Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver, BC, Canada. And we're going to talk about something that I think people confuse. Injury recovery versus rehab. How are you doing, Wil? 

Wil: I'm doing really well. Thanks, Mark. 

Mark: What's the difference? Is there a difference? 

Wil: Yeah. So first of all, recovery is really like an aspect of healing within a certain time frame. And it's obviously very dependent on the kind of injury that you're experiencing. So it could be like, you know, a simple ankle sprain to something a little bit more of a back strain to a disc or something like that. But ultimately the time frame, the time frames vary, but the process is the same. In the varying time frames. 

So I'll just give you a simple example, like with an ankle injury, a simple ankle injury where you tear some ligaments, maybe, and you may have a recovery time frame where it needs to heal, right, within four to six, to possibly even up to eight weeks. But it doesn't mean that you're not improving and you that you can't work on the rehab of that injury at the same time.

And so that recovery process really is looking while you're healing, addressing sort of the three main processes of that healing, where the first part of it is really when you're injured and you have the most swelling. Everything just balloons up. And sometimes it doesn't happen until the next day or up to 72 hours.

And so that's normal. That's all part of that physiological process of healing when you get injured. So there's essentially three stages to this healing. So there's that first phase that I just talked about where you get that acute swelling, and then you have the middle phase.

And so the middle phase is like the sub acute phase where you don't get any more new swelling. But then you start to go sort of in this process of the healing is now about okay, yeah, that's lay down a little bit more like groundwork here to kind of repair things. So the analogy is sort of like, let's say you got a cement building structure and that a pillar gets damaged and, you know, the concrete gets wiped out a little bit.

And now this phase, where we're pouring the concrete. We're trying to mix it, get things stabilized again to a certain extent. And so that's kind of that phase of it in the sub acute stage, like it's sort of the, your body is now trying to regenerate and reproduce cells to basically repair, right, and heal.

And so a large part of that is obviously clearing out that swelling. And then trying to get things functional again, and this is where, like, rehab is actually important in all aspects of these phases. And then in the, sort of, the third stage of that healing phase is really, and like I said, it varies. It could be, like, a shorter phase or a longer phase, depending on the type of injury, but then they call this the remodeling phase. 

So the remodeling phase is in that second phase, we talked about it being sort of like you're pouring the concrete and you're just pouring it over the broken areas or the patches that need concrete. Well, in the remodeling phase now we're trying to shape it. And then to take it a step further, we're also strengthening it a little bit more. And so we're changing the integrity of that repair aspect. 

 So to give you more concrete example, really looking at, no pun intended, so you have an ankle injury. Now you're in this third phase of healing and the swelling's come down. So you do specific strengthening to get it stronger, so it actually influences how that joint and the function of that joint will actually behave biomechanically. So how it will move in other words. So not just motion, but like a function of that motion.

So not only do I want it to move forward, backwards, left and right, and then all these other angles, but I want it to be strong in that way, and I want it to also have the reflexes to be stable. That's the remodeling and that important part of that rehab in the later stages. Now, a lot of this stuff starts to, like, happen, but if we don't, like, mold it specifically, then it may not be as nice and as specific as the way that we guide it to be.

So for example, like a lot of people that sprain their ankle and will go through the three stages of healing on their own and will do what they think they can to rehab it on their own. And it ultimately seems fine. They don't feel like they have a problem. Well, let's say they decide to like, say five years or maybe not even five, maybe two years or five years or 10 years down the road. I want to take up triathlon training. I want to do an Ironman. And then so they go through this process of or of initiating a training regimen. And then they start to increase intensity and everyone's different, some people might hit certain barriers quicker than others.

But if you're not fully rehabbed and you think you are from, like, say, this ankle injury that you had a couple of years ago or five or 10 years ago, and it will be expressed in like something that you do later on. And so what ends up happening is that then you have all these things that have happened in terms of compensation.

So in other words, your body has adapted to the slight limp that it's produced because you weren't able to fully put weight on that left ankle for the first three weeks properly or whatever, right? You weren't strong enough that left ankle and you're still compensating on the other side and your balance and your reflexes in that side weren't fully developed.

So the problem with this is that you can also come back with, you know, as you're training and you're increasing intensity, you can actually re injure that area or injure something else even worse. 

So research studies have shown that when you injure your back, and let's say you just run through that whole process of recovery and you get better. And then you do your own rehab, which is legitimately fair because there's a lot of information out there on the internet. But you don't fully rehab it properly. There is a very, very high likelihood that you can re injure your back, but even injure it worse or do something else. 

So that's pretty clear like when you extrapolate that to like other injuries and other areas of the body that get injured. And you look at this concept of recovery and rehab, they happen hand in hand. Like you do the rehab process during your recovery process, but then it continues on. 

So that last phase, which we call the remodeling phase, can be anywhere from like two weeks, three weeks from like a very simple injury, like maybe a very minorly sprained thumb and you rehab it. It only takes two weeks for that last phase in your rehab. Then like something a lot more involved, where it can take up to a full year to rehab. So like a year and a half, for example, like a total knee reconstructive ligament surgery. 

Mark: So would it be fair to say that rehab is actually, anytime you've injured yourself, there's a corresponding change in how your brain kind of operates the nervous system to compensate for that injury. And then part of the rehab is really reprogramming your brain and your nervous system so that it starts to work as you get stronger and recover properly. So that it goes back to normal or even better than what it was before it was injured?

Wil: Absolutely. And I think you hit on something that was really important. You mentioned about how you reprogram your nervous system and and you change your brain in the way it thinks about things. So that process is done through the actual physical act. 

So you set yourself up in your environment to be able to succeed. And I want to take a quote from James Clare, the author from Atomic Habits. He wrote this book that basically, I think is just amazing. He talks about how you do a whole bunch of little habits. All these little things in and of itself is not going to give you a result that you want, but you you do them every day or you accumulate them. And over time, you can get one big result. 

And I think that's amazing because in that concept is very similar to, I think what you're speaking about Mark, is that the change in your nervous system, it doesn't just happen like that. Like it takes time. And you have to it do the thing over and over again. And that's the same thing with like our bodies. In order to get strong, I can't just do the exercise once or even just three sets of 10 for even a few days. I may get a little bit stronger for a couple days, but it's not going to be sustained.

But if I do that same exercise every day for six to eight weeks, I'm going to definitely notice a difference, but I'm also going to notice a sustained difference, which is the key. And that's the thing right there and that's how your nervous system gets changed.

And I think that that's the really important key point about rehab because as you look at the kind of things that you want to do, you also want to ask yourself, well, how do I want to behave? Like, who is it that I want to be? Like, it's almost an identity around the kind of activities that you want to do.

So instead of just focusing on the goal, it's like developing habits or a system. And so James Clare very succinctly says that, "people who set goals will win once, people who set systems win repeatedly". And it's the same thing with rehab, it's got to repeat it over and over again.

