Why New Year, New Me doesn’t work !!!

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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

Mattress Selection & Sleep

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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

The Infinite Game of Health & Wellbeing

Reading Time: 4 minutes

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.

Lessons from Lou !!!

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Many of you might not of heard of the name Lou Gehrig in the UK as our baseball heritage isn’t the strongest! But hopefully by then end of this short article you’ll understand what a remarkable person he was and some of the lessons we can learn from him to apply to our own lives!!

Lou was born into poverty but instead of using this as an excuse he used this as significant driver in his life. Despite a challenging start in he never missed a day of school and regularly attended gymnastics classes at the request of his parents and from which he developed tremendous lower body strength. Despite this he was an ungainly athlete who had to work hard as he was not blessed with graceful athletic movement and technical skills.  Lou was not born a gifted athlete, he made himself into one of the best of all time through sacrifice, dedication and commitment. He didn’t drink or smoke but had the humility to not pass judgement on those around him that chose to. He merely saw abstinence from such activity as the best pathway to achieving the success he visualised and desired. 

Lou Gehrig played 1st base for the New York Yankees in 2130 CONSECUTIVE games for the New York Yankees over 17 seasons in the M.L.B. He never missed a game !!! 

He had a career batting average of 340 including some 495 home runs.  This amazing feat of physical and mental endurance stood unchallenged for 55 years. Lou is a 6th all-time RVI, 2x MVP, 7x All-Star and 6x World champion and M.L.B Hall of Famer.

In addition to these games Lou travelled over 200,000 miles primarily by train and bus playing in exhibition games all over the globe.

He played through illness. Multiple injuries, once being struck on the head by a pitcher who remarked to Lou ‘that will be the end of the run then’.  Despite requiring hospital admission, the next innings Lou was back on the plate the following game. Doctors once x-rayed his hands to find 17 healed fractures, yet Lou had never sought treatment or complained and remained steadfast in his appearances at the plate.

Lou was a ‘quiet leader’ – one that lead by example on the pitch and brought others on the journey with him. Lou was relentless in his routines and a pillar of his success was dedication toward physical fitness.  He had high expectations of those around him and this allowed them to achieve incredible success at his side.  Surround yourself with other like-minded people with similar goals and aspirations and the chances of success are greatly improved.  

Dedication pays dividends.

Discipline isn’t deprivation – it brings it’s own rewards for those committed enough to achieve their goals.

At the end of his phenomonal career, aged just 36, Lou was unfortunately diagnosed with A.L.S (Amyotrophic Lateral Sclerosis) which is a life limiting, neuro-degenerative disease. Yet despite this recent diagnosis he stood at the plate on his final game and gave this speech

2 years after diagnosis he passed away leaving behind him one of the greatest sporting legacies ever achieved

We live in a comfortable era (mostly) and generally standards of living are at their highest for many. Unfortunately, this also allows an age of Alibi’s – people/athletes giving excuses as to why their desired outcomes aren’t attained. 

A primary question to ask yourself is – How much do you want it ???

If the desire for change isn’t strong enough or commitment to change isn’t consistent enough then these goals will be more difficult to achieve or impossible to do so.

A hallmark of Lou’s career was his relentless desire to achieve high standards both externally and internally and thereby influence others around him. You can do the same.

Lou didn’t use excuses not to turn up and perform. You can do the same.

Lou wasn’t a ‘born athlete’  – he created everything he subsequently became through hard work, sacrifice and dedication. You can do the same.

You are capable of more than you think – even in extremely challenging circumstances. Lou often worked in the ‘ugly zone’. You can do the same.

Adversity is a driver for change. Lou was born into poverty but was steadfast in his vision of where he wanted to be in life. You can do the same.

When you find your passion in life – whatever it is – GO ALL IN. Only then you discover how fulfilled and content you can be in life.

This fascinating new epsiode of the High Performance Podcast with Danny Cipriani discusses this topic but also provides a deep insight into performance under pressure and the personal devlopment Danny made as a result.

Lou Gehrig was a remarkable man.

I have to be honest, that before Iistened to Ryan Holliday’s new book ‘Discipline is Destiny’, I wasn’t aware of this giant of sports performance.

I am now, and hopefully this article will make you aware of Lou Gehrig’s remarkable career and legacy along with the lessons we can all learn from him.    

5 ways to boost brain function

Reading Time: 2 minutes

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)

Do I need my test results to see you ????

