“”The Gym is open!!!” One physio’s lockdown experience: Part 2″

Thanks again to Jo who has found time to put fingers to keyboard….

So…it’s Saturday 25th July, day 2 of my 4 day shift, I’m still working down in Birmingham at the NHS PPE call centre- I can’t say getting up at 5.30am 4 days a week has been particularly easy- but I feel like I’m doing “my bit” and has been extremely beneficial- not just financially, but also working with a great bunch of folk.

The weekends are relatively subdued, with very few calls to take- but today there is some excited discussions revolving around the fact that gyms are opening today for the first time since the lock-down. So who’s going? Is it safe? What are people looking forward to getting back into? Classes? Weights? Yoga/ pilates?

My ears prick up, not only because I’m a regular gym user myself, but with my physio hat on, I wonder (perhaps rather pessimistically) if we will see some sports-type injuries in clinic?

“But exercise is GOOD for us right?!”

The positive effects of exercise are well documented, but like anything, too much of a good thing can cause us problems- or more specifically, in respect to exercise; too much of a good thing TOO QUICKLY causes problems.

The reason for this is revealed when we understand what happens to the human body and all it’s varied tissues (bone, muscles, tendons…) when we STOP doing an exercise or sport that we do regularly- and lock-down has provided this rather unwelcome and unique period of rest.

The human body is the most incredible organism- without any input from us, it can change and adapt almost on a daily basis! In terms of the musculoskeletal system, the stimulus to adapt comes from our environment and what we do in it. Some studies that have looked at this in professional athletes- showing that in as little as 2 weeks of rest, muscles start to get weaker and tendons contain a little less collagen (the protein that makes the tendon “stiff.”)

“But I’m not Usain Bolt!” I hear you say…

Well, this “de-training affect” as it is known, has also been shown in “normal” people. A research study carried out in 2000 (https://pubmed.ncbi.nlm.nih.gov/11127215/)   looked at bone mineral density and muscle strength around the hip joints of a group of pre-menopausal women who participated in a 12 month programme of impact training, along with lower body strengthening and resistance training. They measured these parameters at the beginning and end of the 12 month training period, but also at the end of a further 6 month period of rest. The researchers found that there were measurable increases (3.2%) in bone density around the neck of the femur (thigh bone) and also on average, a 15% increase in muscle strength- at the end of the 12 month training period. But these increases had disappeared by the end of the 6 month rest and returned to the baseline measures.

I see the affects of this in my work with the student athletes at the University of Derby. There are pronounced “spikes” of injuries which occur just after periods of rest- especially on returning after the longer summer break and also from the Christmas holiday.

The “partner in crime” with the de-training affect is the speed and intensity of training following this rest period. “They’ve just had 3 months off, they need to train EVEN HARDER than normal!” is a common phrase I hear from coaches. At this point, athletes often enter periods of very high intensity training, or perhaps training twice a day for the first week or so- which can be a recipe for disaster for some students.

The principle is the same for you- you might be thinking about returning to the gym as they open today- and planning to do more sessions in the first few weeks, or an extra spin class straight after your normal session/ or adding an extra 10kg on to the bar/ attempting new exercises not tried before…in an attempt to make up for lost time and try and address the lockdown bulge! 

We would call these “training errors” and they will all increase your risk of getting injured. Another piece of very interesting research that has guided the sports medicine fraternity, is that of Australian Physiotherapist Tim Gabbett (https://bjsm.bmj.com/content/50/5/273). He concluded that  “Excessive and rapid increases in training loads are likely responsible for a large proportion of non-contact, soft-tissue injuries.” In addition, he also concluded that an “appropriately graded” medium to high intensity exercise may actually protect against injury.

So- what does that mean for you? It’s not easy to give specific advice, but firstly, make a plan, based on what your pre-lockdown schedule looked like- did you train 3-4 times a week? Then start with 2. Don’t train on consecutive days- give your body a day off at least between sessions- this is when the muscles and other tissues adapt (get stronger)! Start with low-medium intensity workouts. If you like working with weights, start with weights that are a little lighter than you would’ve lifted pre-lockdown. This will allow you to focus on your technique- poor technique can also be another factor that can increase your risk of picking up an injury. Build up your session intensity/ weights SLOWLY aim to be back to your pre-lockdown level within an absolute minimum of 4 weeks.