Mark: If you're looking for superb recovery and rehabilitation in Vancouver, the guys to see are Insync Physio. You can book online at insyncphysio.com or you can call them at (604) 566-9716. Or if you're in North Burnaby, you can book at that office online the same or by calling (604) 298-4878. Thanks Wil. 

Wil: Thank you.

Mark: Hi, it's Mark Bossert. I'm here with Iyad Salloum of Insync Physio in North Burnaby, and we're gonna talk about exercising with medical conditions. How you doing Iyad? 

Iyad: Good, Mark. Thanks for doing this.

Mark: So is there. I'm sure we're probably talking about things like heart disease or diabetes or other medical conditions. Should you exercise when you have these kind of conditions? 

Iyad: Yeah, that's primarily the topic. I've seen a huge influx of people who kind of come to see me for, let's say like a sore back. And you know, there's really often conditions that can happen from a reduction in activity versus an increase in activity. So like just aches and pains that we get just from being in prolonged positions. So just being a bit more sedentary. And then, you know when I suggest the idea of an exercise program to get them up and moving, they are often shocked or surprised by the fact that they do have options to do that and that they could be done safely.

And I think really, If we think about like the main kind of things that most people will have of a certain age. So we see a lot of people, for example, who have high blood pressure and are on medication to control that. Or some form of other kind of cardiac conditions. And then we also have like, you know, your other metabolic syndromes like your diabetes and a few other things that could really, really impact your response to exercise. And also like your energy levels and your ability to participate. 

So often we see people get kind of a bit more concerned and worried about like, well, I don't want to go too hard. What if I hurt myself? Which is completely reasonable and this is where I guess working with us could be a really helpful thing for them.

Cuz we can kind of walk them through it step by step and kind of build up kind of a tailored program to help them get back to whatever you wanna get back to. 

Mark: So a thought that occurs is what, and the exercise program could be just lifting weights, it could be going for a walk. It could be it could be stretching and yoga type things, or Pilates. I imagine that with your background, more medical training, medical oriented training, you can provide a more complete package of training for someone to be maybe safer. 

Iyad: Absolutely. So one of the things like you wanna think about is like, I'll give you an example. More recently, we worked with somebody who had had a heart transplant, and they were telling me how they had a tough go initially when they were trying to start exercise because they felt like they couldn't warm up fast enough. And that's actually something that could happen because when you have a heart transplant, you rely on a different system to get your heart rate elevated and kinda more excited.

And this is something that usually is reviewed upfront. However, imagine like you're going through a heart transplant, it could be a bit overwhelming to kind of try to absorb all that knowledge in that kind of, preoperative phase and maybe the first rehab phase that they, they have to do after surgery.

So then kind of review some of the energy systems, so they'd have to target and some of the strategies that they'd to do to go about a warmup. Also, the cool down, they said they crash after exercise. And they're following like a stock program that was given to them. So we were able to take that, look into their medication. We consulted with their physician obviously about what's appropriate, what's not. What are kind of things that they foresee being an impact. And then based on that it gave a very specific exercise program. 

We used their smartwatch that they had on their hand to help keep them in his zone of exercise that everybody's happy with both medically and also the person themselves. And then based on that, we were able to progress them. And now they have a nice exercise program. They really like cycling, so we just built it around cycling. 

Obviously we wanted to make sure that they also have enough capacity in their muscles and in their other areas that need to be engaged during that activity. So it's not just gonna be, oh yeah, here's a heart rate. I want you to stay below and have at it as much as you wanted. It was very much based on the measurements and based on where they wanna go. And then we built the program from their goals working backwards to fill in the gap. Yeah, it was quite interesting. 

And then the other thing is like, yeah, the medical training does help for sure. We monitor things like blood pressure. We're gonna monitor things like heart rate. Sometimes in certain conditions if somebody has some issues, for example, like COPD, which we don't see too often in the community, but in the hospital, we'll monitor a few things like how much is their blood oxygen saturation and things like that, because we need to be safe ultimately. 

So we don't wanna necessarily, give them something good at the expense of something else. So we try to kind of be a bit more of a reasoned approach, but also like, ultimately the goal is safety. And that's where we see a lot of those clientele and people really feel more comfortable working with somebody with more of a medical background in that case. 

Mark: So it feels like the overall message, is exercise is still important, even if you have a medical condition. In fact, that might even be extremely important. 

Iyad: Absolutely. And this is where I guess our understanding has changed over the years. It used to be that you have a condition, you don't wanna ever exercise or simulate or exert, but we've found more recently with quite a few studies that this is quite safe. But it has to be done in the right way. 

So we follow very safe, let's call them mobilization guidelines, to kinda get people up and running. And then also the other thing is we have found like one of the physicians we work with, we kind of built a program for one of their clients and we were able to really enhance how they responded to their diabetes medication just with the exercise program.

So that was quite significant. And then they felt more energetic and they felt less lethargic and all that stuff because the way diabetes works is like an uncontrolled level of blood sugar and one of the ways you control blood sugar is not just through the liver but also through your muscles. So we were able to build a specific program that addresses a little more kind of on that peripheral side, so they're able to help regulate that blood sugar.

So then even though they were still on medication, that response was much more pronounced for them. And they were happy because now they felt like, oh my God, I have had this type two diabetes and I can't do anything. And when the options kind of open up for them, it is quite a freeing thing because you start doing things that you normally wouldn't do.

So this person hadn't traveled in a while because they were worried about what would happen to them. So I think like really comes back to that independence and just being able to trust your body to handle what you want it to handle. So that's where we come in and help out with obviously our healthcare colleagues who are in the medical system as well.

Mark: If you have a medical condition and you want expert advice on an exercise program that will actually help you move and feel better about, you're not limited, you're not restricted because you have a condition. Maybe a little bit, but not as much as perhaps you've assumed. The guys to see are Insync Physio, you can reach them in North Burnaby, you can book right on the website, insyncphysio.com, or you can call them (604) 298-4878. Or in Vancouver (604) 566-9716. You can book for either office. Thanks, Iyad. 

Iyad: Thank you.

Mark: Hi, it's Mark Bossert. I'm here with Wil Seto of Insync Physio in Vancouver, Vancouver's favourite physiotherapist office, and we're talking bodies. How you doing Wil? 

Wil: I'm doing good. Thanks. 

Mark: So today we're talking about abdominal injuries from rock climbing. Is there something different about hurting yourself in your guts when you're rock climbing?

Wil: Yeah, so, you know, in rock climbing especially, you know, you get into like these more athletic type of climbs these days and then with the advent of indoor climbing with the bouldering and the type of routes that they're setting these days. You know, you're using a lot of your core strength now.

