Alex Derksen- PT, CF-L1, FRCms

🩹 Calming down pain doesn't mean that you will suddenly be able to perform the way you want

🤔 If you've been frustrated by recurring pain or injury in the past, it might be time you try a different approach. One that focuses on improving your body's strength, tissue tolerance and fitness instead of just focusing on pain

👂At Apollo, ⁠We make sure we listen to your stories and set you up on a path to reach your goals. We want your rehab plan to morph with you as things change

🤓 We have systems and programs in place to keep you moving forward until you cross the finish line. That means a program may start like traditional rehab, but will end up feeling like a strength and conditioning program to properly prepare you for the activities you want to be doing

🏋️S&C is rehab - that's the Apollo way. Let us show you Rehab Reimagined:

🔥 Recover. Rebuild. Perform 🔥

💪These are the stages we help our clients through to make sure that they come back from an injury feeling and performing better than before they got hurt

🏁 Everyone is starting from a different point, and has a different end goal

🧑‍⚕️We use our assessments to determine which stage you are starting at, and which stage you need to get to in order to perform how you want

📊 Moving from one stage to the other is not determined by length of time/number of sessions, but instead is determined by you meeting specific goals

✅ Meeting these goals proves to us, and yourself, that you are ready for the challenges of the next stage.⁠

💥 This is what Performance Therapy looks like. Helping you feel stronger, fitter, and more athletic than you ever have

🏆 At Apollo, we make sure you are ready to perform

Our adult playground workplace 😍🔥💪

A one-stop-shop health & performance centre! From youth athlete development to adult weekend warriors, we got you!
🏃💨🏋️‍♂️🤸🏾‍♀️

Vancouver Island just got leveled up 💯

𝗪𝗲 𝗱𝗼𝗻'𝘁 𝗮𝗹𝘄𝗮𝘆𝘀 𝗻𝗲𝗲𝗱 𝘁𝗼 '𝗱𝗼' 𝘀𝗼𝗺𝗲𝘁𝗵𝗶𝗻𝗴:

𝗔𝘁𝗵𝗹𝗲𝘁𝗲 𝗘𝘅𝗮𝗺𝗽𝗹𝗲:
➡️ Injury/discomfort is acute ➡️ no real history or mechanism of injury ➡️ red flags cleared ➡️ been training really hard over the last block or two

𝗦𝗼𝗹𝘂𝘁𝗶𝗼𝗻:
➡️ 4 weeks of shaving off the top end of intensity and volume of the athlete's training and the aches and pains ended up dissipating.

⏰ By taking advantage of natural history, while continuing to train, it may allow you to continue to practice your skills, while simultaneously letting the body cool off for a period of time

🧐 We are not trying to 'fix' anything. We are also not doing nothing. We are also not following a boom-busy cycle of discomfort. We are just shaving enough of the top end to allow your body adapt and thus create an opportunity to progress your training further for the long term.

👴👵 Remember were trying to train for longevity not just your current 3-6 week block to try and hit a new PR. Don't be afraid to listen to your body and pivot. It may actually be what you need to see the gainz later on.

𝗧𝗮𝗸𝗲 𝗵𝗼𝗺𝗲 𝗽𝗼𝗶𝗻𝘁𝘀:
➡️ Mother nature is a beautiful thing.
➡️ Addition by subtraction.

🤷 This is just one option. It may not work for everyone. But you also may be surprised by its positive effects.

🤸🏾‍♀️ Normal movement, normal healthy movement is thoughtless and fearless. Hence the major goal of the rehabilitation plan.

🤬 I'm tired and fed up of the bull$hit, outdated and nocebic physiotherapy fad that is so 'body' focused on muscle 'imbalances' and 'correct' muscle patterning.

🙅🏻 99.999999% of the world doesn't think like this when they move, don't let a therapist tell you otherwise.

👑 Listen to Louis. He knows a thing or two.

🤸🏾‍♀️ Normal movement, normal healthy movement is thoughtless and fearless. Hence the major goal of rehabilitation.

