What We Offer in Our Physiotherapy Clinic


What We Offer in Our Physiotherapy Clinic | Nova Active Rehab

If you’ve ever suffered from a case of tennis elbow, a strained muscle, or a back injury, you probably know firsthand what a difference a trusted physiotherapist can make in your recovery. Physiotherapy can provide some much-needed pain relief and it’s a therapy that focuses on strengthening the body to restore function and mobility. Physiotherapy will also provide you with education on how to reduce your pain and prevent it from coming back. It’s this philosophy of equipping patients to manage their injury that makes it so effective.

Nova Active Rehab has been helping residents in Port Coquitlam and the surrounding areas for years, regain their strength after injuries. But what exactly do we offer in our physiotherapy clinic?

1. Solutions

The number one reason to start physiotherapy is simple: it works. If you’re experiencing a soft tissue injury or if you are dealing with chronic pain, physio could be a great option to finally find some relief. Fully backed by medical research, physiotherapy applies scientific knowledge of the human body, helping people rebuild strength after their injury or debilitating condition. 

Regularly seeing a physiotherapist can help manage your pain levels, as well as helping you to stay mobile in your daily life. In addition to assisting with current pain and injury, a physio treatment can actually prevent future recurrence. Say you have a history of back pain and injury—working on strengthening the muscles in your back can dramatically lower your chances of randomly injuring yourself. Couple this with improved flexibility and mobility, and the benefits of physiotherapy become very clear. 

2. Accessible, trusted experts

Our staff is highly trained in anatomy, physiology, and sports injuries, with years of theoretical and practical experience with the human body. No part of our bodies exist in a vacuum—each body part is affected by surrounding tissues, and impacts the areas surrounding it. Understanding the interplay of each part of our bodies is a crucial skill when it comes to treating patients. A physical therapist must have intimate knowledge of how an injury in one area can affect other parts of the body, and in turn, know where to start when approaching treatment.

Nova Active Rehab also offers telehealth physiotherapy, a new way of getting the benefits of physical rehab from the comforts of home. Online physiotherapy is a great option for people with very limited mobility, who may not be able to easily leave their homes. We are dedicated to helping people everywhere live an active, healthy, and pain-free life, which is why we’re so excited to offer this remote alternative to traditional sessions.

Nova Active Rehab’s staff members are friendly, professional, and good at what they do. What sets our team apart is our passion for physical health and wellness. There’s nothing quite like watching a patient’s strength, mobility, and even their overall outlook improve over the course of their treatment. We get a lot of satisfaction out of working with our clients to overcome their physical obstacles. Physiotherapy technically focuses only on the physical, tangible elements of recovery, but we believe that the mental aspect is just as important. By having a dedicated team of specialists behind you, celebrating your victories and helping you overcome limitations, you’ll find recovery to be even more achievable.

3. Customized treatment plans

It might be a cliche at this point, but it’s true: there’s no one correct way to tackle physical rehabilitation. Even if you were to compare two patients with the same injury, you still wouldn’t be able to approach their recovery in the same way. In addition to the mental aspect of recovering from pain or injury, which is different for everyone, we all have different limitations to work within. Some people have a much lower pain tolerance, meaning that exercises might need to be adapted to be less challenging. Likewise, we all move differently, so a patient’s mobility and flexibility will need to be considered when developing a treatment plan.

All these factors, and more, are taken into account when creating a recovery plan at Nova Active Rehab. We take the time to sit down with you in our consultations, in order to get to know you, your life, and your body. Once we have a strong foundation of knowledge, we can move forward with treatment. We’ll lay out a roadmap to recovery, and check in with you frequently to see if any adjustments are necessary.

4. Goal-focused recovery

Various disciplines of physical therapy are sometimes criticized for not having a clear end-goal. If you’re dealing with an injury or chronic condition, the last thing you want to hear is that you need to attend therapy in perpetuity, with no end in sight. And while not every issue can be solved quickly, we believe in the power of goals to motivate recovery. If we are treating a person with a car accident injury that prevents them from working, our end-goal might be to get that person fit to return to work. If we’re treating a basketball player with a strained hamstring, we’ll focus our treatment around the goal of getting them back on the court. These long-term goals give us something to work toward, and remind patients why they’re doing physiotherapy in the first place.

For injuries that are more long-term, goals can still be used to great effect. If a patient is dealing with long-term pain, we might create goals around pain management and strength, aiming to control and limit the amount of pain they experience on a day-to-day basis. In addition, shorter term goals can act as waypoints on the map to recovery, giving patients a more quickly achievable objective. This could be flexibility goals for someone with chronic pain, which are good signifiers of improved strength. Overall, we are big believers in the power of goal-based recovery and rehabilitation. In order to achieve the best possible health, patients need to be motivated to continue their treatment, in the clinic and at home.