And then you add these movements where you're really twisting your body, and maneuvering your body in a way where you're trying to now like, get up the climb or finish the climb and it can really lead to more potential injury in the abdominal muscles, especially if you don't take care of them.

Mark: I'm gonna assume that the main symptom is it hurts, but is there something more that you look for or that people come in and tell you about? 

Wil: Yeah, so depending on how bad it is you know, you usually like, feel and hear like a popping sensation into your abdominal area. And if it's really bad, then you get this intense pain. And you know, you end up like letting go of your hold that you're climbing and you like fall to the mats. But it can range from like that kind of intense to like say you finished the climbing session and you kind of like pulled really hard and you're doing a lot of twisting motions and bending and extending or whatnot, like the motions that put you more vulnerable to that.

And then you kind of feel more sore down in your abdominal area after and it sort of persists. And you might have a little bit more of a minor strain, which is actually something that you also wanna be a little more cognizant of post climb. So sort of different degrees of it and that's what I look for.

In terms of more specific things that contribute to these strains, it's things that are involving like rotation, especially extreme rotation of trying to reach, side bending motions and then really extending in the spine. Those are the main ones. 

But then like I said, with the more dynamic nature of climbing where you're doing what's called a dynamic movement or a dino, you know, those sort of powerful moves combined now with like the twisting and bending and extending, are the main things that can lead to a strain in your abdominal area.

And most climbers that we treat, we treat quite a lot of climbers in the clinic, they are not so great at recovery and stretching and making sure that the mobility is restored. Especially in 10 sessions. That's something that we're finding a lot of.

Mark: Is there, if I'm feeling this, is there an appreciable difference between like, just, you know, I've done too many stomach exercises compared to I've actually hurt myself. Is there some kind of gauge I could say, oh, I've hurt myself. 

Wil: Yes. That's a really good question Mark. So what you're speaking of, like if you're doing a lot of sit ups and you feel that pain, like the next day is what you're alluding to, I think. Yeah.

That's a condition called delayed onset muscle soreness and so DOMS is the abbreviation or the acronym. And that's very normal. Like if you're doing a lot more than normal sit ups or if you haven't done it in a while, then DOMS is actually very prevalent. And so you'll feel sore and that soreness will last for, you know, up to 48, 72 hours and then it goes away.

And you don't feel anything happen, like when you're doing your sit ups or when you're doing your, like, you know, oblique workout or whatever you did in your workout. And you don't feel anything until the next day, to get outta bed and you're like, oh, I feel a little sore. So that's definitely some muscle damage going on through there, but it's like it's definitely excessive muscle damage. Whereas when you tear the abdominal muscle, you end up actually damaging it acutely. And you usually feel something like more immediate. So I think, point that you're trying to get at to is like how you determine the difference between that maybe versus like the more mild versions of it.

Where you don't feel it until after because obviously with the more acute strains you feel it and you feel popping and it's like a sudden pain. Right. So that's more obvious. Where it's the more mild ones, you might have felt something go, you know, like how you sometimes feel the muscle tension abnormally, so you feel something and then you're sore after.

And that's when you know you've strained something and it's more mild. Or like you have a workout, like you're climbing whatever, and you're doing all those things and you have a really hard one and you do feel sore, but then you're like, two hours later, the same day, you feel abnormally more sore.

So you shouldn't feel abnormally more sore like that, you know, like one or two hours right after. And then the key thing actually is you're looking at that timeframe of like post 48 to 72 hours. So if it's still sore after 72 hours, like where it's not going away or getting any better, that's where you know you strained something. Where it's more of a tearing of the muscle as opposed to this other micro damage that's more related to the delayed onset muscles soreness. 

Mark: So how do you diagnose this? 

Wil: Yeah, so that's a good question too. So, first of all there's different grades to the extent of injuring your abdominals. There are three different grades. Grade one being like the micro tearing and stretching of muscle fibres. And you could say that the delayed onset muscle soreness is sort of in that category, or it's a grade one. And grade two is now you actually have partial tearing of the muscle fibres. And then grade three is now like complete tearing or rupture of muscle fibres. 

And so there's different things that we test for in the clinic when we look at, you know, what you're able to do and not do, and really rule out whether or not it's something else. Is it a hernia? You know, so that's another common thing too that we gotta rule out. Because if you have like lower abdominal area, then you know, you're always suspecting hospital inguinal hernia. And some of the things can be very similar, like, you know, if you're like, oh, coughing, you know, that can hurt the abdominals, but also it could be a hernia. I won't get into that too much, but those are things that we kinda look for. We wanna rule out that it's not other things as well. 

Mark: Sure. So what's the typical course of treatment?

Wil: Well, the biggest thing we gotta unload. So we gotta basically don't do things to put force or tension into abdominals. Like even, I mean, it's it sounds kind of funny, but not. We had an individual that had a tear in their abdominal. And even laughing really hurt. So I was like, if you wanna watch movies this weekend, don't watch anything too funny. Because you just gotta rest, right? It's gotta rest. And especially from the acute injury, you gotta give it that, you know, real good time period, 72 hours to let that acute phase kinda really settle down. 

And then once we can start to like move through now. Okay. The acute phase is over. Gently start to move through mobility phase or getting more range of motion through the torso. So obviously the range of the motion that you were working through that maybe that caused an injury, if it was an overstretch, then we wanna work those last, but we wanna start getting mobility. Because it can actually then cause other issues happening where you're compensating. And then working through strength. So the strengthening of not just where you've injured, but then now the core, the inner core. 

Quite often a lot of people like mistaken your abdominal muscles for your core muscles. Well, in sense it's true, but it's your outer core. It's not your inner core. It's not your stability core. Because your abdominals actually attach onto your pubis in your pelvis, all the way up into like your chest bone, like on the tip here.

And they don't actually have any attachments on your back. So the more inner core stabilizing muscle, they actually what you wanna work on. And there's like you know, specific regimen that we can prescribe to see where you're not activating, to really say, yeah, this is what you need to work on.

And that's key because when you have an abdominal injury, then you can be prone to having a back strain after, if you don't rehab them. Because then you're not activating your core properly. Then you're gonna start doing all the outer core muscles instead of the inner core that actually attach on your spine.

So then once you get the strength going a little bit more in this coordinated fashion, then now it's looking at, well, what we call functional strength and really getting you to build final stages of movement, like the end ranges of where you really need to to get them feeling like you're back to your full mobility strength.

Mark: If you had some kind of abdominal pain, that's not going away. You can't just rest and hope it's gonna get better. Get in to see the folks at Insync Physio. You can book online at insyncphysio.com, or you can book by calling them (604) 566-9716 for the Vancouver office. Or they also have a North Burnaby office, (604) 298-4878.

Both places book online. Very easy to do, but you have to book ahead. They're always busy. Thanks so much for watching and listening. We appreciate it. Thanks, Wil. 

