healing rates and aids rehabilitation of soft tissue injuries is of low to moderate quality, due to the near impossible task of providing a placebo for ice. . I'm not saying throw it out. Ice is great for pain management, and often times if it hurts too much, you won't want to move it anyways. The negative aspects of impaired regeneration could potentially be outweighed by moving earlier after an injury and more often! . The key is to MOVE. If you're still RICE'ing a week after you sprained your ankle you're probably overdoing it. Load it early, load it often, and progress it. Judge your improvement by the week and not by the day. . Stay critical! . Wesley Wai, MPT . #physicaltherapy #rice #anklesprain #sprain #strain #softtissue #physiotherapy #movement #rehab #sportsinjury #icing #physio #rehabilitation #sportsrehab #keepmoving #painmanagement #strengthtraining #vancouverphysiotherapist #vancouverphysio #physiotherapist See more

CAUSATION AND CORRELATION AND LOWER BACK PAIN . Correlation is not causation. . Internet explorer use did not contribute to declining murder rates. The success of Whole Foods is not related to the rate of developmental disabilities. These graphs are clearly misleading us.... . But in the case of our bodies, it should be straight forward right? Those signs of degeneration, herniations, and bumps are the reasons my back hurts right? What if we just aren't seeing the full picture? . Abnormalities that we find in patients on imaging are often found in people that have NO symptoms either. In a review completed by Brinjikji in 2014, they concluded that much of the degenerative and abnormal changes found in lower back scans are "generally part of the normal ageing process rather than pathologic processes requiring intervention" (1). Disc bulge and disc degeneration have associations with lower back pain in adults 50 or younger, however the associations are not strong enough to imply causation (2). Even if disc herniations are seen, the size and type identified do not seem to be related to lower back pain nor patient outcomes (3). . Scanning seems relatively harmless, right? The labelling phenomenon that comes with imaging has been shown to "worsen patients' sense of well-being" (4). Multiple studies have found that patients with low back pain who underwent EARLY lumbar imaging showed NO BETTER HEALTH OUTCOMES when compared to no imaging or delayed imaging groups (2). . I'm not saying imaging is useless - the answer is IT DEPENDS. The determining factor should be whether or not the management of an individual would CHANGE because of the findings on a scan. Such cases would include certain red flags determined on the clinical examination. These incidences are RARE in lower back pain, one study in Australia of over 1100 patients reported as low as less than 1% of all lower back cases (4). . Think about that - LESS THAN 1%. So no, you probably don't have that rare disease you Googled. Still, go talk to a health professional if you’re concerned. . So if these findings don't explain the full picture, what else is there? . Think critically! . Wesley Wai @ Vancouver, British Columbia See more