GTP TV: Ep 19 – When to see a doctor, chiro, physio, massage?

Hey guys! I’m here with Goalie Training Pro TV, episode 19. And the title of this is “When to See Whom” which I believe is the proper grammar, because I think you would be the subject and whom would be the object.

So that’s whom, not who. So there’s a little free grammar lesson in addition to all the goodness we have coming. Next week will be episode 20, and we’re going to talk about the ELDOA technique, which if you don’t know what it is, it’s like voodoo magic, it’ll be kind of cool. I think we should have a party for episode 20 or something like that. Free champagne for everybody!


You can also check out the full video here >>

But so we’re going to talk about basically when to see the doctor, the physio, the chiro, the massage therapist. We’ll talk a little bit about osteopaths. I’m sure there’s somebody I missed. You can e-mail me and say “I go to a naturopath” or whatever, which I think is great too. But this is what we’re talking about this week.

And it’s all over the map. So the other thing you don’t have to e-mail me is if I say, “Well, it is probably best to go see this person for this.” And then I know somebody is going to e-mail me and say “Oh, I had that and I go to my doctor and my doctor’s fantastic. My doctor gave me this and that and everything and it was good.”

Perfect, that’s great.

Everything is on a continuum. So there are some physiotherapists who are great at doing manual therapy too, because they’ve done extra training. There are some chiropractors who know a lot about strength and conditioning, so they can talk to you about your training. There are some doctors who’ve done extra training in musculoskeletal assessment, so we all … just like there’s strength and conditioning cultures.

I know a little bit more about injuries because I worked in the physiotherapy clinic. So there’s crossover, and it’s just like everything. There’s good, better, best. So we’re just giving you some guidelines if you’d really like to use them and not sure what to do. If you know that your family doctor knows so much about sports and has looked after your injuries and does a great job, then keep doing that. If it ain’t broke, don’t fix it. This is just some advice if you’re like “Geez, I don’t know who to go see.”

So a doctor, so your family doctor is what I’m talking about. I know that at the Fowler Kennedy Clinic, where Bryan and I worked, we had sport medicine doctors. So they were primary care doctors who did additional training in sports medicine, so they have a little bit more of an idea how to assess your sports injury, and lots of background. That’s what they do all day long.

But I’m talking about just your family doctor. They’re great to go to if you’re sick, like if you have something going on or a cold, or something sort of medical related that doesn’t seem to be getting better. If you think you need a prescription for something, if you think you need an x-ray for something, if it hurts, if you have burning when you pee, you should go to your doctor. Or if you need a referral to a physio in order to get it covered under your health insurance.

Sometimes they’re not the best for strains and sprains. So a lot of you … even those of you that train online. “Oh, I pulled my groin, I went to see the doctor and he just said rest it for two weeks and then we’ll see how it is.”

Well, almost anything is going to feel better after two weeks of not doing anything. So then what often happens is he maybe gives you anti-inflammatories … you don’t do anything for two weeks, it feels good. And then that’s it. Rest two weeks and we’ll see how it goes.

Then you go back on the ice … well now you’re two weeks de-conditioned, you haven’t really done anything to help that scar tissue remodel or to just see “Hey, where are my weaknesses?” You go out on the ice, you do something … maybe it feels fine just skating around, you go into practice and then you really tear it even worse.

So they just often don’t have the assessment skills to determine what it is. Or even someone will have a muscle strain and they’ll be like “Oh, they said I sprained my hip.” Well, you don’t sprain your … you know, a sprain is a ligament. A strain is a muscle. Then a sprain too … someone who’s assessing a sprain, so a sprained ankle, sprain of the knee, they should be able to tell you what structure is involved.

So people will say, “Oh, I went to the doctor. I sprained my knee.” Okay, well what ligament in your knee does he think you sprained? “Oh, he just said I sprained my knee.” Well do you know what grade it is? Grade one, two, or three? No, that’s just all he said. He just said rest it and see how it feels. So maybe not the best for that. And again, it’s not really meant to be in their wheelhouse. They’re looking after the general health of their patients, and they’re so busy they don’t necessarily have the time.

The other one too is concussions. There’s at least some of you that I’ve talked to who asked me about it. Some of you go and the doctor will say, “Well, I think you just got your bell rung.” You know and it’s like … we don’t actually use that term anymore.

If you have a concussion, you have a concussion, and it’s either grade one, two, or three. So that’s another thing that you really want to look after. And so you can go see … again, there are doctors who specialize in helping athletes with concussions and managing their return to sport. That’s exactly who you want to see. If it’s somebody … you know, you go to the doctor, “Oh, I think you just got your bell rung a little bit. Take a couple of days off and see.”

That’s not actually concussion protocol. So there is a protocol that you follow, and really … even with just a grade one concussion, it’s going to be about five days before you’re even going to be getting back onto the ice even for a light practice. So that’s another one to look at.

