My First Entry into the World of Back Pain and Patient Interaction

I am currently out and about gaining experience and working on some assignments for university. This morning I came across my first patient who has been dealing with a history of back pain for 8 years. Now I will admit I was very nervous from the outset as I have no experience of dealing with or treating back pain and my exposure to back pathologies etc was over a year ago in college. I felt the subjective assessment went well and I delved into all elements of the biopsychosocial model. I did feel that a small element of the persistent nature of the pain was linked to a lack of understanding of what the pain was, the anatomy of it and “protecting” it by guarding the area with a lack of movement.

However the point of this post is about the objective assessment and how I interacted with the patient in relation to their pain. The patient had quite a pronounced loss of ROM in lateral flexion, extension and all their mobility was coming from their thoracic spine. There was a distinct lack of mobility in the lumbar spine and this is where I fell down completely. I was unable to maintain a neutral facial expression and my body language wasn’t great, the patient picked up on this and I could tell it was influencing them. I was giving away too much and it wasn’t helping the patient. I wasn’t sure what language to use to describe their issues and fell into the trap of trying to “simplify” it for them which in my mind is incredibly ignorant and downgrading so I cannot see why I did this.

Even worse was the language I used. As the patient was coming from a manual labour and construction world I decided likening something to concrete as a joke was a great idea. Let me tell you it wasn’t. I could see the patient running with this and within seconds was already trying to fix my mistake. However I did manage to turn it around and I could see the patient coming around.  Reflecting on today I have a huge amount of work to do on my patient interaction and understanding pain. I can see how easy the traps are to fall into but also how easy it is to influence a patient in a bad way. I also came to the conclusion that when you try to “simplify” the message this is where things go wrong.

It was a bad first day, unfortunately for the patient (unfairly) and myself. I take full responsibility and I know I need to do better. Doing a course is something I definitely feel is necessary. I have bought Louis Giffords and Lorimer Moseleys books and I hope they will help in the long run. What I have learnt from today is that nothing can substitute experience, language is just as important as the treatment and I have a lot to learn.

Thankfully I have another opportunity to meet the patient again this week and I can rectify my mistakes.

PART 4

Welcome to Part 4 of “What Inspired you to be a Physio?”. Again we have two great stories from two very experienced and talented physiotherapist’s. 

First up is Gill Dean Lofthouse who has 25+ years experience as a chartered physiotherapist specialising in TBI, SCI, Neuro, Orthopaedic & Respiratory physio. 

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“I grew up fascinated by hospitals and all things medical. I was a quiet myopic child who preferred reading and had insatiable curiosity.
My best friend at primary school had an older sister who had been ‘knocked down’ age 7 and consequently was a wheelchair dependent hemiplegic who I helped feed jelly to.
My parents were teachers in mainstream then special needs education – and had an ex pupil who was severely injured when he fell 100 foot off scaffolding at work. During his recovery my dad would bring him to our house.
I still remember my dad carrying him from the car into the house. He was an inspiration as he later became a professional dancer! My mum became the manager of one of the first PH daycare centres in the 70’s – I physically stopped growing at at 12 being 5ft 7 and strong and in the absence of hoists, over the years learned to stand transfer any size and disability of client.
At age 15 and knowing I wanted to do an active job in something medical, a community Physio who was visiting clients at the PH day centre took me with her for a few days to Burnley General  hospital.
I never looked back. I have the best job in the world and would never change it. I’ve worked internationally and around the Uk in the NHS (16 years) and privately and I’ve never stopped learning skills to put in my ‘toolbox’ to enable make me the most effective and efficient I now can be. I’m all about enablement and independence. I will always be a physiotherapist first. Lucky lucky me.”

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Following this we have Alan J.Taylor MSc MCSP HCPC Reg PGCHE who is  an Assistant Professor/Module Convenor in the Division of Physiotherapy & Rehabilitation Sciences in the University of Nottingham. I think it is clear Alan is a very talented man from his piece. Alan also has a blog that can be found here.

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A bicycle ride into physiotherapy and beyond … (Alan J Taylor)

A few years ago (!), aged about 14 years of age, I took off on a long, long bicycle ride over the hills of Derbyshire … the ride took me up the infamously steep Winnat’s Pass and many other painful climbs. I’d done a bit of preparation, but that ride made my legs hurt more than any other. I remember wondering about the mechanisms that led to that deep ache inside my legs, and instinctively gave them a rub or massage, as best as I knew how. Of course, you know what happened. Almost miraculously, they began to feel immediately better, looser, more supple … the pain had seemed to drain away. Frankly I was flabbergasted, how could that simple ‘leg rub’ make my aching muscles feel fresh and new again and ready for another pounding in Derbyshire?

