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NEW YEAR, NEW ME DOESN’T WORK !!!!

So now I have your attention…. Let’s expand on this…

This time of year, thousands of people decide that they will change their habits in a positive way …

Be that starting to eat healthier, lose weight, start exercising, cut down alcohol or reach out to the person they have lost contact with …

And whilst at first impression this might seem like the perfect time of year to do so, after a short period of time this good intention may have waned or indeed disappeared altogether!

So let’s look at the reasons why this occurs and maybe offer some alternatives to keep you on track toward better habits, whatever they may be in 2023 …..

When you look at the science and literature pertaining to human behaviour some similar trends explain why humans find it quite challenging to change behaviours and tend to ‘regress to the norm’.  At a brain level we are designed to find the easiest and most convenient solutions to challenges and problems so our brain will do anything it can to reduce friction and avoid barriers to change to find an efficient solution. What the literature suggests is that when we have well defined behavioural patterns our brain tends to super-insulate these pathways at brain level making them easier to recognise and execute.  So, think about that for a second because you can probably recognise several examples of this both positive and negative.  A positive example might be having a protein shake after each gym workout to assist regeneration and recovery.  Whilst a negative example might be using alcohol to cope with a stressful situation. Both are related to behavioural patterns and after a while they become associated behaviours well defined at brain level.

So, if we want to make positive changes where do we start? 

Well, let’s get the big rock out of the way first!!!! CONSISTENCY ……

The reason why people often find themselves making New Year’s resolutions is because their consistency making good choices throughout the weeks of last year has been, well, INCONSISTENT. For example, if you have gained weight this year it’s relatively simple. You have CONSISTENTLY over-consumed calories. If you want to lose weight you need to CONSISTENTLY be in a slight calorie deficit by manipulating nutrition, burning more calories or both. People make this far to complicated or make various excuses. It really is quite simple in most cases.   

Let’s expand on this point because it is so important and often explains why people don’t achieve goals whatever they may be. Setting good habits and remain consistent with them is challenging and often boring for some but it is the solid foundations upon which behaviour change house is built!  Without consistency habit alteration is likely to be successful only in the short term and ultimately fail.

So, how do we achieve consistency ???

Well start TINY. BJ Fogg’s excellent book ‘Tiny Habits’ and James Clear’s ‘Atomic Habits’ clearly outline that most will fail if they set goals too large. I’m sure you have heard the analogy of ‘How to eat an elephant’ – cut it up into small pieces!  The literature suggests that if we set small goals and positively encourage ourselves when we achieve them this is an important step in the process of habit formation. By making things tiny we make them more realistically achievable.

We also need to REDUCE FRICTION.  So, by this I mean reduce and mitigate barriers to change. Make habit change easy and enjoyable. For example, rather than cutting out a problematic food group (such as crisps or chocolate) try reducing them.  Go for reduced portion sizes or lower fat options. Try low/no alcohol lager rather than stopping drinking altogether.   

You also need to create an ENVIRONMENT FOR CHANGE.  Put yourself in a position that makes forming new habits as easy as possible.  Examples of this might be making sure your gym is within 15 mins of work or home to make hitting your sessions as easy as possible.  Or try packing your gym bag the night before so you aren’t rushing around early in the morning and either forget something or miss your session completely. Have a 2-litre water bottle on your desk at work, it is then easy to achieve your goal of adequate hydration rather than having to walk to the kitchen for water.  With regard to nutrition, it is often easier to achieve your goals if you and your partner or whole family are eating the same, healthy meals.  And one of the best things to do is FOOD PREP! Spend 60 mins once per week batch cooking/preparing food for the week as this allows you to be consistent with nutrition and you can also ensure you eat a balanced diet through the week.

Both of these habits help us to keep our MOTIVATION MONKEY happy. BJ Fogg outlines the ‘Motivation Monkey’ in his book as the analogy of an excitable, well intentioned primate that is full of good intentions to form new habits and create new behaviours only for that intense motivation for change to wane over time toward a diluted version of our initial vision. Think about examples of that for a second…. The January gym newbie who by spring no longer attends. The well intentioned christmas puppy owner who struggles to find the motivation to walk the dog in the depths of the english winter. The well intentioned tea-totaller who attends their first social event and finds themselves succumb to a sneaky pint or 2 … We really have to work hard to be consisten and the eaier we can make this the better …

Another very useful approach is to remove clutter and aim to become an Essentialist. In his excellent book ‘Essentialism’ Greg McKeown discusses various issues that people have by saying yes to too many people and essentially over-burdening themselves with options. This then results in people feeling like they are on the proverbial hamster’s wheel, constantly running like crazy yet achieving very little.  If we take some of these principles and apply them to habit change, they can be very useful! As Stephen R Covey popularised in his book ‘7 habits of highly effective people‘, work our what your key priorities, non-negotiables or Big Rocks are, make them a priority and address them first before committing time to other things. In doing this you have a ripple effect that catalyses change in many other parts of your life.

