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Table of contents:
- What is Physiotherapy?
- What is Orthopaedic Manual Therapy?
- What is IMS?
- My First Visit
- Rates & Cancellation Policy
- ICBC/ WorkSafe BC (WSBC)
- From a legal perspective
What is Physiotherapy?
Physiotherapy is a branch of medicine dedicated to the treatment of muscle, joint, bone and nerve related injury and dysfunction. It is the primary health care profession that works along side medical doctors to promote wellness, mobility, relieve pain and restore function. Physiotherapists are all university trained holding baccalaureates, masters, and doctorate degrees. Their education and clinical training gives them the knowledge and skills to assess and treat illness and injury. Because of their training, they are competent to identify when a client’s symptoms are beyond the physiotherapy scope of practice and will be able to direct the client to the appropriate health care professional.
As primary health care professionals, patients do not need a physician’s referral to see a physiotherapist. Patients covered under MSP, WCB and ICBC for example do not need a physician’s referral for physiotherapy. Most extended health care plans also recognize the need for direct access as well, however, a few still require a physician’s referral for reimbursement purposes.
On your first visit you can expect that your physiotherapist will take a thorough medical history and ask you questions about your areas of complaint, how the injury occurred, and anything else that would be relevant including work conditions, exercise habits, overall health, previous injuries, family history, etc. Your physiotherapist will be able to take a look at the big picture from past to present and narrow the focus to better explain why you are having the pain and dysfunction you are having now. Physical examination and testing follows the history taking and is a critical component of the initial evaluation process as it confirms the diagnosis and identifies which tissues (muscle, cartilage, bone, nerve) are involved and to what extent they are injured. This is very important and must be done correctly because different tissues need to also be treated very differently. Accurately identifying which tissues are injured the first time means a faster recovery for you.
A trained manual physical therapist will be able to palpate and identify whether a joint is restricted, hypermobile, in spasm, arthritic, or bound down by scar tissue. It is this part of the physical assessment that requires the most amount of training and experience since a joint restriction is treated entirely different from a hypermobile joint or segment. The prescription of medical exercises following manual therapeutic intervention is vastly different in a joint restriction as compared to an unstable joint. For instance, in the unstable joint, exercises must work to enhance joint stability and limit the overall range of motion and enhance joint control, where as in the restricted joint, exercises must challenge the end ranges of motion and it may be necessary to hold the joint in certain angles to promote a stretch of the joint capsule. Once again, manual diagnostic techniques are crucial in determining the appropriate exercises and promote faster recovery.
What is Orthopaedic Manual Therapy?
ORTHOPAEDIC MANUAL THERAPY (OMT) OMT has it’s roots in medicine dating back to 400 BC when Hippocrates first used manual techniques to alleviate low back pain. Although medicine and manual therapy has evolved and advanced very much since then, Hippocrates, also known as the “father of medicine”, can be credited for laying the foundation upon which manual physiotherapists practice even today.
OMT is a specialized branch of physical medicine requiring advanced level of physical therapy training where skilled specific hands-on techniques such as manipulation/mobilization are used for the management of neuro-musculo-skeletal conditions. Scientific medical exercise and manual methods are based on clinical reasoning, evidence, and a thorough understanding of anatomy and physiology, and underpins all effective treatment plans. Expected outcomes may include managing pain, increasing range of motion, reducing soft tissue tension, eliminating joint inflammation, increasing joint mobility, improving joint stability, restoring normal movement patterns, improving general fitness, and returning to work, sport, and daily activities.
OMT is employed by physiotherapists and physicians alike in the diagnosis and treatment of impaired soft tissues and joint structures. Manual therapy diagnostic techniques form the medical justification for ordering radiological tests such as MRIs and CT Scans. Manual therapy treatment techniques modulate pain, increase range of motion, reduce or eliminate soft tissue inflammation, induce relaxation, improve contractile and non-contractile tissue repair, extensibility and/or stability, facilitate movement and improve function.