I set out to find myself a regular ‘masseur’ who was also a coach, and used massage (to good effect) as part of my preparation from that day on. The experience had stimulated an on going interest in the complex physiology and psychology of the human body. I decided to explore ways in which I could be a part of that, and soon came across the profession of Physiotherapy … A confused teenager had found his metier, almost by accident. I’d discovered a profession (and physical modality) that would blend my love of sport, cycling in particular, and would feed my fascination with the human body and mind for a lifetime.

As a cyclist, I became moderately successful. I learnt how to suffer (I can safely say, I ‘know pain’) and I learnt how to win. I won many exciting races during a long career as an amateur cyclist and spent three years as a professional, completing the Professional ‘Kellogg’s Tour of Britain’ in 1988.

My physiotherapy training took place at the ‘Nottingham School of Physiotherapy’, and after qualification, I had the pleasure of working in a variety of countries and different settings. I had the experience of working for a Pro-cycling team, and on many top ranked events from triathlon to tennis. My journey took me all around the World and back again.

I still ride my bike for enjoyment, and regularly commute the 12 miles each way to my work at the University of Nottingham, School of Health Sciences. That is where I try to pass on my on going passion and enthusiasm for EBP and physiotherapy, to both undergraduate and post graduate students. I keep up a small amount of clinical work and devote my energy into physiotherapy education … Striving to keep up to date with the ever changing World of evidence based medicine, and it’s application to our profession.

Each day I remind myself as an educator, that we must “prepare our students for their future, not our past” … and that means keeping abreast of a dynamic landscape and embracing change.

As a physiotherapist I like to think I’ve helped a lot of patients and no doubt … hindered a few too, but I’ve never stopped learning. I am lucky enough to travel the World as a lecturer on various topics within Physiotherapy, and collaborate with some amazing and knowledgeable people, on peer-reviewed publications and other projects. I developed and maintain a passion for writing, which was sparked by my MSc in Sports Med, where I finally learnt to think. I do my utmost to pass that skill on to EVERY student (and clinician) I meet. I also write as music ‘critic’ and can occasionally be found strumming a guitar or banjolele myself.

My all time favourite quote comes from the legendary singer, musician, philosopher and poet Leonard Cohen  …

 

“There is a crack in everything … that’s where the light gets in”.

The way I personally use that immortal line, is to remind myself (and others) that no one, and nothing is 100% ‘right’, and that blind, unquestioning followers of any teacher, guru, god, school of thought or otherwise are not really thinking critically

So never allow yourself to be lead along by the nose. My advice is to develop the art of healthy critique and THINKING … that way, ‘new paths are made’.

Incidentally, most folk would say that my pain relief from the massage was ‘psychological’, I would (still) say, with a smile on my face, ‘au contraire’ … sometimes we have to agree to disagree … enjoy the journey ☺

You can read some of Alans peer-reviewed papers here and here …

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 Again thank you to all who participated.

The Future of Physiotherapy

The future of physiotherapy in my mind is very bright however some changes are required before we can reach a level that is fully satisfactory. To me a fully satisfactory level is one where patients are in control of their outcome, the physiotherapist has taken an open minded and informed approach to the patient’s pain where all causes are taken into account, exercise is promoted and all practice is evidence based with clinical reasoning applied in a large dose. For me that would be the ideal formula with room for variance and experimentation. Now I am not dismissing the great work that is being done as we speak and there are plenty of physiotherapists who are already implementing this strategy. I take my hat off to them; those are the people who are driving the profession forward.

Physiotherapists are perhaps the most adaptable healthcare profession because of the type of skills the job demands. We are problem solvers and creative thinkers by nature and that is why I see physiotherapists at the forefront of an improved healthcare service if we really want it. A recent physiotalk on twitter and a great question of the day from Tom Goom got me thinking on a physiotherapist’s scope of practice. Really if taken seriously we have a lot of room for growth. Tom asked a question along the lines of can a physiotherapist have a role in “performance” and I would be inclined to say yes, but let me explain why. What other profession has such a wide range of skills and knowledge relating to the human body its anatomy, its physiology.  Don’t we all study the brain, the skeleton, muscles, organs, the body’s chemistry and physics? So why not I say?

For me exercise prescription and health promotion is well within our scope and we must really take charge and control of this because society has lapsed into inactivity, and, obesity is starting become far too common a word. I believe that, in the next few years, physiotherapists will be the leaders that change this whether it is in a community, sporting or medical setting. We must give our profession the respect it deserves but also ensure others do too. That is why in the future we must be the leaders that get society running, jumping, chasing……… living.

