Saying goodbye to rugby…..Again!!

So where do I start? This year I returned to playing rugby for the first time in five years. I had been away from the sport as a result of a Talor dome fracture of my ankle which occurred during a rugby match of all things. I ended up doing the usual where I spent a very long time after getting my initial scan where the prognosis of the injury changed from week to week. After doing this for nearly 5 weeks I decided to stop going to the hospital and decided to sort myself out as I had reached a point where I had to meet with new doctors each week and have a new diagnosis each time. I spent the following year rehabbing my injury but had reached a roadblock. I wasn’t able to walk more than five minutes without my ankle swelling up and I would be in excruciating pain. At the time the ankle would lock up and cease when I was walking.

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Giving Blood

Recently I gave blood. This is not something special or something new, or at least that’s what I believed when I went into the clinic. Due to my job, I understand the physiological makeup and function of blood and its importance but that is about as far as that goes. I’ve never received blood or been in a position where I would have to worry about it. I have had surgery and done all the rehab imaginable but I had thankfully never been in a position where I needed to receive blood. I have given blood Read More

Hiking as a form of rehab

Hiking has easily one of the most popular outdoor activities in Ireland after field sports. Irelands landscape allows for some of the most enjoyable and challenging hikes possible. As enjoyable as hiking can be, due to the environment in which it is done in, it can also help train or challenge several different aspects of our health. The long-distance pushes our cardio, the changes in incline and decline push our entire lower bodies and backs, the altitude makes it tougher on our respiratory Read More

The 5 Benefits of Cold Water Swimming

5 reasons why you should begin open water swimming as soon as possible, keeping it to 5 is always going to be tough, as there as so many benefits to open water swimming, be they physical, mental or for the benefits to rehab.

  • Makes you feel amazing afterwards

The cold water can help painful muscles, joints or other tissues that Read More

IronMan 70.3 Dun Laoghaire

This year I was able to be, again, involved in the Dublin Ironman event.  The Dublin Ironman is a half Ironman and the route normally involved entering the Irish sea for the swim at DunLaoghaire. After a 1.9 km swim participants will transition over to the bike section which involves a 90 km cycle up the Wicklow mountains. The last section is a 21.1 km run back towards and around DunLaoghaire finishing close to the starting point of the race. If this is a half Ironman you can imagine how physically exhausting and mentally challenging full events are as well as something as, to be frank crazy as the Kona Ironman race in Hawaii, which is a 3.86 km swim, 180.25 km cycle and 42.2 km run in searing heat and hostile terrain.

Those in the event range from professionals, seasoned veterans, triathlon club members, endurance sport activists and then some of the most normal people who decided this was to be their new obsession for the coming year. Prior to race day I spent the 2 days beforehand dealing with various cases and individuals with issues ranging from simple checks on niggles, strapping, soft tissue work and full on consultations and real down to the wire decisions regarding if a certain person could compete in the race. The two days beforehand were long and tiring but being able to prepare so many people for such an event felt great.

On the race day myself and seven other therapists set ourselves up well before the end of the race was even in site. our first patient of the day had injured themselves in the water which was incredibly choppy on the day. The slow and steady stream of people who had injured themselves during the race and those professionals who had finished the race in an inhuman time suddenly became droves of being being accessed, looking for soft tissue work and even a few being stretch out because the could no longer do it themselves as a result of exhaustion. From 8:00 am in he morning until nearly 5:30 pm we provided care to a large number of the participants.

The Ironman event is such an endurance event that even the therapists are exhausted after it all. The event makes you feel like you can really do any kind of event. For all the people who loved and hated the training process you were hard pressed to find a single participant who wasn’t happy that they choose to compete, maybe only a few disgruntled partners and family members not as enthralled in the sport having to wait an entire day for the event. Yet the comradery expressed in the event and the dedication needed and shown by so many people, you can only appreciate and admire all those who decided to undertake the event.

This was my second year involved with the Ironman, in different roles between both roles and I definitely hope to involved again in the future especially with events such as the first full Ironman event being held in Cork in 2019 and the Hell of the West triathlon which I have been persuaded to train and enter next year.

