gardening…

image of clinic front with bluebells

It’s that time of year! A bit of sunshine, a bit warmer and we migrate outside. For some of us spring gardeners we dust off the mower and search out the various gardening tools and go for it!

red flower

Often it’s the next day, (typical of any unusual activity) we can’t move! Or at least we can’t lift our arms up, can’t bend over to tie up our laces…..  usually this eases up over a few days. it starts raining and we don’t repeat these activities until the next spell of good weather. 

Wouldn’t it be lovely to be gardening ready? If we really consider the level of physical activity we are doing then it makes sense to make sure we’re fit to start with. Its likely that unless we gradually do a bit of gardening building up over time then we will feel some soreness in the muscles we don’t use to do these activities.  Bending and leaning and moving heavy loads. but if we maintain a basic level of strength and flexibility then it’s likely to be a much more enjoyable and satisfying activity. 

I do love a kettle bell myself, or any free weight. Something that you can use to mimic some of the unusual positions / activities you do. Starting off with basic exercises such as a farmers walk, mimicking carrying something or kettlebell swings will get your body used to different movements.  There’s lots of ideas  out there, just remember to start light and gradually progress as the exercises become more familiar. And of course, if you’re struggling and want someone to work with you then please get in touch.

      [email protected] / 01159721319

A few thoughts from Mike Whichello from OneStop Wellbeing who is currently working with us 
 
“It’s a funny old thing is pain. My role back on the very front line of the NHS within GP clinics has been really interesting so far. Its given me a slightly different perspective to those patients that I was previously seeing within secondary care, who had been referred by their GP. 
 
No less than FOUR of my patients today presented with pain that had come on as a result of doing some gardening over the weekend. We have one good weekend of weather, and look what happens!! 😂 
 
Now clearly, on balance gardening is actually not an inherently dangerous activity (within reason). But much like other activities, if the demands that we place upon our Musculoskeletal system outstrip our capacity, then we can start to run into some discomfort. 
 
Each of these 4 patients were 50+. I’m fairly confident their pain will not persist for too long. With a bit of reassurance, not over medicalising their pain, and a gentle return to activity, I’m sure they will be back tending to the lawn in no time. 
 
But for me it was a nice illustration of the need to continue to build and maintain our Physical resilience and capability, to ensure that as we move through the decades, we can still do the things that bring us joy and happiness at the weekend.
 
So just as it would be … moronic to tell people that they shouldn’t run for their health, because their knees might hurt, the same applies for gardening, and its potential to cause you some back pain. 
 
But rather this post is just here to plant the seed (see what I did there?) 🌼 that much like your financial pension, the sooner we start paying into our physical reserves, the deeper those reserves go, and the better quality of life we have and maintain into those later decades. 
 

Anterior Knee Pain

physio assessing knee

You may have seen that we’ve joined a challenge this month. As a team we’re aiming to clock 200 miles. Although the event is called “Run For The Trees” any moving miles count.

So often we hear “I can’t run / had to stop running because my knees hurt” so its probably a good time to address one of the common causes of knee pain and what we might be able to do about it.

Our knees are relatively simple structures, a hinge joint but there is a degree of rotation / twist too which allows full movement and conformity to rough surfaces along. We have a couple of meniscus’s in the middle that aid movement and shock absorption and a bunch of ligaments, the most common being the cruciates which we sometimes hear about being injured in football / skiing.

A typical cause of knee pain that we see in clinic is described as “Anterior Knee Pain” this is the common term for pain around the patello-femoral joint. The patella acts as a pully system for the thigh muscles (quads) and typically pain is diffuse / non-specific and changeable when irritable. This is a really annoying condition, depending on how severe things are depends on how effective treatment strategies are. 

One things for sure, patience and perseverance are key. Its worth seeing whether there’s tightness / weakness in the lower limb especially that might be contributing to mechanical forces.

The main management for AKP usually involves activity modification and a load overview. i.e. gradually changing our activity levels over time and considering speed, time, surface and general life events alongside a gradual increase in distance.

Pain is not the best way to monitor whether things are better / worse as many factors influence pain. Noticing if you get any swelling / heat around the joint is more useful, especially if there’s a change in these symptoms.