To be a leader you must also be a teacher or educator and I think that in our future this will be a big facet of our job. Right now through blogs and research many physiotherapists are pushing the profession forward by imparting their wisdom to their colleagues and those who are in university. We must now focus on educating patients whether it is about their treatment, exercise, diet or health in general we must get the message out there and let it spread.

I raised the question of physiotherapy and nutrition yesterday and I really don’t think it is outside of our scope if we get the required training, whether it is part of our undergraduate programme or upskilling once qualified. We are in a great position to change our patient’s lives in a sustainable and healthy way. I am not saying that we take over the job of sport scientists or nutritionists but why not work in sync with them? Why not back up their message and add our own?

For example look at the role of Gerard Hartmann, the Physio to 61 Olympic medallists. He radically changed the preparation, training and, to some extent, the running style of Paula Radcliffe which ultimately had a huge role to play in her success. A brilliant article on this can be found here. I know this is a very extreme example but why can’t this be done on a smaller scale?

Evidence based practice is the cornerstone of physiotherapy now and in the future. We must be led by the research for the sake of every patient that falls under our care, ourselves legally but also for success because quick fixes aren’t the way forward for anyone. We must aim to return each patient to optimum functionality without having a reason to return to us and without evidence this will not be achievable. However with this we must be able to take the research with a huge pinch of salt because really there isn’t the perfect article with results that applies to every patient so we must be guided by our own conscious as well as the evidence. This is not a call for the return to the dark days of the “guru” led approach, far from it.

There is at the minute a movement away from the biomechanical approach and to incorporate a much more wholesome view of the patient. In other words viewing them as a person made up of complex systems that are interlinked rather than a patient with damaged tissue. This is something that will hopefully revolutionise the world of physiotherapy because no injury or pain is simply structural and everything must be taken into account. How I remember this and validate it to myself is by thinking of my previous injuries and how I felt. Were those little twinges I felt in my hamstring when I made my return to football all in my head or was I about to break down again? The answer? both because the fear I had was holding me back causing me to hold back and I broke down again not physically but mentally and I never played properly again because of it. It is my aim to never let this happen to my patients because I hope that I will incorporate every aspect of that person’s life, pain and injury into their treatment to allow them to live their life to the full. I hope that this is the future of physiotherapy where every physiotherapist uses evidence, compassion, understanding and an open mind to ensure the best care is given to every patient.

PART 3

Welcome to Part 3 of “What Inspired You to be a Physio?”. Once again we have some very interesting stories from very talented physiotherapists.

First up is Paul Lagerman aka The Naked Physio whose excellent blog can be found here. Paul is also running The Big Naked Pain and Brain Campaign which everyone should check out. 

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“I’ve always worked around people, my parents owned a hotel in the beautiful northwest of Scotland and I was roped into helping out. I really enjoyed talking to the guests and finding out more about their day. The hotel was a stalking and fishing lodge so lots of the guests would come in with aches and pain from a days hike on the hill. It was always so interesting to see them the next day all full of life? The day before they were moaning and suffering. Was it the environment, the awesome nights sleep, or perhaps the ‘hearty breakfast’ the next morning.

Growing up for me was all about adventure I was always outdoors, sailing, hiking, cross-country runs, adventure sports you name I was doing it.

I was definitely more of a practical learning student hence why I got great marks in physical education and biology. I always remember my P.E. teachers remark when we got hurt during P.E. “it’s only pain laddie!” he would say, which appeared to condition us to just get on with it. I look back on that now and think how interestingly complex that comment actually is.

Another event that happened in my school days was I suffered from terrible sunburn as a child and got an enormous blister on the outside of my arm. The school nurse would dress it (but never popped it?) She would say, “you need to be really careful with it because if you burst it will be really painful and could get infected.” Being the outdoors type I of course didn’t really listen. So there I was a sub ready to come on for the school footie team when the ball made direct contact with arm and the blister exploded! I screamed but then all of a sudden there was no pain. I shrugged it off and played the best game of footie of my life. I never did get an infection.

A final experience which sealed my desire to become a physio was receiving treatment myself for a groin injury. I was in Edinburgh pursuing a strength and conditioning degree. The physiotherapist (who is now a very good friend) opened my eyes to this wonderful world of anatomy and physiology, pathology, electrotherapy and rehabilitation.  I had found my calling this is what I wanted to do. So I finished my strength and conditioning degree and pursued further education in physiotherapy.