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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

My pain has gone…I’m better !!

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The most common reason why a patient may seek physiotherapy assessment and treatment is PAIN!

(see this blog post for more on this)

Pain that is in some way impairing function or sports participation, disturbing quality of life or just becoming intolerable. 

And it is sometimes surprising just how long patients’ allow symptoms to persist for before consulting a health professional for treatment. In no small part this is influenced by delayed access to consultation and treatment, self-diagnosis and attempts at google searching a diagnosis and management (see this blog post) or in some just a stubborn stoicism to ‘put up with symptoms’ whilst in others they have an impression that ‘they are beyond help’

In fact, the overwhelming majority of conditions are amenable to treatment and achieve fantastic outcomes.  Take a moment to check out our website, google and facebook reviews!

So, now we understand pain to be the most common reason why a client may wish to seek advice and treatment we begin to understand why patients often judge the cessation of physio treatment often upon pain alone. In the clients’ perspective this was clearly the most important barometer of outcome success. Clients often perceive their treatment to be complete when their pain has resolved but there is often quite a way to go to attain optimal outcomes from treatment and importantly mitigating the risk of persistent or recurrent symptoms.

It might be helpful to view treatment and rehabilitation as a journey. And on this journey (let’s say the destination is full, pain free function) you need to pass through several stations to successfully reach the destination. Each of these stations builds upon the one before and is very important in successfully reaching the end point.

The first (or certainly an early station for most) should be, and often is, resolution of pain. Reducing pain allows improved movement, better sleep and enhanced functional capacity and is often the beginning of the rehabilitation journey.  This vital step allows the brain to move away from ‘threat mode’ and start to normalise movement patterns, build strength and endurance capacity. All vital foundations for later stages of successful rehabilitation and successful return to sport or activities of daily living.

And this early success in pain reduction is where patients may also decide that their rehabilitation journey should end, as pain was their most important reason for seeking treatment. But evidence demonstrates that the absence of pain has poor correlation to reducing the risk of recurrent symptoms. And this is because painful symptoms often leave behind a legacy of altered movement and inhibited strength and endurance capacity. So effectively the body exits this painful episode with reduced load/force capacity, reduced function and impaired endurance.  This then makes it somewhat easier for the body to become over-loaded (as it now has reduced capacity) and the same or other tissues to become pain sensitive. And in some cases the injury or pain recurs and becomes persistent over time.  

To outline typical phases of rehabilitation in most cases it will follow the phases outlined below

  1. Pain reduction
  2. Normalised movement and range
  3. Strength endurance
  4. Maximum strength and force capacity
  5. Rate of force development/speed/power

And this is important to understand irrespective of age, gender, sports participation or functional capacity. The ability to jump down from a step, play football with their child or participate in high performance sport are specific to the individual but the rehabilitation principles remain similar. It is merely the magnitude and requirements of these factors that alters.

Also, this does not necessarily mean that you will require lots more physiotherapy sessions – it is the timing of these sessions that is the important factor.  Each time we aim to see you at a point of progression in the treatment plan thus maintaining momentum and motivation. 

You can be assured that we aim to be as efficient as we can in the smallest number of sessions required and we are fully transparent at initial assessment and in your welcome email. You have decided to consult an expert in their field so it makes complete sense to follow their guidance as they are working to achieve the best possible results in the most efficient way.

Therefore, it is very important that you follow and complete the treatment plan initially outlined by your therapist and this includes continuation of care beyond the ‘painful phase’.  Taking time to rebuild high quality movement, regain strength and endurance will not only lead to improved outcomes but also reduced risk of recurrence.

So, before you may think that you have fully recovered and possibly ask to cancel your session based upon reduction of pain please consider the above information and most importantly open a discussion with your therapist about what areas need to be covered in the remainder of your treatment plan if this hasn’t already been discussed. They should be able to clearly outline your progress along your treatment plan and where you need to head next.

Spending a little time in the short term by successfully completing these phases of the treatment plan can save ongoing, recurrent or persistent symptoms and more lost time from work, sport or just spending time doing the things you love in life!

I hope you have found this information useful

I’d be happy to help further and you can contact me on 07970110526 or admin@active-therapy.com

Or if you wish to book an appointment you can now do this quickly and securely online via our website www.active-therapy.com

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

Andrew Caldwell BSC (Hons) MSc MCSP

Physiotherapist & Sports Performance Consultant  

Clinical Director – Active Therapy Ltd

Sounds fishy!!