🤬 I'm tired and fed up of the bull$hit, outdated and nocebic physiotherapy fad that is so 'body' focused on muscle 'imbalances' and 'correct' muscle patterning

🙅🏻 99.999999% of the world doesn't think like this when they move, don't let a therapist tell you otherwise

👑 Listen to Louis. He knows a thing or two

🔥𝗧𝗼𝗽 𝟭𝟬 𝗞𝗲𝘆 𝗣𝗮𝗶𝗻 𝗖𝗼𝗻𝗰𝗲𝗽𝘁𝘀🔥

🥂Because it's NYE and we all like a Top 10 before a new year.

𝟭. 𝗣𝗮𝗶𝗻 𝗶𝘀 𝗻𝗼𝗿𝗺𝗮𝗹, 𝗽𝗲𝗿𝘀𝗼𝗻𝗮𝗹 𝗮𝗻𝗱 𝗮𝗹𝘄𝗮𝘆𝘀 𝗿𝗲𝗮𝗹.
➡️ All pain experiences are normal and are excellent, though unpleasant response to what your brain judges to be a threatening situation. All pain is real.

𝟮. 𝗧𝗵𝗲𝗿𝗲 𝗮𝗿𝗲 𝗱𝗮𝗻𝗴𝗲𝗿 𝘀𝗲𝗻𝘀𝗼𝗿𝘀, 𝗻𝗼𝘁 𝗽𝗮𝗶𝗻 𝘀𝗲𝗻𝘀𝗼𝗿𝘀
➡️ The danger alarm system is just that- there are no pain sensors, pain pathways or pain endings.

𝟯. 𝗣𝗮𝗶𝗻 𝗮𝗻𝗱 𝘁𝗶𝘀𝘀𝘂𝗲 𝗱𝗮𝗺𝗮𝗴𝗲 𝗿𝗮𝗿𝗲𝗹𝘆 𝗿𝗲𝗹𝗮𝘁𝗲.
➡️ Pain is an unreliable indicator of the presence or extent of tissue damage- either can exist without the other.

𝟰. 𝗣𝗮𝗶𝗻 𝗱𝗲𝗽𝗲𝗻𝗱𝘀 𝗼𝗻 𝘁𝗵𝗲 𝗯𝗮𝗹𝗮𝗻𝗰𝗲 𝗼𝗳 𝗱𝗮𝗻𝗴𝗲𝗿 𝗮𝗻𝗱 𝘀𝗮𝗳𝗲𝘁𝘆.
➡️ You will have pain when your brain concludes that there is more credible evidence of danger than safety resulted to your body and thus infers the need to protect.

𝟱. 𝗣𝗮𝗶𝗻 𝗶𝗻𝘃𝗼𝗹𝘃𝗲𝘀 𝗱𝗶𝘀𝘁𝗿𝗶𝗯𝘂𝘁𝗲𝗱 𝗯𝗿𝗮𝗶𝗻 𝗮𝗰𝘁𝗶𝘃𝗶𝘁𝘆.
➡️ There is no single 'pain centre' in the brain. Pain is a conscious experience that necessarily involves many brain areas across time.

𝟲. 𝗣𝗮𝗶𝗻 𝗿𝗲𝗹𝗶𝗲𝘀 𝗼𝗳 𝗰𝗼𝗻𝘁𝗲𝘅𝘁.
➡️ Pain can be influenced by the things you see, hear, smell, taste and touch, things you say, things you think and believe, things you do, places you go, people in your life and things happening in your body.

𝟳. 𝗪𝗲 𝗮𝗿𝗲 𝗯𝗶𝗼𝗽𝗹𝗮𝘀𝘁𝗶𝗰.
➡️ While all protective systems can become turned up and edgy, the notion of bioolasticity suggests that they can change back, through the lifespan. It is biologically implausible to suggest that pain can't be changed.

𝟴. 𝗣𝗮𝗶𝗻 𝗶𝘀 𝗼𝗻𝗲 𝗼𝗳 𝗺𝗮𝗻𝘆 𝗽𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝘃𝗲 𝗼𝘂𝘁𝗽𝘂𝘁𝘀.
➡️ When threatened the body is capable of activating multiple protective systems including immune, endocrine, motor, autonomic, respiratory, cognitive, emotional, and pain. Any or all of these systems can become overprotective.

