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Tag Archive Physio

Physiotherapist or Sports Rehabilitator: Not The Same!

By Chris Liversidge In , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

With the advent of Sports Rehabilitation as an Undergraduate Degree, and Sports Rehabilitators appearing in the marketplace, I’m often asked what the difference is ~ and whether someone should seek help from a Physiotherapist or Sports Rehabilitator for a musculoskeletal condition.

What is a Physiotherapist?

  • The term “Physiotherapist” describes a professional who uses physical and manual methods to restore function, and rehabilitate ‘patients’ with physical conditions
  • Both “Physiotherapist” and “Physio” are legally protected titles. This prevents anyone without a certified degree in Physiotherapy from
    • using the title of Physiotherapist
    • or describing their role as that of a Physiotherapist
  • Physiotherapists are, alongside all other Professions Allied to Medicine (PAMs), required to have registration with the Health and Care Professions Council (HCPC), a regulatory body requiring members to demonstrate appropriate continuing professional development, to maintain their registration. Without this, a Physio is not entitled to practice

To complete the undergraduate degree, a Physiotherapist must study and demonstrate competence in the care of a range of conditions – not only musculoskeletal in nature, but also neurological conditions, respiratory disease, general surgical and orthopaedic surgical conditions and more.

The qualified Physiotherapist is then armed (as most do initially) to take up a post in the NHS or other medical institution, to continue to develop their practice. It is during the initial 2-3 years that the Physio will work across all fields of the profession, and also begin to develop a special interest in a specific area (e.g. musculoskeletal, neurology, etc.). As experience and depth of knowledge is gained, there is too much ongoing learning required to maintain expertise in more than one area.

Having said that, the early broad learning in the Physiotherapist’s career is essential, as there is a great deal of overlap in some areas. For example, some neurological knowledge is key to musculoskeletal rehabilitation, as the two systems are not mutually exclusive.

What is a Sports Rehabilitator?

  • Having completed an undergraduate degree in Sports Rehabilitation, this practitioner has knowledge specifically in the assessment and rehabilitation of sporting/musculoskeletal complaints
  • As the title suggests, the emphasis is often on returning a ‘patient’ to a specified level of sporting capacity. Manual/hands-on therapies are also used by a Sports Rehabilitator
  • However
    • There is no training offered in a broader systems rehabilitation approach (e.g. neurological rehab)
    • This practitioner is currently not a “Professional Allied to Medicine”
    • The qualification is not currently regulated by the HCPC, and practitioners are therefore not required to meet their standards to practice
  • There is also currently no avenue for the Sports Rehab practitioner to work in the NHS or medical institutions, nor to register with health insurance providers such as BUPA, AXA, etc.

Overlap
There is a great deal of overlap. Both practitioners are able to provide hands on treatments and exercise prescription, to improve symptoms. Technically and literally, a Physiotherapist practicing in the musculoskeletal specialism, rehabilitating patients back to sport, is a sports rehabilitator.

However at the time of writing this blog, the lack of HCPC registration means the Sports Rehabilitator is not found working in the field of elite sport, because of the extent of medical overlap often required in musculoskeletal roles within professional sport.

Extended Scope
It is also worth noting that, critically, a large number of medical conditions can masquerade as musculoskeletal problems. The key here, is to have a practitioner who has the correct experience to differentially diagnose whether your condition is truly musculoskeletal, or is masquerading for an underlying medical problem.

Physiotherapists with this level of expertise are highly experienced, usually having worked in a hospital/medical setting in musculoskeletal care, for at least 8, or up to 10 years, and have seen a very large volume of differing conditions over many years. They are referred to as Extended Scope Physiotherapists (ESPs).

The key skill of an ESP is knowing what is a rehabilitation problem, what isn’t a rehabilitation problem, and for the latter, who is the correct professional to refer to.

Summary

  • The key thing to remember, whichever practitioner you choose, is experience
  • A Sports Rehabilitator has a good depth of training, and many offer a good service in managing the recreational athlete
  • However, one must bear in mind the breadth of training in Physiotherapy, and the advantage of the medical training incorporated in the Physiotherapy degree

Of course, the extent of experience of your chosen clinician is vital too. For me, the choice to open a Clinic was one I gave a lot of consideration to.  I felt this choice was realistic after I had accumulated 10 years of experience, knowing I felt confident to assess whoever walked in through our front door – but I also continue to humbly accept that I have, by no means, learnt all there is to know!

