Author Archive by Chris Liversidge

Extended Scope Physiotherapy at North Light

By Chris Liversidge In Ankle, Arm, Back Pain, Chris Liversidge, Elbow, Expert, Expertise, Extended Scope Physiotherapy, Foot, Hand, Hip, Huddersfield, Injury, Joint Pain, Knee, Musculoskeletal, Neck, North Light Physio, North Light Physiotherapy, pain, Physiotherapy, Shoulder, Sports Injury, West Yorkshire

North Light Physiotherapy Associates’ Practice Principal, Chris Liversidge, is an Extended Scope Physiotherapist (ESP)

What does Chris’s expertise mean for you?

In a nutshell, being treated by an Extended Scope Physiotherapst often means faster differential diagnosis of acute physical injuries, and many other longer term musculo-skeletal conditions.

ESPs are able to work beyond what is usually recognised as standard Physiotherapy practice.

However, many people will suffer an injury or acute muscular problem (for example, following a fall or accident, an episode of back pain or a sporting injury) and assume their GP is the best place to go.

Waiting times can be long, and GPs don’t always have the depth of up-to-date developments in physical medicine – so whilst they may usefully prescribe painkillers or anti-inflammatories, combining this with a course of immediate Physiotherapy treatment may actually be far more successful than pain relief alone.

When you are suffering acute pain, an Extended Scope Physiotherapist (ESP) often provides:

a faster differential diagnosis of the injury/problem
more specific treatment
a faster recovery and return to normal function
If tests or other medical investigations are required, an Extended Scope Physiotherapist can recommend which is most suitable to request, and in many cases, directly order investigations.

A faster solution to pain – that’s got to be a winner!

What does the term “Extended Scope Physiotherapy” actually mean?

Extended Scope Physiotherapy (ESP) practice is growing in prominence, both in private medicine and in the NHS. On their website, Cumbria Partnership NHS Foundation Trust describe an ESP as:

“A Clinical Physiotherapy Specialist with an extended scope of practice. This implies working beyond the recognised scope of Physiotherapy practice, for example requesting investigations (ultrasound scans/nerve conduction studies), using the results of investigations to assist clinical diagnosis and appropriate management of patients; listing for surgery, and referring to other professionals. ESP’s hold post-graduate qualifications (eg. MSc), Society of Orthopaedic Medicine (SOM) membership or equivalent, and most have a Diploma in Injection Therapy.”

You can also find out more about the work of Extended Scope Physiotherapists at www.CSP.org.uk

To work at this level requires a number of years of experience, with a wide variety of conditions. Critically, this involves identifying conditions which are not suitable for Physiotherapy, as quicly as possible, and referring on to the correct specialist, as soon as possible.

To make an appointment with Chris Liversidge or any of our expert Team at North Light Physiotherapy, use our Contact form or call 0845 177 0780

Physiotherapist in Low Back Pain Shock!

By Chris Liversidge In Back Pain, Chris Liversidge, Holmfirth, Huddersfield, Musculoskeletal, pain, Physio, Physiotherapy, Rehabilitation, West Yorkshire, Yorkshire

Hi everyone-
Just wanted to send a quick message of encouragement to those carrying back injuries, frustrated at being unable to exercise “normally”, however that may be. There is always hope!!

Physio Develops Back Pain!

Last April, I had a sudden onset of Lower Back Pain. In the initial stages, it took me an hour to get from the bedroom to the kitchen!! Not the usual story for someone with my energy levels!

Out of Hours GP

So, I had to put my own advice into action-as it was a Saturday, with the GP closed, I had to go to the out-of hours GP at the Hospital (**Note- I didn’t go to A&E**). Armed with Naproxen and strong Co-Codamol, I was able to get my pain levels under control (this was my new 10/10 pain!). The key here, is that exercise/mechanotherapy is the critical component, but without pain relief, this would have been impossible! Don’t fall into the trap of believing that pain relief “masks” further damage- normal movement **doesn’t cause damage**!! However, even at this stage, simple tasks such as getting on/off the bed, putting shoes/socks on etc, were a major undertaking, and remained painful.

From there, I was slowly able to exercise/position myself in my direction of preference, and things started to ease. However, I was still a long way off either running or cycling- my 2 main exercise passions. This really did demoralize me, and scramble my brain.