 

 

 

 

Faculty of Sports & Exercise Medicine Conference 2018

Last week I attended the Faculty of Sports & Exercise Medicine (FSEM) conference at the Royal College of Surgeons Ireland. This year the Conference had a focus point in the return to play post shoulder injury. For those of you that don’t know what FSEM is – it’s an annual gathering of doctors,  surgeons, researchers, physiotherapists, and of course athletic therapists, presenting findings from studies as well as new methods of rehabilitation and surgical interventions to conditions and injuries. We basically come together to discuss the latest developments in the field of physical health. This allows for a body of knowledge, that would normally never be dispersed to be tangible for all.

There was some savage speakers this year. With the likes of Eanna Falvy, the Irish rugby team doctor who spoke about on field management and the occurrence of shoulder injuries in rugby. He interestingly   spoke about how rugby has evolved from its beginnings to something barely comparable to what it once was pre professional era. Body size, strength, play style and aggression have all lead to an increase in injuries especially those in the shoulder where the ideal of aggressive rugby in the breakdown via the poaching of a ball and active clear out has lead to an increase in shoulder injuries. He also spoke of the need to prepare athletes for the season ahead of them as you cannot prepare the athlete mid season, when training load and type are dictated by schedules and physical conditions there and then.

Edel Fanning described the return to play for contact athletes after shoulder stabilisation surgery. She described how the loading of the uninjured side and reductions in strength from one side to another or from internal to external rotators can make it difficult for athletes to return to a position where equilibrium is achieved once more. She also showed how rather than basing rehab plans off pre described time frames and rather base it off objective and measurable improvements from the athlete.

Nick Grantham described a very different int of view coming from a strength and conditioning background but showing how no one field within health and fitness is isolated. He described the strength, power and honestly versatility of an athletes shoulder using downhill biking as an example and showing how specialised a certain activity can make an athlete. He described rehab in a far less rose tinted light than it is often portrayed with the focus being placed on the avilable resoucrces and pjysical attributes being available to each and every specific athlete. We often to much on the on the structures that have become injured rather than the reason why they have become injured sometimes trapping ourselves in a loop of repeated returns and failures of tissues.

Probably my favorite piece of information from the entire conference which states that essentially just following information previously recorded and not catering rehab as an individual experience will not produce outcomes where rehabilitation’s effectiveness is maximised. Essentially, everything is situational and so you cannot paint every injury or condition with the same paint brush. Sean O’ Brien also spoke on his professional career and often as therapists we can forget but the athlete or patients point of view regarding their injury and rehab.

In all i really thought the conference was great and a huge amount of knowledge and opinions were expressed. Not all pieces were directly relatable to every field of expertise but something to better your skills as a practitioner  was present in nearly every talk, workshop or conversation on the day.

Foam Rolling

What exactly is foam rolling and why does everyone talk about it and also treat it like a way to fix every kind of muscular pain /problem in the body. Well foam rolling is normally the use of a hard cylinder shaped object placed against a fixed point that a person will apply there body weight to it and cause it to move. The fixed shape and weight applied causes the soft tissue directly underneath to experience increased pressure directly at the point of contact acting as a form of self myofascial release.  Self myoyfascial release can be done using a classic foam roller, lacrosse ball, theracane, muscle roller sticks or even something like a yoga block. Self myofascial therapy has gone from something only done by people who compete in sports and endurance activities to something many people have introduced to their everyday routines, like stretching.

The goal of self myofascial therapy and in turn foam rolling is to return muscle and soft tissue to its original elastic state. People aim to apply these pressures so that tissues that feel sore, stiff or shortened return to a more normal state and sensation. When creating this motion many people experience pain or referred pain with many stating knots in the muscle. There a re no such thing as knots in muscles but areas of tenderness or trigger points as a result of tissue having to produce a function it is not fully developed for or under great stress can cause this pain or the referred pain may be experienced.