Reading Time: 3 minutes

Many people are aware of fish oil supplementation and/or supplement their diet with them on a daily basis for a number of reasons … But things have come a long way from the days of cod liver oil off a spoon!!

So, lets start this blog post with a case study… ME!!!

I had been diligently taking ‘high strength fish oil’ from a well-known, reputable provider for 18 months and I therefore PRESUMED that this type and dosage would be adequate… Big mistake!

Firstly, I hadn’t measured my Omega 3: Omega 6 levels with an appropriate test to provide baseline information. So I didn’t know if my levels were adequate or insufficient. ‘If you aren’t measuring then you are guessing’… Something I tell my clients ALL THE TIME but failed to do so myself on this occasion. And this particular test is REALLY easy to do with a home based, pin prick kit which measures the ratio of Omega 3:6 in your blood at the point of measurement ….

As it turns out despite daily supplementation following the recommended dosage of my provider at the time that my Omega 3:6 ratio was were 8:1. The recommended levels are 3:1 – I was way out !! And upon further research it was easy to understand why as my daily fish oil regimen just wasn’t potent enough nor adjusted for body weight …

So why are fish oils important and why should you be adding them to your daily routine or at least take a test to see if your current supplementation regimen is adequate??

Well let’s start by digging into some basic information on Omega fatty acids …

Omega 3 and 6 fatty acids are considered ‘essential’ because our body cannot manufacture them so we have to obtain them from dietary sources or supplementation. The key aspect is the ratio between Omega 3 and Omega 6 intake ….

Omega 3 Fatty acids are divided into

ALA (from nuts, seeds,meat)

EPA and DHA (from oily fish such as herring/tuna/anchovies/salmon/mussels/oysters/crab)

It is the EPA/DHA concentration that you will commonly see advertised when browsing fish oils on the market ..

And herein lies the first issue – most people don’t eat enough oily fish and many forms of farmed fish such as salmon are becoming lower in Omega fatty acids!!!

So, it is very likely that large % of the general and sports population just don’t ingest sufficient quantities of Omega 3 fatty acids from daily meals alone.   This can therefore result in Omega 3:6 imbalance due to the effects of westernised diets which tend to be higher in Omega 6 and lower in Omega 3 with subsequent Omega 3:6 test ratio’s of 15-16:1 being reported!

Making my test results look quite positive !!

Potential benefits of optimising Omega 3:6 ratio  ???

Reduced triglyceride levels and high blood pressure

Can relieve symptoms of inflammatory arthritis

Can regulate mood state and cognition

Assist muscle recovery after exercise

High quality oils in our diet are the pre-cursors for sex hormone production such as testosterone, oestrogen and progesterone

Improved heart/lung dynamics in cyclists

There is also suggestion that it could assist muscle building in those with sub-optimal protein ingestion.

So you can see that there are a whole range of health and wellness benefits supported by research and many, many positive case study reports (although these are associations as opposed to cause and effect).

In contrast the risk profile for fish oil supplementation is negligible and potential benefit well demonstrated and therefore this is certainly an area for most to consider !!

So what to do next ???

  1. Take a test  – before supplementation begins to ascertain baseline levels and again at 90 days (3 months) after supplementation has commenced

https://www.zinzino.com/2011288434/GB/en-GB/products/Health/309011

  • Start taking Balance Oil daily which is a comprehensively designed, body weight specific fish oil supplement that you ‘shot’ each morning !! The oil also contains other beneficial ingredients such as Vit D3

https://www.zinzino.com/2011288434/GB/en-GB/products/Health/300000

(There are also vegan and water based based options – contact me for more details)

**All balance oils are batch tested and informed sport registered for athlete safety regarding doping control

  • Re-test at 3 months and correlate this to how you feel and your level of daily and sports specific function.

And it’s as easy at that !!!

It is highly likely you will feel some significant benefit from optimising your Omega 3:6 balance such as cognition, mood state, cardiovascular function and recovery from training or injury.

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

Andrew Caldwell BSc (Hons) MSc MCSP

Consultant Physiotherapist/Clinical Director – Active Therapy Ltd

Independent ZinZino Partner

Physio v Osteo v Chiro – Who do I choose ?

Reading Time: 3 minutes

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

Dr Google !!

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