Turning a Corner

By the time June arrived, I felt my pain was under sufficient control to begin a light jog. We were in Scarborough, and I was covering a game with Yorkshire Cricket, I had 1/10 pain, and the sun was shining.
I plodded very slowly, for a 1/2 mile, and on arriving back at the hotel, was in 6/10 pain!
“So you’ve caused more damage again” I hear you say! But how I reply? Movement is physiologically normal, and running didn’t cause me trauma or damage in the absence of back pain, so why should it cause me damage in the presence of back pain?!

At this stage, the tissues in my back were still sensitive, and so would register pain more readily- the brain has a clever way of sensitising tissues if it perceives a threat, a bit like an over-anxious parent wanting to protect their child if they try to climb a tree, for example.
The key thing was, on arrival back at the hotel, I had some Paracetamol, did my back exercises, and my pain was quickly back to 1/10!

From there, the process was repeated- I managed to slowly increase my running distances- setting off with little or no pain, returning with 3-4/10 pain, but reassured that I was progressing, each time getting a bit further, with slowly decreasing pain (at this point, remember that 2 months earlier I was in 9/10 pain just to put on my socks!!) It still took a bit of convincing for Mrs. L. to believe that although I set of running with no pain, and came home in 4/10 pain, I was not “damaging/worsening” my back!

And so it continued- and now, here I am having run two 10k races (my favourite distance), in 42 and 41 mins respectively!!

Physios are made of the same stuff

Now don’t get me wrong- there were dark times-I did doubt myself- pain messes with your head in that way-, and I did come in for some criticism too (“you’re a Physio, you shouldn’t have problems like this-what hope is there for the rest of us?”). This was hard to take, but I had to reassure myself I could sort the problem. The thing is, I’m made of the same stuff as everyone else, so there’s no reason I shouldn’t develop back pain. The measure of me was, whether I was good enough to solve the problem? The answer was a resounding yes!

Reassurance

So what can one learn from this experience? I am clearly able to empathize with sufferers of lower back pain. But I’m proof it can be managed- and the 2 keys were: pain control allowing me to then do the bit that works- rehab exercises!
Whatever happens- don’t give up- when the pain was at its worst, I did question whether I’d ever get back to running and cycling- that’s just human. The human body is extremely adaptable, resilient and robust- trust this, and with a good dose of patience, you can get there!

Send us a message, or call 0845 177 0780 to see how we can help!

Chris Liversidge is Practice Principal and Extended Scope Practitioner at North Light Physiotherapy Associates, Huddersfield, UK.

Fear Avoidance (What you Resist, Persists…) by Chris Shorter

By Chris Liversidge In Back Pain, Chris Shorter, Dizziness, Fear, Huddersfield, North Light, North Light Physio, Pain Management, Physio, Physiotherapy, UK, Vestibular Rehab

Evening folks! Hope you’re all keeping warm in the snow!

I’ve got a real winter warmer for today’s #Advent blog series: a guest blog from my colleague at North Light Physio, the multi-talented Christopher Shorter. He’s done a great piece about what we in the #pain management business refer to as “Fear-Avoidance”!

Check out Chris’s website: www.mind-body-rehab.com

Without further ado, over to Chris! Enjoy!

What do #backpain and #dizziness have in common? Answer: Fear

More notably fear avoidance of movement.

I work with a number of different conditions in the public and private sector and despite the large variety of cases I see, there are many common themes. Fear avoidance is a big one, it was first defined by Lethem et al. in 1983 but I’m guessing it was around much longer than that.

Fear keeps us safe, fear holds us back from injury and shoots us with a boost of adrenaline when needed. However when fear turns into a chronic apprehension of movement it begins to work against us.

You can acronym fear down to this: (I’m not claiming this, I heard it on a podcast a long time ago!)

F = FALSE.
E = EVIDENCE.
A = APPEARS.
R = REAL.

So we can fear something that is not real. Some evidence may suggest it is, such as the belief that pain is always a sign of damage or symptoms occurring when we move, but in a huge amount of cases it is our beliefs that need changing…it is basically just false evidence.

Let’s apply the fear avoidance pattern to dizziness (aka vertigo/ labarynthitis/neuritis). Dizziness can be due to problems with the balance control system of inner ears. It is in fact very common and a high proportion of A and E visits can be due to this. The dizziness linked to the inner ears / nerve pathways of the ears is called a vestibular problem. In some people you can get a short lived vestibular problems just like most of us will get an episode of back pain once in our lives, the causes can be diverse (but that’s for another blog maybe), both can resolve can quickly. Some facts about dizziness are:

Almost 1 in 4 adults under 65 report dizziness or vertigo, often causing occupational difficulties or preventing employment, but less than 25 per cent had received treatment (Collertan et al 2012).
Dizziness is one of most frequently reported symptoms for people over 75 seeking medical assistance (Sloane & Dallara 1999).

