Sticks & Stones – Bec Van de Scheur

STICKS AND STONES…

 

Best selling author Don Miguel Ruiz in his book The Four Agreements reveals what he believes to be the primary sources of self-limiting beliefs. The first and most important of these principles is to be impeccable with your word.

 

It sounds easy enough, as a professional we are under the agreement to ‘do no harm’. As a colleague, friend, family member or acquaintance we aim to be courteous, thoughtful, and kind. The problem is not so much our intention but our awareness of the words that we use to convey meaning. Some of which may, without our knowing, pass through the filter and hold more weight than what we give them merit.

Because the fact is, words do ‘hurt’ and not just emotionally.

 

This-is-a-cartoon-image-of-brain-coupling-during-communicationThere have been a number of studies detailing placebo and nocebo patient responses to explanations regarding interventions by a professional within their field of expertise.  An example of this is a study by Varelmann et, al. (2010), where one hundred and forty healthy women at term gestation requesting analgesia were randomized to either a placebo (“We are going to give you a local anesthetic that will numb the area and you will be comfortable during the procedure”) or nocebo group (“You are going to feel a big bee sting; this is the worst part of the procedure”). Pain was assessed immediately after the local anaesthetic skin injection using visual analog scale scores of 0 to 10. Median pain scores were significantly lower when reassuring words were used compared with the more intense nocebo words. This study and many others are beginning to show a pattern suggesting that more reassuring words may improve the subjective experience.

 

Lorimer Moseley has stated that:

 

‘100% of the time, pain is a construct of the brain’.

 

 

Now this is not to say we lie to our patients. We also have an ethical obligation to be truthful and transparent when gaining consent, giving a diagnosis, a prognosis or offering advice. However it is important to recognise that therapists are in a powerful position in their ability to influence a patient’s perception regarding pain and recovery. It is our responsibility to have an awareness of words that we use and whether or not they have a connection to negative suggestions and connotations, as this may feed into a fear generated belief system and adversely affect recovery.

 

 

“The human mind is a fertile ground where seeds are continually being planted, the seeds are opinions, ideas and concepts. You plant a seed, a thought, and it grows. The word is like a seed and the human mind is so fertile. The only problem is that too often it is too fertile for the seeds of fear” (Ruiz, 1997).

 

IPainf a patient comes to you with concerns about an injury, anxieties about returning to sport or a fear of whether their pain will ever resolve it is important for us to recognize the power of the words we use and the long-term impact they may have on a persons wellbeing.

 

…We do not want to be unconsciously watering the seeds of doubt, fear or despair.

 

It sounds relatively simple to strip down and remove some of these negative connotations. However, some of these words are more subtle than we realise. They are words we use often without acknowledgement. For example;

 

  • Words such as ‘try’ suggest anticipated failure.

 

  • A statement like ‘don’t worry’ is associated with there being something to worry about (Allen, et al, 2011).

 

Terms such as ‘chronic’, ‘disc’ ‘damage’ or  ‘osteoarthritis’ may be enough to set off a flag for danger and generate a fear or anxiety driven response.

 

 

So where to from here?

I invite you to be impeccable with your word.

 

Below is a list of resources to assist in better understanding this concept, strategies for intervention and some great tools that can be shared with patients. Knowledge is power.

 

 

Resources

 

 

 

 

 

 

 

References:

  1. Cyna, A.M, Marion, A.I, Tan, S.G.M, & Smith, A.F. (2011).Handbook of

  Communication in Anaesthesia & Critical Care: A Practical Guide to   

  exploring the art. New York, United States: Oxford university press.

 

  1. Ingraham, Paul (updated Nov 18, 2016, first published 2010)

  Pain is Weird. Retrieved April 26, 2017, from

https://www.painscience.com/articles/pain-is-weird.php

 

  1. Ruiz, D.M & Mills, J. (1997). The Four Agreements: A Practical Guide to

  Personal Freedom (A Toltec Wisdom Book). California, USA: Amber-

  Allen Publishing

 

  1. Varelmann, D, Pancaro, C, Cappiello, Eric C & Camann, W. R. (2010)

Nocebo-Induced Hyperalgesia During Local Anesthetic Injection

Anesthesia & Analgesia: 

March 2010, Volume 110, Issue 3, pp 868-870.