By really focusing on what is important to us we free up time and we can focus better on key things that matter most and have the time to execute them fully and achieve our goals. For example, by trying to cram way too much into each day we spread ourselves very thinly and this results in us rushing things that really matter or not doing them at all. Go back to our examples of food preparation, specific times to hit the gym and packing our bag the evening before our exercise session. If we are over-burdened with non-essential tasks and we are likely to rush or miss the gym session, skip food prep and grab nutrition which might not be the best whilst all the time feeling over-whelmed with things to do thereby increasing friction to change and resistance to new habit formation.

Finally, when you are aiming to set new habits recognise you don’t have to live like a monk 100% of the time. It’s like standing at the bottom of base camp at Everest looking up and thinking how is it possible to climb THAT!  A good rule of thumb is the 90/10 approach. By this if you are getting things right (gym attendance, nutrition, hydration, sleep) 90% of the time don’t sweat about the other 10%. The odd meal you enjoy, piece (not whole bar) or chocolate, beer (1/2 not 10) or glass of wine (not bottle) won’t de-rail you from achieving your goals in the long term. People get very focused on setting weekly targets and sometimes this is too short a period of time when we know most of the literature suggest periods of up to 90 days to set new habits which stick.

So, I hope this article has been useful …… And that the keys message coming across is that you have to set a well-chosen destination but the stick with this CONSISTENTLY over TIME …  If you do this then you will achieve your goals and most importantly change your behaviour and form new and healthy habits

Happy new year and thank you for all your support in 2022.  I look forward to providing you with more useful blogs and vlogs in 2023

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The average human spends approximately 1/3 of their life either asleep or attempting to get to sleep!

Sleep is vital for optimal human function and deprivation of sleep is linked to increased risk of death, increased risk of illness and reduced cognitive performance and mental wellbeing.  Dr Matthew Walker is one of the world’s leading experts in sleep science and outlines the benefits and health risks associated with sleep quality in this fantastic TED talk

So, a valuable aspect of sleep hygiene is the surface upon which you sleep and the effects it has upon both the duration and quality of the sleep you experience. If either is impaired, then the science is clear … IT IS NOT GOOD …

I thought it might be useful to discuss mattress selection as this often-overlooked area of sleep hygiene can result in some profound changes in the quality of your sleep patterns and therefore correlate to improved health and wellness.

The first place to start is the process of how we select a mattress. It’s pretty awful!!!

Considering that we spend so much time sleeping it really is worth getting this right.  Think about it for a second. When we are selecting a pair of footwear for running, we typically have a gait analysis, try several pairs of trainers on, run in them to evaluate comfort and then we make our informed decision.

When selecting a mattress most people might have a cursory perch on the end of a mattress in a bed store or sprawl across it for a few seconds remarking ‘oh that feels soooo comfortable’ spending often less than a few minutes making this choice. Even less informed would be simply choosing what you might think works form the internet and hoping for the best based upon mattress ‘tech speak’ around mattress technology which has tenuous evidence to support it’s claims.   

The good news is that in today’s market there really isn’t any reason why your decision can’t be more informed than this. And this is because several of the large mattress manufacturers offer extended trial periods.  Effectively you can purchase an appropriate mattress, trial it for anywhere between 100-365 days !!! And if the mattress isn’t well suited you can simply return the mattress for a full refund.

I have personal experience of this.  I purchased a mattress from one of the major mattress providers who provide one of these extended trial periods. I won’t mention which one specifically as this isn’t very relevant. I bought this mattress as my original mattress was coming to the end of it’s lifespan. However, I then noticed that I was experiencing an achy, stiff low back upon rising which quickly resolved steadily by mid-morning. Interestingly I also noticed that across 6/7 work trips on different mattress surfaces that these issues resolved only to return when I slept on my mattress at home. I noticed that my sleep was becoming impaired, and I was needing to sleep with a pillow between my knees for comfort.

I was approaching 350 days and contacted the manufacturer as I knew the mattress was within it’s trial period and they initially offered a mattress topper to see if this made a difference, which it didn’t. I established that the reason for my ongoing symptoms may have been that the mattress density was too soft for me specifically. So upon further feedback they arranged free collection and a full refund. I have subsequently used this to purchase another, firmer mattress and within 1 week my symptoms have fully resolved.   My sleep quality has been restored to normal and I no longer need to sleep with a pillow between my legs for comfort.

So. My advice would be to take advantage of these extended trial periods. They really do allow you o make a fully informed decision on the correct mattress density for you (and your partner) rather than investing significant funds in an unsuitable mattress with no form of recourse.

Equally, don’t forget the vale of adequate sleep quality in our health and wellness and the relationship that a good mattress can have to us all gaining a better nights slumber.

I hope you have found this article useful and if you need some further information then check out this article on mattress selection from The Sleep Foundation to which Dr Matthew Walker is a scientific advisor

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This post was inspired by this recent presentation by Simon Sinek. For those of you who have not heard of Simon, or his work, I encourage you to initially watch this presentation and then explore his body of work. It really is inspirational reading/listening and has certainly had a marked influence on my life, how I view the world and also operate my business.

