Short vs Long

When we see a client in our practice, we go through a series of important decisions. But one remains the most difficult, when do you focus on a short term ‘fix’ and then, when do you think about the long term?

Once we have a comprehensive history of the problem we will examine the area and develop a reasoned diagnoses. Straight away we then have to make a decision, do we concentrate on the injured area and continue to formulate a plan based on this, or do we continue to assess and find the reasons behind the injury and focus on the long term? Here lies the dilemma.

The main factors that will influence this decision are actually found out during our history taking and further signalled by our diagnoses. The most straight forward example to describe this is an acute muscle injury vs a gradual onset of knee pain.

For an acute muscle injury, it is most likely that initially we will focus on the injured tissue and be singularly focussed on managing that area, looking for quick, short improvements. These injuries are normally traumatic and come on suddenly and the explanation of the injury will reflect this. It would not make sense (and quite often you are unable) to start looking around the body for reasons why that muscular tissue has been injured. You wouldn’t put a footballer on a treadmill to look at running style the day after they have sustained a tear of their hamstring! Instead we identify the hamstring injury, get an accurate idea of the degree of injury, remove the factors that may worsen the injury (this may be running, or in extreme cases even walking) and immediately start to get that athlete moving in different ways. Quickly you would see improvements and then it logically makes sense to progress to looking at the long term and for reasons as to why they may have injured the hamstring area.

Conversely in the second example, a runner with a gradual onset of knee pain, it is logical not to get internally focussed on the injured area only. Instantly when talking to the runner we would see there was no clear reason why the injury occurred. We will most likely ask much more in depth questions as to the runners training history, their load management (see previous blogs) and look at the whole body to see why the knee is getting over loaded. This case would be appropriate to look at running style as there is likely to be a certain volume of running that the runner could do without pain. We then formulate a diagnoses and as before remove the problematic variables. Then we formulate the plan, involving rehabilitation for any of the issues we may have found with a focus on the long term improvement from the offset.

Obviously there are exceptions to these basic rules, but those exceptions still follow the same trends as above. You get an accurate diagnoses, remove the influences that could make the injury worse and then start the rehab process involving as much of the long term factors that you have identified as you can. It is more a question of when you look at the long term, not if!

So next time you are unfortunate enough to sustain an injury, think about the above to help you understand where your rehab focus needs to be!

If you have any questions please get in touch over on our facebook page!

 

 

 

End stage rehab and self management

What a busy week!

Thank you to all of our patients for making this a challenging, and interesting period.

As physiotherapists we are always looking to give people the tools they need to solve problems themselves. We don’t just try and ‘fix’ you in the short term. A prime example from this week was a patient who initially came to see me a few months ago. During this first period of physiotherapy they had sustained a sudden onset of lower back pain. This was the first time it had happened to them and therefore involved a lot of fear of the unknown. We were able to help the patient resolve the issues and get them back to work and back to being active with their family. This same patient came back to see me this week and was able to proudly tell me how they had fully fixed themselves following a recurrence of back pain following an unfortunate event in the cold weather. They stated how the pain had come on, described their symptoms and was able to rationalise the situation based on the information they had received from us. This directed them on how to resolves the issue as quickly as possible. The first episode lasted 8 weeks. The new injury lasted only 1!

This stresses the point of education. We will always give you a full explanation of the problem and aim to give you the tools to get yourself better.

When considering your rehabilitation as physiotherapists it is our job to match your treatment to your goals. Its been great to see a few athletes this week reach the end stage of their ‘return to play’ targets.

This is an area often overlooked by athletes. Once you have achieved the advanced stages, you are not in pain, you have full movement and your strength scores are back within normal targets, what do you do to make sure you are ready to play? In the advanced athlete we would do this in conjunction with coaches and a multidisciplinary team of support staff, including nutritionists and psychologists. We develop a plan that is specific to each individual and specific to their sport.

To illustrate this point, think of a rugby player following an ankle injury. They are not in pain, they have full movement in their ankle and they can complete all strength requirements in the gym. Whats left to do? Well, we need to build a complete picture of their specific position, involving how far they run, how fast they run, if they lift or kick and even what kind of boots they use.

Once you have a complete picture, we then break down that activity into its component parts, test the athlete based on those components, and fill in the gaps. The rehabilitation should start to look like the sport. In this example, when lifting in the line out, how much force goes through the ankle in good technique? We would then reproduce that movement and force in the gym, this could be a ‘thruster’ exercise. But this wouldn’t be enough on its own, as in real life the ground is not flat and the weight is moving around to try and catch a ball. We have to recreate this, to a lesser extent, using unstable surfaces and loads, commonly adding resistance bands or external forces into the equation. By the time you have finished the athlete should feel confident they are ready to get back to their sport. It is worth noting that this process of accessing movement and training for it is often the way we try to improve an athletes performance.

Finally, good luck to all athletes and teams competing this weekend and a special get well soon to our proprietor, Mike, who has a sore throat.

 

Dan