The Power of Words

Within my day to day job as a physio I see different people every day. Sometimes I am fully booked and see 14, sometimes I have a quiet day and maybe see 2 or 3 but on average I see 8 people. My job primarily is to "fix them up" or at least that's what the general population believe I do. Really, my job is a mixture of being an educator, being an inspiration, occasionally being a shoulder to cry on, and more often than not a sounding board for beliefs, behaviour patterns and most commonly - fear. I don't think any injury comes without it - and often takes many forms. It is similar to grief in this way, and affects everyone slightly differently - which makes me enjoy the challenge of assisting to unwrap the various barriers people face within their recovery.

If I can speak to those 8 people and create a space where they can feel comfortable, speak about the way they feel and offload any anxieties - surely this will help with their recovery. In actual fact I believe it is the thing that propels them through their recovery.

This is why I wanted to write this blog about the power of spoken word. It is the single most useful thing I can do in my job as a Physio, and the effects can be awesome. 

Let's take an example. Mr Smith comes in to see me today as he has slept badly on a return flight from Singapore and as a result has a stiff and painful neck. After the clinical assessment and questioning (ruling out anything more sinister) I tell him not to worry, this is a simple case of neck pain after poor neck position for a prolonged time, it is temporary and it will get better. Perhaps he may need 1 or 2 sessions of physio to help with pain relief and correct movement once more but after that he will be fine, and will just need to stretch, exercise and keep his neck moving, being aware of posture etc.

All seems pretty straightforward?  Ok, next in the clinic is Mrs Jones, she had to return to the UK and cut her bank holiday break shortin Singapore as her father is ill in hospital with a chest infection. She has pain in her neck and upper back, and is finding it difficult to move properly. I could tell her the same as Mr Smith, the problem is a temporary thing and her pain is most probably heightened by her increase in recent stress level with her hospitalised father. However, I could also tell her that this is a serious neck condition, she has degeneration in her neck and her pain will take 6-8 sessions to improve. She may require an X-ray and MRI scan to check for any further damage.

These 2 people will have a very different experience when they see me - and I need to be able to assess and judge this when I first meet them.  (I also have a responsibility to be ethical in treatments and not to dupe people into believing they are worse than they really are you'll be pleased to know!). Now in these two examples I’m not saying everyone is as straight forwards as this, and when we are on the vast subject topic of pain and managing pain, and the psychological impact of pain - there is much more to it than just telling someone they will be ok and not to worry! My point is that this is just the start of good and honest communication, with reassurance and support at the heart of the message.

There is of course the timing and delivery of the message, the subtle psychological aspects to the message and the empathy with the way in which it is delivered. But this blog is not long enough (and I am not qualified enough!) to go in depth into this realm of communication and the way in which we do this. I'll briefly say that as a physio I must choose my words carefully!

A lot of my day job is to do with good communication, and the method in how you explain a problem to someone can put them at total ease, or cause added stress to the situation - which in turn then can then cause further break down of confidence, cause a negative belief that they will not get better and thus expand their overall recovery time.

I'm not saying all cases are as straight forward as the 2 above, but the power of the words we use can have a dramatic effect on the people we see. I have found through my clinical experience the more encouragement you give someone to get moving again, and reassurance that the problem is more minor than they think (so long as ethically it is!) they generally tend to have a better outcome.

So, yes as Physios we sometimes have a tough time convincing patients that movement is the best thing for them, as for years we have the belief that bed rest is best. However,  movement is the best way in many cases to assist people to get on with their lives and progressing swiftly and confidently through to their full recovery.

 

Alternative Summer Training Ideas

In the mid-summer there are less running events and more social events scheduled with weddings, summer parties and BBQs in our diaries. Maybe you completed a spring marathon or a longer run in the earlier part of the year and so it can often now feel like there are fewer big events to train for, and less opportunity to train with the social side of things increasing.

 

This piece will give you some ideas about continuing your training in a different way, to maintain your fitness but give your body a break from simply running junk miles - and getting fed up of it.

 

Another reason for varying training is the change in weather. Training through the winter in the UK prepares your body for wind, cold and rain whereas the warmer weather can slow running times, leave you dehydrated and make training session seem more laborious.

 

ERGO

This is one piece of kit that is totally overlooked in every gym I've worked in- and without good reason!
Using an Ergo or rowing machine has huge cardio benefits, and means you engage more of your upper body than you would do as a recreational runner who doesn't use any other form of exercise.
A great challenge is to row a pre-set distance (my suggestion is 1 or 2K) and see how long it takes. Then do it again a week later and aim to beat your time, form is important and this shouldn't be overlooked so always ask if you're unsure.