Physiotherapy at Nova Active Rehab

If you’ve been living with an injury, or chronic pain, and you’re simply bearing with it in the hopes it will get better, it might be time to consider physiotherapy. Similarly, if you’ve just been the victim of an accident or injury, whether automotive or sports-related, you stand to gain a lot from dedicating yourself to your recovery.

At Nova Active Rehab, our team of expert physical therapists employ their skills, knowledge, and hands-on experience to help guide you through the process of rehabilitation. By no means is physical recovery an easy journey—it takes work, discipline, and faith in the process. However, with Nova Active Rehab’s goal-based treatment, customized recovery plans, skilled physical therapists, and effective practices, we can help make the road to wellness a whole lot less challenging. 

If you’re ready to get started with physiotherapy in the Tri-cities area, please contact us today, and set up your first consultation.

Comparing Physiotherapists and Kinesiologists


Overview

If you have ever wondered what the difference between a kinesiologist and a physiotherapist is, or you have no idea what a kinesiologist is to begin with, you have come to the right place. The information that follows will give you a better idea of what each profession is, and when you might want to consider seeing one and/or the other.

Keep in mind that this information is about kinesiologists and physiotherapists in British Columbia, and may not be completely accurate when applied to other countries, or even to other provinces or  territories within Canada.

Education

First off, it is important to understand the educational differences of the two professions:

  • Kinesiologist: Before practicing as a kinesiologist, individuals are required to first obtain a bachelor’s degree in kinesiology (or equivalent, such as human kinetics) at an accredited post-secondary institution. This is four years worth of studying and practical experience.
  • Physiotherapist: To become a physiotherapist, a master’s degree must be earned following a bachelor’s degree. Most individuals will acquire a bachelor’s degree in kinesiology first before going on to receive their master’s in physiotherapy. Combined this is six to seven years worth of studying and practical experience.

As you can see, physiotherapy requires a greater level of education than a career as a kinesiologist. This gives physiotherapists an even deeper understanding of human anatomy and musculoskeletal injuries, and expands their potential scope of practice (eg. ability to learn and apply more invasive techniques, such as dry needling).

However, it is important to note that there are many options of continuing education for individuals in either profession once they have begun working. In other words, a kinesiologist specialized in gait analysis of marathon runners is likely more knowledgeable in this area than a physiotherapist specialized in rehabilitating individuals who were in car accidents, and vice versa. Furthermore, while it is not required at any point, both kinesiologists and physiotherapists can progress further academically if they so choose.

Methods of Treatment

Given the significant amount of overlap in the education that both professionals have, you might be wondering why these are distinct professions. While both are heavily educated in human anatomy and biomechanics, and both can prescribe a rehabilitative exercise program, the primary methods of treatment are what largely separates kinesiologists from physiotherapists.

  • Kinesiologist: Most kinesiologists are primarily active therapists – they use demonstrations and educate others on how to improve themselves physically. For example, they can teach clients how to correctly perform strengthening and stretching exercises that are relevant to their needs. They can also assess and give advice on how to improve posture, gait, and other biomechanics. Kinesiologists can apply these techniques in a fitness context with athletes, or a rehabilitation context with injured individuals.
  • Physiotherapist: Most physiotherapists are primarily passive therapists – they perform various techniques that require minimal effort from the client. Dry needling/intramuscular stimulation (IMS), cupping, manual stretch, massage, transcutaneous electrical nerve stimulation (TENS), laser, taping, shockwave, and extracorporeal shockwave therapy (EWST) are several examples of different passive therapeutic modalities that a physiotherapist may use. They work almost exclusively in a rehabilitation context.

As with the section on education, it is important to understand that these are not strict rules that the two professionals must follow. Kinesiologists can learn how to apply many of the same passive modalities as physiotherapists, just as physiotherapists can choose to provide more active rehabilitation. Typically it comes down to a combination of the needs of the client and the preferences and expertise of the professional.

How Do I Know Which Professional to Choose?

In many cases physiotherapists and kinesiologists go hand-in-hand. For example, if you have recently been in a car accident and you are still experiencing a lot of pain and decreased mobility, it is probably better to see a physiotherapist. The various passive techniques can help manage pain, increase mobility, and will typically be a lot less demanding on your body than engaging in active stretching and strengthening.

At some point you should transition to seeing a kinesiologist, as they can further your strength and mobility with an exercise program that you can perform on your own, even once you are no longer seeing the kinesiologist. This will likely come at the recommendation of the physiotherapist or your physician.

There are some situations where you may only want to see one professional or the other:

  • Kinesiologist: If you are not suffering from a major trauma like a car accident or a severe sports injury, but rather just some overall stiffness and difficulty doing certain physical tasks, you may be able to just skip right to seeing a kinesiologist. The same might be said if you are looking for a strength and conditioning program specific to your athletic goals and needs.
  • Physiotherapist: Many extended health plans cover physiotherapy but not kinesiology. For this reason, physiotherapy alone might be a better option financially if you do not think you need extensive rehabilitation. You may also choose physiotherapy if you believe you are in good shape, but you are just having a bout of pain or stiffness that passive treatment might help manage.