Wil: You bet.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physiotherapy in North Burnaby. We're gonna talk about rehab specifically after surgery. How you doing Iyad? 

Iyad: I'm great, Mark. Thanks for doing this. How are you? 

Mark: I'm good. Is this something that you guys see a lot? People come in for help from a physiotherapist after they've had surgery?

Iyad: Yeah. A lot of orthopedic surgeries and even some neurological surgeries will involve a fair amount of rehab afterwards. Sometimes in the hospital, even like if somebody has like abdominal surgery or whatever, you'll see a physio involved. Unfortunately, what tends to happen is when people go home, they're discharged from the hospital, they're kind of left to their own devices sometimes, and then they have to figure out what to do.

Now, in some cases, you're lucky and you have some kind of instruction that's given post-surgically, like, you know, like a protocol of some sorts to follow. So that kind of helps a bit. Especially if the person has some exercise background. But often we see a lot of people kind of leave it be for a while and then they come in maybe a bit too late sometimes, and then they're like, oh, I wonder why it hasn't changed in the last month or so. It's because maybe they're not progressing their tolerance activity as well as they could have. 

And then in other times where people are told right away by the surgical team, we need you to kind of rehab this so, you know, consult a physiotherapist and work with them. So that's where we'll see them from the beginning and we take them along their journey and we work from anywhere from the adolescent kid who has a knee surgery after a ligament tear of some sort. All the way up to, let's say multiple traumas where somebody has like several fractures and they get, you know, potentially some hardware put into their legs and then all the way up to hip and knee replacements, which will happen typically in their like older group.

Not necessarily, but most commonly will be in the older group where people have had a long bout of arthritis, either the knee, a hip, and then they get the surgery and we'll help 'em come back to whatever level they need to come back to. 

Mark: So what's important about this in terms of changing the healing for someone? 

Iyad: It's actually really interesting. I was talking to one of our surgeon colleagues, and he labeled it as an interesting thing. He says, like, you know, to heal from a surgery perfectly, it's a three-way dance. So there's the surgery itself, and there's what the therapist recommends and there's also what the patient does.

So it kind of ends up being influenced by the three things. So obviously, like the surgery itself going well or not going well, it's gonna matter. But then also the rehab program has to be tailored for that person. Like for example, if you have a soccer player who wants to get back to high level soccer, and they had an ACL reconstruction, that program needs to prepare them for a return to play to soccer. Not necessarily just running in a straight line or just being able to do a squat, cuz that's great, but probably not enough for that person. 

And then the other thing that comes down to it is, you know, unfortunately as in a perfect world, you'd have supervised exercise day and night. But then some people are gonna need to do some of the home programs on their own, which usually we coach them through it and like, again, most surgeons are quite supportive of that, and they'll try to emphasize the importance of them doing the stuff at home. So we'll see that kind of emphasis on like some home program, but where it affects healing is in function.

So the way I kind of describe it to people, I'm like, okay, yeah, you had an ACL reconstruction, the surgery fixed the structure. So now that you have something that's restricting that shin from moving in let's say, abnormal way, well now it's up to you to make that knee work for you. And the way it works is like, you know, you gotta expose it to early phases, it's a lot of range of motion. Just to get over the stiffness and the swelling and all those things. And then you progress strengthening you know, there's flexibility in strengthening and there's a whole bunch of stuff including coordination. Control exercises that we would kind of work the way with.

And then, you know, I find it the most helpful also for people who tend to be a little more on the cautious side. So you see a lot of hesitation. People do a little less than they should sometimes. Obviously there are people who do too much. But honestly, for the most part, I see people who tend to under, let's call it underload themselves and under stress it because they're worried that it could, for example, harm the surgery or harm the knee or harm the hip or harm the ankle, whatever surgery they've had.

And I think this is where, you know, we work really closely with the surgeons to kind of give them the appropriate dosage of movement so that they're not under moving, but also not going overboard at the same time. 

Mark: How often is getting that chain of movement that needs to happen, it's not just a knee that's involved in rehabbing a knee. How much is it, and if someone's had a not necessarily a traumatic injury, but maybe arthritis or something, how often is that a really key component for the healing? 

Iyad: Yeah, of course, of course. That's a really important thing. Like, it's really funny actually, sometimes we have people coming in with boots and they said their instructions are not to weight bear for six weeks.

What we are able to do is get people exercising in non-weightbearing conditions. So we could do a ton of different loading programs and even like cardiovascular programs that don't involve weight bearing on the foot, for example, or on the knee or on the shin or on the affected area.

And that's kind of like, I guess, where we get to be as creative as we wanna be and we 'd stress the person's body in a good way so that they don't lose their capacity in other areas. So imagine you had a foot fracture and then you're not allowed to weight bear. Well, we could still get people strengthening their quads and their hamstrings and their musculature. And that won't affect necessarily the healing of the foot, but then it makes it so that when they're allowed to weight bear, their function is a lot higher to start with. And then we don't have to kind of go back and rebuild on some of those areas that have just lost their tolerance and capacity to do what we need them to do.

And again, this is gonna depend on person to person, obviously. Like if you're doing stuff in your ultimate goal is to be able to walk around with your friends. And that's obviously gonna be a lot different than somebody who wants to get back to rugby or soccer or hockey or anything else like that.

So that's where we tailor it to the individual. But then, you know, early days, a lot of it tends to be education heavy, where we just tell people like, look, this is what you're allowed to do. We give people some parameters to function between,. And then also educate them on when it indicates that if they went too hard or didn't go hard enough, like, cuz you know, people are scared of pain sometimes and rightly so if you don't know what you're dealing with.

But if you at least understand what that pain actually means, or it doesn't. You're much better off psychologically, cuz you're gonna be a lot more comfortable and confident, you know going through the motions and then doing your rehab. 

Mark: Bottom line, is it fair to say that this is about getting you back to the activities that you want to be doing quicker and more the way you used to be able to do it before the surgery.

Iyad: Yeah. And then like a lot of it is removing uncertainty. I really wanna emphasize like that uncertainty is usually the killer. People just look around and wonder like I'm gonna try to run for the bus today. Like, that's kind of like how I've had people kind of tell me. Yeah, that's when I did realize I couldn't run anymore.

You know, after like three months full stop after an ACL reconstruction. So, you know, it's about being, and also accountability is a big part of what we do. Sometimes when you're consistently being followed by someone, you kind of are more on top of things. But yeah, it is about building you up to what you need to do, and it's about restoring your function as well as we can.

But also it's really important for troubleshooting. I find sometimes we're able to identify things that maybe weren't obvious in the early doors, but you know, you'll start to see something and you'll start to see if there's potential complications that happen afterwards. Just having that contact point, like last month we had somebody who had a routine knee surgery.