So there were several events that happened in my teenage years that inspired me to move into physiotherapy. I came into physio quite late having completed my sports and conditioning degree and realizing that I needed more NHS based experience to get accepted onto a physiotherapy degree.

The final inspiration came from my lecturer at Brunel University. His pain lectures were fascinating and entertaining and I was hooked on the neurobiology of pain. Since then things have advanced significantly.

Once I was a practising physiotherapist in the NHS I drew upon all my experience of my teenage years to really understand patients. There was a mixture of frustration and bewilderment but at the same time huge reward when it came to changing peoples lives particularly those that were bogged down by persistent pain.  Once I had realized and accepted that I could not cure people with my “magic hands” things started to change patients were more appreciative and grateful. I realized this was down to my listening skills and communication skills.

I love being a physio and would not change it.  What is more exciting is what is on the horizon, a change is coming, a significant shift in healthcare, in the way we as clinicians and also the public see, think, do and understand ourselves and each other.”

Following The Naked Physio we have Paul Kirwan.  Paul is a Physiotherapist in Connolly Hospital, Dublin and works for Bohemians FC in Ireland. Paul is also a Clinical Research Fellow in Royal College of Surgeons Ireland. He can be found on twitter here.

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“I played sports and had a good few injuries meant a lot of time with physios… good and bad. I was thinking about medicine but loved the exercise mix with injury management so physio became the choice. Plus one particularly great physio who made difference between back to sport or just discharged. Met her 20 years later. Still working & enthusiastic. no regrets!!”

Next up we a piece from my best friend in college who is just as determined as I am to succeed in the world of physiotherapy. I am sure she will go all the way to the top. I particularly enjoy this piece because one, its from a student and two, it sums up everything that drives Physiotherapists day in day out – a desire to help people.

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“Being a physio wasn’t always what I had wanted. All I wanted was to help people and improve their lives in whatever way I could. Being a nurse was never what I dreamt of, I couldn’t quite imagine myself doing that. Medicine was always an option, it was always something that fascinated me but in the end it wasn’t meant to be, I didn’t have the brains! And so physio was a natural progression in my eyes. It was a profession that would allow me to help people, to make a difference and to change lives. It was a course that would open my eyes to the world that would challenge me and ultimately fulfil what I had always dreamt of doing. And now, after two years of studying, I know that I would never have been happy doing anything else. After only 3 weeks of placement I already know that this is what I want to do, its how I want to lead my life. I want to dedicate my life to others, to their development and improvement and really make a difference to their lives. People deserve to experience life, to have the chance to live as everybody else does and I dream of making that possible for every patient I encounter.”

Finally we have this brilliant reply from  @Ireland_ed on twitter that made me laugh. It shows sometimes we stumble onto the things we are best at. 

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“would be happy to help,you may not want me tho!didnt get the grades for psychology so did PT #bestmistakeievermad“

PART 1

Here is the first instalment of what inspired you to be a physio. There will be 3 parts posted in the next week so keep coming back for the next instalment. 

First up is Tom Goom from the brilliant The Running Physio blog, http://www.running-physio.com/ . Tom is a physio at the Physio Rooms, @thephysiorooms , and is also a course leader for Running Repairs.

“I’m a Physio because of my mum’s feet. When she was tired after work she’d often ask me to give her a foot rub to help her relax. I seemed to be naturally quite good at it and she suggested I looked into physiotherapy. After some work experience in outpatients at a small community hospital in Swanage I was convinced. Since then there’s never been anything else I’ve wanted to do (apart from a short unsuccessful career in stand-up comedy but that’s another story…)

I’ve always enjoyed MSK Physio but in recent years my blog has transformed my career and how I work. It’s made me hungry for answers and keen to share them with others, both patients in clinic and people online. I get a huge buzz from seeing research ideas work in practice and being creative in what we do. Over 20 years since massaging my Mum’s feet I still find Physio exciting, rewarding and fulfilling. 20 years from now I hope I still feel the same!” – Tom Goom

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Secondly, We have Mike Stewart who is a Clinical Specialist Physiotherapist & Inter-professional practice-based educator and Course leader for award winning, evidence-based Know Pain CPD events. Mike is also involved in the knowpain.co.uk website which is an excellent resource. Mike was also good enough to provide what he thought were the rewards of being a physiotherapist.

“Essentially, I’ve wanted to be a physiotherapist since about the age of 14. I’m not sure why as I’d never had any previous experience of physiotherapy. Back then my thinking was pretty simple – I enjoyed human biology, sociology and physical education. Physio therefore felt like the right thing to do.