References

https://study.com/articles/Kinesiotherapy_vs_Physical_Therapy_Whats_the_Difference.html

Proper Posture and Postural Cues


What is Good Posture?

Posture can be defined as the position or alignment of body parts. Good posture is when our body is positioned in a way that places the least amount of strain on our ligaments, bones, joints, and muscles. Click to read about neutral spine. It should be relatively easy to maintain such a position for extended periods of time. 

What is Meant by Center of Mass and Base of Support, and How Are They Related to Posture?

Describing what good posture looks like is more complicated than you might think. To start, it is important to understand the concept of center of mass. Center of mass can be thought of as the single point where all the mass of an object is evenly distributed around. For example, in a uniformly-shaped object, such as a perfect cube or sphere, the center of mass would be in the exact center. In a human with a healthy weight, average dimensions and who is in a standing position with excellent posture, the center of mass would be located inside the body, behind the navel (belly button) and near the bodies of the lower lumbar vertebrae.

A second important concept is base of support, or the area beneath an object that is bounded by the points of contact that the object has with the supporting surface. Again, this is explained better through an example; if we think about our ideal human in their perfect standing posture, the base of support would look something like a trapezoid. Furthermore, when standing with good posture our center of mass should be situated over the base of support that is created by our feet. Ideally, it would be directly between our feet so that there is even distribution on both sides of our body. The following picture will help demonstrate this:

Notice the trapezoid-like “base of support” (marked in green) that is created by the contact of our feet with the supporting surface. The red dot labeled “center of mass” is where the center of mass of our body should be located in our base of support (when we are in good standing posture) if we were to draw a straight line from it down to the ground.

What Does Good Posture Look Like?

Now that we understand how posture works, we can establish what this looks like in the human body. The following pictures will show some of the many reference points you can use to help you find a good posture:

What Are Postural “Cues”?

Postural cues are simple ways of reminding ourselves to adjust our posture into a better position. Of course, there are an infinite number of cues you could develop for yourself, so long as they adhere to the information about good posture provided thus far. The following are a few memorable ones that I have picked up over time:

  1. Drool Test (Head/Neck) – If you were to let yourself drool to the point where the saliva ran from your mouth and down your chin, then when it drips it should land at the top of your sternum. If the drool lands in your sternal notch (concavity at the base of the neck behind the sternum), your head is too far back. If the drool lands past the top of the sternum, then your head is too far forward. You could also place a ruler against your chin and down to the top of the sternum. If you reach a point where you as feel as though you are restricting your airway, even if it is before the ideal position of the drool test, stop the movement before that point.
  2. Shoulders Back/Chest Puff (Shoulders/Chest) – It is becoming more common to find individuals with shoulders that are rounded forward, and a chest that is rounded inward. If your shoulders are too far forward (refer to pictures of good posture) then you simply need to remind yourself to pull them back slightly. At the same time, puff your chest out minimally. It is important to realize that these are small, subtle movements; if you pull your shoulders too far back you are asking for backward rounded shoulders, and if you puff your chest out too far you are going to hyperextend your lumbar spine.
  3. Spread the Ground (Hips) – In an ideal standing posture, our feet should be pointed just slightly out from perfectly straight forward. Feet that are pointed inward or markedly outward are less optimal. This postural cue will help with feet that are pointed too far out (more common than inward-facing). Essentially, you want to push outward from your heels, as though you are trying to spread the ground apart that is directly beneath you. You should feel work from the muscles around your hips.
  4. Soft Knees (Knees) – From your neutral standing posture, if you were to suddenly extend your legs at the knees, your knees should move backward slightly before “locking”. If no movement occurs at the knees when you perform this action, it means that your knees are already locked in your neutral position. For this postural cue, remind yourself to unlock your knees ever so slightly when standing. It will likely feel very odd for the first few days, but your body will eventually adjust.
  5. Arches Up (Feet) – If the arches on the inside of your feet are absent (flat arches), it can strain and alter the posture of other parts of the body, such as the knees. For this postural cue, activate the muscles in your lower legs that pull the feet upward at the arch, but maintain contact with the floor at the balls of your feet and your heels. Avoid curling the toes while performing this.

Does Posture Only Refer to When We Are Standing?

Although it has been the focus of this post, it should be noted that posture doesn’t exclusively refer to when we are in a neutral standing position. In reality, it includes any position that we place our body in, whether it be static (such as sitting or standing), or dynamic (such as running, jumping, squatting), though dynamic positions are often referred to as our “form.”