Strengthening / stretching trends seem to vary, but essentially maintaining or regaining a robustness in the body is essential.

We’re happy to work with you to help if you struggle with knee pain.  Knowing what’s causing any pain and what you can do about it is empowering. Hopefully you can then do the activities you enjoy without having to avoid them.

                                      “Remember, if you’re moving, you’re lapping everyone on the couch!

             If you’re struggling with something, get in touch, we’re happy to work with you if we can.

                                                   0115 9721319 / [email protected]

Hamstring tendinopathy

Training for anything isn’t always a smooth journey. We sometimes set our sights on a goal and even with the best intended preparation, it doesn’t always go to plan. Sometimes things get in the way from our training plan, other commitments, inclement weather conditions and occasionally an injury.

I was off one sunny Sunday morning for a long run, just making the most of a free morning.The plan was to enjoy a 25-30km route with no agenda other than to be out for a few hours to build up some endurance / time on the legs. 

Not far from home I tripped over a tree root. I managed to save myself from going head first but felt a pull at the top of the back of my left leg which made me pull up sharply. I was able to walk it off and decided to continue with my plans, shortening my stride so I couldn’t feel it pulling. In hindsight that may not have been the best idea, but I was able to continue without feeling it so I did.

I didn’t get a significant reaction following the outing, no obvious bruising or swelling, just a tightness that meant getting up from any period of sitting I could feel the back of my leg.  I couldn’t bend down to take my shoes off without bending my knee and there was a dull ache deep in my buttock cheek, directly over the hamstring origin.

This persisted over the next few weeks, I was able to continue training as nothing seemed to make the symptoms worse, it just didn’t get any better.  In addition, sitting for any periods of time, especially driving was really bothering me. I just wanted to move. Even short journeys of 10-15 minutes I was shifting about in my seat and getting out stiffly.

Time to do something specific to try and get things back on track.

I got it assessed by Finn in clinic who diagnosed a hamstring tendinopathy.  Basically a grumbly tendon from being overstretched. These are typically resistant to resolving and need a persistent approach to gradually load the tendon.

I started off with a graduated loading programme within range, isometric holds, non-aggravating regaining range exercises and gradually built up over time to loading the tendon at end range increasing to high loads at long muscle-tendon lengths. 

This was over several months and although things are now pretty low key, I continue to work on this area specifically when I do weights because things easily tighten up again and get grumbly if I don’t.

Images are some of the eccentric exercises
I did from the Aspetar Hamstring Protocol

At risk of blaming my age, I have noticed that the niggles I’ve had have been more resistant to resolving and needed a much more consistent approach to managing them.

Tendinopathies in particular can take months to completely resolve, depending on why its happened.  Addressing the robustness of the tendon to ensure its ready for what it is you’re expecting it to cope with is essential.

Lesson learnt by me; consistency, patience, and to stay positive maintaining health and well-being with non-aggravating activities. It really helped to have a clear diagnosis and plan to work with too.

               If you’re struggling with something, get in touch, we’re happy to work with you if we can.

                                                   0115 9721319 / [email protected]

Happy New Year….

2023 – what plans / aspirations did you have on January 1st? Did you make any resolutions?  How are you getting on?

Strava reviewed 800 million activities logged by users, and reported that most have stopped their new flurry of activity by the third week in January.   Jan 19th is framed by Strava as “quitters day”

However, if we re-frame the New Year’s Resolution to an intention instead, it allows us some scope to let things slide, without “failing”    It allows us to re-start simply without beating ourselves up.

It’s 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.  Thinking about developing new habits, making your goals achievable can help.

If we think of fitness / exercise as a way of life, contributing to health and well being as opposed to an aspiration to become what we perceive as an ideal, then maybe we can embed some of our best intentions into a way of life.

So taking the long term view and considering being healthy as a goal seems a sensible approach.

If your best intentions are hampered by injury / niggles or unsure how to start then get in touch.  We can work with you on a 1:1 or you can join one of our small friendly groups. We have classes for beginners or those who already practice and want some inspiration / guidance. 

yoga – Monday evenings 5-6pm

pilates – new classes starting soon on a Wednesday evening

tai chi – space to join our classes on a Thursday morning.