For more on the history of OMT:
Intramuscular Stimulation (IMS) is a dry needling technique that uses acupuncture needles to release shortened and tender muscle bands from neuro-musculoskeletal dysfunction. It is a diagnostic and treatment tool for myofascial pain of neuropathic origins. This treatment technique was first developed by Dr. Chan Gunn (C.M., O.B.C., M.D., PhD.), and bridges the gap between traditional Chinese acupuncture and western medicine.
How does IMS work?
Very often, the nerves throughout your body can get hypersensitive, stemming from trauma and/or repetitive strain. When irritated, nerves’ supply to your muscles becomes abnormal, which in turn causes the muscles to become super-reactive and shortened. This manifests itself as tightness and stiffness in your body. After a fine needle is inserted into a supersensitive muscle, the muscle will grasp it and create a cramping sensation. This will then stimulate a reaction that leads to the release of endorphins, resulting in relaxation. The tiny wound caused by the needle’s introduction into the muscle can further induce the healing process. Once the tension in your muscle has been reduced, it decreases stress and tendon slackening, and decreases the pressure that is being put on your joints, discs, and nerves. As a result, the pain signal is reduced and the muscle relaxation slowly returns the blood flow to the area. Furthermore, this allows the nerve and muscle to re-pattern to normal function. A diagnostic test such as an X-ray, CT scan, or MRI may not show any visible signs of your injury, making it impossible to detect supersensitive muscles through conventional means. However, an assessment by a trained Gunn IMS practitioner can help determine if this technique is suitable for you.
What conditions may benefit from IMS?
A wide range of neuro-musculoskeletal problems, such as the following:
- Tension and headaches
- Neck pain and whiplash
- Upper, mid, and low back pain
- Frozen shoulder and rotator cuff tendonopathy
- Tennis elbow
- Carpal tunnel syndrome
- Sciatica/piriformis syndrome
- Leg stiffness/numbness
- Plantar fasciitis
- Repetitive strain injuries
Does IMS hurt?
When a needle is inserted into a normal muscle, you will only feel the prick of the needle itself. However, if you have supersensitive muscles, you will feel a cramping, aching, or even grasping sensation. Some patients describe it simply as a pressure point, and some patients describe it as akin to a Charlie Horse. After your IMS treatment, you may experience increased soreness for a few days, followed by improvement in your overall pain state. Mild heat and resting may help to relieve post-treatment soreness.
How often is IMS needed?
Typically, treatments are once every 1-2 weeks in order to allow time for your body to recover. The number of treatments depends on the severity of the problem, the nature of the condition, your general health, your body’s healing ability, and the condition of your nerves. According to a published study on low back pain, the average number of treatments is 8.2 sessions.
What should I wear to my appointment?
Wear something that allows your physiotherapist to access the area of concern in order to perform a full examination of the spine and limbs, i.e., shorts and a bra instead of a tank top. Gowns are available if needed.
Who can practice IMS?
IMS is practiced in British Columbia by Certified Gunn IMS Practitioners (CGIMS), who are either registered physiotherapists or medical doctors. Currently, UBC Gunn IMS training operates under the British Columbia College of Physicians and Surgeons and the BC College of Physical Therapists.
How can I access IMS treatment?
If you think you have a condition that may benefit from IMS, you can simply make an appointment with our Gunn IMS qualified physiotherapists, Agnes Ku, BScPT (Hons), BScKin, UBC CGIMS and Jonathan Lui, MScPT, HBSc, CAFCI. IMS is included in the scope of physiotherapy practice. Our physiotherapists will assess your condition and advise you on the best approach for it. For further detailed information, please browse the following websites: http://ubcgunnims.com http://istop.org
The Canadian Academy of Manipulative Physiotherapy (CAMPT) is Canada’s member organization of the International Federation of Manipulative Physical Therapists (IFOMPT) which is part of the World Confederation of Physical Therapy and the World Health Organization. CAMPT’s role is to advance orthopaedic manual therapy practice, education and research in Canada, and to monitor Canadian education programs to ensure they continue to meet the standards of IFOMPT. Our members are all physiotherapists, who have chosen to focus their skills in the area of orthopaedics (muscle, nerve and joint problems). We treat our patients using manual therapy and specifically tailored exercise programs.