Retrieved from http://journals.lww.com/anesthesia- analgesia/Fulltext/2010/03000/Nocebo_Induced_Hyperalgesia_During_Local.42.aspx

 


 

Becs Van de Scheur – Physiotherapist & Pilates Trained [Mat Work Level I]

From the East Coast of Australia, Bec graduated with a Degree in Human Movement Science before going on to complete her studies as a Physiotherapist in which she graduated in 2012 from the University of Newcastle, Australia.

With a background in private practice and aged care Bec enjoys working with individuals of all ages and all sporting backgrounds placing a large emphasis on education, with an aim to empower individuals by providing them with the skills they require to take ownership over their own health.

With a keen interest in holistic management and pain science Bec believes in offering a combination of hands on therapy and individualised exercise prescription.  Bec has completed her Level 1 Mat work pilates training and also offers Dry needling and Western acupuncture techniques when indicated.

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Part 2: Beginners Outdoor Training

Hello, welcome back, so how did you get on with your first taste of outdoor training?

Courtesy of Nike Women Outdoors
Courtesy of Nike Women Outdoors

The time has come to move things along and challenge the system a little more. So I’m going to outline the next level with a new set of exercises. Each one will be slightly more advanced than the previous set but similar movement patterns.
As usual begin with your pulse raiser, run, cycle, light jog. Remember it’s only a pulse raiser so nice and easy. Once you’ve picked your spot begin your dynamic stretches. This session will follow a similar course as the previous one so you can stick with the same warm-up.

So to recap:

Dynamic warm-up: Heal kicks to bum, high knee run, high kicks (opposite leg to opposite hand), walking lunges, hamstring stretch, light squats. Finish off with arm swings (windmill motion) and hip rotation. A dynamic warm-up can be what ever you want, as long as it replicates your session.

Session: 20/25 minutes

We’ll do five exercises and three sets. As before if you feel you can tackle 4 then go for it but maybe for the first few sessions start with 3 and build from there. Mark out a 20 metre area for your jog/run as before (which will follow each exercise). You maybe already at the level where you can increase the distance or better still be able to sprint there and back.

1. Split squat x 10 reps per leg (20 metre run there and back)

Split Squat
Split Squat

Stand with one foot in front of the other, split stance, feet pointing forward. Torso nice and upright. Bend at the knees and pulse down until your back knee almost touches the floor. Your front knee should be nicely inline with your front foot. After 10 reps swap legs

2. Reverse lunge x 10 per leg (Run)

Reverse Lunge
Reverse Lunge

Much the same as a forward lunge only in reverse. Take a big step back bending both knees until they are at 90 degrees. Drive back through the heel and push forward. Then repeat on the opposite leg

3. Spider-man press up x 10 (Run)

Spider Man Press Up
Spider Man Press Up

Begin this exercise much in the same way as the traditional press-up. Arms directly under the shoulders, lower until elbows are pointing behind you. As you lower to the ground bend one knee to bring it up to your elbow. As you press back up your leg returns to start position. Repeat with opposite leg. Do five leg raises on each side

4. Single leg squat thrust x 20 (Run)

Single Leg Squat Thrust
Single Leg Squat Thrust

Start in the usual press-up position, body straight. Bring one knee forward under your chest. Jump one leg forward and one leg back at the same time. Alternate as quickly as you can

5. Reverse Bear crawl (begin at start point and crawl 20 metres, then run back)

Reverse Bear Crawl
Reverse Bear Crawl

Get down on all fours. Place one hand and opposite foot backwards and walk. Changing sides as you go. This is a little bit harder than walking forward and should really test your endurance. Once you finish, if you can, crawl (forward) back!

On completion of your first set rest for the usual 90 secs then go again. Hopefully with a few weeks under your belt you should be able to slowly cut down your recovery time. Once you’ve completed your 3 sets go for a light warm-down jog around the park for about 5 mins. Follow this with your usual static stretch, remembering to focus on all the big muscle groups, quads, hamstrings, calves, glutes, groin and hip flexors. Finishing with some arm stretches.
Like before I’ve set a fairly low rep rate to begin with. As you get used to the new set of exercises you’ll soon be adding extra reps and sets onto your routine. As a bit of variation mix up your session by adding in the odd exercise from our previous list. It keeps your body guessing and avoids getting too used to the same movement patterns. It’s also more fun. Look to do this set at least twice a week but three times will really get you moving and closer to your fitness goals.