This may all sound like common sense- but you’d be surprised how many injuries we see in clinic that are related to simple training errors like these! If you do pick up an injury or you’re not sure where to start, then book yourself in and we’ll be able to give you some more specific advice.

I hop you enjoy a safe gym-return folks!

Please get in contact if we can help at all: enquiries@impactphysio.co.uk / 0115 9721319

Let us know how you're getting on!

Attending your appointment: what to expect…

When you arrive for your appointment we will invite you into the building once you have reconfirmed your symptom free status. We ask you to wear a face covering for the safety of our team, and we will greet you wearing the appropriate PPE for your safety.

We will conduct as much of your appointment remotely to maximise the time you are at clinic for essential assessment and treatment that can not be done remotely.

Following our Risk Assessment we have implemented specific processes which address all the controllable risks. These include;

  • Team health screening prior to each clinic
  • A controlled one-way system
  • Reduced numbers of the team on site at any one time
  • Staggered appointments & time inbetween to allow for extensive cleaning & airing of rooms
  • Clear distance markers throughout the building
  • Numerous hand sanitising stations with guidance to ensure effectiveness
  • Appropriate PPE
  • Enhanced cleaning processes; related to virus protocols

Please get in contact if we can help at all: enquiries@impactphysio.co.uk / 07977 239893

“Walking the walk (or sitting the sit!) One physio’s lockdown experience.”

It’s 7.30am on a Sunday morning, day 2 of my 4 x 12 hour shifts…post-furlough I’ve needed to find myself some work that will keep me from going stir-crazy at home- working at the coal face back in hospital was not an option for me as a single parent- so taking up a position with Unipart, who look after the logistics for the NHS’s PPE supply chain, seemed to be a good second option.

10 weeks in now, and it’s been an eye opening experience- on all fronts- from both the  physical and mental perspective! I’m hoping that with my physio hat on, I can offer some thoughts that might help you cope with the ups and downs of working life- especially if your job involves a chair/ desk/ computer screen.

The first, and probably the most fundamental challenge I’ve faced, is that my pre-COVID working lifestyle couldn’t be any different from what I am currently doing. Most physios will tell you that they will invest just as much (if not more…) in a comfy pair of trainers for work, than they would on a pair of Lauboutins! We’re on our feet A LOT!

Working with athletes and patients alike, I’m constantly on my feet- either watching patients perform various functional movement tasks, demonstrating exercises or standing at the couch and treating. So, moving to a job that involves an hour’s drive either way and then sitting at a desk for 12 hours, for 4 days back to back- has provided a significant change in what my body does- in terms of position and the loads placed on the joints and muscles. 

We know from various research papers, that the human body adapts very quickly to new conditions; once elite level athletes stop training, there is a measurable reduction in muscle strength even after just 10 days! For us mere mortals, it will be a case a couple of weeks perhaps.

So…picture the scene- I’d survived my first 4 days- alien environment, lots of new stuff to learn, along with A LOT of sitting…I really felt like going for a run, get myself into the fresh air! When I say run, I should quantify that- it’s a steady 1 minute run: 2 minute walk. I should also say at this point, that I’m not a “runner” as such- I’m a regular gym goer and I throw myself enthusiastically around a netball court x 1 a week…with a VERY occasional run.

During this first run, at about the 30 minute mark, I felt a sharp cramping sensation in my right calf that literally stopped me in my stride- let’s stop, walk a little- have another go… nope! Definitely not going to “run this one off!” So, disappointingly, I limped the rest of the way home and popped a bag of frozen peas on it for 20 minutes. I could still feel it the following day so I concluded that I’d pulled it (but not torn; no bruising or swelling and although slightly sore, walking was much easier.) So, what to do about it? Something that we see commonly in clinic, are people who hurt themselves and then rest too much- many weeks in some cases- then returning to running once pain-free, without having prepared the injured muscle adequately, often resulting in re-injury. 