“Fellow” status in the CAMPT is both a membership classification and a professional credential. As a professional credential, a “Fellow” in CAMPT is an international recognition of competence and expertise in the practice of orthopaedic manual therapy by a physiotherapist licensed in the Canada. To achieve the Fellow credential, a physiotherapist must complete a credentialed fellowship program in manual therapy. The “Fellow” is a physiotherapist who has demonstrated advanced clinical, analytical, and hands-on skills in the treatment of neuro-musculo-skeletal disorders. Fellows serve their patients and the public by demonstrating excellence in clinical practice, education, and research.
To maintain the professional credential of Fellow, a physiotherapist must be a member in good standing in the CAMPT. The Fellow membership classification affords the member special privileges to vote on issues related to practice standards, international affairs, and bylaw changes. Additionally, only Fellows are allowed to serve on the executive committee as President, Vice-President, Secretary, or Treasurer (any member in good standing may serve on the executive committee as Member-at-Large). These requirements are in place to comply with the constitution and bylaws of the International Federation of Manipulative Therapist (IFOMPT) of which the CAMPT is the representative organization from the Canada.
Credentials Acronym Definitions:
FAAOMPT – Fellow of the American Academy of Manipulative Physiotherapy
FCAMPT – Fellow of Canadian Academy of Manipulative Physiotherapy
CAFCI – Certificate of the Acupuncture Foundation of Canada Institute
DPT – Doctorate of Physical Therapy
MPT – Masters of Physical Therapy
BScPT – Bachelors of Physical Therapy
BScKIN – Bachelor’s of Science in Kinesiology
MTC – Manual Therapy Certificate
MCPA – Member of the Canadian Physiotherapy Association
IMS – Intramuscular Stimulation
My First Visit
Please come in 10-15minutes prior to your first appointment so you can fill out some paperwork without cutting into your appointment time. You can also choose to download the forms directly below, under Patient Intake/Consent Form, and bring it into our clinic at the time of your appointment.
Please wear comfortable clothing for your treatments:
- Tank tops/t-shirts: upper body injuries that require revealing certain areas of the body
- Shorts: for hip, knee and low back injuries
- We also have shorts and gowns for those who didn’t have time to prepare
For full details, please download our Fee Schedule here: BQ Fee Schedule <<
Your appointment time is reserved specifically for you. If you need to reschedule an appointment, 24hrs notice is required so we may give this time to someone else, otherwise a cancellation fee will apply for the time lost. Thank you for your cooperation.
ICBC/ WorkSafe BC (WSBC)
Burquitlam Physiotherapy understands the emotional stress many patients unnecessarily have when dealing with injury claims (such as ICBC or WorkSafe BC injury claims). To address this, Ivar Lee, a Personal Injury Lawyer and partner at the law firm Paine Edmonds LLP, provides free initial consultations to all patients of Burquitlam Physiotherapy. Whether it is an assessment of your claim, answering questions about how treatment costs are covered, or whether pursuing an ICBC injury claim is better than a WorkSafe BC claim, Mr. Lee is there to help clarify and simplify the complicated process of injury claims to our patients. Mr. Lee is happy to provide free initial consultations either over the phone, at one of Paine Edmonds LLP’s office locations, or even at your home if that is most convenient for you.
At Burquitlam Physiotherapy, we understand how emotional stress and frequent communication with so many parties during the course of an injury claim can be a distraction from therapy. Having Mr. Lee serve as a legal resource for our patients is how Burquitlam Physiotherapy will help to ensure you are able to focus on your recovery.