So, what does all this have to do with lifelong fitness and wellbeing you may be asking!

Well, in the presentation Simon discusses James Carse’s work who authored a book called Finite and Infinite Games which subsequently influenced Sinek’s publication called ‘The Infinite Game’. Sinek outlines ‘games’ and how we play them.  Now these can be games in the traditional sense for example football, rugby, etc but this context can also be used to model situations and behaviours.  So in this blog post we are going to use ‘exercise participation’ as the ‘game’.

He goes on to describe that ‘finite games’ have known players, defined rules and an agreed outcome i.e. most goals/points in an agreed time-frame or format WINS the game. And the key emphasis here is the ‘winning’ part.

In contrast ‘infinite games’ have known AND unknown players, the rules are changeable, and the aim is to continually perpetuate the game (keep it going) as opposed to winning.

So, finite against finite works just fine i.e. 2 football teams competing against each other

And infinite against infinite is also stable as eventually as the game/situation evolves 1 person/entity loses the resources or will to continue and drops out of the game

The problem arises when you pitch finite versus infinite philosophies!!

In this context we can use the ‘taking regualr exercise’ as the game. An example of this might be setting a target in the gym, attaining that goal and gaining the WIN!! Or achieving a target weight, attaining that goal and gaining the WIN!! Defined rules, specific outcome often over a defined timescale. Invariably what happens is that if/when people attain this shoort term goal by taking a ‘finite game’ approach they subsequently find themselves in a health and wellness rut as lifelong health and wellbeing is an infinite game !! Common issuues with this are stagnatation, regression or loss of motivation to continue and they subsequently discontinue or become more erratic. The don’t ‘stay in the game’

The other issue with a finite mindset can be that your focus can shift toward what others are doing rather than focusing on your own goals/objectives. This is ofetn further fuelled by the continual daily barrage and consumption of health and fitness related images on social media which only work to re-enforce this obsession with others and what they are supposedly achieving.

Let’s now contrast that philosophy to one which is based on the infinite game principles.  Where the approach is toward goal setting focused upon a vision of your own health and wellness journey and the route this might take and the ‘stations’ it might stop at along the way. But also imagine that the end point of this journey is death, and the start point is birth. And our primary objective might be to be that little bit better than we were last year thereby attaining incremental gains along the way.

Sinek’s suggestion is that adopting a finite mindset will result in stagnation and eventually a lack of will to continue and subsequent cessation of regular exercise.

He outlines 5 principles which are actually based around leadership but can also be adapted toward our health and fitness journey

1. Just cause – a cause so important that we are willing to make sacrifice to achieve it. In this case out just cause is our lifelong health and wellness. There are certain decisions and sacrifices we may need to make to achieve this. For example, a healthy diet, good sleep, positive mindset as opposed to excess alcohol/poor nutrition, continual late nights/erratic sleep and engaging in negative patterns of behaviour. It has to be something we believe in.

2 .Trusting teams – you can view this as supporting others on their health and wellness journey and the ‘team’ is the wider population. For example, when you are in the gym offer the assist/spot, offer support toward those engaged in fitness activities, pass on knowledge when appropriate to help others. These behaviours toward others make them feel comfortable and encourage them to be their best and achieve their goals. Successful companies such as Gymshark are clear adopters of creating inclusive environments and communities I the health and fitness space.  

3. A worthy rival – those who you might know who are more successful at maintaining good health and wellness, positive mindsets or regular patterns of exercise for example. Rather than this be a ‘threat’ which is often the case which then results in people making excuses and avoiding addressing the underlying issues. The goal is not try to try and beat them. Instead view this as an opportunity for inspiration to evaluate our own strengths and weaknesses and make positive change Rivalry is about you advancing not winning! Try and identify some worthy ‘health and wellness’ rivals and draw inspiration from them.

4. Capacity for existential flexibility – the ability to make a profound shift to advance our ‘just cause’. In our example this might be getting out of an exercise rut, trying a new form of exercise, engaging the services of a coach because our motivation and direction have waned or challenging the status quo of our nutrition because better evidence has emerged.

5. Courage – challenge conventional approaches and belief systems. Up until a few years ago dietary sources of fat were seen as the devil and were touted as being linked to cardio-vascular disease and vast numbers of people became ‘fat phobic’. Fast forward to current day when it now commonly accepted, and research supports the approach that healthy dietary fats are essential for human health and the link to cardiovascular disease is not robustly substantiated! Ask questions, gain knowledge and have the courage to challenge the status quo!

So, in life and your own health and wellness journey ask yourself ….

What game are you playing?? Finite or infinite??

The only true competition in the infinite game of our own health and wellness is YOU, and your goal is to ‘stay in the game’. And therefore, the only person we need to ‘out-do’ is ourselves (not others) and what we have done previously.

I hope you found this post useful.  If you have, I’d appreciate a like, share and connect with me on social media to provide some feedback.