 

ROCK CLIMBING

Indoor Boulder sites and rock walls aren't that hard to find, and an hour’s session can really leave you feeling like you've had a thoroughly good workout. Building great core strength through this callisthenic style exercise is a great alternative to dong planks every day! And letting your mind work on the 'problems' or routes to find a way to the top really does make it feel like you aren't doing as much exercise as you really are.

 

BOOTCAMPS

Many organisation now run boot camps throughout the summer, (and some more hard core throughout the winter too!) Generally sociable and a lot of laughs it can be a good way to engage more upper limb workouts and if working with a partner gives you some friendly competition

 

PARK LIFE

Frisbee, catch, handstands and cartwheels take us back to school days. If family commitments and social engagements are stopping you from training use these types of day trips to your advantage. Plenty of fun and a great way to keep your children involved and active.

 

TRIATHLON

A personal favourite of mine is taking part in triathlon training; there is still the run element but being able to train for 2 other disciplines (swimming and cycling) means there's less demand on just the lower body and a better balance of using fundamental muscles (i.e. core muscles) to keep you active.

Triathlon has been described as a "lifestyle sport",  as in being able to complete each discipline within a normal week and substituting sessions inside (i.e. swimming in a pool) if the weather is bad outside.
I'm not saying every runner should take part in a triathlon, but the idea of cross training to maintain good cardio, without placing overload onto your legs is a great one.

 

This list is endless, and in no way am I saying stop running over the summer, just finding new ways to exercise or exercise without even feeling like you are cannot be a bad thing. So as always, let's get moving to see the benefits!

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Challenge Roth: A Race Report

One of our patients has been working towards a sub 10 hour Ironman finish. He recently took on the challenge that is the iconic race Roth, and luckily for us, he’s shared his race report. Inspirational.

It’s Friday 7th July, 4:30 am and I’m standing in the dark on my driveway, waiting for my lift to the airport……..Nope, not to go on holiday. To go to Germany and race Challenge Roth Full distance tri with one aim…… Sub 10 hours for the distance.

The excitement begins to mount en route and is intensified when I meet my fellow Havering Tri club mates in the departure lounge. Amongst us, we have 3 newbies (to the full distance) and 3 others including myself.

This excitement is only briefly knocked when I hand across Shaneequa (my bike) to the baggage handlers not knowing whether I will ever see her again. As I stood there to watch my prized possession disappear into the unknown I hold my breath and say a little prayer to the bike gods that she would be safe.

After a relatively short and uneventful flight (with a comedy pilot) we landed and I raced off to see if Shaneequa had made it. The conveyor belt started and hurrah!! She is first out still in one piece. Nothing will stop me now!

After a minor boot space issue with our hire car, we head off and reached our hotel shortly after. We then head off to the expo to register. Now the Roth expo is like no other. It’s actually half decent! I resist the temptation to part with money I haven’t got and just collect my number.

Fast forward to race day:

The swim:

For me to have any hope of quicker times then my swim has to improve. I went for a swim lesson once and was told by the instructor, “Ah yes, I see what the issue is. You and the water are not friends. You’re fighting each other and at the moment the waters winning’. Yeah, thanks for that Sherlock! Needless to say, it’s not natural for me and my technique is somewhat…..lacking. I have tried really hard with my swimming in the last 8 months and committed to the swim more than ever. But despite that, I was still at roughly the same level of pants. Even so, I hoped.

For some unbeknown reason, I was put in swim wave 3. The pro men were wave 1, pro women wave 2, and then me?!! Oh dear. There are an awful lot of people to swim over me from the remaining swim waves! I figured that the best/safest way for me to get around would be to position myself off of the racing line and mirror the bank for sighting. I started at the back of my wave and the cannon sounds and off we go. To my suprise, I am not the slowest swimmer in my wave. I am however about the 4th slowest! After about 200 meters I am caught in no man’s land between my swim wave and the wave behind. It’s only a matter of time that I am caught and sure enough, it soon happens. My plan was to allow the waves to pass and then try and get onto the feet of the quicker swimmers for as long as I could to draft along. And that was that. Nothing really happened, I didn’t really get into any bother and just swam as well as I could. The only issue I had was losing my swim hat about 500 metres into the swim, (but hey, the water was warm anyway and it cooled me down). I exited the water in 1 hour 20 to a 2 minute PB………. On target.

T1: T1 was quick and largely uneventful. I didn’t have any issues, found my bike easily and off I went.