You will also require a referral from your physician in order for ICBC or WSBC to consider coverage approval. With your permission, we will contact the appropriate parties to seek coverage as quickly as possible. For full details, please download our Fee Schedule here: BQ Fee Schedule
From a legal perspective
If you have been involved in a motor vehicle accident (ICBC), please see our FAQ section provided by Ivar Lee from Paine Edmonds.
Q. What do I do immediately after a motor vehicle accident?
A. First and foremost, stay calm and don’t panic. Make sure you and anyone else in your vehicle do not require immediate medical attention. If so, call 9-1-1 for assistance. If immediate medical attention is not required, often times emergency services (ie. police and paramedics) will not attend the scene.
If it is safe to do so (ie. both vehicles have been pulled over to a safe spot on the side of the road or the police have attended and secured the scene), you will next need to exchange the following information with the other motorist involved:
1) License plate number, year, make, and model of each vehicle;
2) Your names, addresses, and driver’s license numbers;
3) Names and address of the owners of the vehicles; and
4) Names of your insurance companies.
If there were any witnesses to the accident, make sure to secure their names and contact information (address, phone, or email address).
If the police attended, make sure to ask the attending officer for the police file number (they’ll often write it down on a business card).
If you have a smartphone with a camera and again it is safe to do so, take photographs of the damage to both vehicles as well as any skid marks left at the scene. Also take a photograph of the accident scene itself (ie. a photograph of the entire intersection). If you have any visible injuries (ie. cuts or bruises), take photographs of those as well.
After you leave the accident scene, seek immediate medical attention (ie. hospital, your family doctor, or a walk-in clinic) so your injuries can be documented by a medical professional.
After you have received medical attention, contact your insurance company. If ICBC is your insurer, contact ICBC Dial-a-Claim at 604.520.8222 in the Lower Mainland or 1.800.910.4222 to report the accident giving the details you’ve gathered as well as a description of how the accident occurred. You will be assigned an ICBC claim number as well as an appointment to meet with an estimator to assess the damage to your vehicle and a bodily injury adjuster to discuss your injury claim.
I highly recommend you seek legal advice before discussing your injury claim with an adjuster either in phone or in person. If you retain a lawyer, you do not have to meet with the adjuster because your lawyer can handle the rest for you.
Q. What do I do immediately after falling in a store because of a slippery floor or other hazardous condition?
A. Again, stay calm and don’t panic. If you need immediate medical assistance, ask one of the store’s employees for First Aid assistance. Most stores will have an employee trained in First Aid; if they don’t, they can call an ambulance for you. Also, ask for the store’s manager so that you can report the incident to them so they can notify their insurance company about your injury claim.
If there were any witnesses to your fall, be sure to get their names and contact information:
(address, phone, or email address).
If you have a smartphone with a camera and again it is safe to do so, take photographs of the hazardous condition that caused your fall (ie. if it was a puddle of water, take a photograph of it as well as any skid marks left by your footwear, if any). If you have any visible injuries (ie. cuts or bruises), take photographs of those as well.
After you leave the accident scene, seek immediate medical attention (ie. hospital, your family doctor, or a walk-in clinic) so your injuries can be documented by a medical professional.
The store manager or an adjuster with the store’s insurance company will likely contact you to discuss your injury claim. I highly recommend you seek legal advice before discussing your injury claim with an adjuster either in phone or in person. If you retain a lawyer, you do not have to meet with the adjuster because your lawyer can handle the rest for you.
Q. Why doesn’t ICBC pay me the full amount of my treatment?
A. This is often the biggest source of confusion for people dealing with an ICBC injury claim. When ICBC pays for a portion of your treatment, they are paying this under your “Part 7” or “no fault” accident benefits coverage that is included with your ICBC insurance policy (there are other ways to be covered which are set out in ICBC’s regulations). Think of it as a limited, extended medical insurance included with your ICBC insurance policy.