Fortunately, having worked with a lot of court-based sports at Derby University (with all the associated calf and ankle problems!) I know the importance of good strong calf muscles- and how they can protect the ankles and lower legs- so, I got going with the calf strengthening circuit that I had devised for the athletes to do. It’s a series of various types of calf raises (also known as heel raises) that don’t require any pieces of gym equipment (apart from a step/ set of stairs) that can be very helpful when trying to prepare a previously injured and weak calf muscle.

But how do you know if your calf muscle is strong enough to run? Well, as a general rule of thumb in the clinic, if someone who’s had a significant injury (knee surgery-ligament repair or muscle tear) and wanting to return to running or a running-based sport, I would ask the patient to perform a single leg calf raise endurance test (how many can they perform to fatigue- off a step?) I would expect to see around the 25 rep mark- or certainly no less than 5 reps difference compared to the non-injured side. 

I duly did this and within a week or so, I went out for another run- but knowing that I hurt my calf at around 30 minutes, I felt it sensible to keep it to 20 minutes (the reality being; it felt good so I managed 30, but no more!)

 

So- key questions to ask yourself before doing something new;

  • What does the new activity involve?
  • How does is differ to my normal “day to day” activities?
  • Am I strong enough/ flexible enough to do this new activity?

You may need some help addressing these kinds of questions- our staff can be really helpful when it comes to starting something new.

Closing thoughts;    “Most injuries occur in people who’ve done too much, too quickly having done too little for too long!”

Thanks++ Jo Keegan for finding the time to pen your experience and share it with us

Please get in contact if we can help at all: enquiries@impactphysio.co.uk / 07977 239893

Please also keep in touch just to let us know how you're getting on!

Essential Face 2 Face Appointments

001750_COVID-19_Face-to-Face Consultations_Flow Chart_V6_0

In this ever changing environment we want to continue to support the community whilst maintaining the safety recommendations which are required to reduce the risk of contracting and spreading COVID-19. 

We are now able to offer face to face appointments for those who cannot be treated remotely. 

We have protocols in place to ensure that risk is minimised. We will ask you to consider your own situation carefully before you are invited to the clinic. This includes your own health and circumstances, we will run through an extensive screening process prior to confirming your attendance.

We have procedures at our Long Eaton Clinic which include;

  • Controlled & Limited Access 
  • A one-way system & clear distancing markers throughout
  • Extensive cleaning & time between appointments for airing the room
  • Appropriate PPE for our team & we ask you to wear a face mask
  • Limited time in clinic; assessment questioning remotely prior to your attendance
  • Our team are health screened prior to confirming your appointment

 

We are happy to rearrange your appointment as required due to developing symptoms or if you are asked to self-isolate and its no longer appropriate for you to attend.

The health & well-being both of our team and of you are our priority at this time and we thank-you for supporting us.

Please get in contact if we can help at all: enquiries@impactphysio.co.uk / 07977 239893

Please also keep in touch just to let us know how you're getting on!

The next stage?

We have monitored the changes during this pandemic closely, there are still a lot of unknowns and speculation, however we continue to maintain our stance of supporting the community by offering remote consultations for all interactions.

However, we are aware that many of you are wanting to know when services will be resumed, so we wanted to give you some insight into our decision making.

Essentially, we are allowed to offer urgent face to face appointments. However we are fortunate that truly urgent cases are very rare within our usual case load, and long may this remain! Most urgent cases can be evaluated correctly via remote consultation, and this would always be the first port of call. If identified then as always referral on to the appropriate medical service is our priority and the best management.

We are currently ensuring that when the time is appropriate that we have clear processes in place that are easy to follow and ensure safety for our team and those who need to use our services. We guarantee that we will not be conducting any face to face consultations before this process is robust.

We continue to maintain our high standards in everything we do, and in the current situation, it is the most critical time to ensure this. 

We maintain that any initial consultation will be conducted remotely through our current systems, and in almost every case we can manage your condition / concerns in this way. We will weigh up in every case the risk in relation to the benefit. 

Thank-you for continuing to support us, we really appreciate the messages of support and gratitude. As a small local business it means a lot to have this support. Please forgive the mini show off photo (with my husband!) shared in the hope it brings a smile, and because it took ages to even manage it! In order not to drum up any extra business  I would add “please don’t try this at home”!