I encourage you to watch the full presentation below and consider checking out some of Simon Sinek’s work. I am sure you will find some value from his work.

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I have just read a concise, useful document from James Hewitt, Performance Coach which can be downloaded in full using the link below. I have summarised 5 key points that you might find useful but I encourage you to download and read the full document if you want to improve cognitive function and performance !!

Tip 1  – Nature & Cognitive Performance

Spend 15-55 mins each day outside as studies have shown that visualising natural images (trees/grass/sea) have been shown to restore attention and improve motivation.

If you can’t get outside then look outside through a window at natural images and this can also help

Tip 2  – Nutrition & Cognitive Performance

Consider ingesting 10g of nuts and seeds, omega fish oils and nutritionally dense foods each day to reduce risk of cognitive decline

There has been no diet (vegetarian/vegan/plant based/keto,etc) which has been shown to offer benefits for cognitive performance and brain function.

Tip 3  – Caffeine & Cognitive Performance

Caffeine ingestion is very well studied and has significant benefits (and drawbacks) on cognitive function, alertness and reaction time.

Don’t drink caffeine past lunchtime as it can impair sleep

1 double expresso is sufficient to gain the effects you desire – more isn’t better !!

Tip 4  – Napping & Cognitive Performance

After being awake for 17-19 hours your reaction time can decrease by 50% which is worse than having a blood alcohol level high enough to be arrested for drink-driving !!!

Consider 10-20 mins nap to restore cognitive function and alertness

Try a Nappuccino  – have a coffee just as you are about to nap and the effects of caffeine ingestion will kick in around 20-30 mins later and reduce post-nap sluggishness !!

Tip 5  – Exercise & Cognitive Performance

Exercise has been well demonstrated to reduce anxiety, improve depressive mood states, improve confidence, enhance emotional stability and enhance memory and cognitive function.

As little as 20-30 mins of moderate intensity exercise is enough to incur these benefits

taken from James Hewitt, Performance Specialist

(https://mailchi.mp/42afb44cc87c/jhnewsletter)

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This is a question often asked by clients when they are either contacting the clinic to book an appointment or indeed deciding whether to consult.

So, I thought it would be useful for me to provide some guidance on the subject to allow you to make an informed decision and ensure there are no delays in your treatment pathway.

So, let’s start with a scenario …

You have been to see your GP and they have requested an MRI scan of your lower back (lumbar spine) and you are awaiting your results …

Do you need to wait for the results of this scan to be forwarded back to your GP before booking an appointment to see us?

Well, in the majority of cases, the answer would be NO … So let me explain this a little further …

In many cases these tests are being requested when their clinical indication is far from robust and are often ordered after a limited, non-expert assessment or to appease pressure from the patient who may request ‘I want a scan!’

So, let’s expand this further …

Often a request for imaging is made after a thorough clinical examination by an expert in musculoskeletal or orthopaedic care … If this assessment is limited or compromised then the request for imaging may well be inappropriate and may not alter your subsequent treatment options ..

This might seem a surprise but literally thousands of inappropriate requests arrive at radiology departments around the UK on a weekly basis !!

The second issue is then the timescales taken to request the imaging, generate an appointment, undergo imaging and your referring clinician to receive your results … Often Weeks !!

Weeks of potentially wasted time and delay in your treatment awaiting results which, in many cases, won’t alter the way your condition is managed ….

All requests for tests need to be made to answer a specific clinical question … And this clinical question needs to be based on thorough examination and robust clinical reasoning ….

So let’s suppose you book an appointment to see us and we feel it is appropriate to wait for  your results prior to comencing treatment then we would … In doing so we are still ahead of the game and often provide interim, expert advise on appropriate management of your condition ranging from pain management, exercise and modifications and also detailed education about your condition. This ensures you have a detailed knowledge of your potential condition and can begin treatment without delay …

If you have any doubts, queries or questions then just drop us an email at admin@active-therapy.com and I’ll be happy to help and provide any advise necessary

I hope you have found this information useful and if you have, others are also likely to, so please share as required !

You can view and book an appointment to see us in clinic or online using link below

https://active-therapy.connect.tm3app.com/book/physiotherapy_initial_assessment_treatment

or drop us an email at admin@active-therapy.com

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This is a question that many clients consider when they have pain or injury and are trying to make a decision on which health professional to consult.

So….Right from the start let me be transparent by saying that one profession isn’t ‘better’ than another! The purpose of this blog post is to provide information which assists you in making the correct decision and achieve outstanding results.

My primary piece of advice is to consult a healthcare professional who clearly has experience and expertise in the specific area you have an issue and can assist your recovery. This healthcare professional should be working to evidence informed standards and ensure that you are an active participant in your treatment, and this doesn’t just consist of treatment only, particularly manual or soft tissue therapy only! This re-enforces what we term ‘therapist dependence’ and this is not advocated, nor does it put YOU in control of YOUR treatment ….