Remember these exercises are all about quality and not quantity. Always focus on your form and posture.

Good luck and look forward to our next set of exercises as we progress forward.

Level 3 PT- Outdoor Training Specialist. Chris Watson
Level 3 PT- Outdoor Training Specialist. Chris Watson

**Please note this programme is designed if you already have a basic level of fitness. Any medical problems or injuries please seek professional advice before attempting this session**

Part 1: Beginners Outdoor Training

Now you’ve made the decision to head outdoors to train, it’s time to get some structure into your session. As a regular gym goer you’ll probably have your own routine and level you feel comfortable with, certainly an idea of what stage you’re at in terms of what you deem hard or easy. So lets pretend that this is a whole new experience and start at the beginning.

As a new client I would assess your fitness level and always start fairly easy and go up through the gears as your potential unfolds. The harder you work the faster you’ll progress. Progression can be achieved with every session, no matter how small.

Shall we begin?

We’ve started with our pulse raiser, as mentioned in my previous article Outdoor Training, this can be a run or a cycle. I would recommend about 10 mins at a nice steady pace, nothing too energy sapping as there’s plenty time for that. This is followed by a dynamic warm-up. Usually base this around what you intend to do during your session. For example, if you are planning a forward lunge set, incorporate some walking lunges into your warm-up. This ensures your legs are ready for this movement. Always keep your warm up stretches dynamic at the start. Static stretches come at the end.

Week 1: Beginner session (1 hour)
10 mins pulse raiser – Run/cycle at a light steady pace

5-8mins dynamic stretch: mark a distance, either, with cones or between two trees about 10m apart. A good range for this session would be: Heal kicks to bum, high knee run, walking lunges, high kicks (touching opposite leg with opposite hand), light squats and a two step hamstring stretch (walk two paces, bend from the hip, keeping your legs straight and sweep your hands across the ground). Follow this with some hip rotation, arm swings (in a windmill motion) and a chest stretch.

Session: 20/25 mins
We’re going to start with five exercises and do 3 sets at varying rep rates (depending on the move). After each exercise mark a distance of around 20 metres and jog there and back to your start point. As you get stronger turn your jog into a sprint raising the intensity of your workout.

1. Squat x 12 reps (run 20m and back again)

Squat: Feet shoulder width apart, relaxed stance, back in natural state. In one smooth motion bend your knees, sticking out your bum (as if about to sit on a chair), finishing with your thighs parallel to the floor.
Squat:
Feet shoulder width apart, relaxed stance, back in natural state. In one smooth motion bend your knees, sticking out your bum (as if about to sit on a chair), finishing with your thighs parallel to the floor.

2. Forward Lunge x 12 (alternate legs, 6 per leg. run)

Lunge: Large step forward, with hands on hips. Leading leg parallel to the floor with your knee at 90 degrees and nicely in line with the front of the foot. Drive back up through the heal and repeat on the opposite leg. Make sure your back leg doesn't touch the floor
Lunge:
Large step forward, with hands on hips. Leading leg parallel to the floor with your knee at 90 degrees and nicely in line with the front of the foot. Drive back up through the heal and repeat on the opposite leg. Make sure your back leg doesn’t touch the floor

3. Press-up x 12 (run)

Press-up: Body in a nice straight line, head, shoulder and bum. Arms under your shoulders. Slowly press down keeping your arms nicely tucked in and elbows pointing backwards. Keeping abs braced let the chest lightly brush the floor and push back up.
Press-up:
Body in a nice straight line, head, shoulder and bum. Arms under your shoulders. Slowly press down keeping your arms nicely tucked in and elbows pointing backwards. Keeping abs braced let the chest lightly brush the floor and push back up.

