Phy-video-therapy?

Physiotherapy and video consultations – New assessments and injury management.

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These are very worrying and strange times, for everyone.

I have been agonising over the past week about the options for continuing to offer Physiotherapy services in the current climate.

Ultimately, the combination of collective responsibility, social pressure and doing everything we can to halt the spread of this virus and help out our NHS colleagues on the front line made the decision easy.

During this unprecedented time, we all have had to adapt and find new ways to keep supporting your physical (and mental) health. The world can’t stop and now, more than ever exercise is so important.

I have now moved to all online voice only or video-call sessions via phone, facetime, skype or zoom.us app. This will continue for the short-term (I hope) and we will be able to seamlessly transition back to face-to-face and hands-on when we are able to do so safely.

I have moved all my current patients in treatment seamlessly over to video appointments where possible. But what about new assessments and acute injuries?

What can we accomplish in a new patient online session?

  • Face-to-face detailed subjective injury history taking
  • Full objective assessment including range of movement, strength tests and special tests
  • Diagnosis of the injury
  • Advice and anatomical description
  • Provide realistic timeframes for management and recovery
  • Provide recordable exercise prescription and self-mobility techniques
  • Demonstrate taping techniques
  • Goal setting for the next session
  • Online exercise programming software integration

Fitness-and-Tech

I am an experienced Physiotherapists and worked in A&E for four years as a musculoskeletal injuries specialist. I still work part-time for the NHS in a Consultant Physiotherapist role, predominantly running Orthopaedic triage clinics which means a lot of very quick assessments and decisions on care! I am also a qualified musculoskeletal Sonographer, Independent prescriber and practice injection therapy.

I thought it might be helpful to give two examples of remote sessions I have been involved with this week.

Case study 1 – 40 year-old fit and actively man was unfortunately stranded in France due to the COVID-19 outbreak. With limited equipment and self-isolating, he took up trail running. After a few runs, he missed a step and felt a sharp pull in the back of his leg. After the pain subsided he hobbled home and used the RICE (Rest Ice Compression Elevation) protocol. After a few days, he noticed some bruising at the back of the leg and then contacted me to organise a ‘zoom’ remote session. After a quick chat and subjective assessment, we moved on to an objective look at the injury. I was able to instruct him to perform some movements and tests including palpating. We were very quickly able to diagnose a likely grade 2 medial hamstring tear. After this we went through the anatomy of the injury, timescales for recovery, ‘do’s and don’t’s’ and then recorded a comprehensive rehab plan for the next two weeks. The whole session lasted 30 minutes and we will follow-up in two weeks to progress and get him back to full activity ASAP! Knowledge and correct diagnosis is key!

Case study 2 – A 33 year-old yoga teacher injured her shoulder two weeks prior. We had a brief telephone call to ascertain what the injury might be and it sounded like she may have injured her rotator cuff and was now suffering from a shoulder impingement syndrome. This was restricting her full range of movement and causing pain at night, sleeping in the shoulder. The main thing was that she was unable to teach fully with the pain and modify her practice. We agreed that a zoom appointment would be beneficial to confirm the injury and advise on rehabilitation. We arranged a zoom consultation the next day. Again, with the visual assessment, it was clear that it was in fact her acromioclavicular joint (ACJ) that was strained. This changed the advice that I would have given just over the phone. We were then able to discuss the injury fully, record a full and specifically tailored exercise plan including stretches, mobility and straight work in addition to demonstrating a. taking technique to offload the joint and reduce the pain. We will follow-up progress in one-week.

I hope these two examples help explain how useful a video consultation can be and can help you avoid long-term damage, reduce pain levels and get you back to what you want to do sooner!

If you want to discuss if a video appointment is right for you, please contact me directly at emerson@xphysio.com and I will be happy to email or call you back for an initial free 15 minute chat and advice.

Self-pay rates are £40 initial consultation (£30 CrossFit members) and £30 follow-up (£25 CrossFit members).