The surgery was successful, it was great. Unfortunately, one of the wounds got infected. The patient had no idea that it was infected. You know, after two minutes of looking at it, we referred them back to their family doctor. They were able to contain that infection. It was starting to kind of spread around their knee.

So it was, it was good that we kind of dealt with that pretty early. But like that's kind of another area where, you know, again, in a perfect world, you see your surgeon every day, but then unfortunately that's just not gonna happen in any way, shape or form. Just because of the workloads and also like the role description that we each have and how we kind of fit into this healthcare model. So like that's kind of where, again, most of the time, you can think of it as like coaching to get you back to where you need to go.

Mark: If you've had surgery and you wanna recover back to well full function of whatever that is. Whether that's gardening, running, professional level sports. And you're in Vancouver or North Burnaby, the people to see are Insync Physio. You can book online at insyncphysio.com. They have two locations, North Burnaby and in Vancouver. The Burnaby location, you can also call (604) 298-4878 to book. You have to call and book ahead or book online. They're always busy. Thanks, Iyad. 

Iyad: Thank you.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum, he's the clinical director of Insync Physio in North Burnaby. And we're gonna talk about vestibular migraines. Wow, big words. What does this mean Iyad? 

Iyad: Yeah. Hi Mark. First of all, thanks for doing this. Yeah, so we've been seeing quite a few of these more recently. A lot of them don't know that those headaches are migraines because I think the word migraine's so commonly used, you know, people say, oh, I had a headache, but it's not a migraine. Oh, I have a headache and it's a migraine. A migraine isn't necessarily just a severe headache, but it also has to follow certain kind of criteria.

So usually in those cases, people suffer from, you know, diagnosable migraines, and then those migraines seem to have an additional kind of cluster of symptoms, which involve a bit of dizziness, a bit of vertigo. And you know, identifying those things is probably the first most important step. And we see a lot of people kind struggle with that.

Before the migraines, you know, from our physician colleagues, we tend to create a program that helps address any of the vestibular impairments that have created from the migraine. 

Mark: So I guess the obvious thing would be you've got a headache. The symptoms would be you've got a headache, but you are feeling vertigo. What's the difference between dizzy and vertigo?

Iyad: That's a great question. So dizziness is just the general term that we used to describe any feeling of being unsteady, being uneasy, like you know, people will have different descriptions for that. So they'll say, oh, I feel lightheaded sometimes.

And then some people will say, I feel like the room is spinning. That room is spinning phenomenon, that's vertigo. Because it's the illusion of movement in the environment when we are not moving. And then we have different types of dizziness too, where people say, I feel like I'm floating on a boat, that's another kind of complaint. Like you're riding a wave. Those kind of things where you feel a bit of unsteadiness when you move. All of those things could be called dizziness, but vertigo is specifically when we have that perception of things spinning or that the room is moving when you're not. 

Mark: So I imagine this is pretty upsetting for people to have the amount of pain that they're possibly having with the migraine and then the bloody room is spinning. Yeah. So what's what kind of causes, what are the possible causes? 

Iyad: We actually don't know what causes migraines. We know it'll affect certain people more than others. Women seem to be more susceptible to this. But we actually have, and there's been a few kind of theories about it, but there's no real kind of magic bullet that we could say, oh, this is what causes this. However, you know, whenever I see somebody in clinic and they've been complaining about spinning or dizziness or vertigo or whatever, one of the first questions we ask is to rule out headaches. And the reason we wanna figure out headaches is well, there's also the neck.

The neck can cause headaches sometimes. You can get something called the cervicogenic headache. But the neck can also be a source of dizziness where we have a bit of this, let's call it a mismatch with our senses, where let's say your vision tells you one thing, your inner ear tells you one thing and then your neck telling you something else.

So that kind of loss of position sense could cause that too. So that's why we wanna figure out what kind of headache they are now. Lucky for us, the neck headaches, most of us physiotherapists, even the ones who don't treat vertigo are quite adept at treating and assessing for neck related impairments that cause the headaches. But we tend to go a little step further into vestibular work, where we try to figure out what kind of headache it is. And if it is, let's say a migraine or if we're suspecting a migraine, we will pass them on to our physician colleagues, get them the help they need. And then we would treat the resultant after effects of that migraine. 

And I think it's really gonna worth noting that this is the thing that I see equally, over and under diagnosed, if there is such a thing. Again, a lot of people who say they have migraines when it could be a tension type headache or a cervicogenic headache where we treat their neck and they never have a headache again. And again, a lot of people who think it's tension and think it's stress, but it's actually just a migraine.

And so we would wanna kind of take our time and actually get a good idea of what type of headache we have. And we have certain criteria that help us kind of give clues as to is it this thing or this thing. The good news is, some people with just the treatment of the migraine completely lose their vestibular symptoms, which are the unsteadiness, the dizziness, the vertigo potentially.

And that's a good sign. So we try to really get those let's say differentiated, what type of headache we're dealing with and then try to get them the proper help, because it is very treatable. 

Mark: So what is the treatment? What do you do? 

Iyad: So our physician colleagues will prescribe the adequate medication for that. And that seems to be quite effective. At least the people that we've worked for in the clinic seem to respond quite well to that. Usually afterwards lets say we will assess things like, are they able to maintain their gait stability? We will assess for if they have certain movements that they're sensitive to, and then we give them a program to address those impairments.

There's really no one impairment or two impairment thing that you kind of say that, oh, people with vestibular migraines get. But they do get vestibular impairments that look a lot like some of the other things that we've talked about in the past, like inability to focus on an object while they move, sensations of the room spinning with the head turning so quick, you know, things like that.

And we try to just rule out what are we dealing with here? And then the most important thing is giving a program that's specific to the impairment that we see. Because the impairments are so wide, it's just really important for us to figure out what's the biggest contributor. Because some people just need to work on their balance and postural control and they get better.

And some people need to do more retraining of the reflexes, like the vestibulo ocular reflex, and a few other things that we would prescribe exercises for, to help figure out their impairments there, like if they have a gait stability issue, for example. 

Mark: So this does not sound like a candidate for Dr. Google to figure out what's going on. 

Iyad: It could be a good way to kind of figure out if you should talk to someone about having a migraine potentially and getting the help you need. But it's kind of hard for you to diagnose your own gait stability issues. I mean, it's really hard for you to see your eyes when you're trying to move your head side to side. So it is hard for you to self-diagnose. And it's way easier for somebody just to have a quick look at it, assess you and move on instead of trying to throw random treatments at the wall and see what sticks.

For the most part, if somebody has a migraine spectrum, they can't get medication unless they get a prescription for certain things. So it's not like you can just go to the pharmacy, just try random things. But yeah, I would just strongly encourage people who have this, to just get a workup and see, are you actually dealing with migraines or is this another type of headache? And if it is another type of headache, is this something that could respond to just regular treatment of manual therapy exercise and advice. 