Sometimes the dizziness symptoms persist. They may not be as intense as the initial episode but they are enough for us to start to limit our movement and cause us some anxiety about keeping the dizziness at bay. Medication can also be prescribed as a dizziness sedative, but patients should be encouraged to wean off this. So a typical coping mechanism is commonly to self-restrict neck and head movements, limiting activities around the home or out and about. Classically busy places such as supermarkets become tricky to move around in. Our movements can change, when we turn the head we tend to turn the whole body in a robotic manner. Stiffness can also develop in the muscles and joints of the neck, as well as neck pain and headaches. This is where the importance of education comes in and I commonly tell my patients the following:

For the vestibular (balance) system to reset itself (to recover) it needs to experience normal movement of the head and neck. It also needs to experience error signals (i.e – dizziness). It is OK to move the head and neck and it is also OK to feel some dizziness when doing this (this helps to re-calibrate the system).

Being told to move normally again is often quite anxiety-inducing in patients but believe me it works and it can be done at a pace comfortable for the patient (known as graded exposure to movement, not “in at the deep end” stuff!).

If we now look at this pattern in back pain. As physio’s we often find the patient is very apprehensive when bending forwards. For example and they may use mal-adaptive movement patterns (not moving normally), such as keeping the back entirely straight or arched when bending to pick an item from the floor. This is fear avoidance due to fear of pain, or fear of damage, or both. I accept that in the first few days, sometimes weeks of back pain we maybe move less to protect our self but if this goes on for many weeks, months, even years in some cases, it can become very disabling. So just like a dizziness problem the area affected can become stiff, tense, very sensitive and weaker, not to mention in a lot of cases the pain persists. So again for clinicians; education and listening skills are vital. Hearing from the patient why they have changed their way of moving and what they are fearing is very important and can lead to a lot of clinical reassurance and confidence building. Movements restriction are often due to outdated beliefs, for example thinking our back remains damaged long after the time for healing has occurred. So just like for vestibular rehab, movement is encouraged, with bags of reassurance when needed.

In vestibular rehab when we start to move our head again it can invoke some discomfort or dizziness, remember this is normal. Similarly when moving our back again it can induce some pain or stretching type discomfort. Beginning to move normally again may initially feel stiff or painful, but this is hurt not harm.

A great line which also applies on many levels in life is ‘what you resist persists’. So if you are resisting movements due to dizziness or pain linked to fear of worsening symptoms, be open to the fact that your self-restriction may be holding you back.

This blog is a guide to give an idea of the concept of fear avoidance on how it applies to subsets of two conditions. This may not be the definitive answer but in some cases it is. A full assessment is always required. Pain and dizziness have many more factors feeding into them, anxiety is a big feeder, as is our emotional health.

Contact me for a more detailed consultation. I offer consultations and treatment for vestibular rehabilitation and assessments for chronic and acute pain.

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Chris Shorter is a Chartered Physiotherapist with North Light Physiotherapy Associates, Huddersfield, UK. Find out more about Chris and his work at at www.mind-body-rehab.com

Posterior Ankle Impingement

By Chris Liversidge In Ankle, Chris Liversidge, Elite Sport, Expertise, Huddersfield, Musculoskeletal, North Light, North Light Physio, Orthopaedic, Physio, Physiotherapy, Rehabilitation, UK

Afternoon!

Here’s the latest #Advent instalment in our series. A daily evidence-based info-hit from the North Light world of physical health, wellbeing & performance! This is a day late-you know, like when you forget to open your calendar on one day, so you get 2 the following day? (Another instalment to uploaded earlier this afternoon!!)

Also look out for an announcement in the next couple of days in the run-up to Christmas – you can be involved, as long as you’re not on the naughty list!.

So…
I had the privilege recently of attending the operating theatres at Leeds Nuffield hospital to observe Mr Mark Farndon carry out a hindfoot endoscopy (keyhole surgery approaching from the back of the ankle). These opportunities are a key part of the ongoing development of our private service provision at North Light Physio, our individual professional development and in our responsibilities to the sporting partners we provide to. Critically, a great means of reinforcing well-grounded knowledge, and developing relationships with surgical staff – collaborative working being critical to patient care.

The case in question related to a cricket player (bowler) complaining of pain at the back of the (in this case, left) ankle on delivery of the ball. See image of the front foot below, and how the shin bone is angled backwards against the back of the foot/ankle (forced weight-bearing dorsiflexion).