Insurance companies are now fully supporting and covering these sessions to allow your rehabilitation to start, progress and continue.

Stay indoors and stay healthy!

Emerson

Pec mobility drills… for everyone!

Shoulder problems?

With many injuries and restrictions I find the the pectoralis minor is often very tight and more importantly weak.

Whether this is the symptom, cause or just a secondary factor, mobilising this region is very useful.

This is a nice routine to work on the #mobility of this often tight and prohibited region.

Try:

– 10 reps arm @ 90 degrees palm up

– 10 reps @ 90 degrees palm down

– 10 reps @ 100, 110, etc Palm down depending on your restriction

– Finally you can lift the shoulder off the ground for 30 seconds to stretch out.

Test length / movement before and retest after. I like this pre and post-lifting, especially for any overhead movements #pullups #snatch #OHP # muscleups #physio #crossfit #rehab #WOD

 

German football efficiancy!

Just returned from a brilliant trip to Greece and Turkey! For my honeymoon no less!

Wanted to share a great little article I read in the BA business magazine about World cup… you have to admire the Germans!

http://businesslife.ba.com/Ideas/Features/How-Germany-reinvented-football.html

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We have the most entertaining league in the world no doubt but at what cost?

Rolling, rolling, rolling… why are we foam rolling?

Keep rolling, rolling, rolling…

They are in every box, gym, yoga studio, and sports club in all shapes and sizes, textures and densities! I get a lot of questions about foam rollers!

How often? How hard? How long? Before or after exercise? Which muscles?

Chris Beardsley, a well-known sports science writer, wrote an informative article in 2013 looking at some of the evidence around foam rolling: http://www.strengthandconditioningresearch.com/2013/10/01/foam-rolling/

The article is well worth a read! It got me thinking so here is my take on things…

What tissues are we actually affecting?

Fascia – mainly. Fascia is an uninterrupted viscoelastic tissue, which forms a functional 3-dimensional collagen matrix. Basically, fascia surrounds and penetrates every structure in the body, head to toe. It is an innervated, continuous, functional organ of stability and motion. And it is tough!

What is foam rolling?

Foam rolling is a form of self-myofascial release. What is myofascial release? That is another well-debated subject! It has been suggested that applying pressures to tissues can:

1) Rehydrate tissues

2) Reduce pain (a neural response?)

3) Improve vascular function

4) Release trigger points and break up adhesions

5) Reduce the effects of DOMS (Delayed Onset Muscle Soreness

6) Improve tissue range of motion (ROM).

What is the evidence?

There is limited, good quality evidence; however, Chris Beardsley has summarised the findings so far:

1. Foam rolling may reduce arterial stiffness, improve arterial function and improve vascular endothelial function – therefore potentially increase blood flow.

2. Foam rolling may have no detrimental effects on athletic performance pre-workout – therefore no effect.

3. Foam rolling may increase joint ROM while not impeding the production of muscular force or rate of force development – pre workout mobility could increase range. It is at least as effective as static stretching however does not reduce performance which static stretching has been shown to do (http://journals.lww.com/nsca-jscr/Abstract/publishahead/Differential_effects_of_30_s_vs__60_s_static.97324.aspx)

4. Foam rolling does not acutely affect counter-movement, squat or depth jump performance. A dynamic warm-up is better.

5. There is mixed evidence on whether foam rolling increases flexibility long term.

6. Foam rolling reduces muscle soreness. A more recent study concluded that the reduced feeling of fatigue may allow participants to extend acute workout time and volume, which can lead to chronic performance enhancements (http://journals.lww.com/nsca-jscr/Abstract/2014/01000/The_Effects_of_Myofascial_Release_With_Foam.8.aspx).

When should you foam roll?

 

Based on the evidence and also clinical experience these are the recommendations:

 

–       Foam roll myofascial structures to increase joint ROM pre-workout. Be specific – work on the areas that you have problems with and be specific to the exercise you are about to perform. Don’t replace a dynamic warm-up – supplement it.