Mark: So if you want expert help, if you're feeling dizzy, if the room is spinning, if you've got headaches along with it, the guys to see are Insync Physio in North Burnaby. You can reach them at their website, insyncphysio.com or you can call and book (604) 298-4878. They also have an office in Cambie (604) 566-9716. Thanks, Iyad. 

Iyad: Thank you.

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Wil Seto of Insync Physio in Vancouver. One of the top physiotherapy clinics in Vancouver, and one of the best physios in Vancouver. And we're talking about arthritis and how physiotherapy might be able to help you. How you doing Wil? 

Wil: I'm doing good. Thanks Mark. 

Mark: So I thought that, you know, arthritis was just, you take pills to try and make the pain go away and you just, you, you live with it. Am I wrong? 

Wil: Well, let's say you can break it down a little bit more. So let's talk about like one specific type of arthritis that we actually deal with a lot with our physio group at the clinics. And that's called osteoarthritis. So there's all these other different types of arthritis, which like rheumatoid arthritis and then all these other arthritis is that are basically kind of more systemic in origin. And you take pills for that as well.

And, you know, sometimes with the osteoarthritis and I'll explain to you what that is in a second, but like with osteoarthritis, you know, sometimes the doctor will actually also prescribe Tylenol as a pain reliever. And so what osteoarthritis in very simple terms, It's just basically a degeneration of your joint, based on wear and tear. So there's not a systemic issue going on in terms of like the same type of rheumatoid arthritis. So with rheumatoid usually affects multiple joints and it's not like isolated to one area because of wear and tear.

Now, if you've had like an injury per se, so I'll give you a specific example. Like let's say an individual, an athlete, tears their ACL and their meniscus, and they have to get that meniscus that little cushiony part in the knee removed and the ACL repaired. Now they lack more of that cushion. Now it is true that you will have a higher chance of developing osteoarthritis cause it's the wear and tear of the joint.

So this is where, you know, the question of how does physio help with this type of arthritis. That's a very good question. And ultimately, you wanna look at the joint being like, so in the joint you have what's called synovial fluid. Synovial fluid is basically like the oil for your joints.

And so you essentially wanna keep the joint moving and that's gonna keep joint healthy. And what you also wanna do is you wanna keep all the muscles around that joint functioning and healthy too, which will keep the joint moving in equilibrium. Because the other thing you don't wanna do is that you don't wanna have excessive amounts of force pulling on that joint because there's imbalances in those muscles.

So for example, going back to the ACL example. Let's say I get super, extremely tight in one of my quad muscles, my rectus femoris, because you know, like I compensate post injury or whatever. And so now I'm gonna get a lot more increased excessive forces on my kneecap, which is called the patella. And it's gonna come up, causing a condition called patella alta. So what happens is then you're gonna get that rubbing and you're more prone to a degenerative effect in your kneecap. So we want balance things out. We don't want to have things imbalanced. And so that's important too.

Now, going back to what I said about that synovial fluid. The more, we keep the body moving, the more that we pump the fluid in and out. So that fluid carries nutrients to the joint, because usually in the joint, you don't really have a rich blood supply. So then you would need to rely on that synovial fluid and you need to have a pumping mechanism.

So merely getting the joint moving, pumps out that old synovial fluid and then pumps in fresh nutrients for that joint, keeping in healthy. So that's how physiotherapy can help. Prescriptive exercises looking at what exactly is tight, what exactly is weak, to support a more optimal alignment. Either of the joint. So in your knee, for example, if you're like a runner and you're trying to get back to running post injury. Maybe your hip muscle, called your gluteus medius is weak and it's causing this alignment issue when you're running in your knee. 

So we address that, then that's gonna make things move more smoothly in the knee, and you're not gonna get an abnormal biomechanics happening in the knee. And so that's the really important thing is we're also retraining your neuro muscular system. So neuro being the nerve, muscle skeletal system. So getting that all, working together properly. Helping you develop a more optimal way of moving those muscles around that joint for better joint health.

Mark: So bottom line, if you've got some arthritis showing up, pain, it needs to be diagnosed by doctor first. Correct? 

Wil: Yes and no. We get a lot of people that come in that haven't been seen by a doctor. And we're like, yeah, that looks like osteoarthritis. And, you know, you can confirm it with a scan, but if it's really kind of borderline, you're not really sure. Then we send in the doctor for more additional tests, maybe rule out other types of arthritis. So that's possible too. 

Mark: And you work in conjunction with doctors all the time? 

Wil: Absolutely. Our whole team does, yes. 

Mark: Referring back and forth. So if you've got some joint pain, And you want expert analysis and you wanna see if it can get better or you've been diagnosed with osteoarthritis and you want to not have it get worse. Cause if you don't do anything, it's gonna get worse. But if you start moving in a proper way, you're gonna get that synovial fluid in there. You're gonna have a longer expectation of good movement in your joints. And a lot less problem when you're 90 years old, like my dad, and can't really move all that well. And so you want get into Insync Physio. Where to book Insync physio.com or you can give them a call. The Vancouver offices, (604) 566-9716. And they also have an office in North Burnaby. Thanks Wil. 

Thanks Mark. And remember motion is lotion.

Lie on your stomach on top of a built up mat 5-8 inches high. Keep your feet wide apart with toes to the ground, with your face and chin clearing the mat and your arms straight and wide grasping a large exercise ball on the ground.

Dribble the large exercise ball with both hands while you keep your front lower core engaged and lower back straight and so you prevent it from going into extension. Activating the lower quadrant core muscles will enhance and optimize your strength and movement patterns to your full potential. Repeat this for 10 seconds doing 10 reps 2sets daily.

This exercise can be progressed by increasing your dribbling up to 20 seconds for 5 reps 2 sets and ultimately to 30 seconds for 3 reps 2 sets.

If you have any bad or questionable pain or discomfort discontinue this exercise and consult your local physiotherapist before continuing. 

Mark: Hi, it's Mark from Top Local. I'm here's Wil Seto, Insync Physio in Vancouver. One of the highest rated physiotherapy offices, most popular in Vancouver and North Burnaby. And we're going to talk a little bit about some of the deeper reasons why Insync Physio does things the way they do. How you doing Wil? 

Wil: Yeah, I'm doing great, Mark. Thanks for the introduction. So I really believe, I strongly believe in our commitment to excellence. And the way that we do that is by having myself and our physio team commit to having their skills and their training and expertise at their top game.

And so we have training in sports physiotherapy and advanced manual therapy, which are two specialty areas that are basically very vigorous training programs, where at the end of it you get all this expertise in terms of assessment and treatments and skills that are internationally recognized.

So we have therapists that are always looking to better themselves. And we're very evidence based practice. We use the most latest research evidence to really look at the underlying cause and the root cause of your injuries and aches and pains. So, that's the first thing. 

