Goal setting for health entrepreneurs

Setting goals for your business is one of those things we all hear lots about when we’re setting out as entrepreneurs. Writing a business plan, knowing what you’ll be doing in 1 year, 5 years – maybe even 10 years time. That’s the right way to do things, isn’t it? Thinking big! Aiming for the stars!

But when we’re up to our eye-balls in getting paperwork for tax, attracting our first clients, watching our finances, learning how to navigate social media and everything else the shouty world of the internet tells us we need to have to run a successful business, who has time to set goals?

The thing is, setting goals for our business is essential to keep moving forward, boost our confidence and guarantee growth.

Without goals we’re all just paddling along doing the same old things, wondering why it’s (often) not working.

Here are my top 3 tips when it comes to setting goals as a health entrepreneur:

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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.

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.

What does Pain mean to you

What does pain mean to you?

Pain is always a very difficult topic to discuss. So many people describe pain in different ways and pain itself and the idea of what it truly is, how its perceived and what we should do when we experience, especially in terms of injuries or activity, seems to change on a regular basis. For a long time therapists use to chase the pain finding the symptoms of pain, leading to initial short term improvements but never caused the pain to fully leave or the true cause to be chased down and dealt with. We as humans became heavily dependent on getting rid of pain so we could function long enough to compete or just get through the day. this lead to many people suffering in the long term, with tissues being damaged and movement patterns leading to injuries merely being ignored instead of changed.  The international association for the study of pain describe pain as “An unpleasant sensory and emotional experience associated or as a result of actual or potential tissue damage”.

In certain sports they have become dependent on the idea of deal with the pain to allow an individual to compete for a long enough period and then to essentially come off injured. American Football is the worst culprit for this and still continues to chase the symptoms instead of the cause.  Sadly leading to the abuse of NSAIDS, painkillers normally injected into an affected area but the overuse of which can cause tissue degeneration. Other sports have already moved away from such methods but often we find ourselves stuck in a situation where we have an athlete asking to play and willing to push through an injury, coaches balancing their want for player safety and need to produce results and therapists stuck between the want of their patient and the knowledge of what is truly occurring to them and what will occur with further stress.

People often want a quick solution and don’t want the hassle of consistent or prolonged rehab or activity when a quick solution of masking the pain will allow them to do the same. America alone spends $323 billion dollar in 2015 on pain medication with it likely to increase to $450 billion by 2021. Obviously this includes individuals taking pain medication for conditions that cannot be cured through rehabilitation and activity but a huge sum of this money is towards people suffering chronic but curable pain as well acute pain due to musculoskeletal injuries or tension.  Looking then to the entire world the money spent on short term relief of pain is astronomical in comparison to the price of what rehabilitation or increased levels of activity cost in the long run. 

The issue with always masking or reducing pain is that pain is not always a bad thing. Pain normally allows for us to find the cause or the issue or the reason behind injuries. It also allows us to prevent ourselves from returning to a position where our tissues cannot, at that time, deal with the loading asked of them.  Pain is a way for your body to protect itself by trying to force us out of positions or activities that is causing damage or this sensation to be produced. Pain not only causes physical changes but mental as both are interlinked to a level where we often cannot control it. Pain will lead to physical change which will lead to mental changes in the form of a change in movement patterns and the reaction to fear. This is often an unconscious factor but often leads to prolonged changes in the way we function. We can also become over saturated with pain meaning we can become hypersensitive to it or almost numb to its presence, both as bad as the other in functional terms.

Pain can illicit a response from several systems including the motor, endocrine, sympathetic nervous and immune system.  Pain also does not always mean tissue damage in the sense of an injury.  For muscle and tissue to correctly develop it has to be broken down and built up, with the correct loading for more avascular tissues. Pain is also exceedingly selective with pain producing a different  response or level of pain depending on its cause or placement of injury depending on the activities of each person e.g. knee pain in an Olympic weight lifter vs a musician. Our body has specific healing phases with each tissue type having a different time-frame of healing. Masking the pain or introducing exterior stimuli to reduce pain before these stages are complete to an excessive level can cause issues where a premature return to activity occurs several times causing chronic problems.

Our biggest issue stems from a mixture of refusing to spend the time needed on correct rehab to produce long standing results and our lives revolving around excessively sedentary lifestyles. We only need to be active in the correct manor for short periods each day but we find it difficult to entertain the idea of it. Time seems to be the real killer with us normally not having the patience or willingness to give time over to what seems hard to make things easy in the long run, instead doing what is easy and maintaining what is wrong for the long run.

Physio v ATT

The Difference Betweeen a Physiotherapist & an Athletic Therapist

My qualification is a B.Sc in Athletic Therapy and Training, meaning I am an Athletic Rehabilitation Therapist. There is often confusion as to what I do when I describe this to people. I often get called a physio, physiotherapist, sports physio, sports therapist, physical therapist or a massage therapist. I am in fact none of these things and an accumulation of skills from all of these things. Athletic Therapists or (AT’s) are not widely known even within athletic and sports circles in a country such as Ireland. This is very different in countries where Athletic therapists are better known and more widely implemented especially in America, Canada and Australia. It is a mixture of people perceiving what I do and making a connection to something like physiotherapy, which is widely known and spoken of.  Yet, when people hear I’m not a physio the uncertainty sets it. It’s concerning when people ask which course I did “was it the 6-week course or the 12-week course you did to become a stretch therapist?” I actually spent 5 years in university and thousands of hours in clinics and pitchside being overviewed and assessed on practising my skills and knowledge.