 

–       Use foam rolling post-workout for quicker short-term recovery.

 

–       Regular use may help longer-term recovery and sustained performance.

 

–       Make it functional – get into end of range or dynamic positions to mimic what you are going to exercise.

 

–       It doesn’t work for everything – use other tools and types of mobility drills too!

 

How should I foam roll?

 

I work on trigger points. These have been well mapped out by Travell and Simon’s (http://www.triggerpoints.net/). Find a ‘tender’ or ‘tight’ spot, and then apply pressure with the roller for up to 20 seconds. IF it has started to ease, stay on it for another ten seconds then release. 30 seconds maximum – you don’t want an ischemic response, which will just be painful and may actually start to damage the tissue. Try to work through a few specific trigger points along the structure you are working on. Spend 60-90 seconds rolling out the area, then move on! This shouldn’t take you more than five minutes to be effective – even when looking at a large area like the lateral thigh / Illiotibial band (ITB).

Vastus_Lasterallis

I also really like it for thoracic extension – more of a joint mobilisation. Great pre-Olympic lifting and for any overhead movements where extension is key:

Other resources:

 

https://www.youtube.com/channel/UCnnB4zDBqZHhQ4uLTAX8eYA

http://catalysttrainingsystems.ca/2013/11/youre-not-stretching-what-you-think-youre-stretching-part-i/

http://catalysttrainingsystems.ca/2013/11/fascia-part-2/

 

Not a bad video demonstrating basic positions for foam rolling:

 

So there you have it! As always, if you have any questions please feel free to grab me or contact me!

 

Emerson

07903247247

emerson@xphysio.com

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Return of the King! Ledley’s testimonial May 12th at White Hart Lane…

I thought I should write a few words about a very special day for one of my best mates!

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Ledley King is publicly acknowledged as one of the most naturally gifted defenders that England has ever produced and is probably of the few players to have dedicated his career to one club, Tottenham Hotspurs. He had a great football career which was unfortunately hampered by numerous injuries. Despite these Ledley played 323 times for Spurs and represented England 21 times. He also still holds the record for the fastest goal scored in a premiership match at just ten seconds against Bradford in 2000!

As a Physio and close friend who spoke to Ledley a lot about injuries, rehab and training I can say that I doubt there are many professional football players or athletes that could manage such a consistently high standard carrying injuries week-in-week-out.  It was common knowledge that Led didn’t train with the team during the week and was wrapped up in cotton wool. Some weeks he would barely kick a football but be ready to play when needed. You wouldn’t know it when he controlled a ball instantly, knocked an effortless cross field ball or marshaled a £50m centre forward all game. Not today Robben…

Few people outside of football know that he had a severely restricted range of movement in his knee. He couldn’t fully straighten it and had blocked flexion at around 100 degrees – crazy to think that despite this every single England manager wanted him in their squad.

“I don’t like defenders who hold the shirts of other players. The only defender here who doesn’t do that and sometimes still gets the ball off my feet easily is Ledley King. He is the only guy who doesn’t hold players. He will get the ball off you without you even noticing. For me, that is a good defender. He plays without any contact yet is somehow still strong and gets the ball without doing any fouls.”

Thierry Henry.

“He is like a magnet for the ball, a thoroughbred of a defender and the best centre-half in the country.”

Jamie Redknapp.

“Without doubt, King is one of the best central defenders in England.”

Fabio Capello.

“He is the best central defender I have ever seen.”

Martin Jol.

“He is an absolute freak.”

Harry Redknapp.

Anyway… hope to see you down at his testamonial game on May 12th at White Hart Lane where the current first team will play a ‘legends’ team including Ginola, Sherwood, Sheringham and Crouchy!

http://www.tottenhamhotspur.com/news/king-of-the-lane-040414/

Tickets are priced as follows:

Adults – £20.00

Seniors (65+) – £10.00

Junior (U16) – £5.00

Family Package (Two Adults and Two Juniors) – Available in all areas at £40.00

Hospitality packages are also available for the game.