My first ever experience of physio was during a week’s work experience at my dad’s work. He worked for a large oil company and they had a physio department on site. It was an interesting experience and I worked with 2 different physios with very different approaches. One was approaching retirement and had been a remedial gymnast. He believed in exercise for his patients. The other was younger and had recently completed his degree. He strongly believed in manual therapy for all patients (this was back in early 1990s).

It was fascinating to see their different approaches. Despite their differing methods, both felt that play was a necessary part of being a physiotherapist. This has always stuck with me and I now teach the importance of divergent, creative practice regarding pain education and rehabilitation.

Unfortunately, I found this freedom to play and my ability to be creative within practice was stifled during most of undergraduate experiences. Again, this was back in the days when you were expected to rigidly follow a certain approach to physiotherapy. Looking back, I was fortunate to meet other colleagues and educators who recognised the importance of trying new things with patients and not just sticking with the same old methods, same old results approach.

There are many rewarding features of being a physiotherapist. Top of the list here has to be the ability to guide people back to doing well. I’ve attached a screenshot of a card that I received recently from a young girl in a wheelchair which sums this up nicely. Previous clinicians had given up on her because she was too complex. I have always sought challenges throughout my career and was drawn to people with complex, persistent pain. It never felt fair that these people had often been provided with poor quality care. The opportunity to develop communication skills and incorporate psychological management skills within my practice has made my role far more rewarding. On reflection, my biomedical short term, quick fix approach to physiotherapy failed to provide me with a sense of purpose. I also didn’t like people being dependant on me for only short term gains.” – Mike Stewart

Here are some more rewarding things about being a Physio : By Mike Stewart

1. An ability to provide hope and optimism for people makes you feel pretty good. You don’t meet many miserable physios!

2. The variety of job roles and environments to work in. There aren’t many other jobs where you can choose to shift your career path but still remain in the same profession.

3. Educating other clinicians. It’s enormously rewarding to see other HCPs helping their patients.

4. Inter professional working. It’s great to collaborate with different professions both within healthcare and beyond.

5. The challenge of constantly having to reflect and adapt your practice.

6. Having fun with patients and helping them to take control.

Mike was also helpful enough to provide this image of what inspires him everyday.

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The excellent quote in the featured image is from Ben Croxford of Express Physiotherapy who has been excellent to me and provided brilliant advice. He can be found at @ExpressPhysio on twitter.

My Favourite Physiotherapy Blogs

The Running Physio – http://www.running-physio.com/

I have to admit I spend too much of my day on this blog reading the wonderful pieces from guest writers and Tom, @TomGoom on Twitter, instead of studying. The reason I really like this blog is that is written with its audience in mind, everyone can read it, the language is simple and the evidence well explained. Its evidence based, dealing with important topics that are varied and interesting and we can learn from it. The fact there is a lot of guest writers always means there is a new and interesting opinion to read and I have yet to get bored of reading it.

The Sports Physio – https://thesportsphysio.wordpress.com/

Ran by the well known Adam Meakins, @Adam Meakins on twitter, who writes well thought and passionate pieces on the important topics in the world of physiotherapy today. He generally challenges the strongly held ideas, but in a thought out manner with plenty of evidence to back up his argument. He gets a lot of stick for this but it is people like him who challenge things that will drive physiotherapy as a profession forward. His thoughts on trigger points are well worth a read.

Better Movement – http://www.bettermovement.org/

I have only started reading this in the past week and it is already one of my favourites simply because of these articles, http://www.bettermovement.org/2012/review-of-conference-with-moseley-and-hodges-on-pain-and-motor-control/, offering a summary of a pain summit by Lorimer and Hodges. It is a must read for anyone with an interest in pain science. I have read the first four parts and it is probably the best thing I have read this year because it is so well put together.

Kinetic Revolution – http://www.kinetic-revolution.com/

This is a blog mainly focus on running and all of its intricacies. It isn’t a physiotherapy blog as such however it does throw up some interesting idea’s and thoughts on the possible causes and fixes for injured runners. The free thirty day challenge is interesting and quite fun to do I definitely feel the difference after doing it. For anyone interested in the science of running its a good site for trying out different ideas. It is ran by James Dunne, whose daily emails always cause serious procrastination.

Cor Kinetic – http://www.cor-kinetic.com/
One of the first blogs I came across as a physiotherapy student and it got me hooked straight away. Its 5 R’s OF REHAB is pinned to my wall. It offers a different perspective on things and is updated quite differently.  This is my favourite post on the blog http://www.cor-kinetic.com/meaningful-movement-pain-memories-and-recalibration/ . Its a good blog to get you thinking and approaches physiotherapy with a very wide view which is good to see as an aspiring physiotherapist.