The concepts of center of mass and base of support still hold true in most of these situations. For example, you may have heard that you should bend at the knees while lifting an object off the floor, and to lift it close to your body. This is because if you bend entirely at the lower back and lift the object far from your body, your center of mass moves forward and well outside of your base of support. To maintain your balance (prevent you from falling forward), the muscles of your lower back would have to work astronomically harder, which can result in an injury.

Can I Achieve Perfect Posture?

In reality, there is no such thing as a perfect posture. We all have individual differences in our anatomy and biomechanics, whether it be the result of genetics, individual factors (eg. poor postural habits, age), or environmental factors (eg. poorly designed work environment, disease), that bar us from developing and maintaining a perfect posture.

However, although we may never be able to perfect the posture of our body, we are all capable of making improvements to our posture over time in one way or another. Just remember that these changes should be done very gradually. In other words, don’t hold a postural cue through an entire day when you are first performing it, otherwise you are going to fatigue your body and create new aches and pains. Short holds of 15-30 seconds at a time for a few times each day is a good start, and then you can slowly increase duration and frequency every few days until it becomes habitual.

References

Justin, B. (2016). Postural and Palpation Assessment.

Importance of Neutral Spine


What is Neutral Spine?

Neutral spine can be defined as the position in which our spine maintains its natural curvature, and in which it is most biomechanically efficient. In other words, a neutral spine is one that is in ‘good posture.’ It is at its strongest and safest when in this position, and so is the most resistant to pain, fatigue and injury.

So, what is the natural curvature of the spine? The first thing that might come to mind when visualizing good, proper posture is someone who is standing or sitting perfectly tall and straight; their spine is as straight as a pencil. However, this lack of curvature is actually improper, and can lead to a variety of problems. A healthy, neutral spine is as follows:

  • Slight anterior (forward) curve at the neck, or cervical region. This is referred to as cervical lordosis.
  • Slight posterior (backward) curve at the upper and middle back, or thoracic region. This is called thoracic kyphosis.
  • Slight anterior curve at the lower back, or lumbar region. This is known as lumbar lordosis.
  • Slight posterior curve at the pelvis, or sacral region. This is referred to as sacral kyphosis.

The image below provides a visual representation of a spine with healthy, natural curvature. Starting from the top of the spine and moving downwards, you can see curves in the following order: cervical lordosis, thoracic kyphosis, lumbar lordosis, and sacral kyphosis.

Why Should I Keep My Spine Neutral?

As mentioned earlier, a neutral spine is best able to absorb the forces being placed upon it. It is most resistant to fatigue, and the muscles that attach to it and help stabilize it are not being stretched or shortened out of their optimal functional lengths. If we continuously function with a poorly aligned spine, many health problems can emerge.

An example of this can be found in individuals who have a forward head posture, which is as it sounds – the head is situated farther forward than it should be. To counterbalance the increased weight on the spine of a head that is in this anterior position, the muscles of the upper back are constantly being stretched and overworked, which can cause irritation in them. Furthermore, the actual vertebrae (segments that make up the spine) at the lower neck region become more vulnerable to several problems, such as degenerative disc disease.

The pictures above show the harsh angles of varying degrees of forward head posture. This is just one example, as problems can emerge throughout the body from poor posture, not just the neck region.

How Do I Maintain Spinal Neutrality?

The biggest part of maintaining a neutral spine is simply developing awareness and good habits. For example, choosing to text with your phone held in front of you, rather than constantly bending at the neck to stare down at the screen. Once you have found that position of proper posture (a mirror or another person can help), consciously remind yourself to get back into it when you feel yourself slipping into a less ideal alignment. Eventually it will become more of a habit, and you won’t have to think about it as frequently.

This is sometimes easier said than done, as our workplaces and daily activities might force us to get out of spinal neutrality. In these cases, it might require more than just a behavioural change. Let’s use the example of a desk job: you are forced to sit and look at a computer or paperwork for several hours each shift, and maybe your work area is not optimized for good spinal position. Perhaps your chair is not an ergonomic design, or your monitor and desk are too low. Whatever the issue, these can lead to health issues in the long run and should be addressed as soon as possible. In this situation, purchasing or asking your employer for a taller monitor, or a better chair and desk, could greatly assist your ability to maintain spinal neutrality and health. Or, switching to a standing desk could be another viable option.

The following image on the left shows poor desk posture, while the image on the right shows a more neutral seated posture.

Training a Neutral Spine

Another important component of spinal neutrality is training your body while it is in a proper position. Once you have an idea of where your spine feels neutral, perform some exercises from this position! It will help strengthen the muscles and good habits even further. It is best to avoid exercises that will repeatedly contort the spine and facilitate poor postural habits, such as sit-ups and crunches. Exercises like planks will work the same areas without leaving a neutral spinal position – so long as you maintain good form.