Credit: BASRaT for the infographic, outlining decision making for conducting face to face consultations. 

Please get in contact if we can help at all: enquiries@impactphysio.co.uk / 07977 239893

Please also keep in touch just to let us know how you're getting on!

Keeping You Active during isolation

Physiotherapy Telephone and Video-Call Consultations

We’re embracing new ways of working here at Impact Physio as we adjust to this period of isolation, we continue to work to support your ongoing health and well being.

In this post we look at:

  • How can physiotherapy help by telephone or video-call
  • How can you prevent injuries from worsening

How can physiotherapy help by telephone or video call?

It’s a challenging time which has seen innovation and new ways of working come to the fore. We quickly set up our remote consultations in the interests of public health and  safe-guarding the health of vulnerable patients. Recognising that our role continues to be empowering you to return to optimal health and function. There are many ways that we can help you achieve this and remote working is an asset to enable recovery.

Remote working by telehealth, where a doctor or a physiotherapist assesses and gives advice by telephone or video call has been widely used in rural communities in Australia for many years. It has become more widely accessible with advances in Internet and mobile phone technology.

You’ll recognise that when you usually attend for a physiotherapy assessment, we begin by asking questions about your symptoms and taking a history. This part of the assessment helps us to determine what type of injury you have by analysing it’s mechanism and history. This essential part of assessment has not changed.

Whether it’s a ligament sprain for example or related to a flare up of a long term condition, such as osteoarthritis, related to a change in activity, this discussion helps us to know the best way to address your symptoms. We continue to advocate empowering our patients to be able to manage their symptoms effectively and to support their return to function by progressing the loading on the injury through exercise and guidance to gradually increase your activity as symptoms allow.  

We can also determine whether there are more serious symptoms which need to be investigated further, referring onward as appropriate.

The hands-on part of the assessment is often used to identify symptomatic structures more specifically and associated factors such as weak or overly tight muscles which have contributed to an injury, these often occur in recognisable patterns. Our physiotherapists have a wealth of experience in recognising these patterns and knowing which approaches are most likely to be effective when we can’t physically assess you.

How can you prevent injuries from worsening?

It’s far easier to address an injury that you’ve had for a couple of
weeks than an injury that has progressively worsened over three months!

We often see that musculoskeletal injuries and exacerbation of musculoskeletal conditions are related to a sudden change in activity or routine. As a nation we are being encouraged to value the benefit of exercise and being encouraged to do this, for some this is an increase in usual activity levels. It may be that you have more time to exercise and spend more time in the garden at the moment, perhaps trying a yoga class online or physical challenge.

People who are working from home, may be at the kitchen table and sitting in positions for prolonged periods of time are experiencing increasing neck and shoulder pain. On the other hand, some of those who have been continuing their treatment remotely have reported an improvement in their back pain whilst staying at home and not driving for long periods of time!

We’re all adjusting to working and living differently. There are ways we can help you to prevent symptoms worsening at this early stage, sometimes with advice and a few simple corrections to your office space; or a mini routine of exercises with reminders to move more often.

We anticipate that for some, a medical screen of problems to decide if further investigations are needed and some bespoke advice is all that is needed to keep you functioning. At the moment during this uncertain period of time where we are not able to do the things we are used to doing, or having to do things very differently, being able to feel positive about your physical health is essential.

Please get in touch via our contact page or email enquiries@impactphysio.co.uk
if you have an injury or ongoing musculoskeletal symptoms which don’t improve
or are worsened by a change in your activity.

We’re still here and committed to “keeping you active“!

Some examples of conditions appropriate for Telehealth

COVID-19 Action Plan

To all our clients at Impact Physio

We are monitoring the situation closely and are following the guidance of our governing bodies, the local health authorities and World Health Organization (WHO), to ensure we are doing our part to keep you and our wider communities safe. 

If you have any concerns about attending your appointment, then please don’t hesitate to contact us. If you need to reduce your risk due to personal or wider responsibilities to others, are within a vulnerable category yourself or need to self-isolate due to a persistent new cough or have a fever then please don’t physically attend your appointment.