 (Repost Discoveries Soccer club)

The force applied by the weight of your body upon the object can allow for tissue to produce a reactionary force often causing a release of the tension built in muscular tissue. This often alleviates the pain which s a symptom normally allowing for the cause of the pain to be better identified and solved. When the pain or reduction in functionality of the tissue is not that bad self myofascial release in the form of foam rolling can be used as an effective method of maintenance and preparation for activity.

Caution should be taken when using such methods though as it is best used into areas with large or deep surrounding muscular tissue such as the lower or Lumber spine or the neck. Areas that only have a scant amount of soft tissue can be aided by these methods but as many people often find it difficult to judge the force they are applying by the use of their body weight it can also cause bruising or low grade strains into sensitive areas.

Foam rolling is best used in conjunction with other injury prevention and maintenance methods such as stretching and warm up/ coll down protocols as well as prehab exercises put in place to strengthen often problem areas while reducing the sensation of pain into areas often plagued with pain as a result of their nature of being the bodies natural force absorbers. To keep our tissues in as good a condition as possible while maintaining a high quality of activity is one of the most important benefits foam rolling can have for many people. reducing pain and allowing people to experience relief from tightness and stress allowing for a greater quantity and quality of movement and as such performance.

Some of the best techniques for foam rolling are the most basic the roll out areas such as the T-Spine and calfs but also areas such as the base of the neck and lower Trapezius between the scapula. using a lighter force in more specific areas can be more beneficial than trying to apply as much pressure as possible as many people foam roll regularly but don’t benefit greatly from it due to poor technique.

Wellfest 2018

So this year I was able to make my way to Wellfest. For anyone who doesn’t know what Wellfest is, it is essentially a two day festival where fitness and health in most of its forms gets a chance to show what its made of and allow people to experience it. Im a little late talking about it as it was nearly 4 months ago now, but I still think it is an event worth talking about and how it reflects Ireland right now. Wellfest has only been running fora couple of years now but has already become an event where thousands of people attend over two days. The event had a large number of successful and big name fitness and health enthusiasts such as Joe Wicks, Davina McCall, Simone de la Rue, Hazel Wallace and other home grown talents such as Movement 101 and Gerry Hussey. These individuals represent all very different aspects to modern health, from yoga, classes, diets, mobility and even psychology. The event represents perfectly how health and fitness has become the fasting growing industry in Ireland. Be it food, clothing, supplements or health related ideals, Wellfest acts as both a showcase to well established and start up health and fitness related businesses. Wellfest is a very unique event in the sense that fitness and its importance is given a very large and obvious spotlight.

Fitness in Ireland is going through its renaissance period where more gyms, clubs and fitness related businesses are springing up constantly. As time has gone on individual gyms within large urban areas have moved away from the old style of old school, super functional gym that may not have been what anyone could be called pretty. The new model of gym are style functional but they have now needed to be become apart of a larger industry where the best are the best for a reason. The model is perfectly shown in Flyfit and Raw gyms where near 356 day memberships, in several places and functional machinery and equipment with a pleasing aesthetic controlled by people normally with a background normally rooted in a far greater understanding of human physiology and anatomy has gained them some of the greatest success in the Irish fitness scene. Other people then such as the Happy Pear who have turned lifestyle into a successful business have shown that the fitness industry is not solely about gyms and sports clubs anymore.

This is then showcased in really only one event altogether in Ireland. You have yoga classes being held beside mindfulness talks, across from cooking tutorials and mobility classes while a HIT class it booming out across the field and various entrepreneurs passionately push their products and visions. You have people who do not share the same points of view and would rarely get a chance to speak with anyone who holds a different opinion literally sharing the space beside one another discussing their points of view and where they hope they take their own ideals in the future. It is definitely a unique event and it still also shows the growing and somewhat childish side of Ireland where we haven’t yet come to terms with the fitness industry and our knowledge of it. You have a fairly young demographic at the event but it does also show how it is continuously changing and trying to encourage a greater mixture of people to feel comfortable in the industry. This could be seen in the people who brought their start ups tho the event and the addition of a kids section for parents at the event.