This is not uncommon, but we weren’t able to settle his symptoms sufficiently with Physiotherapy alone. On referral for imaging, an os trigonum (accessory bone at the back of the Talus) was demonstrated- see images below.

The consequence is the likelihood of impingement in the back of the ankle, due to a physical lack of space – the joint lining can become inflamed, and swelling can build. The long tendon flexing the big toe (Flexor Hallucis Longus, FHL), can also become involved, given its proximity.

In this particular case, following surgery to remove the Os Trigonum, recovery has been excellent, and as we speak, the player is taking a full part in pre-season training, with no symptoms at all.

So, what did I learn from this case?

1. As good as we are as Physiotherapists, we can’t solve everything through Physio – knowing when to refer on is critical. The skill of knowing when to refer-on takes years of exposure – especially with conditions which do not appear regularly in our practice.

2. Reinforced my strongly-held belief in team-working across specialities- and how vitally important this is outside of the hospital setting, particularly when working in different geographical areas to the surgical team. Being there to discuss the rehab with the surgeon during the procedure is completely invaluable.

3. Knowing the pathology, the surgeon, the individual, and the feeling from the surgeon as to how well the procedure went, all give us a great advantage in preparing for, and delivering high-quality and timely ankle rehabilitation, to allow a speedy recovery!

An informative case to work on, and rewarding to see excellent progress!

Remember- get in touch below if you want our advice with your ankle problem!

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Christopher Liversidge (MSc, BSc (Hons) MCSP, SRP) is Practice Principal at North Light Physiotherapy Associates, Huddersfield, UK. Click here to contact Chris, or call 01484 660663

5 Keys to Healthy Knees – use our expertise!

By Chris Liversidge In ACL, Armitage Bridge, Berry Brow, HD1, HD2, HD3, HD4, HD5, HD6, HD7, HD8, HD9, Holmfirth, Honley, Huddersfield, Joint Pain, Knee, Meltham, MPFL, MSK, Musculoskeletal, Newsome, North Light Physio, North Light Physiotherapy, patella, Physio, Physiotherapy, Rehab, Rehabilitation

Having specialised in the rehabilitation of lower limb injuries, and particulary knee injuries, for many years now, I have observed 5 key objectives to achieve quickly to optimise knee function. This is irrespective of whether the rehab is post- injury, or post-operative. With these 5 goals in place, the knee will quickly function more normally.

1. Reduce swelling.

After an injury to structures inside the knee, it will swell- an effusion. This is known to cause reflex muscle inhibition, which can cause the quadriceps muscle to switch off, and the knee to feel as though it may give way. Minimise the effusion to optimise quads activity.

2. Restore full Active Extension.

The ability to actively fully straighten the knee is critical. This is the ability for you to switch on and tense your front thigh muscle (Quadriceps) by choice. If this is not possible, you cannot actively keep yourself upright on your feet- the knee will give way.

3. Restore full Passive Extension.

This is the ability of an external force, i.e not you or your quadriceps muscle, to straighten your knee: e.g. ability for it to sag straight under the weight of gravity, or for someone (usually a Physio, when testing the knee), to pull it into a fully straight position. If this is not possible, it may indicate something inside the knee is mechanically blocking it. This must be dealt with quickly, as a block to extension left untreated can leave the knee stiff in the long-term, and will disable your ability to actively straighten your knee, and may again lead to giving-way or buckling of the knee.

4. Mobilise the Patella.

The patella (kneecap) is free to be moved within a specific range when the knee is relaxed. Often, usually after surgery, this ability for the kneecap to be freely moved is limited, and can have a consequential negative impact on the ability to develop quadriceps strength, and cause kneecap pain. This can be restored by manual therapy during Physio sessions.

5. Normalise Gait.

The walking (gait) cycle is often significantly affected by pain/stiffness after injury or surgery. The adaptations to the walking pattern, if left unaddressed, can have significant negative effects on knee health: loss of movement, stiffness, muscle shortening and quadriceps inhibition. Normalising the gait cycle as quickly as possible is critical to knee health!

If you, or anyone you know are affected by these problems, please don’t hesitate to get in touch. Our expertise will get you on the path to healthy knees in no time!!

To book an appointment with the experts at North Light Physiotherapy, PLEASE DO NOT LEAVE A COMMENT HERE!

Call us on 01484 660663, or pop over to our Contact page

White Rose Ultra: Fuelling your epic adventure

By Chris Liversidge

For this month’s installment in our series helping runners prep for the White Rose Ultra Marathon, Sarah Walker, our S&C coach at the North Light Strength and Rehab Centre, has come up with a fantastic blog to help your nutritional preparation!