The second thing is really our care and commitment to caring and helping people. And I mentioned this before, in previous segment about how we really just want to, you know, provide people with that ultimate experience of being able to find, you know, their best way of moving and being able, overcome their injuries and their aches and pains. And that's super important for us because that's the most gratifying thing for us. And we love to be able to do that. That's what drives us to be better.

And the third thing is really, and I mentioned this before, about one of our core things is their commitment to building a better and a stronger community. And that's do not just the people that we help in the clinics, but even ourselves within the clinics amongst ourselves, where we always try to make each other better. We always share our information when we are helping each other. It's like, as one person goes up the ladder, we're all pulling each other up. And so this is really cool dynamic that we have as a team. And as a result, we're able to then have that transfer over to our clients in the clinic. But then also within the community that  we work with other allied health care professionals. Like doctors, even some of the sports med doctors we work with and people like kinesiologists and trainers, and healthcare people that are involved in the overall picture. 

So the biggest thing then is you know, why Insync Physio and you know, what does it mean to come into our clinics?

So what, you know, I think ultimately it's like, what do you want to become in sync with? So when you have an injury and when you have aches and pains, you know, we're helping you to not just overcome your aches and pains and your injuries, on the physical level. So it's like, what do you want to become in sync with?

So looking at that physical aspect, but looking at how you think about that process. Looking about how you want overcome that injury and looking about how you feel about it. How do you feel about yourself in the process and how we can get you from that A-B process as well? Because ultimately, you know, we will listen. We will definitely listen to what you want. Like with so many different variety of people from like, you know, the super, highly competitive athletic population where, you know, we've had athletes that I've worked at the Olympic Games. To World Championships and National Provincial Championships. To the weekend warrior where we know what you want and we will listen to you, but ultimately we will help you with what you really need.

And so going back to that question is what do you want to become in sync with? And that's a really important question that we try and bring back to ourselves all the time is how can we help you, but ultimately, how do you want to be involved in that process? 

So I hope with everything that I've said about that today that really inspires you to just think about, you know, whatever injuries and aches and pains that you're having and goals that you have for movement and physical activity and other sports. Or even just staying fit and active that you ask yourself, what kind of involvement in your own process in this that you want to be a part of. Because ultimately, when you look at the healing cycle, it's us helping you and also you helping yourself by looking at how you want to be involved in this process as well.

Because as much as we can provide a lot of the technical things and all the hands on things to really give you tools, that's what we have. Like, I feel like we have these tools that we can provide for you. To help guide you along that path for healing. And the healing isn't just the physical. I mean, yes, you're going to experience, you know, like a progression of whatever injury that you're experiencing, whether it's like whiplash, a spinal injury or, you know, rotator cuff impingement related injuries or whatever it is. Ultimately it's going back to looking at how you can also be an important part, an integral healing process to your recovery. 

So thanks for listening.

Mark: Insync Physio, you can reach them at insyncphysio.com. Check out their ratings. They have many, five star ratings. They're all five stars. Vancouver, (604) 566-9716 or in Burnaby 604-298-4878. Call to book, or you can book online at the website. Thanks Wil. 

Wil: Thanks Mark.

Hey Everyone! It’s Wil Seto from INSYNC PHYSIO, Sports & Orthopaedic Rehab clinics.

As most of you know, we’ve closed our clinics since mid March to help stop the spread of Covid-19. It’s drastically changed the way we live now. Our united efforts in practicing the safety guidelines outlined by the Ministry of Health in BC seem to be working. Evidence shows the curve is flattening and in fact dipping.

On Friday afternoon May 15th, The College of Physical Therapists of BC officially announced guidelines to help us re-open our clinics on Tuesday May 19th. We are looking forward to being able to help you, our patients in the clinics again.

Most of our Physiotherapists will still be offering virtual online consultations to continue helping our patients who prefer this modality. As we navigate this new landscape, we will have clinic guidelines and cleaning protocols in place to keep our community safe.

We look forward to welcoming you back again! Thanks!

Masks are mandatory for the duration of your visit. If you do not have a clean mask on or did not bring your own reusable mask, you will be asked to purchase a mask for $1.50.

Tim: Welcome everyone. My name is Tim Begley. I'm here with Iyad Salloum. He is a physiotherapist who is offering tele-health. So I'm excited to find out more about telehealth and exactly what it is. So Iyad, please tell us what is telehealth? 

Iyad: Yeah, thanks Tim. So basically when you go see your doctor, your physiotherapist, your chiropractor, any practitioner, really, your assessment, you know, for a new injury involves, you know, a little conversation about what happened and the patterning of it and how it's affecting your life. And then, you know, they proceed to assess you and provide you with some kind of treatment ideas and treatment plan. 

Tim: Normally it's, you go in person. As a person. 

Iyad: Yes. Yes. You'd hope so at least. And then I'll, you know what, this is, what tele-health allows us to do is deliver that same kind of a service just to be a different medium. So we're using either a video conferencing platform, kind of like you and I are doing here, or just over the phone and it really just, maybe cuts out some aspects of the in person contact, but maintains that the meat and potatoes of this whole interaction, which is, you know, what can you do about your injuries and what can you do about your own function and recovery?

Tim: Right. So instead of someone actually, you know, going, attending a clinic. They would from their computer, from their home, they would hop on exactly like what, this is, which is a conversation, right? Whether it's a video or phone call but they'd have a conversation and then, so then you'd be, I guess you'd be asking them, would it be the exact same questions as if they showed up in person.

Iyad: I think it would be more or less the same. There might be a little more focused on the patterns of this, because it's one of our main diagnostic tools that we have. And to assess you properly is, you know, that the subjective history, the history of the complaint and the patterns of it. So yeah, I think it's, although it's different, it's more or less the same. 

Tim: Right. Right obviously it's not exactly the same, but similar questions. That's awesome. I know a lot of people are very excited about this right now, and you know, but there's a lot of practitioners who are starting to offer it from like a client perspective, from a patient perspective. Do you think that people will be successful even though they're just tuning in from their home from their computer. They're not actually coming. You can't actually, you know, see them. Do you think people will still be successful? 

Iyad: Yeah. There's no reason we think that it shouldn't be. We have actually a lot of data on this too. So we've studied this. Is it as effective as, as other forms of treatment, like in person treatment or other kinds of ways that it's delivered in classes. Yes actually is shown to be very successful at improving people's quality of life, reducing their pain and improving their function. So I have no doubt that people could be successful using telehealth.

Tim: Yeah. So people will be successful. And there's also, it's not just your opinion. There's actual research studies onto this now too, aren't there? Because it's been around for a little while. 