The bike:

I jumped on the bike and began spinning the legs out. I took it easy for a few minute to get my heart rate back down to a non-cardiac arrest state. Then settled in nicely and tried to enjoy the ride. Now one thing for sure, Roth is not flat. I wouldn’t say it I hilly either but is definitely rolling. The support was awesome especially when I hit Solar Berg Hill for the first time. It didn’t matter that I got held up behind slower riders and the crowd as it was just unreal. My eardrums have only just stopped vibrating now. It was a wall of noise and I couldn’t help but smile the whole way up it.

On completion of my first lap, I looked down at my Garmin to see I was on target. I had one slight issue on the bike. I had forgotten my energy bars when I flew out which meant I had to buy some from the expo. After taking the first bar I thought I’d need dental surgery if I persisted with the rest so I ended up ditching these at the second feed station. That wouldn’t have been a problem but it meant I was running out of gels on the second half of the bike course so I switched to the race supplier. This was squeezy, a gel I haven’t used before. (Error, but more about that later).

I finished the bike feeling pretty good and looked down to see 5 hours 12. A 12 minute PB. On target.

T2: On the entry to T2 I decided that in order to save more time I would attempt a flying dismount. Of course I did, why wouldn’t I, I mean it’s not like I hadn’t practised it. So needless to say my first ever attempt at a flying dismount was just that, ‘flying’! I picked Shaneequa up off the floor and handed her to a waiting volunteer before running my silly backside into the change tent. The rest of T2 I’m happy to say was fine.

The run:

Easy I thought, this is what I do. All I needed was a 3 hour 20 marathon and I would have my sub 10. WRONG!! The minute I started running I knew I was in trouble. Everything hurt and I just could not lift my knees like I normally would. It’s fair to say that all technique had deserted me and I was running like flamenco on acid. Despite this, for the first two miles, I was on track. However, from mile 3 I was hit with bad stomach cramps and a stitch. Why oh why had I used those gels! My stomach was not feeling good and from mile 6 to 13 I was sick 6 times. I tried to replace whatever I had lost but it was no good, in the end, I was just washing my water around my mouth before spitting it out.

The most surprising part of this run for me was the fact the new course was hilly. I expected the run at Roth to be flat but it was anything but. The weather now had also hit 32 degrees and humidity was also very high. I did what I could and found encouragement from my fellow Havering Tri club mates and Pirates Stanners and Pinky. I was even able to run alongside Les for a couple of miles before I got a second wind for my run into the finish. The highlight of the run was exchanging pleasantries and a high 5 with Chrissy Wellington. Despite all that, I got it done. Run time 3 hours 45. I entered the stadium to milk the cheers of the crowd and crossed the line to finish in a time I thought was around 11 hours.

After experiencing the problems on the run course I decided to go easier and try to preserve as much energy as possible as I knew I had IM Hamburg in 5 weeks to give it another go. Then to my suprise I was handed my finishers certificate. It read 10 hours 22 minutes. That’s a 2 minute full distance tri PB. I had PB’d the swim, PB’d the bike and died on the run, for an overall 2 minute Full Distance PB. Bearing in mind how bad the run went, I’d take that.

So what have I learnt? Well, Roth is an awesome race which everyone has to experience once. The whole town/village/area comes out to support and totally buy into the race. I got my nutrition wrong on this occasions, an issue I will hopefully not repeat. But most importantly I was on target for my sub 10 before the run and I’ll be ready to have another go in Hamburg where I hope to nail it.

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Swimming Open Water

Apps Physiotherapy provide triathlon based assessments and guidance, whether you're taking on Kona or are venturing into tri for the first time - there are swim, bike and run sessions to help you out. The latest blog is all about learning to swim in open water for the first time.
In June I had the awesome job of taking two new triathletes in training to our local lake for a spot of open water swimming.
We had a 6am meet and cycled the 5 or so miles down to the lake, after registering and paying it was time to suit up and get out there.
Tips and tricks along the way to try and help make getting into wet suits easier:

  •  Using gloves to avoid tearing any holes in your suit
  • Using a small plastic bag for your feet to slide the wet suit on more easily
  • Using plenty of glide along your neck to avoid rashes with contact with your suit

The lake is a 900m loop with 3-4 canoeists/paddle boarders to help if you get into trouble and so we start by easing into the water having a float to see the buoyancy of the suits and get used to the water temperature and that googles are fitted and comfortable.

I spend a little bit of time pointing out the buoys, that they should always be on your left as we swim anticlockwise around the lake, and explain how to sight the buoys as we swim. And we're off!