The following are some examples of exercises performed with and without a neutral spine to help you get the idea:

Push-up:

Non-neutral spine (left photo) and neutral spine (right photo)

Squat:

Non-neutral spine (left photo) and neutral spine (right photo)

On a final note, it should be made clear that sometimes we need to leave neutral spine, such as when we are performing a shoulder check while driving. We shouldn’t fear the idea of not being in neutral posture at every second of the day. Rather, we should develop good habits and strengthen our body within a neutral posture whenever possible, so that when we are forced to leave it during certain activities that demand it, our bodies are well prepared.

References

Poor Posture and Neck Pain – https://www.spine-health.com/conditions/neck-pain/how-poor-posture-causes-neck-pain

The Role of Occupational Therapists in Car Accident Recovery


What is an Occupational Therapist?

That’s usually the first question people have – what is an occupational therapist? They are also called an OT (stands for Occupational Therapist).

Occupational therapists develop individual and group programs with people affected by illness, injury, developmental disorders, emotional or psychological problems and aging to maintain, restore or increase their ability to care for themselves and to engage in work, school or leisure. They also develop and implement health promotion programs with individuals, community groups and employers (from the Canadian National Occupational Classification 2016).

They can have a variety of titles – clinical occupational therapist, community occupational therapist, home care occupational therapist, occupational therapy consultant, research occupational therapist etc.

What does an Occupational Therapist do?

From day to day, what does an occupational therapist (OT) do?

An occupation therapist will find out what clients cannot do, and what they would like to do. They are reviewing your ability to perform everyday activities successful and effectively.

Things that an OT may check:

  • Look at your physical abilities like balance, strength, and coordination
  • Mental abilities such as memory, coping strategies, or organization skills
  • Items you use to participate – clothes, furniture, tools, or utensils
  • What social and emotional support is available to you at home, at school, at work, or in the community
  • The physical set up of your home, work, classroom, or other environment

Occupational therapists are problem solvers. There are a number of things they can do.

Help someone overcome a disability:

  • They can educate or instruct you on how to do things with the abilities you have – like getting around your house in a wheelchair
  • They can suggest activities that will help you improve or maintain the abilities you have – e.g. improving your coping strategies

OTs can adapt the materials you use:

  • Could install a grab rail near the bed for you to use
  • Introduce new materials, like a chunky pen, if you have difficulty grabbing small items
  • Adding items like an electric toothbrush or electric can opener
  • Introduce new fixtures like a raised toilet seat
  • A device to help you turn the pages of a book

They can recommend changes to the environments where you do your everyday activities:

  • Possibly adding a ramp, so an area can be accessed by a wheelchair
  • Fitting a stair lift into your home
  • Recommending the lowering or raising of a desk – so it is easier to use
  • Clearing up clutter, or reorganizing your cupboards so you can safely move around and reach what you need

If you are injured, how can an Occupational Therapist help you?

For people who have been in a car accident or a pedestrian accident, an occupational therapist can help you.

Occupational therapists work in facilities, in private practice, in hospitals, and some are self-employed. They provide assessment and treatment, during recovery from vehicle accidents, pedestrian accidents, and bicycle accidents.

They are experienced in handling a variety of cases. These include individuals who have survived accidents but may have physical or cognitive challenges in their lives as a result of their impairment or disability, including brain injuries, spinal cord injuries, amputations, chronic pain, and mental illness.

Occupational therapists can assist by completing the necessary forms for assessment and treatment plans. Then they can work to improve an individual’s function – at various points during recovery. An occupational therapist helps with the recovery process, from discharge from the hospital to resuming normal life activities. A case manager may be assigned to coordinate all the services that may be needed (such as the medical and rehabilitation professionals).

How can you find an Occupational Therapist?

If you are in British Columbia, it is not difficult to find an occupational therapist. One way to do some quick searching is through the College of Occupational Therapists of British Columbia — https://cotbc.org/. They have a search feature on this page. You can call them at 1-866-386-6822 (toll free in B.C.), and you can email them at info@cotbc.org as well. After doing a few quick searches, there are occupational therapists throughout the Lower Mainland. Several of them work in multiple clinics as well.

Occupational Therapists, who are registered with the College of Occupational Therapists of B.C., have to follow a Code of Ethics, and that is also available on the website (https://cotbc.org/).

References:

The National Occupational Classification – 2016 edition http://noc.esdc.gc.ca/English/NOC/SearchIndex.aspx?val=3&val1=3143&ver=16&val65=occupational+therapist (updated on April 20, 2017)

The College of Occupational Therapists of British Columbia. https://cotbc.org/  (Copyright 2015)

Canadian Association of Occupational Therapists. How does Occupational Therapy Help? https://www.caot.ca/site/aboutot/howOThelp?nav=sidebar  (updated 2016)

NHS Choices (The National Health Service – UK). Occupational Therapy – Techniques and Equipment http://www.nhs.uk/Conditions/occupational-therapy/Pages/techniques-and-equipment.aspx (August 2014)

ModernOT (based in Ottawa, Ontario). Case Managers & Certified Life Care Providers http://modernot.ca/our-team/case-managers-certified-life-care-providers/ (Copyright 2017)

Elizabeth Esposito Speaks About Massage Therapy for Car Accident Recovery


Elizabeth Esposito, Registered Massage Therapist and owner of Esposito Massage in Port Moody, shares her thoughts on the ‘need-to-knows’ of massage therapy for car accident recovery. Elizabeth has been practicing massage therapy for the last decade. She is a member of the MTABC and CMTBC. She has a big heart and looks out for the best interest of her patients.