So lets look a little deeper at what each of the professions above have to offer and where they might differ slightly. Although it is becoming clear that there is more merging of treatment approaches between professions. For example, chiropractors providing strength & conditioning plans, physiotherapists providing manipulative therapy and podiatrist offering more than just orthotics. All were previously skills which may not have been provided by each profession respectively.

There are differences in assessment procedures between the professions but again the key aspect is to ensure the clinician you consult is utilising evidence informed assessment procedures. They should be able to clearly explain to you, (in language you understand), why they are using a particular assessment approach and what this will tell them. If they cannot provide this information quickly and clearly on request, then please do not continue your treatment.  It’s a major red flag for quackery and financial opportunism!!

Unfortunately, I come across clients on a fairly regular basis who have been previously consulted and were inaccurately assessed and inappropriately treated for their condition and it is clear that their treatment frequency (number of sessions) was excessive for their condition and requirements and clearly driven by financial gain … It’s really disappointing to see !!

As a rough rule to follow (and many of the private healthcare companies for that matter) if you don’t observe 75% improvement (pain/function/movement) within 4-6 sessions of ANY therapy then question if that particular approach is an effective way to treat your condition. In fact the clinician you are consulting should also be making this same consideration thus offering evidence informed treatment and also ensuring their treatment is effective and cost efficient!

*this is not specific advice and treatment duration/sessions can vary dependent upon individual circumstance.

Again, to provide insight your treatment pathway should roughly follow the following journey

1. Reduce/control pain
2. Restore/Normalise movement
3. Build load control/strength/functional capacity/endurance
4. Develop ability to express force/power
5. Return to work/sport

It is clear to me, from 23 years’ experience as a specialist clinician, that clients often get stuck in Phase 1 with repeated sessions focused on soft tissue/manual therapy and little progression toward restoration of functional capacity or sport’s specific function.  This vital piece of the jigsaw puzzle is so important if we are to reduce the risk of recurrence in many common musculoskeletal complaints such as back/neck pain, knee pain and shoulder pain and mitigate sports injury risk the lowest levels.  

So …. The next time you are in pain or have sustained an injury take a little time to research your options and consider the following points …

1. Evidence informed treatment – using up to date research and their own clinical experience to manage your condition
2. Education – Your therapist should be able to vlearly explain your condition, the treatment options and estimated timescales for recovery and required number of treatment sessions (at Active Therapy ALL this information is included in our welcome email after your initial assessment)
3. Review progress – if you are not achieving acceptable results after 4-6 sessions, PLEASE consider another approach and discuss this with your treating clinician who should be able to provide clear information on why their treatment has/has not achieved the results they outlined.
4. Self-management – if your therapist has provided exercises (they absolutely SHOULD be doing this) then please follow them to the prescribed levels. In clinic treatment AND self-management combined offer the best outcomes for most conditions under treatment.  #
5. ASK – if there is anything you have concerns about, you are unclear about or just doesn’t feel ‘right’ then initially discuss this with your treating clinician and following discussion you still don’t have the answers you require then WALK AWAY … Get another opinion. At the end of the day it is your body, your treatment and you need to feel confident that you are receiving the correct treatment and you are actively engaged in this process …

I hope you have found this information useful.  The post is intended help clients make decisions on the correct treatment for them. As you can see there are several options available and at times this can be a challenging decision for non-medical service users to make !

If you have any queries then please contact me at admin@active-therapy.com or 07970110526 and I’d be happy to help further

Look forward to meeting you soon and helping on your journey toward a pain free, active lifestyle

Andrew Caldwell

Consultant Physiotherapist

Clinical Director

Reading Time: 3 minutesEach week in clinic I have several conversations with clients that start something like this ……..

‘I have been on google and think I have got ‘X’.

The Dr Google issue !!

Where ‘x’ is a specific diagnosis that the client has arrived at themselves often after trawling the internet researching their symptoms. Sometimes this may be in the ball-park but often the client has ended up down a diagnostic rabbit hole and arrived at an erroneous diagnosis. Often times this then leads to discussion unpicking perceptions and belief systems that in some cases have been fairly well ingrained.

The internet is a groundbreaking development which has changed all of our lives remarkably by providing instant access to information. But can be both a blessing and a curse!

The 2 largest contributors toward errored diagnoses are firstly the fact that google has no quality filter. And by this I mean that anyone (irrespective of experience or qualification) can upload information and/or video to google and often this information can be either inaccurate or non-evidence based.

And secondly the client researching this information is not a clinician (most of the time) and therefore the context of this information is often mis-interpreted.  When we assess clients in clinic, we use expert clinical reasoning to put the symptoms reported in context and use evidence informed assessment procedures together to arrive at a specific diagnosis. One of the most important aspects of this is how the information is interpreted and then used by the clinician to administer treatment and guide self-management.

The positive of researching symptoms online would be that you are beginning to understand some aspects of your condition and this may be valuable if you are looking in the correct area.