We are able to offer either telephone consultations or video links to enable your management to continue. In most cases we can continue to offer assessment, advice and our classes in a virtual environment therefore avoiding contact risk.  Please don’t hesitate to contact us to discuss this further or make contact prior to your scheduled time to organise this.

If you are well and able to keep your appointment then we can assure you that we continue to maintain our high standards of infection control. We have also increased vigilance with the most-touched surfaces like door handles, credit card readers, and restrooms. We also ensure our team are following guidelines regarding their own health. 

We wish you all the best at this time and thank-you for your continued support. 

New Year Intentions

2019 – what plans / aspirations do you have? Have you made any resolutions?  How are you getting on?

I recently read on Twitter a post about having intentions instead of resolutions which I liked as a concept,  it allows us to let things slide but allows us to re-start simply without beating ourselves up. Its a great opportunity at the beginning of a new year to have grand ambitions to achieve what we consider to be important. But already challenges and curve balls can have an effect on the best laid plans. The idea of aiming towards our goals but accepting that the path might be difficult and at times impossible to achieve enables us to embrace the uncontrollable and continue to aim high.

Recovery from injury is typically unpredictable and challenging, it can be disappointing when things take longer than expected or a back pain recurs when you think its gone away, but with good intentions, embracing that these things sometimes happen and aiming for the end stage can allow us to absorb the bumps as oppose to giving up.

I’m always blown away when I meet clients from years ago who say they still do the exercises I encouraged them to do when they came for treatment, in one case this was almost 20 years ago! However, full respect – the concept of continuing with exercises / general fitness / use it or lose it is laudable. I encourage everyone to think of fitness / exercise as a way of life, contributing to health and well being. So taking the long term view and considering being healthy as a goal seems the sensible approach.

So my intentions this year are to stay healthy; aiming to walk / do a 7-minute challenge as a minimum every day (for January is my first short-term goal) but with the overall aim of well-being. Might seem simple, but hopefully a few more of the Impact-challenges will be embedded throughout the year too – already we have a team entered in the 10k obstacle course and plans to have a bigger group enjoy the Yorkshire 3 peaks again.

If you have any goals that you need advice / support with then please let us know, we’d be delighted to be part of your health and wellbeing journey. Here’s to a happy healthy 2019.

Healthy happy lifestyles

We’re all getting ready for Christmas and hopefully looking forward to some time off to spend some quality time away from our daily routines. It’s at this time of year too that we often look to consider what 2018 might bring us and what we might like to change.

We all want to try and live a happy healthy life and the role of exercise is key. However, with busy lifestyles work can often get in the way and if we are involved in repetitive or sedentary job roles this may be detrimental both physically or mentally.

Many people spend a large proportion of their time at work. It’s common to feel too busy doing your job to take the time to consider how it impacts on your health.

Office workers particularly spend hours sitting still and carrying out repetitive tasks. The human body isn’t designed for this; we’re supposed to be moving around, so all this time spent at a desk needs to be well managed and regular breaks to maintain activity are advised. Often long periods of inactivity can lead to general back ache and/or neck and shoulder pain.

Other problems include feeling pressurised, anxious and low in mood. These types of conditions are experienced by most adults from time to time. If identified early and managed well, they should not result in time off from work.

There are several steps you can take to ensure you incorporate enough physical activity into your day to help you stay fit and healthy for work. These include:

  • Getting some fresh air every day
  • Doing easy exercises every couple of hours
  • Taking micro breaks
  • Simple stretches to keep mobile
  • Ensuring your work station is comfortable

Source: http://www.csp.org.uk/publications/fit-work 

We hope you have a wonderful Christmas time, a special thanks goes out to all those who will be working continuing to look after us either through health services or safety. The whole Impact Team wishes you a Happy 2018!

Pain….. why does it hurt so much?

pain

[vc_row css_animation=”” row_type=”row” type=”full_width” text_align=”left”][vc_column][vc_column_text]I received a lovely email this week thanking me for making someone feel so much better.

What did I do?  IMO – not very much…. I just asked some questions and then explained what I thought might be going on and what I thought might be a good idea to try.