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 2023.

Exercises: Progressive Overload

During your experience at Impact Physiotherapy, you are likely to receive an exercise programme in some form. You will either receive formal exercises specific to regions of your body, or advice and education around managing training load overall like running distances or frequency.

Sometimes from a patient perspective, it can feel daunting to try to manage this despite our efforts to educate and build a plan with you. So, I am writing this blog today with some basics to take home to help manage your exercises.

Now, what do we know about muscle? They adapt to accommodate the stressors or demands put upon them. So, the more you practice the exercises the more the muscles adapt and get stronger. We may start an exercise using 3 sets of 5 reps and over a few weeks aim to progress to 3 sets of 10reps. This is a simple form of progressive overload, by progressing how many reps you do.

Progressive Over-load simply means making something progressively harder to accommodate the increased ability of your muscles or joints. This can apply in all aspects of your rehab and can be a challenging process. When an exercise is prescribed to you, you will likely come across some of the following terms:

Repetition (or Reps): This is how many times you perform an exercise, for example with a straight leg raise, you would lift your leg up off the bed a set number of times. You may be prescribed 5reps, meaning you would perform the exercise five times.

Sets: This is the accumulation of reps. So 5 reps would make one set. Which you may be asked to repeat two or three times. So, three sets of five reps would mean you would perform the exercise five times, have a rest and repeat this process twice more.

Frequency: This Is how often you do the exercise above. So, it may say once a day, twice a day, or maybe three times a week. This would mean doing three sets of five reps three times a week. And the other days you can rest.

Duration: If you are doing static holds or maybe you are planning on returning to running. This would indicate how long you would hold an exercise or long you would run for.

Rest: Rest typically means how long to rest between each set that you do.

Sometimes we as physios want specifics and set all the parameters above, sometimes it is not as important. It really depends on your goals, so you may be prescribed all of the above or only sets and reps.

Example 1) 3x5reps daily

Example 2) 3sets x 5reps, 3sec hold. Every other day, 2minutes rest.

How to Progressively over-load

Reps: Try to do more reps in each set. So, 3 sets of 5reps over the course of a couple of weeks may be built up to 3 sets of 10reps 

Sets:  You may start with 1 set of 5reps and build up to 3 sets of 5 reps

Frequency: You may start with doing the exercises every other day and progress to daily

Duration: You may be able to hold an exercise for 10 seconds and build up to 30 seconds, or run for 5 mins and build to 20mins

Rest: You may start with 2 minutes of rest and reduce to 1 minute to make it harder with less recovery time.

Resistance: You may also consider instead of adding reps and sets, making the exercise harder with an external load, for example, a dumbbell.

Tempo: changing the time of the concentric or eccentric portion of the exercise. For example, 2 seconds up and 2 seconds down, to 2 seconds up 5 seconds down.

Intensity: Considering a percentage of effort or rate of perceived exertion. You may work at 70% max effort or RPE 7/10. This could be subjective or objective by how you feel doing it, or by lifting 70% of the weight of your maximal effort ability.

Your Physiotherapist will likely discuss how they want you to progress, for example, increase the weight used; increase reps done, or advice may include, starting with 3 sets of 8reps. Build to 3 sets of 12reps then bring it back down to 3 sets of 8 reps but add weight next.

These are just the basics that we hope will help you in the management and understanding of how to progress should and when you need to. Of course, when in doubt speak with your physiotherapist.

Written by: Jack Clayton 

 

First Contact Physiotherapist

Our team is working within our local NHS Primary Care Network to deliver First Contact Physiotherapy services to the local community.

The development of First Contact Physiotherapy (FCP) services across the UK allows people with musculoskeletal (MSK) conditions to access MSK physiotherapy expertise at the start of the pathway, ensuring timely access to diagnosis, early management and onward referral if necessary. 

If you are experiencing muscular or joint aches and pains then instead of seeing your GP you can book in to see your FCP at your local surgery (or hub)

Our FCP’s are skilled specialists and will check you can be referred on for physio treatment or whether you need further investigations or review of medication for example. 

Our team is based within the Erewash PCN at Sawley Medical Centre.