4. Mountain Climber x 12 (run)

Mountain Climber: Begin in an upright press-up position.
Mountain Climber:
Begin in an upright press-up position.
Mountain Climber: Now bring your right knee to your left elbow, with a slight twist of your torso. That's one rep. Repeat on the opposite leg
Mountain Climber:
Now bring your right knee to your left elbow, with a slight twist of your torso. That’s one rep. Repeat on the opposite leg

5. Bear Crawl (begin at start point and crawl about 20m. If you can crawl back. If too hard, one way is fine to begin with. Then run)

Bear Crawl: Drop on all fours.
Bear Crawl:
Drop on all fours.
Bear Crawl: Place one hand and opposite foot forward, walk forward changing sides as you go. The lower you go the harder it gets
Bear Crawl:
Place one hand and opposite foot forward, walk forward changing sides as you go. The lower you go the harder it gets

On completion of your first set rest for about 90 secs and go again. Take longer if needed but try not to exceed 2 mins. The aim is to cut the rest time as you progress. Once you have competed 3 sets and rested for a couple of mins, go for a light warm-down jog for about 5 mins. This is followed by our static stretch. Be sure to stretch of all the relative muscles. Start with the big muscles like the quads, hamstrings and calves. Follow that with hip flexors, groin and glutes. Finishing off with some arm stretches. Always remember to do as it helps with your recovery.

I’ve set a fairly basic rep rate for this session as it’s a good starting point. Complete your first 3 sets and see how you feel. You will be able to tell fairly quickly if you need to add more reps to each exercise or even an extra set. Don’t be scared to push it that little bit each time. Try and fit this in at least twice a week but I’d recommend 3 times.

cw
Level 3 PT- Outdoor Training Specialist.
Chris Watson

Give it a go a see how you get on.

Next time we’ll look at ways to progress your session and the benefits of this kind of training.
Chris

**Please note this programme is designed if you already have a basic level of fitness. Any medical problems or injuries please seek professional advice before attempting this session**

7 Minute Work Out

7 Minutes Is All It Takes To Make The Olympics
7 Minutes Is All It Takes To Make The Olympics

I recently read an interesting article titled “7 minutes to get fit” with the catch line “Do twice a week. Job done”. Instantly I was intrigued, fit in two 7min sessions, this ought to be good, or too good to be true. So I began to read.

Studies have found you don’t need to spend hours in the gym to achieve your fitness goals. By following a quick, tight regime you can make a big difference to your overall fitness. The 7 minute work out is a form of high intensity interval training (HIIT) which means extremely intense bursts of activity followed by brief periods of recovery. Research suggests 7 energy sapping minutes broken down into 12 exercises is comparable to a run and weights session combined.

As a strong believer in hard work and time spent in the gym, or park, I was a tad sceptical of a quick fix solution. It sounded a little like a short-cut way of getting fit and I therefore questioned its impact.

So I decided to put the 7 minute workout to the test. I selected a reasonably balanced set of exercises to begin with. Well I’ve got to say it’s a pretty tough 7 minutes. The combination of aerobic and resistance moves gave me a very
balanced and challenging workout. It has been said that HIIT has shown time and again to “deliver numerous health benefits in much less time than traditional programs”. This all sounds very intriguing and exciting but it’s time to let
the public decide.

Having tested it on myself I decided to let my clients decide if it’s a way of training they’d be interested in. I selected a couple of willing participants and designed a program based on the 7 minute workout structure. Carefully mixing
a variation of cardio and resistance movement patterns and timing each exercise at the desired 30 second length (with a 10 second reset between).

My guinea pigs, whom have a fairly good level of fitness, found the session “pretty challenging” but really enjoyed the variation and tempo, finding competing against the clock both fun and exciting. They really felt they’d worked hard and gained a lot from this way of working. As I had a full session to fill we did 3 sets of 12 exercises with a two minute rest between each set. This added another level to the challenge.

Only time will tell if the 7 minute workout will return the fitness goals we’ve set but it was certainly a good start.

See below an example of a structured session containing 12 exercises:

This way of working, I believe, is best done as part of a 3 set, 2-3 times a week routine. Doing two 7 minute workouts per week will undoubtedly improve your fitness levels but I’d suggest doing 2-3 sets twice of three times per week
(if time allows) for maximum potential. So give it a go and see how you get on. I’d be very interested to know your thoughts on this training approach and if you feel it’s working..

A little bit of advice when attempting the 7 minute workout. It’s pretty tough and only recommended if you have a fairly good base fitness due to it’s high intensity nature. If you’ve not exercised in a while then I would suggest a more gentle approach to begin with and build up to the 7 minute workout.