This is not always a bad thing, more a frustrating thing. Many people ask me “does it really matter?”, and I normally ask them “would you like to be called your title or something close to your title”. Many therapists and qualifications share similar skills, client bases and even places of work. The difference is normally found in our backgrounds, where we learned our skills and they were intended for. Physiotherapists learn in a clinical or hospital setting often attending people who are post-op, suffer from age, disease or extreme injury-related conditions which has affected their physical capability to properly function. Physios normally have to attend individuals who start at a point where slow and steady state rehab is needed. Many physios then go on and learn in greater detail either through placement or further education to deal in more fast based scenarios such as acute injuries incurred by athletes or active members of the population.

Athletic Rehabilitation Therapists are the reverse. We learn in a fast based environment where there is often a shortage of time and excess of individuals such as teams or athletes attending clinics where their aim is to return to activity with the framework to complete most everyday tasks still being intact. AT’s then often learn the slower based and one on one skills later on in their training and in further clinic work when they can better dictate their hours. Both of our aims are the same but it is often controlled by the patients we care for and the environment in which we practice. We learn almost in reverse of each other and we often take differing approaches to the way in which we attempt to rehab our patients. I find that we often show our differences in the way in which we push our clients, this can either be slow with low activity or controlled with a more intensive form of rehab.

It is understandable as to why so many people misunderstand, all the varying therapists and qualifications that are out there. We share the same body of knowledge for most common complaints from patients, we share patients and a competitive environment. What really differentiates us is individual therapists and how they implement their care and knowledge and to whom. I have worked on competitive athletes and people who would, with pride, describe themselves as weekend warriors. I’ve helped people post-op, chronic and acute injuries, musculoskeletal, neural and articular, and the only real difference I think anyone should ever worry about is whether they are going to someone they think can handle the issues you have and that they have the confidence to either take it on with the best of their abilities or has the same amount of confidence to say its beyond their ability to help. As such there are very few differences other than the general public’s knowledge of one profession over the other. This is then something that AT’s themselves must change.

As perfectly stated by the Canadian Athletic Therapists Association; “The treatment varies but the objective doesn’t: an Athletic Therapist’s goal is to help clients return to their usual activities, whether that means playing competitive sports or walking to the mailbox and back”.

The Importance of Communication with Patients

Recently I attended the Coaching Masterclass event held in Dublin City University. Coaching itself is not something I wish to do as a profession but the premise behind good quality coaching can help with dealing with patients and receiving the best quality effort from them.

Often coaches, therapists and others, who would be perceived to be in a position of authority and care, can fail to communicate to the people that come to them.  As professionals in our fields we often talk to athletes or patients and tell them what to do. Not always necessarily listening to their own views and difficulties on the matter. We often lose ourselves in the idea that we know best and that doggedly persevering through any form of set back or failure without making changes will work.

This is of course is a selfish ideal that we can all fall in to. Thinking we know best and that if others just listen to you and do as you say, well then of course they will improve. Sadly this is not true for most. We have seen now for years that not every form of learning will suit each person, “One size fits all” does not always apply.  Within the event better ways to communicate and understand athletes as well as people in general were presented by coaches, sports scientists, sports psychologists and experts of human behavior.

We sometimes act like most people will improve at a steady and homogeneous rate. This is often a trap that health care providers fall in to with set backs and slow progress stumping many of us purely because “Well why wouldn’t it be working”.  Its the exact same way in which we look at performance. We often look at the potential in individuals and we can see where they could end up, but just as many of the people speaking at the event made reference to, you can have the greatest car in the world but it will only drive as well as the person behind the wheel.  Simple example but it holds true to anyone trying to come back from injury or improve their performance. Your body has all the capability in the world, but the effort you put into it and the decisions you make are what determines the outcome.

We normally see this in private when a person can perform to a high standard with ques and a presence to guide them step by step. Adversely we see them falter and become unsure in an open environment with unknowns and the fear of return to play. As such we need to be able to communicate with our athletes/patients in a manner that allows them to grow as an individual with the necessary skills to not only return to general activity but excel in it. These individuals must not be afraid of stumbles and failures as they will be what allows them to grow.

We all want those we aid to grow more and more but each individual is different and cannot always fall under broad methods of training or learning. We cannot merely tell them what to do at every given period. We need to instill in them to ability to return from injury and know the way to prevent re-injury. This can be difficult as most people are in a rush and want to be told what they need to do, step by step. Challenging them while aiding their physical return to play may be what is truly necessary in the long run for player health and longevity within a sport. Knowing the ques for the best result and describe where an individual truly both mentally and physically are also necessary.

Performance as well as the rate a person progresses in their rehab is seen as 90% preparation. If we do not adequately challenge people with factors relatable to their sports or general activities and merely cater to their ability to complete abitrary tasks away from a true to life scenario then we are merely setting them up for a fall. Rehab must become something where the patient, those involved with them and ourselves all share a common goal in mind that we all strive to achieve, a “shared mental model”. This system where we strengthen not just a person physically but also mentally is where we make people return and become even better than they were as staying the same in their position means they aren’t getting better. This responsibility given to the individual will hopefully make them try harder and make them more open to try methods on their return to full health and continuous improvement in their performance, be it on the field of in every day life.