Best Wishes,
Chris

Chris Liversidge (MSc, BSc (Hons) 1998,2001, MCSP) is an Extended Scope Physiotherapist (Musculoskeletal/Orthopaedics) and Practice Prinicpal at North Light Physiotherapy Associates, UK.

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

Call us on 01484 660663,  or click on our Contact page

Sports Massage at North Light Physiotherapy

By Chris Liversidge In , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Who can benefit from Sports Massage?

Sports Massage at North Light Physiotherapy

Sports Massage is useful for various problems, not just in a sports context. Often muscles can feel tight or stiff after heavy or repeated physical activity this can be sporting, occupational or recreational. Muscular tightness and restriction can be reduced, and pain alleviated as part of a more broad based management strategy that may form part of a regular training programme, or a course of Physiotherapy or rehabilitation.

Expertise

Our team have a wealth of experience and expertise.  We have worked with professional sports people, and this experience is invaluable in working with athletes at all levels and abilities.  We can support you, whether in preparation for athletic events, such as endurance running, cycling sportives, or if you only take part in your favourite activities for fun and wellbeing.

To book your Sports Massage, call North Light Physiotherapy on 01484 660663 or head over to our Contact page – looking forward to seeing you!

Ante Natal & Post Natal Pilates

By Chris Liversidge In , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

Becky Walker North Light PhysiotherapyNorth Light Physiotherapy’s specialist Obstetric Physiotherapist Becky Walker tells us more about the benefits of Ante Natal & Post Natal Pilates

“I run the Pilates Classes here at North Light Physiotherapy.  My specialist Ante Natal / Post Natal Pilates classes are suitable from early pregnancy onwards – then once your baby is born, we’ll be ready to welcome you back after your 6 week postnatal check.

The class is a small group, so exercises can be tailored to suit each individual. All the exercises are safe for you and your baby, and will help your body to cope with the many changes it experiences throughout pregnancy and beyond.  The main focus of the classes are to:

  • Strengthen the abdominal and pelvic floor muscles
  • Maintain spinal flexibility/movement
  • Help reduce alterations in posture as the bump increases.

Pilates breathing techniques can also be very useful during labour.”

Pilates is highly recommended by physiotherapists for those experiencing Pelvic Girdle Pain (PGP).

Obstetric Physio and Ante Natal / Post Natal Pilates at North Light Physiotherapy HuddersfieldPelvic Girdle Pain (PGP)

PGP (previously known as SPD – Symphsis Pubis Dysfunction) can occur at any stage during or after pregnancy and birth.  PGP is caused by an asymmetry of movement within the joints of the pelvis and lower back, this causes pain and difficulty moving.  Find out more at The Pelvic Partnership’s website.

 

Symptoms of PGP:

  • Pain and stiffness in pelvic joints
  • Difficulty walking, climbing stairs and turning over in bed
  • Pain and dysfunction can last for months or years without treatment

Treatment of PGP:

  • Manual therapy is the most effective treatment
  • PGP is treatable at any stage during pregnancy and postnatal – Hormone levels can’t be altered, but joint asymmetry can!
  • Manual therapy treatment of the pelvic joints and soft tissue is safe and effective, both during and after pregnancy
  • Breastfeeding can have a positive effect in recovery
  • You can resolve your symptoms with early diagnosis and treatment
  • Research* has shown that women who don’t have manual therapy can experience pain for months or years after the birth of their baby

For more information about pre or post-natal Obstetric Physiotherapy, or to book a Pilates Class with Becky, click our Contact page or call 01484 660663

North Light Physiotherapy Associates Ltd are registered with all major healthcare insurers

*Research: Pelvic girdle pain: The Stickmum project 3 years forward. British Journal of Midwifery, Nov.2018, Vol.26 No.11

Physiotherapist in Low Back Pain Shock!

By Chris Liversidge In , , , , , , , , , ,

 

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.North Light Physiotherapy Neurological Rehabilitation

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

http://northlightphysio-co-uk.stackstaging.com/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 , , , , , , , , , , ,

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 , , , , , , , , , , , ,

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).

http://northlightphysio-co-uk.stackstaging.com/posterior-ankle-impingement/

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.

http://northlightphysio-co-uk.stackstaging.com/posterior-ankle-impingement/

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 , , , , , , , , , , , , , , , , , , , , , , , , , , , ,

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