The Best Resources for Undergraduate Physiotherapists

These are the 5 resources that have really helped me in my first few years of my physiotherapy undergraduate degree. If anyone has anything to add il be sure to update it.

Anatomy Zone – http://anatomyzone.com/

If you are bored of your textbook and atlas this is the way to go. Short videos and lectures broken into the compartments of the body. Its a bit more interactive and challenges you to pay attention. The best bit about it? It’s free. I used them particularly in first year but anatomy is vitally important throughout your degree so definitely worth registering for.

Teach Me Anatomy – http://teachmeanatomy.info/

Again for anatomy but in a different mode. Set at the required detail and level it is exactly what a student needs especially when it comes to blood vessels and nerves in the head and neck. It got me out of a few tight spots in second semester of first year when I was struggling with the anatomy of the head and neck. Just like the above it is free.

Armando Hasudungan –Youtube

 Physiology –  https://www.youtube.com/user/armandohasudungan

Makes the complex physiology problems you are struggling with simple. He does so through lectures and some fine artwork. Even if you aren’t struggling with it you should definitely check it out. 

Virtual Sports Injury Clinic – http://www.sportsinjuryclinic.net/

This website is excellent for getting the basic information on a specific injury, getting a general idea of the rehabilitation process and time to guide you in your management of an injury as an inexperienced physiotherapist. I use it quite a lot for learning about pathologies and answering practice exam questions and it has been very helpful. It adds the detail lectures leave out.

Cappagh Hospital Protocols – http://www.cappagh.ie/physiotherapy-protocols

The go to guides for information on the surgical management and rehabilitation of injuries such as ACL tear, Achilles rupture, Menisci damage, hip replacements etc.

UFC/MMA information and Injury Prevention Day

Having a very small interest and knowledge of MMA/UFC I recently attended a information day on injury prevention in the sport set up by Professor Dan Healy of RCSI along with the support of John Kavanagh. John Kavanagh is Conor McGregor’s coach and is trying to promote MMA in Ireland but most importantly in a safe manner. UFC was subject to some bad press from a Senator recently, I can see why if you aren’t fully involved in the sport, however on the day James Walsh, a Surgeon from Beaumont hospital, presented research that stated the rate of injury was quite similar to other sports. This was eye opening especially because of the physicality and high impact nature of the sport. 

He also presented a case study of a young fighter who skipped stages in his rehab programme while nursing a broken hand. I found this interesting because it threw up the issue of compliance and dealing with patients who want to return to sport no  matter what the stakes are. For someone training to be a physiotherapist it was a very good learning experience, because something like that is something you only experience once you are qualified and practising. What I took from that was how important education was, how the patient must understand the time frame and why at times tailoring training is necessary to avoid further injury. He used the phrase “time is important respect the injury”” and that is something that as physiotherapist and a sports person I will take on board.

Next up was Mr Gary O Toole, Consultant Orthopaedic surgeon, St Vincents Hospital Dublin, Olympic Swimmer and 1989 European 200m silver medalist to speak about “Twisted Knees” in MMA. He spoke about the common pathologies, how they are treated(surgically), including some very nice MRI images of torn Menisci and ligaments, and the mechanism of injury. I felt in particular the the MRI images were interesting because you could see the anatomy and injury so clearly. Secondary to this, seeing how an ACL tear is repaired surgically gave me a better understanding of the need for protection as well as  some loading early on in rehab. It also made me aware of how incredible it was for Conor McGregor to return from an ACL tear in the time frame he did. Mr.O’Toole also spoke about how the surgical approach to meniscal injuries have changed, repairing rather than removing, and he emphasised how rehab with a physiotherapist is vital to managing this appropriately. He quickly ran through the where most of the injuries occur i.e. ACL injuries are very common while grappling.

Following this was Performance Enhancing Drugs in MMA by Dr Conor ‘O Brien, Former Chairman of Anti doping committee 1999-2005, WADA committee member 2005-7 and Irish Olympic Team Doctor 1996. This was a bit of testing topic considering one of the main stars, Jon Jones, (and now Anderson Silva) had tested positive for drugs after his last fight. Mr.O’Brien talked about the set up of drug testing in UFC and how it is self managed within the union and called for stricter sentences and a more transparent system. He did however state that the UFC were beginning to handle it well and stated just his involvement in the day showed how they were making progress. Congratulations must go to John Kavanagh on this because it was a major step in the right direction for the safety and reputation of the sport.