1) Can you explain how massage therapy can help someone who has soft tissue injuries from a motor vehicle accident?

Massage therapy can aid in decreasing the person’s pain perception, will help to increase their mobility and help them with their rehabilitation goals if pain plays a factor in activities that they are not able to accomplish.

2) What is an appropriate length of time to wait before attending massage therapy following a car accident?

I recommend patients come in as close to the date of their accident as possible. The sooner the patient has an intervention from an injury, the faster their recovery.

3) How often do you recommend a person received massage therapy in order to get the maximum benefit?

The severity of the injury determines how often a person needs to attend massage therapy to get the maximum benefit. If the injury and pain is severe, I will recommend twice a week for two weeks. Once the patient starts to notice a change in their body then I will recommend dropping to once a week for three weeks. At that point I will reassess where the body is at. If the person is still getting the maximum benefit then I will recommend to them to come in every other week for three weeks until we can stretch out the length of time between treatments to a few times a year.

4) Is a doctor’s referral required in order for ICBC to cover massage treatment? Is there a maximum amount of treatment ICBC will cover?

Initially there is no doctor’s referral required for the initial 12 treatments. After 12 treatments a doctor’s note is recommended for eight more treatments. After having 20 treatments in total the decision is then made by their adjuster if they will still cover treatment. ICBC only covers $23 of the treatment cost so there is a user fee that is required to be satisfied by the patient. User fees vary depending on the length of treatment, for example a 1 hour treatment costs $110, ICBC covers $23 so the user fee for the patient is $87.

5) What makes massage therapy unique compared to other types of treatment?

Massage is very hands on and your therapist is with you for the entire time. Massage therapy manipulates and works with the soft tissue of a person’s body. It’s very personal because the therapist is working on the patient’s tissue for the entire treatment.

6) Can you de-bunk a myth about massage therapy?

Massage does not get rid of toxins out of your body. The human body has it’s own filtration system through the kidneys and liver. Most people feel the urge to urinate afterwards because getting a massage is like a work out without working out.

7) What qualities should a person to look for when hiring a massage therapist?

What people perceive is a good massage therapist is personal. Sometimes years of experience plays a role, but honestly, there are some great new therapists entering the profession that are often better than an older therapist because they are new and want to impress. Not to say that older therapists aren’t, just sometimes older therapists get into a rut and miss things. It’s all about your relationship with your therapist and personality because getting a massage therapy treatment is very personal and intimate. It is very important to make sure you find a therapist that stays up to date on current research and continues to educate themselves as much as possible instead of what is required.

Aquatic Rehabilitation


Aquatic rehabilitation…it’s not what you think it is. No flippers, swim cap or googles are required and you don’t even need to know how to swim! In aquatic rehabilitation your feet remain firmly planted on the pool bottom in the shallow end. Okay, at least one foot is planted on the bottom at all times and the side of the pool is within reach.

What is aquatic rehabilitation?

Aquatic rehabilitation or aqua therapy are terms given to describe active rehabilitation exercises performed in a swimming pool. It includes range of motion, strength and stretching exercises. The aquatic environment provides gentle resistance while the buoyancy supports your body weight making you feel lighter. All exercises can be performed in the shallow end of the pool. Individuals that are more comfortable in the pool, have the option of performing deep water exercises wearing an aqua therapy belt. The aqua therapy belt allows you to float similar to a lifejacket. Many community swimming pool have aqua belts that are available for patrons to use. By no means is it a requirement to be able to swim lengths using the traditional swim strokes like front crawl, back crawl, breast stroke or butterfly. Aqua therapy sessions are typically lead by a Kinesiologist or Physiotherapist at a community pool.

Who would benefit?

Aquatic rehabilitation is particularly beneficial to individuals:

  • who have high levels of pain from a soft tissue injury (such as from a car accident)
  • who have limited range of motion
  • who struggle with full weight bearing (ie standing and walking)
  • who are recovering from a joint replacement (as a hip or knee replacement)
  • who have chronic pain

Benefits of aquatic rehabilitation

  • increase in range of motion
  • increase in strength and function
  • cardiovascular improvements

What equipment is needed?

A swimsuit is the only prerequisite, however, I also recommend having sandals that you can wear on the pool deck. It is a bonus if you have access to an aqua therapy belt and a pool noodle.