⤵️ Continued below:

❌Stop with the silos.❌

🙅🏻We do NOT need to dichotomize rehab and training.

🐶My pet peeve is an athlete coming in with pages of 'rehab' exercises that a clinician prescribed with the perception that they need to do it before they can train.

🤯It doesn't need to be that way.

🤝Rehab and training can be integrated.

💪🏻Rehab can look like training. Rehab can feel like training. Rehab can be your training.

🔥"ExRx is just a method to elicit adaptations in an individual. Know the constraints that injury or disease impose but implement interventions based on exercise science just like you always would"
~Scot Morrison

𝗣𝗮𝗶𝗻 𝗧𝗿𝗲𝗮𝘁𝗺𝗲𝗻𝘁 𝗧𝗼𝗼𝗹

🤕Pain is all about context. We must rethink pain. Shifting our idea of pain from a measure of the state of tissues to something your body is doing to protect you...so therefore EVERYTHING matters.

🔥The concept of The Protectometer and DIMs and SIMs help people in persistent pain identify potential contributors to their pain state and plan their road to recovery

🛡️It helps reconceptualize pain from the false belief of a 'damage' meter to that of a PROTECTOR.

🤹This Protectometer is in a constant state of judging whether something seems DANGEROUS or SAFE

⚠️A DIM (Danger in Me) is anything your body perceives as dangerous to your tissues, life, livelihood, job, happiness and day to day function.

🦺A SIM (Safety in Me) is anything that your body perceives as safe to make you stronger, healthier, happier and more confident.

🧠Our body concludes it will have pain when there is more credible evidence of danger in me (DIM) than there is credible evidence of safety in me (SIM)

⤵️ How to use this device:

👊🏻First step- look for anything that the body may see as credible evidence of 'Danger in Me' (DIMs) which tells it that it needs protecting and anything that the body may see as credible evidence of 'Safety in Me' (SIMs) to help decrease your protective behaviors like pain.

👇🏻Examples:

➡️Things you hear, see, smell, tough
➡️Things you do
➡️Things you say
➡️Things you think and believe
➡️Places you go
➡️People in your life
➡️Things happening in your body

🪣 Final step- modify and remove DIMs and strengthen and gather SIMs.

👀The beauty of this- we have so many options for recovery! It's just hides in difficult to spot places. It lives in the biopsychosocial factors that make us human.

🏃🏼‍♂️If you've been experiencing persistent pain, reflect and give this exercise a try! (Had to throw in 'exercise' somewhere 😉)

❤️Remember: "for there is nothing good or bad, but thinking makes it so."
~ Shakespeare

𝗜𝗱𝗲𝗻𝘁𝗶𝗳𝘆 𝗘𝗻𝘁𝗿𝘆 𝗣𝗼𝗶𝗻𝘁𝘀 𝘁𝗼 𝗞𝗲𝗲𝗽 𝗟𝗶𝗳𝘁𝗶𝗻𝗴!

🤟🏻𝗣𝗮𝗿𝘁 𝟯- 𝗣𝗹𝗮𝗻 𝗼𝗳 𝗖𝗮𝗿𝗲 𝗯𝗮𝘀𝗲𝗱 𝗼𝗻 𝗜𝗻𝗶𝘁𝗶𝗮𝗹 𝗘𝗻𝗰𝗼𝘂𝗻𝘁𝗲𝗿 (see prev posts)

🤬You're injured or have a tissue irritation. It sucks. I've been there. But you can keep lifting!