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Always concentrate on form and doing the exercise correctly and please research any moves you’re not familiar with to avoid any injury or bad habits.

Remember these exercises are all about quality and not quantity. Always focus on your form and posture.

Good luck and look forward to our next set of exercises as we progress forward.

Level 3 PT- Outdoor Training Specialist. Chris Watson
Level 3 PT- Outdoor Training Specialist. Chris Watson

**Please note this programme is designed if you already have a basic level of fitness. Any medical problems or injuries please seek professional advice before attempting this session**

Avoid HARM for acute injuries (TOP TIPS)

Avoid HARM for acute injuries

After injuring yourself it can be difficult to know what to do. Do you use, ice or heat? Rest or movement? Elevation or massage? The asnwers to these questions are found in the type of injury that you have sustained.

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Acute Injuries

An acute injury is an injury with a sudden onset, usually as a result of some sort of impact or trauma, such as a fall, sprain or collision. Acute injuries are sudden and sharp, occur immediately (or within hours) and cause pain (possibly severe pain). With this form of injury, two acronyms are extremely valuable to remember: RICE and HARM.

RICE

The RICE acronym is one that should be followed as the four factors help to reduce swelling and inflammation that is likely to occur within the first stages of healing for an acute injury. RICE stands for:

  • Rest
  • Ice
  • Compression
  • Elevation

HARM

In contrast, the HARM acronym provides four factors that should be avoided with acute injuries, and stands for:

  • Heat
  • Alcohol
  • Running
  • Massage

HARM is extremely important to remember within the initial 48 hours following an acute injury because both heat and alcohol cause the blood vessels to dilate (open up) – this increases the bleeding in the injured area. Exercising the body part or massaging the area also has the same impact and can be detrimental to the healing process.

Chronic Injuries

Differing to acute injuries, chronic injuries can be subtle and may emerge slowly, with no known factor that triggered it. Chronic injuries may come and go, and may cause dull pain or soreness. Long standing low back pain is a classic example of a chronic injury, and often results from overuse and repetitive movements. However, if an acute injury is not effectively treated, it may lead to a chronic problem.

Heat therapy

Heat therapy is frequently used for chronic injuries or injuries that have no inflammation or swelling – such as nagging muscle or joint pain. Using a heat pad, or getting into a warm bath can help to increase the elasticity of joint connective tissues and stimulate blood flow, which can consequently aid pain relief. Whilst this is often a temporary solution, it can provide relief nonetheless.

Prodced by JB Physio and re-produced with permissions via twitter

Cycling Technique and Muscles

Cycling Technique & Muscle Activation:

Thanks all for taking the time to read my blog about cycling. I’m only a physiotherapist and by no means a coach or bike fitter so these are just my observations and understanding from reading around the topic.

PEDAL_2915652a

Cycling Muscle Co-ordination

The diagram to the left demonstrates the muscular sequence of events in the correct cycling pedal turn.

Right at the top phase of the pedal strike the power should come straight on via the glutes, the muscles of the bottom, and power down to a point where the large quadriceps muscles share the power and gradually become the dominant mover in the sequence.

During the lower section of this movement the calf muscles join the quadriceps to push the pedal through the lowest section of the pedal turn. It is then the turn of the muscles of the shin to pull the toes back up to level the foot out and the hamstring muscles to bring in a powerful pull back up. The final stage of the movement is the muscles of the hip flexors pulling the knee back up to the start phase.

When a cyclist cycles with this sharing of power there is much greater ability to create higher wattage, power, on the bike by not having any dead spots of power during the cycle rotation. It also means that there is greater use of all muscles and no overuse of one muscle group which helps prevent injury and muscle overuse issues.