So, an analogy I often use in clinic would be that of using a plumber to fix my boiler. If my boiler fails or has issues I don’t go on to the web or you-tube in an attempt to try and fix it myself. There are a couple of strong reasons for doing this. Firstly, if things go wrong then I will put myself and my household in a compromised position.  Also,  if the work isn’t completed by an accredited professional then my home or boiler insurance may be invalid. And lastly I am wayyyyyyy more likely to get things wrong as my knowledge and skill base is novice level compared to my local plumber who is an expert in his field. But when we put this in the context of a client self-diagnosing and treating themselves, I often observe that many are willing to take a chance on getting things wrong, attempt self-treatment and this often results in prolonged symptom duration and poor treatment outcomes.

One of the key aims is to gain an accurate idea of the exact nature of your condition from which everything else flows and great outcomes are achieved! 45 minutes with us (or any expert clinician) is well spent getting a really clear idea of your diagnosis, treatment and timescales to recover. We will outline our recommended treatment if appropriate and/or provide exercises and self-management advice. Many clients do need ‘hands on’ treatment but not all!

There are some great sources of information on the internet and in another article, I’ll be highlighting several portals you can access with confidence knowing that they provide accurate, evidence-based information that have been screened for quality by me personally. You (and others) can then access this information to find out more about your condition and/or others as they may arise.

Education is such an important part of understanding your condition and place a premium on this at Active Therapy. But equally this information needs to be accurate and specific to you and your specific condition and requirements. What may be suitable treatment and management for 1 client may not be correct for another even if they present with the same condition. And this attention to detail is again another area we place a premium on when we assess, manage and treat clients.

So, you can see that initially it might seem like a great idea to surf the internet, attempt to self-diagnose and treat themselves. And this can give some acceptable results with regard to reducing pain. But there is progression to treatment which achieves the best results and using pain as a guide to success is flawed as we often observe clients with recurrent issues or persistent weakness because their treatment is incomplete, or they attempted self-management with sub-optimal results.

We prefer to get things right from the get-go, keep treatment to appropriate amounts and then most importantly empower YOU to understand and effectively manage your condition and reduce the risk of ongoing issues.

I regularly say to my clients at discharge ‘In the nicest way I hope not to see you again with the same problem!’ which is meant with the greatest respect and sincerity if we have got things right and the client continues to follow the advice provided.

I hope you have found this information useful but please also contact me at admin@active-therapy.com or 07970110526 and I’d be happy to help further

Look forward to meeting you soon and helping on your journey toward a pain free, active lifestyle

Andrew Caldwell

Consultant Physiotherapist

Clinical Director

Reading Time: 4 minutesMany clients when they first attend physiotherapy sessions remark ‘I’ve never had physio before and I’m a little unsure what to expect!’. So, I thought you would find it useful for me to outline a physiotherapy assessment and treatment session to provide further clarity and answer any questions you might have.

The process of treatment actually begins with very thorough assessment which allows us to develop and treatment plan and subsequently deliver very targeted, effective treatment. After welcoming you to our clean, spacious and private clinic area we begin the assessment by discussing your presenting problem – the main issue that is causing you problems and has resulted in you picking up the phone or sending us an email to address that troublesome pain or injury!

And this is where we stand out from the crowd… And whilst it might sound simple this aspect of assessment is SO important …. WE LISTEN!!!

Yes, believe it or not one of the main frustrations that clients report to us is that no-one has taken the time to allow them to tell THEIR story and thus describe THEIR main problem of concern …. Clients often describe being rushed in and out with inadequate time or that the clinician they consulted didn’t actually listen to their primary complaint or they felt ‘fobbed off’ …. This part of an assessment called the ‘subjective assessment’ and lasts around 15 mins.  This part of the assessment is the patients’ story and at Active Therapy we let you tell this story, guiding you through with specific questions which allow you to fully detail your issues.  We do this without putting words into your mouth nor do we use confusing, medical terminology you won’t understand (but if you are medically literate then of course we will!). This is a very important part of the assessment process as it provides very important information which we then use to help arrive at our clear diagnosis of your complaint and subsequently deliver the most appropriate treatment in conjunction with your own preferences of the options available. By listening to your story, offering you the treatment options available and delivering targeted treatment we achieve outstanding results and get you out of pain and functioning optimally ASAP ….

So, once we have had a good chat about your main issues and you are much clearer about the potential reasons for your pain, injury or sports performance deficit we move into the ‘objective assessment’.  This part of the assessment is the clinical examination can be quite varied dependent upon your condition and the information we have gained from the previous ‘subjective assessment’.  We use research based, very detailed assessment procedures that provide clear information from which we can arrive at a diagnosis.  This part of the assessment often involves being partially undressed as we need to see all appropriate body parts during the assessment to provide the optimal level of information. But don’t worry often shorts (and strappy top if you are a female patient) is sufficient. We always provide professional and private conditions for assessment, and we can always modify the assessment if you feel in anyway uncomfortable. We often find that patients have been assessed whilst fully clothed and since the pandemic maybe just over the telephone.  Both these examples would significantly compromise the accuracy of assessment and most probably lead to misdiagnosis and thus mis-directed treatment and sub-optimal outcomes.