Iyad: Tons. Yes. There's actually two big reviews. They've done a review on just the surgical  patients who have had an operation and it's, they've clustered all these surgeries together and they found that these guys do really well actually with tele rehabilitation where the rehabilitations delivered via video conferencing or phones, like a phone call.  And then there's another one that they just looked across all the populations and they found that a), it was not inferior, so it means it wasn't worse. You want to always deliver something that's not a second grade treatment. Right. You want to always deliver something that's just as good, if not better than, than the standard of care. And then the other thing is that it has actually shown some success in improving people's functions and reducing it.

Tim: Right. And you know, one thing I've found with respect to exercise is if you're prescribing exercises to people, is that, you know, you can show somebody how to do an exercise in person but he's still gonna forget. And you know, whether you're showing them in person or you're sending them a routine, it's really about having good tools to help them remember it, help them stay on track. Do you have tools that you would use to communicate exercises with people? 

Iyad: Yeah. Luckily a lot of the interfaces and the platforms that we use to interact with our clients have a, you know, a different things like screen sharing or different things like where we, the software that I'm going to be using, has embedded exercise prescription attached to it with videos and descriptions. So those are going to be things that are going to be supplemented, you know, throughout the interactions and then given to the client so that they can go and apply these things, you know, in between sessions, let's say. Right. And I think this is really the most important thing when it comes to a building patient self-efficacy and you know,  letting them take charge of their own treatment instead of you know, being handed off to someone, fixing for them. And I think that's why that's probably why we see really good success with this platform.

Tim: Totally. Yeah. And self-efficacy, I'll, maybe I'll speak to that a little bit while you, if you want to pull up and share your screen and show us what the tool looks like, that'd be great that you use. But I think ultimately it comes down to who's the one in control. And for a lot of people, if they turn up to a clinic, they might think that it's up to the practitioner to help them get better. 

And one of the great things about it being remote is I think that people really, feel as though it's up to them to figure this out and to learn how to, you know, be in charge of their own health care and make sure that they recover. So this is what the tool looks like. So I see you have lots of different exercises you can send to people. And then is that a video?

Iyad: I can customize the sets and reps based on what we assessed in the session, basically. So I can get this guy, you know, four sets of 10 per leg.  So this is my quarantine exercise program here that I've designed for some of my clients who want to stay active indoors and maintaining their social distance from other people. So in the absence of gyms, you know, these are definitely good options for you to, to stay healthy and stay fit, which are actually good things for your health overall anyways. 

Tim: Awesome. That is great.  If you want to drop that screen share now and then, you know, a question that comes up really frequently cause you know, I think a lot of people are going to see this. They're going to be like, you know what? I would really benefit from that. You know? Iyad is a very sharp practitioner and he's going to be able to help you find great, especially, you know, if it's like exercise rehabilitation, a great routine. People are going to wonder, you know, is extended health gonna pay for this? Is WorkSafeBC. ICBC. Like are people going to have to pay out of pocket? Can they pay out of pocket? Or is their insurance coverage? Maybe you could speak a bit about how that would look. 

Iyad: Yeah. So initially, you know, cause it's still relatively new to, as a third party payer system, especially extended health providers. You know, like ICBC and WorkSafe. We've seen some changes in the last week. So WorkSafe and ICBC have decided to approve coverage up to the end of the month and they're going to constantly review this. Obviously as things change, I imagine that that line of the end of the month might change very soon with you know, the more we have changes in the province here with the cases of Covid-19. Some other extended health providers, it's been on a case by case basis. So we've actually been able to get coverage for some of our clients but they would have to call in and talk to their providers directly because each plan is different. 

Tim: And I know there's a lot of different insurance companies, a lot of different extended health so probably the best thing for someone to do  is to call their insurance company too, but they could also reach out via the links to the clinic for you or to the practitioner they work with to make sure that tele-health is being offered as well right?

Iyad: Yeah, yeah, exactly. And, the other thing I would really recommend is  to kind of, look at the facts and ask them directly about this. Make sure you have your plan number when you call in, just so that you know, you're actually asking if your plan specifically covers this. From what we've seen some providers have approved this in the meantime. It can be a temporary thing, but I imagine in the future this is going to be a little more complex. 

Tim: Awesome. Yeah. And you know, the other thing especially as it relates to people either deciding they're going to pay out of pocket or, and an insurance company is, you know, is this for everyone? Is this gonna work for every challenge, every ailment? Everyone who would normally come in person? Do you see this working for everyone? 

Iyad: So that's actually a really good question. And the way I would answer this is, you know, when you go see, you're a practitioner in person, let's say a physiotherapist or even your family doctor, a lot of the times, the first session tends to be a triaging session where we try to figure out if this service is appropriate for you. 

Tim: Right. And so by, by triage, you mean you're deciding whether or not to treat them or whether to send them elsewhere? Like, Oh maybe it's more of an emergency than they realize. And you need to call nine one one. Right now. It's less of an emergency and there's something that a different practitioner or a different direction for them to go.

Iyad: Absolutely. So for example, somebody comes in with complaints of numbness and tingling, but we think it might be related to their diabetes we're probably not the best practitioner in that case to help manage that in the meantime. So we can refer them on to their primary care physician to kind of quarterback that. And then vice versa. Let's say if somebody goes in with a case of mechanical low back pain or neck pain or one of those, or just trying to get active, again, trying to get conditioned and want to do, somebody who wants to do this safely. Their family doctor's probably going to end up referring them to a service like ours to help them with that process.

So yeah, I think the first session is probably prudent on that. We need to make sure that the service is appropriate for you. So I imagine if physiotherapy in person is going to be appropriate for you, then so will tele-health. Obviously the biggest difference, there are a few differences in terms of what you're able to get and what you don't get. But generally, I would say for most musculoskeletal conditions, they should be okay for you. 

Tim: Right yeah. And I think you know, I think that that makes good sense, especially in the beginning to point people in the right direction. And, you know, like I've had IMS treatments before, which is a fairly aggressive in person treatment. So obviously, you know, seeing the practitioner, getting that kind of treatment, it's going to be entirely something you wouldn't do remotely. But I think that particularly for pointing people in the right direction, setting themselves up with things they can do on their own at home, regardless of what equipment they have or don't have, is going to be tremendously valuable to people.

Iyad: Absolutely. We see in, in all our history of being an evidence based profession. What's one thing that consistently stands the test of time is good education about your condition, a good knowledge about what's safe and what's not. And also self management tools. And you know, let's call them the cure. How do you fix yourself in this case, right? Those are the things that are gonna help you long term. I'm not saying that nothing else works. I'm just saying that you will still get better if you know what to do properly. Right. It's just going to look differently than if you were to, let's say, go to the clinic, get some manual therapy, some IMS on top of your exercises.

Tim: Awesome. Yeah, I think this has been a great, you know, short overview of what tele-health is about. Thank you so much Iyad for joining me here. 

Iyad: Yeah, thanks Tim, keep pushing the good content out there. 

Tim: You bet.