To put things into context – I received a call from someone we have worked with in the past. They described back pain which came on after doing a lot of something they don’t normally do, we chatted for a bit, I made a few suggestions and said goodbye.  12 hours later, here’s a small cut and paste from their email…

Thanks so much for the chat this morning.  You are a wonder worker.  Already your advice has made a big improvement for me.  Thank you. 

Why? Well that’s the thing – the pain that was being experienced is a combination of lots of things. In this case, my impression is that doing something that they hadn’t done before, quite a lot of it, meant that they were feeling places that they hadn’t felt for a while. The resultant sensation wasn’t nice, which was then made a huge amount worse by worry, anxiety and fear. Worry about why it was so painful, anxiety that they won’t be able to do something special in a few weeks time and fear that there is something seriously wrong. This had been going on for about a week and things weren’t getting better.

Pain is complicated. Hopefully this story illustrates that for such a quick turn around of the severity of pain and improvement in symptoms that this was brought around by how the problem was interpreted and dealt with. In this case having the confidence that it was OK to keep moving and try some very simple exercises combined with reasoning that nothing was seriously wrong meant that the problem had reduced significantly.  Sometimes it helps to reason what might have caused the problem, what was aggravating and easing it and what might help to improve things.

There are lots of experts who can explain it better than I can, I’ve included some of the video’s below. This example is meant to show how sometimes a bit of simple advice and explanation can make a huge difference.[/vc_column_text][vc_empty_space height=”62px”][vc_column_text]

Understanding pain

Here’s a few video’s from experts in the field explains the complexity of pain.

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Why do we hurt? 

Do we actually experience pain, or is it merely illusion?

In this TEDx talk, Lorimer Moseley explores these questions, and position the pain that we feel as our bodies’ way of protecting us from damaging tissues further.

He also looks at what this might mean for those who suffer from chronic pain.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_video link=”https://www.youtube.com/watch?v=gwd-wLdIHjs”][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” type=”full_width” text_align=”left” css=”.vc_custom_1508837556558{margin-top: 60px !important;margin-bottom: 60px !important;padding-top: 60px !important;padding-right: 30px !important;padding-bottom: 60px !important;padding-left: 30px !important;background-color: #ffffff !important;}”][vc_column width=”1/2″][vc_column_text]

Understanding Pain: Brainman chooses

An animated video on managing pain.

The video was produced by a team from Hunter Integrated Pain Service (HIPS), University of South Australia, University of Washington and Hunter Medicare Local (Hunter ML)[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_video link=”https://www.youtube.com/watch?v=jIwn9rC3rOI”][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” type=”full_width” text_align=”left” css=”.vc_custom_1508837556558{margin-top: 60px !important;margin-bottom: 60px !important;padding-top: 60px !important;padding-right: 30px !important;padding-bottom: 60px !important;padding-left: 30px !important;background-color: #ffffff !important;}”][vc_column width=”1/2″][vc_column_text]

Our fears and beliefs about pain 

Jack describes to Prof Peter O’Sullivan about how he had chronic back pain.

He was told he had a back of a 70 year old, he needed fusion surgery and couldn’t play sport .

He now does manual work with little pain – he tells his story of re-gaining his life.[/vc_column_text][/vc_column][vc_column width=”1/2″][vc_video link=”https://www.youtube.com/watch?v=j4gmtpdwmrs”][/vc_column][/vc_row][vc_row css_animation=”” row_type=”row” type=”full_width” text_align=”left”][vc_column][message type=”with_icon” icon=”fa-info” icon_size=”fa-lg” close_button_style=”light” background_color=”#eded93″ border_color=”#eeee22″]

If you’re worried about pain or a problem that’s stopping you getting on with what you want / need to do then get in touch. Book an assessment and we’ll thoroughly assess you to determine what you can do about it.

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Please get in contact if you have any questions.
0115 9721319 / enquiries@impactphysio.co.uk

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Coronavirus

In this unprecedented time, we encourage you to continue to put your health & well being first.

Whatever your pain / problem please make contact and we can help you.

Things are changing fast – for the latest information, please see our Coronavirus page.