Welfest does definitely show the best parts of what the health and fitness industry has to over as well as the growth of this industry in Ireland. The main question is how the event will grow, what direction they’ll try and take it and how health and fitness will mature and grow in Ireland after such an intense period of success and growth best described in an event such as Wellfest who has gone from strength to strength.

Practice What You Preach!

Should you always be able to practice what you preach? Being in a profession within the healthcare system many people have asked me am I capable of doing everything that I normally ask of my clients, be in strength, mobility or balance related. The simple answer is no, I cannot do everything that I often expect and seek from others. This can present some what like an irony that I would not consider myself to me injured or currently harboring a condition but I cannot do some of the things I ask from those that do. The honest answer is that regardless of what you may try and teach someone and expect them to be able to replicate each person has different body structures and capabilities. Each person has also developed differently including their health history regarding the injuries they have sustained and they way in which thy have recovered from these injuries. So very rarely do you find someone who is perfectly functional by the standards we test people. To the extent that when I access someone who is perfectly functional I’m almost shocked.

I have gone through my fair share of injuries so If I was to be tested for things such as ankle or shoulder stability someone may think that I may currently be carrying an injury but as of right this second I’m good. We are not always capable of doing the tests and assessments that we use to grade individuals musculoskeletal health. At times we can hold the testing methods we use a little to strongly. As those who are testing these people and trying to push them forward it can at times create goals that can be excessively difficult for people to cross. People are sometimes not capable of reaching what is perceived to be perfect functionality but most are still capable of doing the sports or events that they wish to undertake. There are always ways around certain functional shortcomings. This may mean doing things in an unconventional manner or simply by breaking activities down to their base elements.

At the same time most people involved in health and sports related activities need to be able to do the basic requirements of that activity. Be it simple skills or some of the functional movements that are heavily demanded in the sport, it is essential purely because to understand the sport and what is demanded of those involved, the best way to help them and make their plan applicable to them and their sports is to be able to understand the sport at a basic level and recreate it. Not to be able to understand every fine nuance of a game but to see the way an individual moves and the way this interacts with surrounding players or athletes can at times be one of the most valuable assets you can have. To understand how an athlete should move in their position and how they normally move themselves can lead you down a path where you realise that they may be carrying an injury or weakness. Seeing a player act differently or out of character can lead you to help them to overcome what may be effecting their game. Behind games, and this is especially true for athletes, lies the core of an individual. So if you cant put yourself in their shoes you may miss the signs behind certain problems. You are not a mind reader although many expect us to be. But at the same time make sure you can practice what you preach, to a certain degree, even to understand where your clients and athletes are coming from to better help them and to allow yourself to keep up with the hectic demands of a physical and demanding job.

Recovery

Road to Recovery

In my profession I help a lot of people to return from injury, be it chronic or acute, it is my job and my drive to get people back to a position where they can return to a healthy and functional condition, if not get them to a position where they can become even better than they were before injury. I have done this and regularly guide, and at times convince people, to give their best efforts towards this end goal. Although I get great satisfaction from helping people to return from injury I have always found it difficult to produce the same level of intensity in my own rehab and return from injury. I myself have until recently been injured or returning from injury for a little over 5 years. My life definitely dramatically changed after injury and lead to a domino effect of injury, rehab followed by complications, rehab and what seemed like an up hill struggle to return to a point where I could confidently under take the activities I wanted to without having to worry about what may happen.

My uphill struggle began in my first few weeks of college when I ended up getting a Talor dome fracture to my ankle damaging all of my lateral ligaments in the process. It occurred in the final three minutes of a rugby game in which a fluke fall and tackle interacted to cause the injury. I had began my Athletic Rehabilitation course and so I had my ankle accessed and was quickly sent to a clinic to get the ankle scanned. Before I made my way to the hospital I went to where I was staying and ended up hitting my ankle off the steps of the stairs attempting to climb them and due to the shock and pain I ended up fainting and collapsing at the top of the stairs. I went to the hospital the following morning but was told there was no fracture, merely ligament damage so I was to just rest it and it would be fine. I proceeded to attend 3 days of college before one of my lecturers told me I was being foolish and was to go home and rest as I was so tired walking around with crutches from one lecture to another that I kept falling asleep in classes.

