The easy answer isn't always the answer

So a wee while ago I read a blog post by Adam Meakins the Sports Physio about the devolving of self-efficacy. Basically we're becoming a society  of people who cannot take care of themselves and healthcare professionals who complicate the process.

Adam is 100% correct. And I felt I needed to write a post expanding upon this with my view.

We are humans and as humans we want to do things in the easiest way possible. We're always looking for the easy answer, the fastest results and what requires the least amount of effort. In one way this makes us very innovative, but on the opposite side of the coin it makes us very lazy. 

When it comes to sports injuries and rehab it is important that the client is on board with their own rehab. If they don't buy into it or aren't ready to help themselves then the whole process is a mute point. Many sports injuries require us as sports therapists or physios to use the biopsychosocial model, which in short means looking at the biology, psychology and social factors of the client. This means it's not just prescribing exercises to help a client, but the client needs help to reduce their stress and ensure their social circle and lifestyle doesn't impede the process. All this equals a lot of work from the client.

Because we're creatures who want the easy answer, most people will see many different professions before realising that most of them are not actually helping. Most seek those who perform manual therapy, which is the most passive of treatments, and means the least amount of work from the individual. However, passive usually doesn't work. So they see a variety of people and then get to a point where they realise they're tired of "treatments" and want to get better. Until a person is ready to make a change efforts to help using exercise and stress relief techniques are futile.

Reliance on passive treatments makes us, well, passive in our own health. Adam points as professionals we need to make sure we're not part of the problem and reassure our clients and not confuse or frighten them. Sometimes a client doesn't need a steroid shot or surgery or even complicated exercises, often simple is best. Obviously, we need to be aware of any red flags when assessing clients, so in the absence of red flags we can proceed as needed.

I'm sure some of my clients have left thinking "Well, that doesn't seem like much." But, I choose the best exercise for what we're trying to accomplish, not the most complicated and cool looking exercises. This may only be 4-5 exercises, maybe less, but less can be more. If a client sees the rehab as a burden that's going to take too much time, they won't do any of the exercises. Short and simple can be the best remedy. I'm not in the business of performing treatments that aren't necessary or try and make something simple sound complicated just to get more work. My clinic is a  no BS zone!

So, if you've been "treated" by a variety of professions and still aren't any better it might be time to seek the help of a professional who won't complicate the problem. If you are suffering from chronic pain there are physios out there who specialise in using the biopsychosocial model to help you help yourself.

If you have any questions about sports injuries or rehab please email me at sara@prestigesportinjury.co.uk

Are the "Jack of all trades" all they're made out to be?

So what's better someone who is a "jack of all trades" or a specialist?

I began asking myself this question as I pondered over the variety of CPD courses I could take over the next year. Do I expand my portfolio into coaching or perhaps a personal training qualification? There are many options for sports therapists and other therapists out there to choose from. But what is best?

My dad used to say he could fix anything except the crack of dawn and a broken heart. And I reckon he could, except for a vacuum cleaner once. He was a skilled mechanic and, even though he had no degree, an excellent engineer. He used his decades of experience to fix cars, planes and pretty much anything with an engine. He had skills that could translate to other areas without changing his occupation. And for me his advice led me to the decision to expand my sports therapist skill set rather than take on a new skill.

I have a tiny aversion to people who try to do everything all the time. I think it's great that they're ambitious, but to me it just means that some skills may be lacking or not fully developed. For example, if you train to do osteopathic techniques, hypnotherapy and personal training is it possible to stay highly skilled in all those areas without letting one slip? We are all allotted the same 24 hours in a day, but I can't imagine anyone is using all their skills all the time or even giving each skill the same amount of work.

Some skills work well together such as sports massage, acupuncture, mobilisations/manipulations, strength & conditioning and rehabilitation exercises. Those are skills that can be used in a variety of settings and can be honed, in some cases, at the same time. But other skills would require a different setting or in some cases could cause a conflict of interest.

I once came across a rugby club whose coach was also their physio. To me this is a blatant conflict of interest as he had no way to separate his desire for his players to play and his need to think of their health and welfare. There were many players that should not have been playing that day, but still did even after suffering concussions. I feel the same way about personal trainers who also do sports massage or sports therapy, and continue to be a personal trainer. Is it not feasible that one could make their clients work out harder than prescribed so they're sore and then suggest they see them for a sports massage? I'm not saying these things happen, but these are the things I think about when deciding my own CPD pathway. Could my clients perceive a conflict of interest in what I do?

For me the welfare of my clients is the most important part of my clinic. This means providing them with quality, knowledgeable information with regards to sports injuries and ways to treat their injuries. So this is where I will focus my future CPD endeavours.

I have already attended a Movement Screening & Strength Training for Runners course in order to provide my running clients with better analysis and techniques for their rehabilitation. And the best part about this course is that the instructors (both physios) had specialisms. One is a hip/running specialist and the other is a strength & conditioning specialist.

