I experienced a proper attack of lumbago today for the first time! (All my ex-employers are like: "what do you mean by first? how about all the times you called in sick because of back pain?!?!"). I'm excited! It is a proper attack, if I sit too long I have problem getting up and sudden movements are sub-optimal. The pain does not go all the way down the legs, though and I have 0 red flags. (If I had any red flags I would not be excited, but on my way to the hospital). So I did a McKenzie assessment on myself and as I thought I have a posterior derangement (known in German as Hexenschuss, which will be one of the cool words in the new category). I was a bit surprised at how painful bending forward was, I still cannot reach my toes, but I guess this is because of increased pressure on my disc during this movement and not an indication of preferred direction. Further tests confirmed this theory. So I gave myself extension exercises (standing and lying down) to do several times per day and fully expect to be pain free tomorrow, because McKenzie is amazing. Unless I spent too much time sitting down writing blog posts.

My workplace is Vifilstaðir, a house built beginning 1900s to be a tuberculosis sanatorium. Part of the structure is in disrepair, such as the old terrace, where patients used to lie for hours under thick blankets in the cold, fresh air, which was faultily believed to be beneficial. It is all very "Magic Mountain" a book I incidentally never finished to read.




Now the house is used as a temporary home for elderly who are waiting for a place in a nursing home. The house is spacy, with high ceilings and from all the rooms as well as the physiotherapy there is a great view of the surrounding landscape, which now in summer is in bloom.



From the house we can see "Gunnhildur", a hill which patients in the sanatorium climbed as a final test if they were ready to go home. There is also a trail called "Tuberculosis trail". It is connected to other trails in the area. There are many recreational areas. There are picnic areas, lava caves and Vífilstaðirlake, a lake where couples from Reykjavík meet in secret during lunch brakes, as me and my colleague found out when we decided to go for a short walk there.




In the pictures I tried to create the feeling of old photographs using Gimp. There are lots of ways to get there, but the one prefer is playing around with contrast and colour balance of the picture and then adding a layer in the hard-light mode and add a gradient in a pastel colour (yellow for daylight, violet for evening light). I feel I start getting the hang of Gimp.

The administrators of Expat-Blog asked in the Forum to write some information about the Icelandic Health Care system. Considering I'm working in it, I decided to answer.

The health care system in Iceland is a NHS style system, which means everyone is covered by the Icelandic Health Insurance, which is financed via taxes.
There is no private system to speak of, but the current government is working hard on changing that, crippling the public health care system while a private hospital is planned to be built.

Immigrants who have been legally residing in Iceland for 6 month are automatically covered. If one is from an EEA country can get coverage via the European Health Insurance Card or is insured directly if one has been insuread/resided in one of the EEA member states 6 month previously. One has to request form E104 (or form E106/E109/E121) from their previous insurance provider and submit it to the Icelandic Health Insurance.
For none Europeans see here.

Even for insured patients there are quite a lot of out of pocket payments, for example for interventions, such as physiotherapy, psychological care or medication (often even for life threatening or chronic conditions, such as heart medication or cancer). The out of pocket payments are paid up to a certain amount, after which the insurance will pay a higher percentage or all. The out of pocket payments for medicine can be up to 62.000kr (425kr) in a 12 month period.
For one physiotherapy session alone one can expect to pay around 4000kr (25€) out of pocket.

Dental care is not covered by the Icelandic Health Insurance.

This is where the trade unions come in. Almost everyone (85%) who is employed is in a union. They play an important part in the social security system, offering financial support for holiday, education and healthcare. Unions will often refund part or all of the out of pocket payments for medication, dental care or therapies. They also have sick day funds for after sick pay rights expire (even for sick spouses or kids!) and disability funds.
See the these two links as an example: http://vr.is/english/sick-payfund/ http://vr.is/english/grants/
One can find out which union you belong to by checking your working contract or your payslip (union dues are taken automatically from the wages)

It comes from Japan, they are beige, so this was the first colour

--Our instructor on the colours of the tape

Last week I went to a Kinesio-taping course. I had actually looked forward to it, taping had already interested me, but a few slides into the presentation my inner alarms started ringing in earnest. Physiotherapy is unfortunately very prone to in-cooperating unfounded treatment methods. There are constant new and exciting ways to think about movement and the body in general. There is also a lot of bs out there. To not completely waste my time in this seminar, I started noting down every bs indicator I encountered during the lecture. It ended up being a checklist of things to watch out for.

1. We can treat anything! Just like the snake oil of old, therapies promising to treat everything should be met with a raised eyebrow. Often, like chiropractics they started out as a specific treatment and then branched out into every direction, coming up with increasingly ridiculous theories on why this treatment would work in a completely different structure than the one treated. Others make their life easier by claiming to target "energy" or by adapting believes on how the body functions to the therapy. See the next point.


2. One structure to rule them all. Here we make up theories on why our therapy is so universally helpful. For chiropractics every condition is due to misalignment in the spine. Craniosacral therapy blames everything on the flow of the cerebrospinal fluid. In Kinesio-taping the fascia (the connective tissue between muscles, ligaments, skin etc) is to blame for any problem you might have.


3. Only my therapist understands what is wrong with me. The above leads to a lot of over-complication of simple conditions. Suddenly the patient must sit through half an hour of presentation to understand his head ache. And as the problem is soooo complicated, not every one can treat it (especially not the patient themselves!). Patient dependency on the therapist is a lucrative side effect here.


4. Scary words. A lot of the theories lead to mundane problems (say back pain) being labeled with words used for actual serious problems. The patient is told that the joints in the spine are out of alignment (if that were true he'd be paralyzed), nerves are impinged, something is wrong with the flow of the cerebrospinal fluid (no, then you'd be somewhere close to death, see meningitis) or "there is an instability". There is a whole body of research out there how use of scary words can lead to chronification of a relatively benign problem. Lucrative as well, I guess.


5. Gurus! There is one person who made the amazing discovery on how this structure is the key to life the universe and everything and his word is gospel. McKenzie suffered from this, but they are moving in the direction of research. To be honest the same seems to be true for Kinesio-taping. A quick search on pubmed did not reveal any trials or even meta-analysis which could back up their "better then" claims, but I did not search for long and might be proven wrong down if I actually look closer.


6. Simply the best. Oh what tales we told. Of the impossible patient who had tried it all and could suddenly walk. How enlightened our methods are while the conservative treatments are stuck in the dark ages. My advise: unless backed up by research these tales are only stories used in a sales pitch and should be treated as such.


7. Trademarks Nordic walking, Masai shoes, Kinesio-tape, there is a huge market for health products. Kinesio-tape actually donated a lot of tape to the 2008 Olympics and then used the use of the tape during the Olympics for advertisement purposes. People are trying to sell you their product, which is ok, but be aware of it.

As my time as a Bohemian Traveller is coming to a close I have been looking at job advertisements and other physiotherapy related subjects. Thus I heard of Robin McKenzies death. He is the brain behind the McKenzie method, my favourite method for managing musculoskeletal disorders. Why?

It emphasizes the use of reliable and valid assessment methods to determine treatment

It promotes therapist independence for patients and treats patients as acitve participants vs receivers in therapy.

Rather than relying on overly complicated concepts it has a non-nonsense test, do and test again approach.

It does not pretend to know the answers to life the universe and everything, but rather encourages research.

I have never met Robin McKenzie, but considering the underlying principles of the foundation he founded, I think he was a cool dude.

Also he first got the idea of directional preference because he "forgot" he had a patient in the treatment room.

I wish my forgetfulness would be that productive.