Common Faults and Corrections

The most common problems that we see with cyclists of all levels are:

  • Overuse of the quadriceps – most people who cycle tend to rely too much on the big muscles of the quadriceps and this can result in reduced power due to inhibition
  • Lack of power on the lift phase – The current advice from British Cycling is that amateurs need to not be concerned regarding the upstroke of pedalling. The risk is an increased overload of the hip flexors. Training the hamstrings and the hip flexors to be able to perform this task is essential if you are to maximise all phases of movement. So an incremental increase in focusing on the pulling on the up stroke should be gradually introduced. However, this comes with a warning: DO NOT TAKE PRESSURE OFF THE OPPOSITE DOWN STROKE. Its easy when learning to ride smoothly to focus on too many things. The skill in using clip in pedals & shoes is timing, up stroke pulling whilst maintaining downward pressure on the opposite down stroke.
  • Tight muscles across hips and hip flexor strain– Its easy, in the beginning to overload the hip flexors due to the flexed nature of cycling. Like all sports, exposure should be gradual and incremental over a number of weeks. The hip is key in cycling and needs to work in an optimal range. The muscles around the hip, as we can see on the diagram above, are important for generating power (hip extensors) but also for moving the foot into the power phase (hip flexor). It’s important not to overwork the hip flexors and not to have too much hip flexion resulting in the anterior hip compression. If the hip has a lack of ability to efficiently bring the knee to the top phase of movement the body usually compensates through the upper body, resulting in swaying at the lumbar spine. This is commonly seen when you watch a cyclist from behind and see their back swaying from side to side with every pedal lift. This happens as the body makes room for the knee to be lifted through and puts a great deal of stress on the spine and the muscles of the lower back. Good range of movement and wiggins_2270877bstrength through the hips allows for good knee lift through the top end of pedal phase and power to go straight on, with the body holding tight and allowing maximum power transfer through the pedals. Lack of adequate range here also tends to result in repeated lower back tightness and pain.
  • Toes pointing down or toes pointing up? The current trend is neither, British cycling advocates a neutral foot position so that the power of the calf complex can be optimised.  If you watch cyclists you will see a vast number who cycle with the toes lower than the heels at all phases of movement. This style of rising will often be partnered with the body being positioned too far forward so that the knee can get over the pedal. This toe pointing style of riding makes it very difficult to use the glutes effectively in the first phase of movement and also makes it much harder to bring the knee back over the top phase of movement at the end of the pedal movement and be ready for starting the next phase. Equally, toes pointing up can result in a loss of power generation from the large calf complex which is particularly utilised in the down phase of the pedal stroke. Ultimately you should find your own style, don’t copy others, find what’s comfortable for you & riding styles can depend on your sport: For example, a triathlete might not be encouraged to ride with toes up because they might utilise their calf complex which in turn might inhibit the initial stages of their running. Yet on the other hand, should a world champion triathlete ask if they should change they’re cycling foot position, probably not: ‘if it ain’t broke, don’t try to fix it’
  • Knee alignment over toes. During all phases of cycle movement, when you watch from the front, the knee alignment should be almost directly above the line of the toes at all times. This is particularly important at the top and power phase of movement. This alignment during power phase allows all power that the cyclist generates to be transferred down through the leg and into the pedal. If this alignment is out the power will not be directed down into the pedal, therefore losing power. The added lateral movement through the body will add strain into the joints of the knee, ankles and pressure across the foot.

 

Thank you for reading and I hope this has given you some insight into cycling technique and mechanics of muscle use when partaking in all levels of the sport.

 

Always remember to enjoy cycling and Lycra is cool, whatever anyone else says. We offer physiotherapy, pilates, & sports massage in Crouch End & Finsbury Park. Please book online here

 

Regards

Team TAP

Clinic_header

Commonwealth Day #10 – Refection #5

Well the end is in sight for Glasgow 2014 Commonwealth Games and I’ve had a blast so much so I might go to Rio.

Working in the poly clinic as a physio to the athletes has been a once in a lifetime experience and taught me so much about the world of elite multi-sport events.

I have had the opportunity to work under a great physiotherapy in Lynne Booth and a fantastic team of physio’s from across the UK.

The next goal for me is to get My Physio in sport bronze award and then continue multi-sport event physiotherapy through UK Athletics and BUCS pathways.

Thanks for reading my previous blogs.

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Commonwealth Day #3 – Refelection 3

XX Commonwealth Games
XX Commonwealth Games

Commonwealth Reflection #3;

The Glasgow 2014 commonwealth games are now well and truly underway with Saturday 26th July promising to be a busy schedule of competition across various sports including netball, Judo, and tracking cycling. The athletes are in full swing and the medals are coming thick and fast with this in mind I undertook my third shift at the Games Village Polyclinic.

 

The What?