I attended the hospital several times over the following 2 months where the assessment of my injury changed per visit. This aggravated me and I couldn’t understand where I stood with it all so I decided I would rest it and do my bit of rehab I had gotten and make a return to rugby and normal life. I spent a year getting back to walking normally but something wasn’t right. My entire leg appeared to have rotated inwards and I was unable to walk more than 5 minutes before pain would make me stop and take a break before I could walk again. In this time I had thrown my efforts into gym work and it was a saving grace but there was a very large gap left by rugby and not because I was a skilled athlete but merely because I had played rugby every year up to this point since I was 6 years old. It was a constant in my life at that point and it was where I had made most of my friends through out as well.

I had decided after a year of this that I had finally had enough and went about getting an appointment with a consultant as rehab, no matter how much effort or dedication I applied to it, was no longer helping and I had changed a number of aspects in my life that I would never have even had to give a second thought about previously. Upon meeting the specialist and getting an MRI I had found out that i had a piece of cartilage that had calcified in the center of the joint as well as a piece of cartilage on the medial edge of the joint that had torn away from the joint line. This was not the worst case scenario and key hole surgery was possible so I agreed to a date there and then. I decided to get it done the summer before third year as that was when my placement began and I needed to be able to walk and stand and just move to do it. So i gave up Summer to be alright for the coming college year. I entered the day of surgery and wasn’t nervous. I had learned a lot already and knew what they were going to do to my ankle. I was more impatient if anything. They rolled me in to the anesthetists and nearly as soon as I remember being wheeled in I was awake back in my corner of the ward post surgery. I began to come to and the pain hit me like a truck at first. Each pulse seemed like agony and it felt like someone raised the temperature in that one ward by about 20 degrees.

My doctor soon came over to me and told me the physiotherapist would be with me soon to talk everything out. I honestly only picked up every second word because I had finally noticed the massive full length leg boot I had on. He only stayed a short time but he told me it was a success and that he would see me in a week. I waited around for my dad to show up and take me away so I fiddled around on my phone and let everyone I knew know that that I was out and in a lot of pain. The physiotherapist came to show me how to use my crutches, little did she know I was a seasoned expert at them by now. I feel bad for her now looking back as I was standing and straight over to the bathroom before she even got a chance to fully explain it all. I got my tea and toast and eventually my dad arrived. I was still feeling the effects of the pain and drugs so I didn’t even realise how long I had been under for. I arrived home and went to sleep or at least what sleep was with a massive boot on your leg. My first real day began with me slipping down the stairs as I fell trying to get myself to the bathroom and me having to go to Shannon Doc to get stronger pain medication. Three days later my letter describing the surgery arrived and I read exactly what had occurred. My key hole surgery of one hour had turned into a four and a half hour surgery involving the removal of cartilage, removal of a bone growth, reconstruction of my Deltoid ligament complex and removal of excess tissue from around my Achilles. I had yet to open my boot so after reading my letter I did to notice I had more than just two dots as scars of my surgery.

My plan slightly backfired so I did rehab and work throughout the Summer but it took 6 months before I was back walking again. Thankfully at this point I was deep into the rehab phase and almost back to normal. Normal sadly did not mean I was able to return to the gym or rugby yet with another 6 months of mobility, balance and strength work needed before I was at the point where I could comfortably enjoy a gym session or a long walk again. I finished out my last year of college and just recently started to play rugby again. My body still remembers what to do but its a few steps behind what my brain demands from it. I still have difficulty and am sore to some degree but in comparison to where I was, where walking was near impossible for long periods, its like a whole different world. Looking back as a qualified health practitioner now I can barely believe the way I went about things. I refused to take proper care of myself and even held onto the belief that because of what my course was, that I knew how to sort my problems. Present me can scarcely believe my naivety but it also gave me a perspective on what pain and injury was and how people view their injuries and themselves while injured. Sort of like a person who has never been to a certain location can never truely describe it, long term and chronic injury is very much a unique journey for everyone. Im glad that my road to recovery has come to its end but now the road to performance has only started.