We had the great pleasure of catching up with Margaret to talk with her about how a career as a semi-professional dancer led her to physiotherapy and why she thinks being a patient has played such a big role in her work.
How do you pronounce your last name?
“Tray-jan.” My father changed his name years before he had kids, so my siblings and I are the second generation of this line of Trajans.
Your background is in dance. How did you end up as a physiotherapist?
When I was in grade 12, I sprained my ankle, which was really my first injury. I was lucky to be dancing six days a week with no injuries up until then. The ankle sprain actually delayed my audition at the Alberta Ballet School. I went to physio for the first time with Ceri Jakobsen in Nanaimo and that was the first time that I considered physio as a future career.
In my early 20s, I was dancing and working in Vancouver and it was tough to make a living. I was serving at a restaurant, teaching dance, and spreading myself thin. So I reevaluated and decided to go back to school. I knew physio was what I wanted to do next and I got a lot of experience on the patient side of things during my years of post-secondary dancing.
I always found it interesting that physios seemed to know a lot about the connections between anatomy, the body, and injury prevention. It all seemed like magic to me. I wanted to understand more about the human body. I get to keep learning in this profession and that’s exciting!
How has being a patient helped you in your practice?
When I was a patient, I had a lot of practitioners explain my injuries to me in different, and sometimes conflicting, ways. I got a lot of mixed information. I would worry about moving and reinjuring myself. So now I try to teach my clients to be knowledgeable about their injuries and not to be scared. I really want people to feel empowered to better understand their pain. I highly prioritize education in order to prevent reinjury while getting people back to the activities that they love!
Pain is a tricky thing
This conversation comes up at least once every shift. I see people mostly for pain but some people come in for other reasons. A lot of people have heard about phantom limb pain so I explain it like this: someone can feel pain in their hand, even if their hand isn’t there. This demonstrates that pain isn’t just a physical thing: it’s not just about what’s going on in the tissue, the process is happening in the nervous system. It’s like a car alarm, designed to let you know before someone breaks in. If pain is the car alarm, it’s there to tell us, “you’re approaching your limit.”
I often use pain as a guide with my clients. Depending on the injury, I will sometimes advise people to stick to their pain-free zone or try to avoid surpassing a low pain threshold. It is a tricky thing, we’re walking a tight rope: doing enough to cause tissue adaptation but not so much that you reinjure.
You’re going to circus school!
Yes! Lately, I’ve been getting back into circus aerial acrobatics. Before I started my undergraduate degree, I was dancing at the Alberta Ballet School for a few years. I loved ballet but learned that I didn’t want to do just ballet. So I went to Vancouver and branched out into all kinds of training! I really loved learning circus stuff, especially aerial hoop, silks, and trapeze.
When I moved back to Victoria to start school, I wasn’t aware of opportunities to do aerial training, so I just focused on school. However, I recently discovered the Island Circus Space! After my first class, I couldn’t straighten my arms for a week [laughs]! I’ve been going once a week for the past few months now and am really enjoying getting back into it!
What’s the most common injury you see?
I see a wide variety of injuries ranging from low back pain and shoulder injuries to instability/hypermobility issues. Since I work mainly in the mornings, my clients are usually either off work because of their injuries or are retired, so I see a variety of clients when it comes to age and injury severity. Sometimes my clients are missing school or work to see me because their pain is so bad, or they’re free (retired). My schedule gives me diversity!
Do you have a favourite type of client?
I really like working with dancers and gymnasts doing activities similar to mine because I feel like I can bring an approach from my past that’s useful. I really love working with those people to get sport-specific. But, I also really love working with people with low back pain because I have also experienced that.
You use visuals in your practice, why is that?
People can feel pain down their leg but not know it’s coming from their lower back. I love treating that and helping them connect the dots because they might never have had pain in their lower back – they feel it in their leg. So I use pictures and models to show things like the nerves connecting the spinal cord to the leg. Clients are sometimes surprised to learn that it’s actually low back pain! I think many of us benefit from visuals to help us see things like this.
Do you practice what you preach?