Join our team

We’re delighted to report that we need one /two people to join our team. We pride ourselves on being a friendly group of active people, and look forward to welcoming someone / more to our team.

We are looking for people who are motivated, dynamic, approachable, and work well within a team. We have a range of experience and specialities and are always keen to learn, so are particularly interested in people with knowledge, skills and interests in the MSK environment.

This can be full or part time, flexible hours to suit candidate/s.

Our main site has 5 clinic rooms, and two of our satellite clinics are situated in great locations; the Sports Centre at the University of Derby and The Derby Arena.

The roles will involve working autonomously to provide clinical assessment and appropriate management of patients / clients with musculoskeletal complaints and sports injuries using current evidence and clinical reasoning.

There is the opportunity for either / both a private clinic setting as well as in a First Contact Practitioner (FCP) role. You will be supported in completing the roadmap.

This is an exciting opportunity for anyone who wants to make the most of this relatively new opportunity but maintain their rehab focus alongside. 

Essential:

  • Degree (or equivalent) in Physiotherapy
  • HCPC registration and Membership of the CSP
  • Experience as an autonomous practitioner working independently without day to day supervision; to assess, diagnose, triage, and manage patients, taking responsibility for prioritising and managing a caseload.
  • Understanding and adherence to CSP Standards of Physiotherapy Practice and Rules of Professional Conduct

Desirable

  • Experience in musculoskeletal private practice

Qualities

  • Ability to demonstrate good clinical reasoning
  • Excellent communication and interpersonal skills
  • Ability to organise and prioritise
  • Ability to work as part of a team

Start date: As soon as possible.  So if you are interested in being part of a special team and would like to know more please make contact.

Please send a cover letter and up to date CV to Rachel

[email protected]

Keep moving…

Our team has been involved in the national vaccination effort – 9 of us have joined the local team and are working away alongside our usual physio clinics. Its a huge privilege to be part of the multi-disciplinary team based at the Long Eaton health Centre and Littlewick surgeries and add a new skill to our repetoire. 

Meeting more than 100 people each day is a pleasure, and the depth of gratitude is humbling. Many of the first to be vaccinated were venturing out for the first time in a year. It’s really sad to see the change in the population since the pandemic started with general activity levels reducing and health deteriorating. The past year has been a rollercoaster for most of us, and it’s clear that the knock on effect of the pandemic will be an effect on our activity levels and mental health.

The activity guidelines still apply, for adults aged 19-65 to do at least 150 minutes of moderate intensity exercise every week (moderate exercises classed as increased breathing rate but able to talk) or at least 75 minutes of vigorous exercise per week (vigorous classed as breathing fast and difficulty talking) or a combination of both.

There’s so much on offer now via video-link / YouTube / SoMe and of course there’s the great outdoors, and the weather seems to be picking up too! The main thing with any exercise or activity is that you enjoy it, as you’re much more likely to stick with it.  And of course, if you have let your fitness slip or not been active for a while then build up what you do gradually. The body wants to move and thrives on activity, but if it not been active to avoid unnecessary aches and pains then think about gradually increasing what you do.

Resources

Exercise – NHS activity levels guidelines

Versus Arthritis Let’s move

Please get in contact if we can help at all: [email protected] / 0115 9721319

Let us know how you're getting on!

Goodbye 2020!

What a year! A time to reflect as we head into 2021, the huge changes that we have made to continue to offer the standards of care we are proud of. Everyone in the team has stepped up to the challenge and pulled together. Its been tough, as a social bunch we have got used to supporting each other from a distance and of course working with you either via zoom or through PPE!

Our strict processes though have meant that we have managed to stay open and offer continued care throughout the pandemic. We are hugely grateful for the support we have received and look forwards now to adapting as needed in order to continue next year.

Our classes will continue to operate through zoom for the foreseeable future and our 4 clinics will respond to local requirements, currently the plan is to continue face to face appointments at our Long Eaton and Pride Park clinics on Jan 4th. Please don’t hesitate to contact us if you have any questions.

Wishing you all a healthy and active 2021!

Please get in contact if we can help at all: [email protected] / 0115 9721319

Let us know how you're getting on!

“”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: [email protected] / 0115 9721319

Let us know how you're getting on!