I am also a firm believer in the referral. If a client comes in and I feel acupuncture might help or perhaps they would like advise on a personal trainer I am happy to refer to other professions. I think it's important to collaborate with other sport injury professionals so that we can all provide the best care with the best techniques for our clients. If an injury is out of my skill set I have a responsibility to refer onwards.

So, why be a "jack of all trades, master of none" when you can be the best sports therapist, osteopath, chiropractor, physiotherapist, sports massage therapist or personal trainer that you can be for your clients!

If you have any questions on CPD, sports therapy or conflict of interests  please feel free to email me on sara@prestigesportinjury.co.uk

Ouch that hurts! Knowing when not to stop treating a client.

I was originally going to do a post about posture, but after this article in the Telegraph, I thought it was more appropriate to do a post about client care and important factors in treatment.

First and foremost, I don’t know the physio in the story and I don’t know his qualifications. Therefore, I am not going to judge him as a person, I am merely going to state some important factors that I feel are important in any treatment.

As a note, I do not perform manipulations. I am not trained to do them, and personally from what I’ve read in research articles, it’s not that practical to use them. As a graduate sports therapist we are not taught them at University but can learn them after the fact. I choose not to use them, others choose to use them. It’s not right or wrong, it’s personal choice

1)      Clinical reasoning. When we perform treatments, we need to use clinical reasoning, we do this through muscle, joint and neurological testing as well as special tests to help identify the potential cause of the pain. Even when sports massages are performed, I use clinical reasoning. This involves asking the client where, how and when the pain starts then performing some postural and movement tests. It’s using this reasoning to determine if and what treatment should be used. If a client has poor knee flexion due to tight hamstrings then it’s reasonable to perform massage and muscle energy techniques to try and improve flexibility, then prescribing exercises for them to do at home. However, if the client is having pain and numbness it may not be the muscle but sciatic nerve pain caused by the lumbar discs or gluteal structures, at which point further testing to rule out a herniated disc would be performed and alternative exercises and treatment would be prescribed. Clinical reasoning is the baseline at which our treatments are founded upon.

       If a client had attended my clinic with neck pain after lifting an object, and was told by their GP it was muscle pain, I would be inclined to further test him prior to treatment. If there was acute pain in neck extension I would be inclined to send them back to the GP for an MRI. GP's are not always right., they spend very little time with the client and are often pressed to get to the next appointment. Working in rugby I have had players with herniated cervical discs and it is important to find out the level of herniation and then prescribing appropriate exercises or if surgery is required. This often means referring them back out to their GP with a letter explaining what has been tested and your findings, I have done this and it has saved me a lot of problems in the long run.

2)      Informed consent. Informed consent is telling the client what you’re going to do and why. For instance, when clients attend for injuries I explain what I am testing, why I am testing and how I am going to do it. I also ask if they have any questions, as I would rather they ask before I start then after. We obtain informed consent before and throughout a treatment. If I am performing a sports massage  I let them know what I am doing and why then if I need to move the client around or use a new method, I let the client know what I am doing and why. It is so, absolutely, important we maintain verbal contact with our clients and ensure they are aware of what you are doing. Heck, I even ask client if it’s ok to undo their bra while doing a back massage, every time, even if I’ve seen them before! It’s not okay to assume if they were fine with it before that they will be fine with it now. We all know what assumptions do!

I also always, always, always tell my clients to let me know if something is painful. I am not there to hurt people, I am there to help. I ask when I start using deep tissue techniques or stretching techniques to let me know if it’s painful. It’s common sense.

3)      Listen to your clients. What is the point of treating a person if they’re not being listened to? It’s important to listen during the history taking to make sure you understand their pain and what they want from the treatment. It’s important to encourage them to ask questions, I would feel awful if my clients were afraid to ask me a question. The real tragedy of this whole story is that the whole thing could have been avoided if the person had just been listened to. If he asked the physio to stop, he should have stopped. End of.

At the end of the day we are all just people and are not perfect, and we need to understand our own limitations. If I’m not sure how to perform a technique I won’t use it on a client. If my client says something is painful, I’ll stop. If my client doesn’t understand something that I am doing, I’ll explain it to them.

For anyone out there seeking treatment, you shouldn’t be afraid to seek help. My advice to you is to not be afraid to ask questions. If you’re looking for a sport therapist or physio, check out their feedback/testimonials or Facebook reviews. If you’re still not sure, call them! You can get a lot of information from a person by speaking to them. When you call them, you can ask about their experience and treatments they use. If you’re not happy, don’t book with them. Go with your gut if you feel like something isn’t right when you contact them.

Thank you for reading my long rambling post, and if you have any questions about Prestige Sport Injury Clinic or any of the treatments provided please do not hesitate to contact me at sara@prestigesportinjury.co.uk