A few months ago, I had some back pain that referred down my leg and wrapped around the front of my hip. I treat so many people with this! To experience it first-hand was such a good reminder about how this feels and what would I tell them to do. It’s helpful to be able to feel it and to be able to resolve it.
What is it like for you to see your clients improve?
It really makes me feel a lot of joy! Injury can impact more than just your body, it impacts your mental health, relationships, and everything. It’s really nice to see people getting better and coming back happier every time I see them because they’re getting back to the things they love.
Why is educating about body awareness important, but hard?
The body awareness from one person to the next can be really variable, for sure. We are often holding tension in places that we don’t realize, or can’t think of what repetitive action could have bothered something but eventually, we dig deeper and find “the thing.” I think we could do a better job of educating at this level. When I think about the things I learned during my undergrad, they seemed like such helpful skills for being the owner of a body and we don’t all get that training!
I think the best way to educate is through experience. We never forget our own experiences. If clients do something that changes their pain for the better, they will always remember that. They’ve already got the buy-in because they know it worked for them.
My partner will come home sometimes saying, “This hurts!” and I’ll say, “Try this!” and later he’ll realize he doesn’t have that same pain. So I think when people are open to trying something new, they can have a lot of success.
How do you get clients to realize it’s important to try new things?
It’s difficult. I think there has to be intrinsic motivation, finding out that person’s “why” and if they can tie their exercises to that goal. But also I think adapting is important too so that people don’t feel like they’re failing. It’s partially on me to make it more realistic: using my knowledge to tweak their exercise to maximize the benefit they gain.
Why is it important to have a continuity of care?
Some patients don’t have a GP (including myself!). It’s a daunting thing to feel like you don’t have somebody you can follow up with. At Arbutus, we can follow people with that continuum of care. We can liaise with their doctors directly if they have one and refer on to other health care practitioners when needed. It’s been nice to fill that gap. I feel really lucky to get the time that I do with my clients.
What’s it been like to work at Arbutus?
One of the big reasons I took the job at Arbutus was because of the great mentorship! Every week, I meet with a more senior physiotherapist and I get to chat with them about my caseload. I’m always getting support from experienced practitioners. When I’m supported, I can better support my clients. We have a strong professional learning network.
How do you decompress after work?
Physio is a career with a lot of responsibilities, so decompressing is important! That’s part of why I’m retaking up circus aerials and I also play music! I play piano and guitar and sing with my partner and his brothers. I really love to cook with my partner; we went plant-based about a year and a half ago. I’ve gotten back into running since finishing school and have been training for some events. I often cycle to and from work to fit exercise in between shifts.
I love being able to bike to and from work because it gives me a chance to have a break and get some exercise. I can mentally prepare for my day on the way in and then decompress and evaluate my day on the way home.
What are some plant-based meals you enjoy?
I really love “buddha bowls,” really anything where we can incorporate little chunks of fried tofu [laughs]! Sometimes we make pasta dishes or vegan mac and cheese. We actually don’t eat a lot of salads, which surprises people because they assume plant-based eating is all salads. We still eat vegetables but in different ways!
What’s new in physio?
I think I’m just learning so much about individuality, there are so many skills in physio that we don’t learn in school. A lot of the things we learn in school are about performing technical, hands-on skills during assessments but really you don’t learn about the human being in that treatment. Each session is going to be totally different, even if the injury is the same. What their personality type is, activity level, what things they want to get back to. I think that’s been a big area of learning. How to adapt my practice to fit the individual.
I have a physio network membership, so I can watch video tutorials and access new research articles. A lot of my learning right now is from the mentorship I receive at Arbutus. I listen to things that aren’t physio related, too, like The Happiness Lab and Hidden Brain podcasts. I can relate to those a lot. There are so many “soft skills” in physio!
What are “soft” skills?
We call them “soft” but they’re critical. They’re professional skills like motivational interviewing and being able to read interactions with people. I don’t think those were things taught in school because we’re mostly learning technical skills. I think my communications have been fairly strong, but it’s always an area I’m very conscious of and something we can always keep working on. I think it’s the biggest thing that makes a difference in how I’m able to help people. It’s really going to come down to if I and the client have a good rapport.