The problem is ICBC’s coverage only obliges it to pay a limited portion of various types of treatment not the actual cost of them.
In cases where you are not at fault for the accident and have an injury claim against the other driver (a type of legal claim known as a “tort” claim) you can sue for the amounts of your treatment that ICBC did not cover up front. Assuming that ICBC is the other driver’s insurance company, ICBC will often reimburse for those amounts as part of your injury settlement.
Whether you are at fault or not, if you have extended medical insurance from another insurer (ie. through your employment, your spouse’s employment, etc.), you should be submitting all receipts for treatment to that insurer for reimbursement. This is not only because such insurance is considered “primary insurance” but often times, their coverage will be far superior to what ICBC is obliged to pay.
Q. Is ICBC or WorkSafe BC responsible for covering the cost of treatment if I am involved in a motor vehicle accident while I’m working?
A. This depends on whether the other driver involved was also working at the time. If you are both clearly working at the time of the accident (ie. you are both couriers en route making deliveries), you will both be restricted to making claims to WorkSafe BC as they will be responsible for covering the cost of your treatment (ie. up to the limits set out by WorkSafe BC regulations).
If you were working at the time but the other driver was not, you are entitled to choose between making a claim with ICBC or WorkSafe BC (see below).
Unfortunately, some cases are not so clear as to whether someone is considered to be “working”. For instance, grey areas often arise when someone is on their way home, going to work, or on a lunch break. There are many factors that can affect this determination so it is best to seek legal advice before making your accident report to ICBC or WorkSafe BC so that all necessary facts and details are provided.
Q. Do I have the option of choosing either ICBC or WorkSafe BC?
A. So long as the other driver involved was not working at the time of the accident, you have the option of making a claim with WorkSafe BC or ICBC. If you choose to make an ICBC claim, in some rare cases, you can still be entitled to benefits from WorkSafe BC even after settling your ICBC claim. As such, it is a good idea to submit an application to WorkSafe BC anyways as this will preserve your right to future benefits if you are so entitled. Make sure your application is submitted as soon as possible before the deadline to submit claims to WorkSafe BC.
Q. Which is the better option?
A. Generally speaking, an ICBC injury claim is the better option if you are not at fault for the accident. Even though in the short-term WorkSafe BC benefits provide better compensation than ICBC benefits, in the long-term you will receive better compensation by pursuing an ICBC injury claim. The main reason is significant types of compensation (such as compensation for pain and suffering and loss of future income) are not available to you if you make a WorkSafe BC claim.
Of course, the ability to in effect “wait” for the results of an ICBC injury claim (which can take some time to settle since a settlement is optimally reached once your injuries have fully resolved and all necessary medical investigations have been concluded) can be a problem in the short-term since choosing to make an ICBC injury claim will mean you are not entitled to receive WorkSafe BC benefits or ICBC “no fault” accident benefits. If you do not have adequate savings or alternative medical and income replacement coverage, you may not be able to afford waiting for an ICBC injury claim settlement and instead may be forced to make a WorkSafe BC claim.
If you are at fault (completely or mostly), it is likely that pursuing a WorkSafe BC claim will be the better option. The reason for this is compensation from an ICBC injury claim is based on the degree to which you are not at fault. For example, if your claim is worth $10,000 but you are 75% at fault, you are only entitled to $2,500. In such cases, the amount of benefits you will be entitled to receive from WorkSafe BC will likely be more.
In some cases where you have elected to pursue a WorkSafe BC claim over an ICBC injury claim and wish to change your decision, WorkSafe BC will sometimes permit you to “re-elect” provided you pay an “administrative fee” which is often based on a percentage of benefits paid to you. In some circumstances, depending on what your ICBC injury claim could be worth, it may be worthwhile for you to consider this. However, it is recommended that you seek legal advice before making such a “re-election”.