Next up was “How to cut weight safely and effectively” with Mr Mark Ellison, Chief Performance Nutritionist to GB Boxing and Manchester United FC. This was an excellent talk, really well presented, full of evidence and actual insight how a professional diets, losses weight and prepares for a fight or match. One bit of info I picked up was that you burn fat faster when doing fasted cardio work. Something I found fascinating was how hydration was managed pre fight and how dehydration leads to injury, CNS dysfunction, an increased core temperature and cardiovascular strain. A simple fact that he provided was if you are 3% below optimum hydration your endurance begins to drop and at 4% strength begins decreasing. In relation to weight loss, in his camps, they work to a limit of 1% of body fat per week to maintain safe levels. A lot of his talk was about preventing radical weight loss and dehydration, especially using dangerous methods such as hours in a sauna. I learnt a lot about nutrition and hydration from Mr.Ellison and it may not be 100% applicable to a physiotherapist but in a team setting it may be valuable.

following that was perhaps the part I found most interesting “How the brain actually processes in a fight” by Professor Daniel G Healy, Consultant Neurologist Beaumont hospital and RCSI who was ably assisted by Owen Roddy, providing experience of being in the octagon. Professor Healy had actual brain scans from Conor Mcgregor, picture available on John Kavanagh’s twitter, to assist him and it was a master class of teaching. He explained how the brain dealt with fear and pain, how it processed the movement of the opponent and the ability of throwing fake shots to muddle the opponents thought process, using mirror neurons. I loved his line “the joints, muscles and bones are only tools of the brain” a line that all physiotherapist’s should use. He spoke of how fighters have a larger colliculus which helps drown out the noise of the crowd.

Sadly I had to leave after this due to other commitments but it was a very enjoyable day and it really opened my eyes to what safety and injury prevention in sport means. Congratulations must be offered to Professor Dan Healy and John Kavanagh for organising this fantastic event and safeguarding the future of the sport and its participants. I am sure it was the first step of many however it was certainly it a step in the right direction. It brought transparency to the sport and made it more accessible. I learnt a lot from the day both as a physiotherapist and a fan of sport in general.

The outline of the day that was held in January can  be found here http://www.rcsi.ie/files/facultyofsportsexercise/20150107030621_MMA%20event%20-%20Saturday%2024th%20Janu.pdf

Also John Kavanagh’s twitter can be found here …https://twitter.com/john_kavanagh

Tips For Starting a Physiotherapy Degree

1. Have an Open Mind

Physiotherapy is a degree that is full of options, variances and pathways. It is a special degree in that really you don’t have a set job or should I say job specifications when you qualify simply because there are so many aspects to physiotherapy that people are unaware of. You could end up on the side of a pitch, in the Intensive care unit, working with amputees or children really the possibilities are unending. This coupled with the fact that every treatment and approach comes with reams of conflicting evidence behind it means that an open mind is necessary to thrive.

2. Learn from Others 

Physiotherapy is a profession that provides itself on its integration with other elements of care and treatment. This is where you can learn from others. Whether it is your classmates, your lecturers, guest lecturers, older students, your tutor on placement or other professions in the MDT you should constantly try to learn because these people  have been in your shoes before and their experience is worth listening to. For example one of the best things I have learnt in how to talk to a patient was by listening to an occupational therapist talk to a 6 year old patient. Every interaction is an opportunity to learn.

3. Research is key

Research seems to have gotten a bad name with students of late for how boring it is. Yes, it can be boring but that totally depends on how you approach. For students starting out I would recommend just starting with a topic of interest, for me it was hamstring injuries, and read randomised control trials. I wouldn’t worry about the quality or base too much on the findings but simply get used to reading them and picking them apart. Try and devise a fun way of reading them as well it will stand to you in the long run. For example, I enjoy graphic design and making infographs so instead of sitting there reading through endless results I make them into inforgraphs or designs.

4. Social Media can be Beneficial 

When used properly. For years now social media has been debated especially because of the harm it can cause but if social media is used for what it was developed for, expressing your opinion and debate, then it is a fantastic learning tool. I would recommend being vigilant about what you tweet especially as a student just starting out as your judgement is still lacking in experience, something everyone has been through, just to avoid any unnecessary trouble. I would recommend separating your personal and physio account to avoid any conflicts arising that are personal and especially because the majority of physiotherapists you may work with are now on social media and can openly see your views. I myself have come across two tutors I have worked under, it really is a small world. However, I have learnt first hand that social media can be brilliant for learning and finding inspiration. Get involved in the debates, read the research and read the opinions of anyone who has one and then develop your own opinion.