Physiotherapists have great manual skills, great assessment skills to be able to figure out like “Oh yeah, my hip hurts.” Well why does your hip hurt? Or sometimes somebody will have a hip pain that just sort of gradually builds over time. Nothing happened to start it, but just “Yeah, my hip just feels sore.” And they’ll go to see maybe a doctor, or maybe a physiotherapist that doesn’t normally work with athletes, and they’ll be like, “Oh yeah, you strained your hip flexor.”

Well, how did I strain my hip flexor when I don’t have a mechanism of injury where I actually strained my hip flexor?

So they’re good at figuring that all out. And when you go to see … some of you will go to physiotherapists and come back and be like “Oh, he said I strained my hip flexor.” Well yeah, you didn’t have a mechanism to strain your hip flexor. Something else must be going on.

What did they do for you? “Oh, they moved my hip around and they put the electrodes on it and yeah, it feels better.” Well, you want someone who’s going to look at the joints above and below. So if you’ve got a sore hip, they should always be looking at your pelvis. Looking at how your knee works. Looking at your back, because some dysfunction is causing that area to be overloaded.

And so very rarely is it actually your hip that’s the problem. It’s often something else that’s going on that’s putting overload on your hip.

So yeah, definitely pains that just sneak up on you. And sometimes too, you guys think “Well, I didn’t do anything so there’s probably nothing anyone can do. Just my hip is sore all the time now.” Not true, again, a good sport physiotherapist is the one who can really do some good assessment and figure out, you know what? Maybe you do have some hip impingement there.

They can help you out, and some of them can do manual therapy to help improve your symptoms, and just guide you too. “You know what? Deep squatting positions aren’t going to be good for you. You need to avoid those when you’re in the gym. Here’s some things you can do instead.”

So another one too is if you have an area that feels tight all the time. “Oh, my right hamstring is tight all the time, but not my left.” That’s a great one to go to for a physiotherapist.

Again, you think “Well, but it’s just tight.” Yeah, it’s just tight until you do something and then tear your hamstring. Because I hear it all the time. Guys are like, “Well, my right hamstring has always been tighter. And then I was in a game and I went to do a kick save, or a split save, and then I tore my hamstring.”

Or again, limited range of motion in your hips. So if you’re squatting, for example, and it just feels like you’re stuck, go see a physiotherapist who can help you figure out “Hey, is this a joint capsule restriction that we need to mobilize and get moving? Or is this something going on in the joint that we need to maybe work around or try other ways to get it moving a little better?”

Be aware if you go to see a physiotherapist … and I don’t mean if you just tore your groin and it’s the first day and they do a pretty gentle assessment and then maybe give you a hot pack or do some ultrasound, or hook up the electrodes to try to settle it down. That’s what they should be doing.

If you just tore your groin, they shouldn’t be like … you know, yanking you all over the place. But if you keep going and keep going and they just do maybe some gentle stretching and then put on heat pad, ultrasound, electrodes to just make the pain feel better, that’s not looking after the underlying cause. So that’s something that might be a little bit like “Hmm, I’m not sure we’re getting there.” And again, if you find a physiotherapist that works with athletes, they want to get you back in the game too.

When I worked at the clinic, it was like … every athlete that came in injured was an opportunity to make that athlete better than they were before they had the injury going back into their sport. Not that I’m a physiotherapist, but that’s sort of the mentality of working in a place like that.

Chiropractor … is great especially … like back pain is what you think of. Because their wheelhouse is a little bit trying to align your spine so that it’s in a biomechanically advantageous position. Not that that’s all they do, but that’s sort of the foundation of it.

So that could … your spine’s out of alignment, that could cause issues in your back, it could cause issues at your hips, at your knees. If your pelvis is out of alignment, that can cause trouble up your spine. So I think they’re a good option to go to, especially if you need a manipulation or an adjustment to get you back where you need to be.

Be aware if you go in, they do an adjustment, “Okay, you’re good.” And you feel good, you feel great, but then maybe two hours later or two days later, it’s just back exactly where it was. And then you go back in later in the week or the next week, they do the same thing, send you on your way. Do the same thing, send you on your way. Do the same thing, send you on your way.

Again, with every profession, there’s good, better, best.

One of the physiotherapists I used to work with had a great expression. She was like, “If you had a toothache and the dentist wanted you to come every week for the same shot, would you keep going to the dentist or would you try to find a different dentist?”

So have an eye for that. And again, if there is … sometimes if you’re just adjusted, adjusted, adjusted, it makes that segment hyper-mobile so it’s easier for it to get adjusted back in, but it’s also easier for it to come out. So if they are doing adjustments (over time) sometimes you just need that back in and you’re good to go. But if you’re needing adjustments over time, I’d like to see them giving you some exercises to help stabilize those segments.

And again, some chiropractors are very well versed. Some not so much. So you want to find someone who can give you strategies to help use your body to keep things together, which is a little bit too, one of the strengths of the physiotherapists, too.

Massage therapists … if you’re tight in areas and you can’t stretch it out … so you stretch them and you try to make it better, but it just never seems to improve. I think that’s a great way to go.