**Please note that all patients under the age of 18 must be accompanied by a parent or guardian during the assessment process.

Once we have completed the physical part of the assessment (around 15 mins duration) we use the information from both the subjective and objective parts of the assessment, along with the results of any tests to date to arrive at the diagnosis of your condition.  This might be problem with a specific tissue (such as a ligament tear) or maybe cumulative overload resulting in pain (too much work in the garden or training overload in the gym for example).  This expert analysis of all the clinical information allows us to form a ‘clinical impression’.  Our lead clinician is an expert in their field with over 20 years’ experience working exclusively in Musculo-skeletal, orthoapedic and sports physiotherapy environments.  We do this expert work, day in, day out and as such we aren’t ‘general’ practitioners. This is in no way dis-respectful to your GP who deal with a whole array of conditions and often don’t have the extended depth of assessments skills or adequate time to accurately assess you and therefore arrive at an accurate diagnosis.  So, for a typical patient with low back pain, you are better placed to see an experienced physiotherapist as your first contact as in the overwhelming majority of cases this will result in an accurate diagnosis and most importantly this is the evidence-based form of treatment required in the vast majority of cases.  If your physiotherapist has any concerns that your condition might need medical assessment, they will refer you to your GP.  The correct pathway has been followed – happy patient and happy GP – huge WIN WIN for all concerned!

But the key thing to understand regarding this is that we EDUCATE you about the diagnosis so that you clearly understand this information, how this effects your treatment plan and what we expect you to do as part of your treatment such as home of gym-based exercise plans.  As part of this process, we can provide timescales for treatment and return to activities of daily living and sport that are of particular importance to you.  We aim that no client under our care leaves our clinic room after that first session with questions and you have a clear understanding of your condition and treatment.  But just in case you do have any queries then you can drop us an email 24/7 and we’ll come back to you ASAP to clarify any specific questions you might have.

Education and understanding are really important factors in clients achieving outstanding outcomes!

And here at Active Therapy we place a premium on high quality, detailed education in language our patients understand.  And for those of you who are visual learners that learn best through images we have a large screen monitor in the clinic room so we can pull up helpful images as part of this process.

So, as you can see the process of physiotherapy assessment and treatment is detailed and targeted and at Active Therapy, we are experts in arriving at accurate diagnoses, providing laser focused treatment which achieves outstanding outcomes!

I hope you have found this information useful but please also contact me at admin@active-therapy.com or 07970110526 and I’d be happy to help further

Look forward to meeting you soon and helping on your journey toward a pain free, active lifestyle

 

Andrew Caldwell BSc (Hons) MSc MCSP

Consultant Physiotherapist

Clinical Director

Reading Time: 3 minutesThis is a question that clients quie rightly ask or ponder at some point when they are thinking of booking an appointment or during the course of their physiotherapy treatment…. And it is important that both client and therapist have a clear and transparent understanding with regard to this at the outset of their treatment pathway …

However (and not to sit on the fence) the cost required to achieve a successful outcome can vary between individuals, their condition and their expectations and specific requirements… So let’s think about a few areas that might influence the number of sessions you require and therefore the cost incurred to achieve that ultimate goal …. A great outcome and a positive experience whilst under our care ….

So, firstly let’s look at the condition requiring treatment. If we look at most common musculoskeletal complaints such as spinal pain, shoulder pain and knee or ankle pain then most patients under our care experience significant reduction in pain and improved function over a timescale of 3-12 weeks and 3-6 sessions of treatment (these are average examples).  You can see already there is variation and this really does depend upon factors such as the duration of symptoms prior to consultation, pain severity and nature, ability to attend treatment sessions and commitment and diligence with prescribed exercises.

Also if we compare a condition which is acute such as a new muscle injury against a long-standing condition such as an degenerative joint then we are likely to see that the acute condition has a more efficient healing potential and therefore might heal in a typically shorter timeframe. That is not to say that we can’t get rapid results with long-standing issues at all but merely an average and typical observation.  In addition those who have required surgical intervention will follow specific timeframes for healing that often are set by their surgeon and then rehabilitation criteria set by their therapist. For example an ACL reconstruction (knee ligament operation) typically requires 9-12 months of rehabilitation as opposed to a sub-acromial decompression (shoulder operation) which might only require 12-16 weks management. You can see how this might effect treatmemt requirement and therefore cost.

Evidence informs us that those clients presenting for initial assessment with high severity pain are likely to experience a slower prognosis to an optimal outcome. That doesn’t mean those clients cannot achieve great outcomes more so that treatment might take slightly longer.  And this might not necessarily mean that you require more treatment sessions but merely that the duration of treatment might be slightly longer.