White Rose Ultra 2016

NUTRITION – FUELLING YOUR EPIC ADVENTURE

**GOLDEN RULE: Never try something new on race day**

Just over one month to go….

At this stage your physical preparation should almost be at a peak.

Your thoughts should now turn to race day preparation.

You’re probably thinking about kit but it’s also a key point in training to be fine tuning your nutritional strategies.

One of the biggest differences between road marathons and trail ultras is the duration. This increases the need to stay on top of nutrition. 100k will can take several hours longer than your marathon PR, so while you might be able to get by with an energy gel and a few jelly babies during a marathon, you will need a lot more fuel during an ultra.

Here’s a few things to bear in mind;

Key Points

The energy cost of running is elevated during ultra-distance trail races compared to normal running conditions.
This elevated energy cost results in a ~12% increase in energy expenditure across the distance.

Here’s the Science Bit.

Despite a lower relative intensity, the energy cost of running is increased on the rough terrain typical of ultra-distance trail running races, compared to level running however, nutrient intake during ultra-distance races has been found to be far below the estimated energy cost (Dumke, et al. 2006).
This energy cost should be met through regular intake of carbohydrates, which are the primary fuel of choice for muscle contraction. As carbohydrates are only stored in tiny amounts in the body, in the liver and the muscles as glycogen, – During prolonged periods of running at a moderate pace, glycogen stores become depleted, and the body begins to break down fat for energy (gluconeogenesis), athletes cannot exercise intensively and may experience fatigue.
After glycogen stores have been depleted and before gluconeogenesis kicks in, a competitor may experience symptoms of hypoglycaemia, which occurs when blood glucose levels are low. During hypoglycaemia, a person may feel extreme fatigue and a near complete loss of energy, often referred to as “bonking”. When this occurs, it is not uncommon to see athletes collapse from the extreme fatigue. Dizziness and hallucinations may also occur…….

That sounds like a DNF to me……

So…. Replacing energy cost is all about keeping the glycogen stores topped up.

But how can we do that – whilst running?!

How: Practice using blocks, malt loaf, jam sandwiches (see list at bottom), Kendal mint cake, gels. Whatever floats you’re boat as long as it is high in carbs.

AS LONG AS YOU HAVE TRIALLED IT IN TRAINING!

Why is it important to practice? We’re all individuals and different things will work for you. Using un-trialled food sources may lead to Indigestion, heartburn, the runs (not to be confused with making you go faster!) Nausea. You’ve got enough on without adding any of these to the mix!

If you like gels just be warned you really will have to have one every 15-20 mins once you have started as with any sugar high a sugar crash will follow.

Ideally a combination of regularly ingested oat based bars for slow energy release and your preferred option of fast to digest sugars (i.e. jelly babies) with some carbs in your drink should keep your energy levels stable (although the running might not!).

Remember to take on plenty of fluid too – I’ll come onto the importance of hydration next month but on average you’ll need 1.49 L per hr, based on the sweat rates of the activity (ACSM, 2007).

It may be cold but you will still be sweating!

So basically, try some things out, find what works and take plenty of it with you. On race day no matter how deep you’re digging DO NOT try anything you haven’t practiced in training.

It’s important to know how to fuel properly, to test out your nutrition plan on long runs, and to be able to choose wisely from the selection of available foods at aid stations.

If like me you’d like to know exactly how much you should be consuming per hour here is a guide below. Grams of Carbohydrate can be found on food labels.

Carbohydrate (CHO) Recommended Intake
When		Recommendations for athletes	Your individual CHO requirement	Type
Pre	3 – 4 hrs prior	140-330g*	330g	Low GI
Ingestion of a CHO rich meal prior to exercise has been shown to increase muscle glycogen levels and enhance exercise performance (Jeukendrup, ed. 2010).
During	Every 15 mins	20-70g per hour*	70g	High GI Drinks –30-40g/500ml + contain sodium. Gels – approx. 25g Bars – 20-30g
* Based upon demands of the sport (Maughan, et al.eds. 2004; Jeukendrup, ed. 2010)

Good Luck with the final stages of training!

Sarah Walker

Northlight Strength and Rehabilitation Centre

starstrengthandconditioning.co.uk

North Light Physiotherapy

Appointments

01484 660 663

North Light Gallery, Top Row, Bankfoot Lane,

Huddersfield, HD4 7NP

Get in touch

admin@northlightphysio.co.uk

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