“”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

Internship: Physio / Sports Therapist / GSR

Internship Opportunity

An opportunity for a newly / recently qualified graduate has arisen with Impact Physio. We are looking for one / two individuals to work closely with a mentor to provide match day first aid cover and support during training sessions throughout the 2016/7 season with Derby County Girls Regional Training Centre.

The role requires commitment for the 32 week season which commences at the beginning of August with pre season training. Training sessions are Tuesdays 17:00 – 19:00 and Thursdays 18:00 – 20:00 through the season. During this time assessment and treatment of injuries will occur. Match day cover on Saturdays for approx. 20 games for the U14 and U16 squads is required.

Training takes place at the University of Derby Sports Centre astro pitches.

Derby County Girls Regional Training Centre is a Tier 2 FA centre. A basic minimum requirement is the FA BFAS course.

For further information please email Rachel Royer.

Remuneration will be £10p/h during training (4 hours per week) and £25 per match day cover.

Interested individuals are invited to send their CV and statement of interest to us at

enquiries@impactphysio.co.uk

World Deaf Tennis Championships 2015

tennis

This week we are at the Nottingham Tennis centre for the inaugural World Deaf Tennis Championships with the Tennis Foundation. Chris and Rachel are the event physio’s.

Luckily we have got time to enjoy some of the tennis too, meeting players from many different countries, Ecuador, Australia and Russia to name a few – lots of fun working with interpreters and athletes.

Semi-finals and finals this weekend, come down and watch to the action, forecast is looking good!

 

 

 

 

event

 

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.