💪🏻You just need to identify the entry points to training:
➡️This will increase load tolerance and capacity in specific positions.
➡️Minimize deconditioning
➡️Continued skill practice
➡️Minimize apprehension to movement and compensatory avoidance patterns

🎚️There are many constraints to employ to get the you back training. We can turn the dial up or down on any of these. These are based on the buckets of need, boundary conditions and prior training history & data:

𝗘𝘅𝘁𝗲𝗿𝗻𝗮𝗹 𝗟𝗼𝗮𝗱: Find threshold. Adjust weight

𝗜𝗻𝘁𝗲𝗿𝗻𝗮𝗹 𝗟𝗼𝗮𝗱: Find threshold. Adjust proximity to failure

𝗩𝗼𝗹𝘂𝗺𝗲: Find threshold. Adjust sets/reps or frequency

𝗥𝗮𝗻𝗴𝗲 𝗼𝗳 𝗠𝗼𝘁𝗶𝗼𝗻: Find threshold. Modify portion of the lift

𝗧𝗲𝗰𝗵𝗻𝗶𝗰𝗮𝗹 𝗦𝘁𝗿𝗮𝘁𝗲𝗴𝘆: Adjust shin angle, stance, grip width, back angle, pelvic tilt, shoulder rotation, etc.

𝗩𝗲𝗹𝗼𝗰𝗶𝘁𝘆/𝗜𝗻𝘁𝗲𝗻𝘁: Modify speed with tempo or isometrics

𝗘𝘅𝘁𝗲𝗿𝗻𝗮𝗹 𝗕𝗼𝘂𝗻𝗱𝗮𝗿𝘆: Constrain task to build up load tolerance, ROM, or desired bucket of need etc.

𝗩𝗮𝗿𝗶𝗮𝘁𝗶𝗼𝗻: Substitute for different movements temporarily (top-down approach: next most specific variation to the primary lift)

🏋️‍♂️Example (see previous posts):
Powerlifter with left sided LBP when deadlifting

🔥Boundary Conditions:
➡️ Exam Findings: Symptoms with end range lumbar flexion and hinge forward
➡️ ROM Threshold: off floor in deadlift
➡️ Load Threshold: ~75% current RM
➡️ Positional Intolerance: split stance RDLs and back extensions

🪣 Bucket 1= Deadlifts with ROM boundary and load threshold
🪣 Bucket 2= Unilateral left quadrant LB constrained loading

𝗘𝗡𝗧𝗥𝗬 𝗣𝗢𝗜𝗡𝗧𝗦:
Day 1:
➡️Single Leg Hinge w/ tempo 2-2-2 (KPI)
➡️ Deadlift: ROM constrained, load focused (KPI)

Day 2:
➡️ Back Extensions off GHD w/ tempo 2-2-2 (KPI)
➡️ Deadlift: Full ROM, tempo and load constrained (KPI)
👇🏻More below!👇🏻

𝗣𝗮𝗶𝗻 𝗶𝘀 𝗙*𝗰𝗸𝗶𝗻𝗴 𝗖𝗼𝗺𝗽𝗹𝗲𝘅!

🤯The possible factors of why someone may experience pain are endless (as shown) so it is truly impossible to know the exact reason why someone is in pain and therefore know the exact process to get them out of pain

😎With that being said we tend to think about pain from a biopsychosocial lens, which helps gain an understanding of the person and their subjective experience (taking it in from a holistic perspective)

🕸️These biological, psychological, and social factors were intended to have an interconnected, non-linear, dynamic relationship with the pain experience.

🧐This means that small things can give large effects, but also large effects in one area may have no effects in the targeted area. And that there are so many interactions occurring that can affect each other that the same treatment may give rise to positive or negative outcomes dependent on the current state of the person

🌍By looking at it from this perspective, we are able to zoom out to encompass all of the factors that may be at play for the person and can consider the person and their engagement and embodiment in the world

👓This shifts the lens from pain arising from a body region or the brain, and instead to it being an experience that emerges through a person, which is inseparable from their mind, body, and world.

🔥BPS helps to understand patients, their lives and contexts.

🤖We are not linear machines and therefore we cannot separate someones pain experience to 1 causal factor. We cannot ‘find pain’, but instead it presents itself through the person in a lived experience as the person makes sense of the world, with it shaping them

❤️Maybe instead, this BPS lens can help treat PEOPLE, rather than pain. Which can lead to greater reductions in suffering, disability and quality of life to improve overall patient care.