This interview shares a professional's personal insights for general information. It is not medical advice. Always consult your own healthcare provider for personal health concerns.

I work in the cardiovascular surgery unit at Toronto General Hospital. My primary role is to see patients after they've had major heart surgery. The core of my job is to assess them, design a safe rehabilitation plan, and work with them to rebuild their strength and mobility. The goal is to ensure they've regained enough function and independence to be safely discharged and return home.

I completed a four-year Bachelor of Science degree in Kinesiology and Health Sciences at York University. After taking a short break, I went on to earn a two-year Master of Science in Physical Therapy from Queen's University. In total, I've been practicing in healthcare for about six years. I started my career in private practice before transitioning to a long-term care home, and currently work at a hospital.

The body's dynamic, relentless capacity for adaptation across all its systems is remarkable. From the networks of our nerves to the vessels of our heart, this principle of intelligent change creates a resilience that is nothing short of astonishing.

This is vividly seen in the neurological system through neuroplasticity. The brain's internal map, with specific areas dedicated to body parts like sensitive lips or dexterous fingers, is not fixed. When a finger is amputated, the corresponding brain area doesn't just wither, it is remarkably repurposed. The "finger territory" shrinks, but neighboring areas for the wrist or the remaining stub expand, forging new connections to maximize control of what remains. This adaptive logic is pushed to incredible extremes, such as in individuals who, having lost their arms, develop such precise neural control of their toes that they can type, play instruments, and perform other fine motor tasks with a dexterity comparable to using one's hands.

This same principle of adaptation through challenge manifests just as powerfully in the cardiovascular system. I once knew of a marathon runner whose years of training stimulated angiogenesis - the growth of new blood vessels. Decades later, when faced with severe blockages in four major coronary arteries, this built-in redundancy became a lifesaving network. The extra vessels, grown through adaptation, created natural bypasses to nourish the heart muscle, demonstrating how past stress can engineer future resilience.

Ultimately, whether in the brain's remappable circuits or the heart's ability to grow its own solutions, an amazing design feature of the human body is this profound redundancy and adaptability. When one pathway is compromised, the architecture of homeostasis ensures others can rise to the task. It is a system that doesn't just maintain balance - rules are intelligently rewritten to preserve life.

In the hospital, we don't just see a patient as having bodily systems like nervous, muscular, or cardiovascular. We also consider their housing situation, their social support, and other life domains. Each member of our team is responsible for one of these areas. I handle the musculoskeletal assessment, while the neurologist, cardiologist, social worker, nurse practitioner, pharmacist, etc., each contribute their expertise.

Our goal is to work together to get the patient back to their baseline. We operate like consultants, constantly putting our heads together to problem solve. Everyone contributes to the same patient chart, so I'm always reading notes from other practitioners, and there's a lot of back-and-forth collaboration. For example, if a patient needs another operation but might be too weak, a nurse practitioner might ask me to assess their strength before the team makes a final decision. At the same time, I check the patient's chart to make sure I don't recommend an activity that could interfere with another aspect of their care.

When we hit a wall in a patient's recovery, especially in complex cases where someone may have suffered a stroke or nerve injury and isn't improving significantly, we hold a family meeting. We sit down with the patient and their family to talk realistically about where things stand, what recovery looks like, and what the next steps might be, which sometimes includes discussions about palliative care. It's a team effort, not just medically, but humanely, to guide each person through their care journey.

One of the more moving interactions in my career happened while I was working at an OHIP-funded clinic, where we saw many geriatric patients. A 72-year-old woman came to see me suffering from a painful case of Tennis Elbow - tendon damage and inflammation on the outer part of the elbow from overuse. For about a month, she'd been struggling with simple daily tasks: opening doors, writing, anything that involved her hand or wrist.

As part of our standard protocol, I began taking her patient history. I asked the usual questions: when the pain started, what made it worse, what made it better… It was during this conversation that she suddenly broke down in tears. Her sobbing took me completely off guard; tennis elbow isn't a life-threatening condition, and her emotional reaction seemed disproportionate to the injury. I paused and gently asked if she was okay. That's when she shared that her husband had passed away just a few months prior. The elbow pain was from suddenly having to manage everything on her own: the household, the chores, the weight of a life she used to share.

That moment changed my understanding of pain. It isn't just about nerve signals or inflamed tendons. Our experience of pain is deeply shaped by the state of our nervous system - and hers was under immense stress from grief, loneliness, and depression. Knowing her story didn't just add context; it completely reframed how I approached her treatment. She wasn't just a case of lateral epicondylitis; she was a whole person carrying emotional and physical hurt.