The poly clinic environment, as I’ve previously mentioned, is a fast paced and exciting environment but requires a cool and collected approach to ensure the athlete gets 1005 the elite care they deserve.  But sometimes the system can be slowed down with bureaucracy  with a classic example of this coming when SEM doctors require ultrasound scans for soft tissue damage. SEM had to refer to radiography for U/S and were unable to perform U/S sans themselves. So SEM referred to radiography but radiography would only do MRI scans due to higher sensitivity rates (1) (2).

 

 

Courtesy of Shoulderdoc.co.uk
Courtesy of Shoulderdoc.co.uk

So What?

The systems clearly works within the polyclinic with this clinic seeing upwards of 400 contacts in a day, but the system can be slowed down. Ideally, the SEM doctor would like to use U/S as part of the assessment process but this may not be time efficient. HCP’s need to carry out a full and thorough assessment of the presenting condition and provide appropriate care, which in this case involved using U/S scans for soft tissue injury. However the radiography preferred MRI scans for diagnostics which cost a lot more money to provide. The resolution came when SEM were finally able to use the diagnostic U/S scans for the athletes. This is by no way a criticism of the current system but goes to show with the best laid systems they need to be flexible to provide a high level of care within a high-octane environment.

 

Now What?

  1. Multi-disciplinary healthcare provision is idealistic and can work with clear and concise communication as well as team work to overcome problems.
  2. Systems and approaches to care provision need to flexible to ensure correct diagnosis and treatment are provided
  3. The athletes are the main priority and excellent care needs to be provided to ensure the best outcome for the athlete

 

Thanks for reading.

 

Tom

 

 

Reference:

1) B Hamilton, R Whiteley, E Almusa, B Roger, C Geertsema1, Johannes L Tol (2013); Excellent reliability for MRI grading and prognostic parameters in acute hamstring injuries; Br J Sports Med.

2) K M Khan, B B Forster, J Robinson, Y Cheong, L Louis, L Maclean, J E Taunton (2003); Are ultrasound and magnetic resonance imaging of value in assessment of Achilles tendon disorders? A two year prospective study; Br J Sports Med

 

 

'prehab not rehab'
‘prehab not rehab’

 

Commonwealth Day #2 – Refelection 2

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XX Commonwealth Games

Commonwealth Reflection #2:

Hello and welcome back. Thank you for reading my first reflection on my experiences in the Glasgow 2014 commonwealth games. After completing my first poly clinic shift, I was excited to get back in clinic and enjoy shift number two on Wednesday 23rd July, OPENING CEREMONY NIGHT

A little wiser from previous shift, I was feeling more confident in my new surroundings and raring to go one day before competition began.

The What?

So Wednesday turned out to be a quieter shift in the polyclinic due to preparation for the opening ceremony. Naturally, most the attendees were either competing the following day or an acute injury needing attention in preparation for the games.  The team scheduled to cover the evening shift was the same team I worked with the previous day, so I was glad to have some familiar faces in the clinic.

 

So What?

A number of athletes came to the polyclinic seeking intervention for strapping and taping, this is something that is usually undertaken by the national team medical staff but as some nations have differing budgets, not all nations have a full medical team at the games and so they optimised the services at the polyclinic.

Over the course my shift I assessed and treated athletes from sports including Judo, weightlifting, hockey and long jump. these four examples demonstrated a good variety of stage of injury and the appropriate treatment undertaken, difference in teams and the medical support available to prevent such injuries, and expectations from treatment.

– A Judo athlete attended clinic requesting strapping and taping for bilateral posterolateral corner of the knees. No pain upon assessment and so I taped the knees. I think there are many properties to tape and differences between tape and strapping but one underlying factor is the psychological impact it has. I believe that it gives competitors confidence to push their bodies to the highest level despite the absence of injury. In the injured athlete it can be high effective to stabilise a joint (i.e subluxed shoulder).

 

Patellar Femoral Compartment Stress
Patellar Femoral Compartment Stress

– I saw another weightlifter with acute patella tendon tendinopathy and high irritability, why is this a common occurrence? I could only assume it was due to an increased volume of training in preparation for the games. In an ideal world I would love to sit down with the athlete and analyse the training volumes to cross-correlate it to the onset of injury but in a fast paced environment like a polyclinic as well as communication limitations, this is unrealistic. If I were set within a national medical team I would use those skills to monitor injuries within training regimes and highlight these impacts on injury rates thus enabling a team to improve training and performance. These guys would benefit from some eccentric tendinopathy rehabilitation.

