gardening…

3rd May 20243rd May 2024 by Rachel Royer

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!

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

1st February 2024 by Rachel Royer

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

1st February 202425th October 2023 by Rachel Royer

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]

When an injury affects your training plan….

30th May 2023 by Rachel Royer

I have recently been fortunate enough to have participated in the Marathon Des Sables (MdS), a 250km 6 day ultramarathon in the Sahara desert. This has been a dream of mine for a while, I’m delighted to say I completed it at the end of April 2023.

Any multi-day event requires a huge amount of resources and focus to even get to the start line. The MdS as it is known, usually has a completion rate of 95% with the greatest amount of “drop-outs” before even travelling to Morocco. Typically 20% of those who sign up don’t make it out there. This is often due to a change in circumstances or more typically due to injury. Balancing the training load for any event is a fine line between over-training and being able to tolerate the distance required to not only complete the event, but in my case enjoy it too.

I focused my training on being able to complete the distances required as well as being able to go again each day for 6 days. For me, this included 5 days of 30km each day, a 85km long day and a 3 day event covering 85 miles sleeping in a sports hall overnight. As well as consistently completing a minimum of 50km each week over time and incorporating cross training to consider strength and general health. I wasn’t able to do any training camps in hot climates but did have some sessions in a heat chamber (Loughborough University) as well as a bit running in sand whenever I could, with family and friends visits to Croyde!

Its important to gradually build up with any fitness, the body likes consistency and a balance. I aimed for a maximum of a 10% increase on distance each week and was careful to include rest days. Either complete rest or walking / swimming / yoga. Another component I considered with my training was the other factors in my life. This is something that’s hard to control, being busy at work, sleep hygiene, other occasions, eating and drinking, or fuel and hydration. There’s a lot to balance, as well as keeping everything in context, not wanting to miss out on family special occasions or socialising / spending time with friends.

My typical week involved a couple of 10km runs during the week then a longer run / two at the weekend. Also a session of two with weights and some yoga. Nearer the event I also started increasing my tolerance carrying a weighted backpack, as a self-sufficient race, you carry everything for the week. This includes food (which weights approx.. 3.5kg at the start of the event) and mandatory kit. The pack weights a minimum of 6.5kg at the start and combined with the 1.5kg of water at each check point typically weights a minimum of 8kg on day 1. The route is all on tracks / sand / and surprisingly a minimum of 500m elevation each day so it was also good to get to the peaks to get some hills in and on varying terrain.

A few months before the event I was enjoying a solo trip on the Edale circuit, and was just coming off Kinder Scout when I went over on my ankle. I felt an immediate sharp pain which made me stop. After a few moments I checked I could weight bear and hobbled to a sheltered spot to catch my breath. As it didn’t swell immediately and I could put my weight through it I managed to walk back to the car with poles. When I took my trainer off there was a localised swelling around the outside of the ankle, pretty consistent with a lateral ankle sprain. The next morning the ankle had ballooned and I struggled to walk. I therefore followed the principles of PEACE and LOVE conscious I was 10 weeks away from the start line and had hoped to build the mileage.

What’s changed in the management of soft tissue injuries?

We used to use the acronym RICE or PRICE/R or POLICE which advocated the use of ICE and anti-inflammatories. However this has been updated in the last few years to shift the focus on early mobilisation once the initial phase has passed and the avoidance of anti-inflammatories and ice, which may delay healing.

Along with having to change my training expectations I also had to re-consider a training plan to maintain fitness and maximise conditions to optimise healing. I was assessed to determine what the injury was and get a rehabilitation timescale / plan to manage my expectations.

The first 10 days of a grade 1 strain pretty much focused around reducing the swelling and regaining range of movement and strength / proprioception in the area. I combined some open water swims and bike riding along with strength training to keep myself in a good place. Its really important if you pick up an injury to consider what you can do as opposed to just what you can’t.

I was fortunate enough to make a good recovery over a couple of weeks following a regime of active rest and elevation initially, followed by regular exercises to regain range, strength and reaction in the ankle. I also used the static bike and rower to keep a cardio-vascular challenge and worked on general strength with weights, Yoga and Pilates.

It’s important if you do pick up an injury, whether it from falling over or something starts to hurt or niggle that you get it assessed properly so you know the best way to manage it. Sometimes we need to protect an area from all movements, at other times its important to keep loading the area so knowing what will facilitate the best healing times is essential. Depending on the structure or part of the structure can make a big difference to how to rehabilitate the area. A muscle responds differently to a ligament or tendon for example. Its also important to consider what else needs to be considered in reducing the risk of re-injury such as strength in other areas of the body.

If you’re planning something special then get in touch, if you want to work with us to make sure you’re robust enough for the challenge, or add something into your training schedule such as Yoga or Pilates. Or if you do pick up an injury then get it assessed so you can set realistic goals. We will work with you with the aim of optimising your recovery so you can achieve and enjoy your goal.

For further info on the management of acute soft tissue injuries;

https://www.physio-pedia.com/Peace_and_Love_Principle

https://bjsm.bmj.com/content/54/2/72

Special thanks to Finn who assessed my various injuries (hamstring and knee rehab blog to follow!) Mariangela for the awesome Yoga instruction and the whole Pilates team for keeping me strong and flexible. And of course the rest of the team for working hard in my absence and cheering me along the way.

Happy New Year….

24th January 202310th January 2023 by Rachel Royer

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

24th January 20236th July 2022 by Rachel Royer

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

5th April 202222nd February 2022 by Rachel Royer

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

10th June 2021 by Rachel Royer

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…

16th February 202116th February 2021 by Rachel Royer

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!

31st December 202029th December 2020 by Rachel Royer

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!

[email protected] / 01159721319

0115 9721319 / [email protected]

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

0115 9721319 / [email protected]

What’s changed in the management of soft tissue injuries?

Please get in contact if we can help at all: [email protected] / 0115 9721319Let us know how you're getting on!

Please get in contact if we can help at all: [email protected] / 0115 9721319Let us know how you're getting on!

Long Eaton

Pride Park

Kedleston Road

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

Let us know how you're getting on!

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

Let us know how you're getting on!