By giving her space to tell her story, I could offer not just physical rehabilitation, but also reassurance and emotional support. We worked together on her condition, and within about two months, her elbow was significantly better. But more importantly, she felt heard and understood. That experience reinforced something fundamental in my practice: the correlation between mental health and physical pain is profound. You can't just treat the injury, you have to understand the person.

Pain is far more than a simple signal of structural damage. At its core, it is a sensation of discomfort that tells us something is wrong, but its intensity is profoundly context dependent. The same objective injury - like a paper cut versus a heavy weight falling on your hand - is experienced very differently. This complexity becomes especially clear when working with chronic pain or injuries where a person's reported pain level doesn't correlate with what an MRI or X-ray shows. Two people can experience vastly different pain from the same physical issue.

The brain interprets pain by assessing multiple factors far beyond tissue damage: Is my body safe? Am I feeling threatened? What was my previous experience with this? What is my current emotional state? Consider a professional athlete effectively playing through an injury in a crucial game versus someone who is sleep-deprived, stressed from work, and then experiences a minor bump - their nervous systems will process the stimuli on entirely different scales. When someone is under prolonged stress, grief, or financial strain, it sensitizes the entire nervous system, amplifying pain. A person might have only "mild" degenerative changes on an X-ray, but if they are coping with systemic life stresses, they can experience debilitating pain that limits function, creating a vicious cycle where pain worsens mental health, which in turn worsens the pain.

Approximately 40% of individuals with chronic low back pain have also suffered from clinical depression, demonstrating how a depressed nervous system fundamentally changes the experience of pain. This is why a crucial part of physiotherapy is educational and therapeutically mental. It's about teaching the concept of pain, helping people understand that their pain is real - it's not "all in your head" in a dismissive way, but rather a real experience constructed by the brain interpreting a threat. We work to calm the nervous system, use gentle movements to build safety, and create a supportive environment. For chronic pain, the goal is often to make the brain feel safe again. The key is finding a balance between two unhelpful extremes: on one side, thinking the pain is purely psychological, and on the other, believing it's solely about fixing a structural problem. True healing addresses the whole person - the intertwined physical and emotional states that shape the experience of pain.

The core problem is that the system is often forced to operate on a model of symptom management rather than treating the root cause. This happens on a large scale. In an ideal physiotherapy scenario for example, we identify and address the underlying issue - which is typically a muscle imbalance or weakness. You cannot fix that with pain medication, massage, or electrical modalities. Those are band-aid solutions for pain.

Real, lasting change requires specific exercises performed with high compliance: for example, 20 minutes, two to three times a week. The biggest gap is that this level of compliance is very difficult for patients to achieve. The hindrances are practical: the funding to afford frequent sessions, and time in their personal lives. After an eight-hour work shift, it's a major challenge. The system puts people in this precarious position. It's simply easier to sit down and take a pill or throw on a heat pack. In fact, the pressure is often on us as therapists to provide that immediate, passive relief - like a heat pack or a pain killers so that a patient leaves the session feeling a bit better, even if it doesn't solve the underlying problem.

The fundamental goal is to be as healthy and independent as you can for as long as you can. This independence applies to the basic activities of daily living - being able to take a shower, use the toilet, prepare meals, do laundry, or vacuum. Being able to do these things is functional independence.

A key consideration in maintaining this is counteracting sarcopenia, which is age-related, programmed muscle loss. This tends to start around age 30, and you can lose between 3 to 10 percent of your muscle mass per decade after that. So, it's an uphill battle. You lose muscle, which leads to weakness and a loss of activity tolerance, and that's how you start to lose functional independence - it creeps up on you.

If you lead an active lifestyle with healthy habits - like going to the gym - between the ages of 30 and 55, you can slow that rate of decline. You build a reservoir of muscle mass so that when you experience sarcopenia, you still have a strong base. Exercises like squats and weightlifting through resistance training help maintain muscle mass and slow the rate of loss. From a young age up to 30 you should be building it, giving yourself more of a reservoir for later. People often say, "I just want to be strong enough to chase my grandkids.", but often it's not something people think about until it's too late.

Similarly, consider your range of motion, which pertains more to injuries. If you get into your 50s having led a sedentary, sitting lifestyle, and one day you fall and strain your shoulder, you might suddenly only be able to raise your arm 40 degrees. That impacts your daily life - putting on a shirt, reaching into cabinets. You maintain range of motion by moving and exercising. If you're not in the habit, it's harder. The stronger you are going into an injury, the better you tend to be coming out of it. Lift weights, for the adaptations we see in bone health such as bone mineral density are critical. Lift weights, go for walks, exercise; your body adapts to do those things. But it also atrophies (e.g., weakens and stiffens) to sitting all day if that's your habit. The key is to build strength and movement into your life now. I wish everyone the best on their journeys to a strong, independent life.