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.

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.

Trying to Set Up a Business

Recently I have been trying to find myself a place to start my work out of. This is always a difficult scenario for anyone hoping to start working for themselves. We spend so long becoming experts in our own fields, while learning this and taking instruction from others, that we often don’t learn more practical skills such as how to do taxes, how to sort our accounts and how to approach setting up a business. Sometimes we become so single minded that we often forget that we aren’t going to simply be able to apply to a single workplace and get that job we want or be able to find the perfect place to set ourselves up with the right number of clients and atmosphere in the area.

Starting a business starts with a lot smaller scale work which I actually find much harder. Setting up various contact pieces such as a website, Facebook page and getting in contact with people, handing out leaflets and business cards. So essentially social aspects and foundations to the business itself. I am not the best when it comes to going in to people and chatting to them about business. Not the actual talking aspect but the part in which you initiate the conversation or send off that first message. This is the same for many people who also find these interactions difficult.

Starting this has really made me far more aware of how much more I still have to learn. Dealing with patients and their injuries is now my normality. Dealing with having to find a space to work out of, put funds together to pay for it, pay for necessary equipment, getting a business card put together and printed, advertising and then keeping track of all that while sorting out insurance and deciding what type of business I should become not so much. These were not things that were going through my head as I walked up a small flight of stairs to receive my degree. I had ideas of having a small holiday and the apply to a couple of clinics and teams and start off from there. That didn’t quite play out the way it did in my head. If you are lucky and skilled enough to find work in an established clinic, you are definitely in a good place and your work probably reflects that you deserve it as well. If you haven’t then its a case of finding out exactly where you stand in this industry and what you do with yourself and that’s a big question.

I had never initially intended to go off and try to set myself up from the beginning. I did not think I needed business cards, a website or anything that would be something for myself. I imagined a few years of working in a fairly safe position, working hard and then maybe going off on my own and after a few years of learning everything I needed be able to set myself up hassle free. I was fairly naive when I see it written in front of me. People told me various different things like “It’ll all happen in time” or “Don’t worry these things sort themselves”, these are not phrases that build confidence. Then someone who is now my business partner and pretty much does all the hard slog to allow me actually do what I want to do simply asked me”Why aren’t you setting up your own space and work for yourself”. It was such a blunt and harmless question but I couldn’t think of an answer that didn’t revolve around “Well people normally work for someone established first and then try and sort themselves out”, except that’s what I thought and I was wrong, as much as that pains my ego.

So here I am attempting to establish myself as a real adult, I mean therapist. With my own space and equipment, with all the social media pieces and contact foundations and I still haven’t really started as many people have already told me, who understand how business really is, that “You never stop, you never finish, you merely keep growing or you fail”. Hearing that actually makes me nervous far more than I ever thought because the idea of failing seems horrible but realistically how would anyone learn if they didn’t fail and try again. Or as my business partner said “If you fail when you’re this small at least not that many people will notice”, which made them laugh and nearly made me hyper ventilate. So here I am panicking over things I shouldn’t and then not even being worried about the actual work itself. I am probably going to end up making everyone a nervous wreck around me until I actually have that very first patient and then after that I’ll be hooked.

Yet if I could give anyone who wants to open up their own clinic or some form of work revolving around health care, look into how businesses actually function, look into social media and how to talk to people and if possible find someone patient enough to help and put up with you because and speaking from experience you will freak out and only afterwards will you wonder why. Im still not really in a position to give advice as I am pretty much as big a noob at all this as there could be but its a case of swallowing all that ego and fear and being ok with a few set backs as long as you keep moving foraward.

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.

 

The Fear of Re-Injury Stopping Return to Activity and Perforamance

A topic that often doesn’t get discussed very often is the psychological aspects of returning from and injury. Whether it be returning to sport or just everyday activities and work depending on the level, type or location of injury many people will struggle to return to normality issue free. I don’t just mean people struggling with debilitating issues mentally regarding their return to health but many people will have times where the struggle mentally in recovery.

Injuries are something that can suddenly shake our attitudes and confidence which in itself is an unsettling feeling for most. We all very much feel that we can just bounce back and if you can all the better. Sadly at times the road to recovery is slow and an uphill struggle. The grind to return is at times monotonous and frustrating especially severely acute or long term chronic issues. I think many people do not give themselves enough credit for the efforts they put in their attempts to recover. We often see athletes and the injuries they go through and we belittle the issues we have ourselves. Its true athletes normally receive far worse types and degrees of injuries but many athletes will have several major injuries and returns to play in their career while having a well developed support system that to them, unless very serious, its just another speed bump in their business.

Yet the fear and difficulty of injury can be intense for even those in the general public. Injuries makes us feel fragile physically and mentally where we fear hurting ourselves or re-injuring the affected area again which makes us overly cautious and, in a vicious cycle, makes us more likely to hurt ourselves.  We become nervous of the movements or actions we do that caused the injury so we limit the movement or stop that activity all together. This means our tissues become accustomed to this reduced level of activity meaning in return it takes far less force to injure ourselves. This dents our mental fortitude further and is the cause for many to give up on many new sports or activities. This fear is not something only attributed to the general public, various studies have shown that athletes at a high level express greater levels of fear even after one injury when returning to sport , with certain studies even showing that fear, due to the possibility of injury, can cause stress hormones to be released, reducing the quality of tissue; e.g. https://journals.humankinetics.com/doi/pdf/10.1123/jsr.2017-0075

https://www.ncbi.nlm.nih.gov/books/NBK278995/

Speaking from experience of returning from injury to sport, the fear of pain can be worse than experiencing the pain itself. Pain does not always means we are at risk of injury. It is the ability to educate ourselves and overcome this fear logically to allow us to return to ourselves that we all need to become far more accustomed to. Fear is natural, but overcoming that fear and not letting it control the way in which our very bodies act is one of the most important things after an injury.

This is just a very simple video showing that injuries happen and the mental aspect of returning from injury is far more important than we all think.