There is much gusto at the beginning and a great pace from each of us, but I quickly realise both girls are going off course and drifting over towards the river bank, a few shouts later and we try staying on each other's toes to keep things much easier - this works for all of about 50m and then the drifting off comes back.
The last tactic that seems to work is me swimming alongside the incorrect side to stop the swimmer from drifting and keeping them in more of a straight direction to the buoy line.

We re-group after a long stretch between buoys to get a breather and some breastroke to try and keep morale up!
The next stages are focused on sighting - the ability to see where you’re going and keep in a straight line to the next buoy.

 Tips for this include:

  • Aim to ''sight'' where you are going every 4-5 breaths,
    you can always do more
  • Don't stop when you sight - try and make the whole movement
    as one as you continue your swim.
  • Use the left and right view as you breathe to help keep you straight too,
    if you can see the riverbank is coming closer on one side pull slightly away from it
  • Trees and buildings can often help for sighting as well as buoys

Approximately 3/4 of the way round we're struggling with googles and trying to adjust them meant we needed a breather. We pull to the side and stand in shallow water to allow hats and googles to be re-organised and ready to push on for the final 300m or so.

Tips for goggles and hats:

  • Using 2 hats can be beneficial if it’s cold (start of season, sea swims etc.)
  • Placing goggles on under hats, or between 1 hat and the next can help prevent anyone grabbing your goggle straps
  • spit in your goggles and wipe saliva round before starting a race, this should help de-fog your googles
  • Always use anti-glare googles if able

Finally we're back to the entry point and a sigh of relief is felt if not heard!
Using Garmin data we can see that a 900m lap around the lake was actually 1.5K swim due to going off course and inefficient sighting.  Using some of the simple points listed above this should really help improve the next open swim session our beginners do!

Cross Training with Hydrospeeding - A guest blog

A colleague of mine decided to change-up her training and shares her ideas of cross training and a fun but challenging new experience: Hydrospeeding

As soon as someone mentions the words ‘cross training’ they often think that the only alternative is to swim.

In clinic I see a lot of cyclists and runners, a vast amount of their injuries are often due to overuse.  The reason for some many overuse injuries are that people tend to stick with the discipline they are training for and forget to mix it up! This is where the benefits of cross training come to play; not only does it help reduce injury by not repeating the same movements thousand of times but it also helps achieve whole body strength and conditioning; which actually aids performance in the long run!

As soon as someone mentions the words 'cross training' they often think that the only alternative is to swim.  Knowing the great cardiovascular benefits you get,without the undue stress and impact on low limb joints swimming really is a great exercise for cross training, however, there are so many other activities that you can do ....

I recently attended the Lee Valley White Water Centre in Waltham Cross as my sister bought me a Hydrospeeding session for my birthday.  I had no idea what this was but I am always game for some adventure and fun!  

I managed about 7 runs in the hour slot and I was shattered!
Wet suits, life jackets, helmets, and fins made it a challenge to walk in let along getting tossed around and capsized by the force of the rapids - let's just say I became very proficient (much to my sister's amusement!) at barrel rolls!   My thighs were burning; my biceps and forearms had a workout from gripping so hard and my cardiovascular system certainly went into overdrive! But boy was it fun!

It was while chatting to one of the instructors that she mentioned they often see marathon runners coming along to Hydrospeed as a form of cross training - what a great idea!

I got me thinking about what over ways we can cross train that is fun yet provides us with the strength, CV workout, stability and conditioning that we need for our chosen sport that will keep us motivated and free from overuse injuries.  Here's a small list of a few other activities I thought of:

  • Yoga - to help lengthen tight muscles; increase balance, core and concentration.
  • Pilates -  to activate core units, strengthen muscles, improve co-ordination and stability and can increase CV workout depending on the form of Pilates used.
  • Powerwave & Body Pump - Weighted workouts that not only increases CV fitness but is a fun way of incorporating those losing weight sessions.
  • Canoeing/ Kayaking - works on CV fitness, core and upper body strength - especially when working against those rapids!
  • Rockclimbing - helps with core strength, stability and upper body strength.
  • Water skiing - A full body workout!
  • Trampolining - Improves CV fitness, tones and engages the core (especially if you intend to do all that flipping and somersault stuff!)
  • Ballroom Dancing - Superb for postural alignment, core engagement, balance and co-ordination, and of course CV fitness

This is just a very short list of about a billion things you can do that will help mix up your training whilst keeping it fun, relevant and more important free for overuse injuries!
So go out there, explore and have fun!

find out more about Hydropspeeding here