Example exercises

Below is a list of rehab exercises that can be performed in the pool. This list is not exhaustive by any means. You can get really creative with using the pool noodle!

  • forward, side ways and backwards walking
  • bicep curls/tricep extensions
  • front and side arm raises
  • arm circles
  • squats
  • lunges
  • leg extensions/leg curls

I have received a lot of positive feedback from clients who have performed aquatic rehabilitation. They were able to perform an exercise routine in the water with less pain. Contact us to schedule an aquatic rehabilitation session. We offer this treatment in most cities across the Lower Mainland.

Interview with Gowri Atkinson of Active Living Physiotherapy


I spoke with Gowri Atkinson, Physiotherapist and owner of Active Living Physiotherapy in Coquitlam, British Columbia. She gave her expert opinion on how to recover from car accident injuries based on what she’s learned over the last 30 plus years as a Physiotherapist.

What led you to studying Physiotherapy?

I didn’t know for a long time which career to choose. Finally, I decided to try for physiotherapy. It would be a shorter route than medicine which would have been too long a haul. I like working with people.

What is your greatest professional accomplishment?

My 30 plus years of experience is my greatest accomplishment. If I’m not sure how to treat a particular problem, I go with my educated guess and gut feeling and it has always paid off. I am always learning about different issues and how to help patients.   

It is important to get the whole picture when assessing a problem. For example, for a patient with knee pain it is important to assess their back, hip ankle and feet. As one problem can cause other problems over a long period of time.   

Who has been your inspiration?

I’ve learned a lot from working beside other physiotherapists. They have influenced me in different aspects of physiotherapy.

What common mistakes do people make with their physiotherapy treatment that interfere with their recovery from a car accident?

Some people are under the impression that physiotherapy is a quick fix without them putting in any effort.

I will give you an example of a lady who had received treatment from me. She had been in a motor vehicle accident.  She told me in the beginning that she did not do exercises. She had 10 sessions of physiotherapy and massage therapy and then quit because she thought she was better. But the pain started bothering her and she came to see me for more treatment. She wasn’t doing much in the way of homework. I tried to inspire her, educate and motivate her about the importance of the home program but I was unsuccessful.  Sometimes you just can’t win. It was very disappointing.

Patients have to be really motivated and be willing to sacrifice their time and put in a reasonable amount of effort on a regular and consistent basis to make a change for their improvement and a healthier life.

How soon do you recommend a person start physiotherapy after sustaining soft tissue injuries from a car accident?

I usually say immediately – sooner rather than later is much more beneficial.   

Some patients see me several months after an accident. They may have had other treatment, for example, massage therapy and/or chiropractic treatment prior to physiotherapy. By this time they have compensated for their problems and learned bad habits. This then becomes more challenging and takes longer to correct the poor postures they have acquired.

It is important to learn how to sleep and sit in the best positions with the least amount of pain and stress to the muscles, ligaments and joints. What can they do at home and at work to decrease their pain and stress levels? The sooner I can get them under my care, the more I can help them.

Guiding them on the right path from the beginning makes a huge difference.

Education from the beginning is a key factor on the road to recovery.

What modalities are particularly beneficial for someone who has sustained soft tissue injuries in a car accident?

Definitely ice and heat – one or the other or both. I like ultrasound. I think it works quite well for a lot of soft tissue problems. I also use the TENS and muscle stimulation machines. Manual therapy is an important tool I use.

What are the benefits of Physiotherapy that cannot be obtained from other therapies?

Every Physiotherapist does things differently. 

I listen to my patients and try to figure out their issues. It is often the little things they tell you that gives me a better insight into their problems. You have to be like a detective and figure out what they are doing wrong or what they can change to decrease their pain and increase their tolerance to a particular activity.

I think listening skills are very important for physiotherapists. I have learned to become a better listener over the years.

As a physiotherapist I strive to achieve long lasting results rather than a quick fix. Also I teach my patients how to manage their problems.

How has physiotherapy changed over the last thirty years?

Physiotherapy as a profession has changed so much. Physiotherapy has grown, diversified and specialized. When I started years ago, we did for example some of the work of kinesiologists, occupational therapists, massage therapists, etc.   

Many physiotherapists acquire specialized skills through further education, for example, vestibular rehabilitation.  I enjoy helping men and women with pelvic floor problems and working with the elderly (gerontology). I also assess and prescribe orthotics when appropriate.   

I had worked with premature babies in the intensive care nursery, with adults and children in the intensive care unit, sports injuries and ICBC patients.

What misconceptions do people have with Physiotherapy?

A lot of people think you need a doctor’s referral for physiotherapy, and that’s certainly not true. For ICBC, after 20 visits you need a doctor’s referral for more treatment to be funded.

Some patients are not quite sure what to expect, some expect a quick fix.