5. Throw yourself into it

Don’t be afraid of being wrong, of looking like you are trying too hard or spending too much time in the library if you want to be a physiotherapist that is what it takes. The best inventions have come from the worst mistakes. To be a good physiotherapist you need experience,college provides plenty of opportunities, don’t be afraid of taking them. Volunteer anywhere you can. If a lecturer asks someone to demonstrate be eager to do so you will only learn from it. This is one thing I wish I learnt earlier, its something I am still developing but if you can do it from the start you’ll thoroughly enjoy it. Talk to as many people as you can, you can learn from other peoples mistakes.

6. Widen Your Horizons

Physiotherapy is more than just massage, mobilisations and exercises. It is about goal setting, interaction. motivation, dealing with pain and fear there are so many issues that are outside the scope of your degree that are vital to being a good physiotherapist. Delve into the worlds of psychology, motivation, pain and you will understand patients more. Sometimes the psychosocial factors can be the factors that are inhibiting improvement. Don’t ignore them and now is the time to develop your approach and foundations.

What made me want to be a Physiotherapist?

It is a question I have been asked a thousand times and for years I have known the answer. I have wanted to be a physiotherapist from the time I first set foot in one at the age of 13. I’m not sure whether it was all the technology, the people, the treatment, the set up or the fancy jargon that dragged me in but from that first session my career was in front of my eyes. After 5 years of treatment as a non physiotherapist I was pretty well versed in the ongoings of a private practice and that of a physiotherapist and I was sure it was for me. That set the destination I just had to build the plane and learn how to fly it. It wasn’t the easiest of journeys, there was plenty of wrong turns taken, but I got there in the end and I sure as hell learnt a lot.

I have always been fascinated with movement and the brain. How we move as humans in such a smooth, refined way is incredible particularly at the speed we move. Taking into account the forces we deal with and in turn generate the human body is inexplicably powerful. I would spend hours watching any sport possible when I was younger and it was always the athleticism, power and speed of the sports stars that caught my eye. It amazed me how Michael phelps propelled him huge body so gracefully through the water, how Roger Federer managed to hit the finest and softest of drop shots at such high speed or how Zidane was so elegant on the ball despite his tall frame. It all came down to one thing – their ability to control a highly complex system and manipulate it to produce maximal results. I was always drawn to how Federer moved his feet to generate power or how Beckham planted his feet as he crossed the ball to generate whip. The finesse of movement is why I am studying to be a physiotherapist. Without movement we wouldn’t be functional, we wouldn’t be healthy and we wouldn’t be alive. I love how fine tuning movement allows us to perform incredible feats and I just want to be able to enable this.

When movement is prohibited or limited because of injury I want to be the one who returns it. When injury prevents someone from reaching their goal I want to be the one  to allow them to reach it. When injury keeps reoccurring, like it did in my case, I want to be the one who finds the solution. I spent 5 years getting physiotherapy treatment, it meant three surgeries, approximately 50 rehab programmes, many failed returns and finally it meant no more but one thing that I gained from this was experience. I have been on both sides of the story. I know now that compliance is important, that non committal explanations benefit nobody, that patients must be treated with respect and honesty. My experience with physiotherapy was both frustrating and brilliant. Looking back on it now I don’t 100% agree with how my case was handled but I know it means I won’t handle a case that way ever. One thing that I l learnt was to give a patient a voice, a say in their goals and treatment because ultimately they will define the outcome. Because of my  experience I want to be the physiotherapist that prevents a young sports person from having to quit, to stop someone having to give up work because of LBP because nobody deserves that. I am not that deluded that I can stop that in every single case, I am not a miracle worker and do not claim to be one but I will give every patient my very best to allow them to be at their very best.

The brain is,to me, the most powerful thing on earth. The control it yields over the human body is incredible. How it organises all those complex systems to work in such a refined manner is beyond my scope of understanding. It amazes me how often it is overlooked, how often the focus is on the site of injury and not the corresponding systems. The brain is becoming more integrated into physiotherapy and personally I couldn’t be happier. For years I have wondered how the brain works and being in college has finally allowed me to understand some of its amazing capabilities. Becoming a physiotherapist is all I have wanted to do because it allows me to bring my two fascinations, the human brain and movement, together. My experience of physiotherapy definitely pushed me in its direction and I have learnt a lot from it. I hope to immerse myself in the world of human movement, injury prevention, rehabilitation and the human brain in the forth coming years pulling it all together to provide the best service I can.