I was thinking about what frustrates me about physiotherapy. What are the things that physios do that confuse me? If I was a patient, what would stop me coming back?
What I don't like is physios that make things super complicated. I'm not sure if that helps position them as an "expert", meaning you've got to pay them because you absolutely can't help yourself. Or it may be that they don't completely understand what they're talking about so can't explain it well. But I don't like smoke and mirrors. I think physio can be pretty simple.
This leads me to ask - if I boil it down, what are the most important things I do to help you recover from your injury?
I think it comes down to two key components:
Usually the most important thing comes down to you doing a stretch or strengthening exercise at home. More often than not it's you consistently making small gains with a home program that makes the biggest difference to your recovery. Not anything miraculous that I can do to you here.
If it's super important, why do some people do their home exercise and others don't? Life gets in the way. It's hard to remember. You've got better things to do.
So, I need to make it as easy as possible for you. That's my job. That's why I'm better than just googling it.
I understand that small stuff gets in the way. You remember to do the exercise when you're in the car and can't do it. Before you know it, you get to the end of the day and it's not been done. There's lots of little things that make a home exercise program hard to do "now" - meaning you leave it for "later". If you have to get on the floor you'll do it "later". If there's too many exercises to do, you'll do it "later". If you have to use equipment - it's not on hand. Any little barrier to getting it done means it doesn't get done. It needs to be easy.
So my practical solution for your recovery comes back to: WHAT WOULD I REALISTICALLY DO MYSELF?. It's lucky I've had a few injuries and have learnt what's realistic and what's not. If I had your injury, what is the one thing I would actually, realistically do myself?
I think that is a great question for all healthcare professionals. Because we know that around 40% of our health budget is wasted on unnecessary tests and treatments. Unnecessary healthcare expenses add up to $45 billion/year in Australia. It is amazing how many things healthcare practitioners recommend to patients that they wouldn't do themselves.
I think we could save a lot of time, effort, and money if all health practitioners had a tick box to sign-off on all investigations and treatments - Would they do it themselves?
So that's what I give you. Things that I would do. I understand what is practical and realistic.
Simple Explanations + Practical Solutions = Happy You!
Monitoring the athlete training response: subjective self-reported measures trump commonly used objective measures (Saw AE et al, 2015)
Research Summary: Saw AE, et al. Br J Sports Med 2015;0:1–13. doi:10.1136/bjsports-2015-094758
Monitoring athletes' response to training is crucial for improving performance and avoiding injury.
Elite level sport utilises an increasing number of ways to measure athlete well-being. Batteries of tests are packaged into commercial products attracting premium fees. This is justifiable if you are Sydney Swans or Liverpool FC, but where does that leave the rest of us? Are we missing out if we're not testing cortisol levels to know if we are over-training?
A recent paper carried out a systematic review where objective measure, such as:
The researchers concluded that the:
Load Management For Injury Prevention
Managing training load is crucial in injury prevention and treatment. A graphic in Tom Goon’s recent blog visualises how training load outweighs all other factors.
Historically we have advised that training loads shouldn’t increase by more than 10% a week. I’m not sure where this figure comes from. I’ve got no problem with it, it seems reasonable, and I’ve quoted it hundreds of times.
There’s a recent BJSM podcast interview with Tim Gabbett on load management for injury prevention. Specifically Tim talks about this paper:
Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers
- Billy T Hulin, Tim J Gabbett, Peter Blanch, Paul Chapman, David Bailey, John W Orchard, 2013.
It is research into fast bowlers but I think the principles apply just as well to any athlete.
They measured the acute workload of the last 7 days (and call it “fatigue”) and compare that to the chronic workload of the previous 4 weeks (which they call “fitness”).
Measuring Training Load
For runners, if the training is reasonably homogenous, we could most simply measure the workload as the total kms/week.
Or we could be more accurate and account for a mixed training program that may include a variety of hills / sprints / cross training etc, by giving each session a rate of perceived exertion (RPE) out of 10, and multiply that score by the number of training minutes:
Training load = session RPE x duration (minutes)
This is called a Foster’s Score, and provides a simple method for quantifying training loads from a variety of different training modalities.
The research subtracted the current 1-week average from the previous 4-week average and called this number the “training-stress balance”.
A negative training-stress balance increases the risk of injury 4 times.
[Last 7 days’ session RPE x duration (minutes)] - ([Last 4 weeks’ session RPE x duration (minutes)] / 4) = TRAINING-STRESS BALANCE
Negative balance = 4 times risk of injury
Essentially this formula means you shouldn’t increase your training load by more than 25% a week.
For people that may be more vulnerable to injury I would change the 4-week average to a 6-week average, therefore, bringing the increase in load each week down from 25% to 16%.
This more cautious group could include:
I quite enjoy the concept of Micromorts & Microlives. Our average life expectancy can be divided into one-million, half-hour units. I enjoy the maths of risk. The things that add or subtract units of our lives.
Sitting Is Dangerous
There’s been some media over the last couple of years suggesting that “sitting is the new smoking”.
Research now tells us that the number of hours we sit each day is an independent predictor of our health, similar to other factors like age, smoking status, obesity, & exercise. It turns out that sitting for 10 hours a day is harmful for your health whether or not you exercise, how old you are, whether or not you smoke, & whether or not you’re fat or thin. Sitting is bad for you.
The longer we sit, the less healthy we are. There are a couple of reasons…
1) Back Pain
Sitting is the primary cause of low back pain, which is a leading cause of disability in the general population (second only to depression), with nearly four million Australians suffering at any one time. Total treatment costs in Australia exceed $4 billion a year. Back pain is the most common musculoskeletal problem, accounting for one in four patients I see.
The longer we sit, the less physically active we are. Physical inactivity shortens our lives. It is the 4th leading cause of death. Physical inactivity is the second greatest contributor, behind tobacco smoking, to the cancer burden in Australia. Physical inactivity is estimated to be the main cause for approximately 25% of breast and colon cancers, 27% of diabetes, and approximately 30% of ischaemic heart disease.
From an evolutionary point of view we’ve had 100,000 generations of being hunter-gatherers, moving around, doing different things all day. We’ve only had 10 generations of industry, where we do the one thing all day, commonly including too much sitting. Our bodies just aren't used to sitting for long periods of time.
Sounds terrible? However, the solution is easy…
New research has found that getting up and moving around for two minutes every hour is associated with a 33% lower risk of dying prematurely.
Breaking up the sitting time appears to be more beneficial to life expectancy than doing daily exercise. You can eliminate the harmful effects of sitting 10 hours a day by getting up for 2 mins every hour.
Breaking up sitting time also is also good for back pain.
I’ve spent years trying to get people to sit with better posture to prevent back pain. It’s super hard to maintain. It takes continuous deliberate effort, which is almost impossible. I’ve tried posture -aids, ergonomic chairs, lumbar supports, cushions, Swiss balls, taping. I’ve given up. You just can’t sit with perfect posture for long periods of time.
I’ve now moved to trying to get people to get up and move for a couple of minutes every 20 minutes. You can get away with sitting with the worst posture imaginable if you don’t stay there too long. Overall it takes a lot less thought and effort for a much better result.
I think the change to less sitting needs to be driven by employers over the next few years, similar to how smoking was fazed out of work places. I think we will see more stand-up desks, stand-up meetings, "walk-around" meetings, and possibly enforced limits on sitting time.
So whether or not we do it for our backs or for a long life, we need to sit less & move more.