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.

Hi everybody. My name is Adam and I'm a registered physiotherapist with Insync Physiotherapy. I'm here to tell you about an exciting new service we are offering. In light of Covid-19, Insync Physio has admirably decided to do our part of social distancing by temporarily suspending all in-person client care. 

While we recognize that health concerns and injuries continue to arise, many are still recovering from injuries and, or continue to struggle with chronic pain. Clients still require exercise for progression and benefit from advice from our movement specialists to return to the activities they love. 

Because we do not know the extent of this pandemic. We have proactively launched a partnership with Physio Track and Jane App to offer a secure encrypted tele-health video appointments. Appointments will be offered during regular clinic hours and it can be booked online using www.insyncphysio.janeapp.com.

We can also call in, to book the appointments. So far, appointments can be booked for 30 minute assessments and 15 minute followup appointments. During these sessions, you and your physio therapist will discuss your injury, perform an assessment, and go over exercises, which will help you move better.

We're really excited about the service. We've already completed several treatments and we find that it is a really great way to just connect with clients and make sure that they're getting the care that they need. So if you're interested or have any questions, please email us  at infoatinsyncphysio.com. Or give us a call at (604) 566-9716. Thanks and stay healthy.

This is a strengthening exercise for your gluteus medius and your Sacroiliac joint.

Start by positioning yourself in right side lying if the right Sacroiliac joint is the injured side. Position your right forearm on the ground with your low back and legs straight, feet together and your inner core muscles engaged below your belly button. Keep your low back flat and your body in a straight line as you lift your right hip off the ground so your body weight is supported by your arm, shoulder and foot.

Then raise your left arm straight up pointing your hand to the ceiling and lower it back down. Do this arm motion ten times for a total of ten repetitions on each side, twice per day.

If you’re unsure about the exercise or have any uncertainty about where you’re at with the recovery of your Sacroiliac joint, consult your local Physiotherapist before continuing. 

As summer begins approaching, hiking can be a great low-impact workout to engage in, offering numerous physical and mental benefits. Walking is one of the lowest impact sports around, but with the increased variability that hiking provides, this adds increased difficulty, hence increased health benefits to the activity. According to the American Hiking Society (2013), and Healthy Families BC (2013), a few of the benefits hiking can provide include: 

• Increased general fitness levels – one hour of hiking can burn over 500 calories depending on level of incline and weight of your pack!
• Reduced risk for heart disease
• Lower blood pressure and cholesterol levels 
• Improved control over healthy weight, and lowered body fat
• Improved bone density and osteoarthritis outcomes
• Reduced stress, improved mood and enhanced wellbeing 
• Increased flexibility and coordination 

American Hiking Society (2013). Health benefits of hiking. Retrieved from http://www.americanhiking.org/wp-content/uploads/2013/04/Heath-Benefits-of-Hiking-fact-sheet.pdf

Faktor, M. (2013). The health benefits of hiking. Retrieved from https://www.healthyfamiliesbc.ca/home/blog/health-benefits-hiking