If we then look at the relationship between the therapist administering the most effective treatment or prescribing targeting exercises (we aim to get this right every time !!) and then subsequently a client fully committing to the treatment prescribed (by attending planned treatment sessions) and being consistent with their prescribed exercise plan we see further variation which can influence cost. For example if client’s do not attend treatment sessions at the intended frequency then we might see treatment effect dissipate and if exercises are not being completed as the treatment plan outlines then they are less likely to be effective. So you can see theta treatment is a partnership between the therapist and client and the best outcomes, in the shortest timeframes at the lowest costs are achieved by both committing fully to the treatment plan. So before you engage in physiotherapy treatment you have to ask yourself an honest question – Can I make time for any prescribed exercises and/or other pertinent information provided to me by my therapist. If you can’t make this commitment, then we probably aren’t a good fit for you as you are unlikely to achieve the results we would aim for.

At the heart of our core philosophy is provided outstanding care that is cost effective for all our clients. We balance the relationship between cost and effectiveness for all patients and you can be assured of a professional approach. And we are transparent about how many sessions you might require and the costs involved. When compared to others with our expert levels of experience we are highly competitive.

Andrew is a musculoskeletal and sports physiotherapy specialist and the assessments provided are comparable to specialist such as orthopaedic surgeons and sports and exercise medicine physicians. However our costs are much lower £50 versus £225-£250 (typically 25% that of an orthopaedic surgeon) for a detailed 45 minute assessment which provides you with clear diagnostic information.  GP’s (unless specifically trained) are not experts in musculoskeletal assessment and treatment and access can be difficult.   Therefore why not choose to be assessed by an expert in this field, over a typically longer assessment timeframe and for a fraction of the cost?

That’s looks pretty costs effective to us !!!

I hope you have found this information useful but please also contact me at admin@active-therapy.com or 07970110526 and I’d be happy to help further

Look forward to meeting you soon and helping on your journey toward a pain free, active lifestyle

 

Andrew Caldwell

Consultant Physiotherapist

Reading Time: 3 minutesPain is probably the primary reason why anyone would seek assessment and treatment from a healthcare professional and remains the most common reason why clients initially contact Active Therapy…. The presence of pain causes reduced quality of life, altered movement and function, disturbed sleep and doesn’t make us particularly positive in mood state … It can cause lost time form work and sport and result in stress, anxiety and effect our relationships with others …

But believe it or not many people ‘put up’ with pain often thinking there is nothing that can be done or the ‘pain will look after itself’ despite having painful symptoms for weeks, months and sometimes years!

So let’s look a little deeper at some of those areas to help you understand the role of physiotherapy treatment in reduction of pain and the fact that the overwhelming majority of conditions are successfully treated.

Pain often begins from 2 primary mechanisms, either cumulative forces which result in tissue overload and subsequent pain or traumatic onset pain related to incident or injury. For those presenting with cumulative onset symptoms (these are typically the majority of presentations) we have to act like body detectives and understand the contributory factors that may have caused the pain rather than merely treating symptoms. For example this can be related to how you move, tolerate loads in daily life or sport and maybe of you have introduced new patterns to movement, training or occupation that have resulted in pain due to tissue overload.

A good example would be the client who presents with back pain which begins when completing a movement they have performed many times before (bending forward, turning, tying shoes) who experiences acute onset low back pain. It is unlikely to be THAT specific movement which has caused the pain. It is typically the point at which the tissue become over-loaded and they experience.  So often a little detailed questioning allows us to understand exactly why pain has occurred at this specific time.

For those who experience pain during incident or trauma  we need to fully understand the mechanism of injury as this guides our thoughts and assessment toward the target tissue that may be injured.

Our process ALWAYS begins with education – what has caused the pain, why things hurt and how am I going to get better?  The treatment process often then begins with reducing a client’s pain level so they can move more freely, sleep better and function better in life.  And this allows the rehabilitation process to really get going where we normalize movement, regain strength and support clients back toward normal life and return to sport.

But pain itself, or the absence of pain, is not a strong indicator of full recovery. Whilst it is the single most common reason clients arrange consultation it is a poor indicator of when you are ready to be discharged from care.  Instead we evaluate pain, strength, function (life and sport) and treatment progression to indicate an appropriate point for discharge.  This means that when we fix you we really hope not to see you again with the same issue!  Unlike many other clinics we do not advocate therapist dependence, regular ‘check up’s’ or MOT’s  – unless there is very specific indication to do so..

Instead we provide comprehensive treatment and rehabilitation then provide YOU with all the advice and exercise at the point of discharge that you need to self-manage your condition thereby empowering you to take control of your own care. We find this to be much more effective and powerful way of managing the conditions we treat …

So… If you are in pain …

Don’t let things linger as in the majority a cases we get fantastic outcomes in very short periods of time

If you have had symptoms for quite a period of time then don’t despair … Even when clients present with persistent pain which has been present for many weeks, months or years we can often achieve fantastic results by taking the time to expertly assess and focus treatment around specific known to result in effective outcomes ….

I hope you have found this information useful but please also contact me at admin@active-therapy.com or 07970110526 and I’d be happy to help further

Look forward to meeting you soon and helping on your journey toward a pain free, active lifestyle

 

Andrew Caldwell

Consultant Physiotherapist

Clinical Director