– I saw an acute adductor strain (Grade I – MRI confirmed) from one of the larger commonwealth teams and experienced first interaction with national teams doctor requesting treatment. As part of the immediate management, the athlete was put on cryotherapy in the shape of ‘game ready’. This device works by pumping ice cold water into a cuff that is attached to the athlete. The machine setting mean temperature, length of time and compression can be regulated by the clinician. Its a marvellous piece of kit to have especially as it addresses two of the five P.R.I.C.E principles for the immediate management of soft tissue injuries.

Now What?

  1. Its important as a clinician that all patient are thoroughly assessed especially if we have not assessed or don’t know anything about the athlete
  2. Don’t just do what the athlete thinks will help. Clinically reason the problem and take suitable action in the form of treatment
  3. Taking treatment requests from medical teams is acceptable but again question the reasons behind the intervention.

 

Thanks for reading, hope you enjoy the blog, watch this blog for more Commonwealth games posts

 

Tom

Enjoying Games Life
Enjoying Games Life

Commonwealth Day #1 – Reflection 1

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XX Commonwealth Games

Commonwealth Reflection #1:

So yesterday saw my first shift in the Commonwealth Games Polyclinic as a physiotherapist. Working alongside multiple professions under one roof is the idealist approach to rehabilitation and it works rather well.

 

Its my first experience at a multi-sport event, such as the Commonwealth Games, and yesterday was interesting. The polyclinic runs as an MSK service for athletes, volunteers and games family members.

 

The What?

Yesterday, I saw approximately 10 athletes from a variety of sports including discuss,  shot put, weightlifting, swimming, and table tennis. The variety of conditions presented included patella tendonitis, ulnar nerve irritation, patella femoral medial facet osteochondral defect, and congenital hip dysplasia.

 

So What?

All athletes receive a full and thorough assessment from one of the qualified therapists in the poly clinic MSK service. As part of the assessment  we have to take a subjective history. One of the learning points that I reflected on from yesterday was communication. The commonwealth games consisting of multiple nations from the commonwealth meant some athletes had limited understanding of the English language which meant they often came with a team member or staff member to aid communication. Naturally, this is time-consuming but can be effective as long ass questioning is succinct and appropriate. A further point around communicating through an interpreter is consent. It’s important that the athlete give consent for the other person to translate.

Lightening Bolt Strikes Again
Lightening Bolt Strikes Again

The polyclinic environment is vibrant and buzzing with athletes seeking professional advice to optimise their performance in readiness for their upcoming competition. The closeness of other professions within this setting means athletes, volunteers and family members can get medical services quickly. As a physiotherapist that has worked in the NHS and private sector, it’s often the case that these referrals can take some time to come to light. However, yesterday saw how effective a polyclinic environment can prove to be, and this was my first experience of the immediateness of a polyclinic environment. I was able to refer a patient to see a SEM doctor for a hip review within  a few hours – usually it would be quicker, but due to it being end of the day, an appointment was booked for the next morning.

 

A further example of the polyclinic environment functioning effectively was demonstrated when an athlete arrived at 3pm to see the SEM doctor with a suspected meniscus tear, saw myself for some immediate conservative management at 3:30pm, booked a MRI 6pm and results returned by 7pm. The speed of action from the polyclinic team meant that athlete was able to have diagnosis and intervention within a few hours and discharged back to the team medial staff for ongoing rehabilitation.

Now What?

  1. The immediate impact of the polyclinic environment has driven me to understand the further need for improved seed of onward referral in acute conditions. this not only eases the athletes and medical team state of mind but also provides the athlete with the best opportunity for recovery effectively.
  2. Communication in a clear and concise manner is important when treating international athletes. even a small mount of foreign language knowledge from the therapist can aid an assessment and information gathering. Use of posters and body charts or visual aids can aid non-verbal communication. Consent should always be gained from the athlete if translators are present, whether it’s a team member or medial team member.

Thanks for reading, hope you enjoy the blog, watch this blog for more Commonwealth games posts

 

Tom