A question I am often asked is, “How long do you think it will take to get better with treatment?”  This is the million dollar question. Improvement is dependent on the patient’s level of motivation, on the extent of their injuries and their pre-injury fitness level. I believe that educating my patients is important as it empowers them to make choices.

What advice would you give to a person who has been injured in a car accident?

Make sure you get out checked out thoroughly by a physiotherapist as soon as possible.

Consult a physiotherapist – ‘your go to person’ – for musculo-skeletal issues.

Interview with Rebecca Stephens, Dr. TCM, R.Ac., B.Sc.


I had the pleasure of interviewing Rebecca Stephens, Registered Acupuncturist and Doctor of Traditional Chinese Medicine, who practices at Healing Cedar Wellness on St Johns street in Port Moody. In her practice, she helps people with musculoskeletal pain and injury, stress or women’s health issues. Rebecca is an instructor of Acupuncture at Boucher Institute of Naturopathic Medicine. Rebecca explains why acupuncture is a unique and effective treatment for musculoskeletal pain and injury.

What is acupuncture?

The textbook definition of acupuncture is: “The stimulation of specific anatomical sites on the body, called acupuncture points, to achieve therapeutic effect.  This is usually done by way of the insertion of fine sterile needles into the skin.”  Stimulation of these points is shown to affect the nervous, endocrine, and circulatory systems, and these effects can be used to address various health concerns. The complete scope of acupuncture therapy employs a few additional tools besides needles, such as cupping, tuina (acupressure massage), moxabustion (warming of an acupuncture point), and gua sha (a “scraping” therapy with similarities to Graston technique).

How can acupuncture help a person who is suffering from soft tissue injuries sustained in a car accident? How does acupuncture reduce one’s pain? 

Acupuncture is a wonderful tool to address pain and dysfunction sustained from injury.  As mentioned in the last point, acupuncture can have effect on 3 major systems of the body, which in turn trigger cascades of effects that can regulate and decrease the body’s production of inflammatory and pain chemicals, as well as increase blood flow to an injured area.  Stimulation of specific points on muscles can help regulate muscle tone, which can greatly improve functioning and range of motion. Acupuncture is also very helpful to the healing process, and has been shown in studies to promote tissue regeneration.

What makes acupuncture different from other treatments?

Acupuncture has both differences and similarities compared to other therapies. With this treatment, the goal is to address the chief complaint while also taking into consideration the state of the whole body.  The thought is a more balanced body is less prone to problems, and can heal itself more efficiently. Acupuncture is different from conventional pain treatments in that it aims to achieve similar effect of pain/inflammation reduction either without the use of, or with reduced use of pharmaceuticals.  It also typically targets much smaller regions on the body (the acupuncture points) than other treatments to achieve the same effect of treating the larger area. You may notice that some of the points used seem similar to target areas used by other modalities, and some points are quite different.  The main differences are the technique and tool used. Overall acupuncture is meant to be a gentle therapy, and is considered very safe with little or no side effects. It is commonly used alone or in conjunction with other therapies.  Most patients report feeling very relaxed and a bit sleepy after treatment.

How often do you recommend a person receive acupuncture treatment in order to get the maximum benefit?

I will usually tell my patients to first try at least 3-4 treatments, to see if acupuncture is going to have an effect.  Then treatment frequency is then dependant on severity of symptoms.  More severe symptoms may be treated 2-3 times per week initially.  Moderate symptoms can be treated 1-2 times per week.  Once improvements are seen, treatments are spaced out accordingly.  It is hard to give an average course of treatment as all problems are different, but courses ranging from 6 – 24 treatments are not uncommon.

At what point in time after a car accident, is it beneficial to begin acupuncture treatment for a soft tissue injury? 

As acupuncture therapy can be applied indirectly (i.e. not at the actual site) to treat an injury, technically it can be started soon after the incident has occurred.  Direct treatment is usually only considered a minimum of 1 week after the injury, and is not typically applied to severely bruised or swollen areas.  Personally, I usually tell my patients to wait at least a week before coming in, to allow the body to rest.

What qualities to look for when hiring an acupuncturist?

Acupuncture in BC is a regulated profession.  Acupuncturists should be regulated with the College of Traditional Chinese Medicine Practitioners (CTCMA) of Canada, and have the designated title of R.Ac. (Registered Acupuncturist), R.TCM.P (Registered TCM Practitioner)., DrTCM or DTCM (Doctor of Chinese Medicine).  This ensures they have the necessary hours of training (3-5 years) and have passed the Provincial CTCMA Board exams to become registered. When seeking treatment for soft tissue injury sustained in a motor vehicle accident, it is helpful to seek out a practitioner with experience in this area.

Do insurance companies typically fund acupuncture treatment?

Yes, most health insurance plans cover some acupuncture treatments.  It is best to check with your individual plan to determine your coverage.  MSP may also cover a portion of treatment price for certain eligible individuals.