There are massage therapists that are kind of for relaxation, and then there are massage therapists that are there to help really remodel that tissue. You want someone who works with athletes who’s really trying to do a therapeutic service for you. And if you can find one that specializes in ART, Active Release Therapy … same goes with chiropractors or physiotherapists, that’s a great tool for them to have in their box.

Actually going back to that too, talking about sort of cross over tools, some physiotherapists have taken extra training so they can also do manipulation and adjustments. So that’s something else that you can be aware of and maybe look for.

And I think it’s not a bad idea to see your massage therapist every couple of weeks, because also they get to know your body, and they get to know “Oh, wow, this is really tight all the sudden. What’s been going on? Has anything changed?” And help keep tabs on that. My thing is to … my preference as a physiotherapist … but to get checked out every month at least, just to make sure everything’s where it should be.

Osteopath … I’m not an expert in osteopaths. But it’s a similar kind of vein to chiropractors. They’re interested in the bones of the spine and of your skull. They don’t really snap, like manipulate things back. They use more sort of pressure to sort of put things back in place. They will also do some craniosacral therapy to kind of work on the fused bones in your skull.

It’s actually pretty cool, I’ve taken a couple athletes to see … we had a really good one in London. I took a couple athletes to see them who just had a lot of concussions and things like that. It was pretty cool … the skill that they have with their hands and their assessment skills just from a different angle. But very, very cool. So something to keep in mind.

Bottom line: there’s good, better, best in everything. So try to find the best you can find.

If your healthcare provider, whoever it is, isn’t looking at your pelvis, ask them to. Because I don’t think they understand … and I don’t think I fully appreciated it until I started playing on the ice with all the equipment on. The torque that’s on the pelvis, and the positions that you put your thigh in that really act as a wrench on your pelvis.

Your pelvis … you’ve heard me say this before, but it isn’t one bone. It’s sort of three bones fused together, so it can get twisted and set out of position. And unless that’s fixed, nothing’s going to be right.

If your wheels are out of alignment and you have to hold the steering wheel like that to go in a straight line … well, you can hold the steering wheel like that to go in a straight line, but it doesn’t make the wheels in alignment. So, sooner or later, something’s going to fail.

So if they’re not looking at your pelvis … yeah, and I had a client … can’t remember if it was somebody online “Oh, I’ve got a sore knee and I’m going to the physiotherapist. It’s been sore for a while.” I said, “Ask them to look at your pelvis.” And they looked at the pelvis and his pelvis was out of alignment, and that probably was one of the key things.

If all they try to do is make the pain feel better, then look elsewhere other than in the acute stage. In the acute stage, you should be helping it … doing whatever they can to settle it down. That’s the first thing. And then start building. But if you’ve been going for three, four, five weeks, and all they do is try to make it feel better without really challenging you or giving you some exercises to work on at home, then I’d be a little leery.

Do exactly what they tell you, and give really good feedback. So think about: how does this feel when I do it? How does it feel on Monday compared to Friday? Is it feeling better, worse, no different? Give good feedback, because I think it really hurts to … if you just go to the physiotherapist, “Well, how’s it feeling this week?” “I don’t know.” Okay, well that doesn’t help me.

And I see Bryan here because he’s the best in the world, but when I see him I try to think … you know, I’ve had some issues with my back for the last while. So it’s like “Oh, yeah, when I was in the gym if I’m bent over and pick something up, that gives me some discomfort now.” Give them as much information as you can for them to work with.

And then if you are doing what you’re supposed to do and it’s not getting better over time, then they should be looking for something else. One of the biggest things I learned working at the sport medicine clinic was if we do the things that typically make this thing better, so let’s say you have patella femoral pain. If we do the things that typically make patella femoral pain feel better, and it’s not getting better, then I need to wonder if this is something else and not that.

So if you’re going and you’re doing exactly what you’re supposed to do, as many as you’re supposed to do, when you’re supposed to do it, and it’s not getting better, it gives you some leverage too. Because if it’s like “Well, are you doing the stretches you’re supposed to do?” “Well, I’m not doing them because they weren’t helping.”

Well, then right away the physio, the chiropractor, whomever thinks “Well, you’re not doing what you’re supposed to do so of course it’s not getting better.” So do exactly what you’re supposed to do, unless it’s making it feel worse. And then stop and tell them which one makes it feel worse, and where, and how.

But if you’re doing that all, then they should be open-minded enough to think “Okay, what else could this be? Let’s take another look.” And it’s not always a quick fix. It’s not … a lot of you took four years to get your body in a mess that it broke down. It’s not going to get out of it in two weeks.

Or maybe they should be referring you to somebody else. So, if they’re not looking for something else or maybe referring you to someone else who they think might be able to help, or just bring them in … Bryan brings in guys all the time “Hey, can you come here and look at this patient with me?” That should be sort of the open-minded approach that they take and that’s when you know, “Man, I’ve got a gem here.”

And then once you’ve got a gem, show up on time for your appointments, pay your bills, do whatever you can to stay in their sphere because if they’re that good, they’re going to get extremely busy and they’re going to start saying no to people because they can afford to. So be a model patient.

I think that’s it for episode 19 of “When to See Whom.” This is Maria from See ya!