65fb40e522504d2aa3c7ec52bf3984e6

Pain is a complicated beast

Sat, 02 Apr 2022 16:06:06 GMT

As the title says, pain is a complicated beast. Through high quality research, primarily in the last five to 20 years, we are confident that pain is an output of the brain.

The correlation between tissue and joint damage and pain? Well, there is no correlation. You can have significant arthritic changes and be ‘too busy for pain’, but equally you can have ‘healed tissues’, yet still have pain.

Think of the examples of people walking across hot coals and broken glass pain free. Closer to home, I have had people come to my clinic with pain due to their bank loans, their job, lack of sleep, excess caffeine and even Brexit! Remember how painful a paper cut is yet the tissue damage so minimal.

During your initial consultation, and if appropriate future sessions, the source of your pain will be discussed. Chronic pain tends to have poor patterns, occurring at random times with random intensity. This is due to sensitisation and rewiring in the brain, along with chemical release and neurophysiology changes. Neuropathic pain will be described as burning, sharp, stabbing and will be originating from a nerve injury, such as sciatica.

Nociceptive, touching, pain, such as dropping something on your toe, will be more of a dull ache spread over an area and usually short lived.

Inflammatory pain will again vary in severity and not present with much of a pattern but is more likely to occur post an activity than during.

Different pain presentations require very different approaches if we are to be successful in addressing that pain source and often a patient will present with a number of sources.

Finally, it’s worth considering the language we use to describe our pain. The patient’s experience and attitude towards their pain, and hence the language they use, is a unique to everyone.

By helping you understand your pain and your experience, my goal is to remove the threat and begin your journey to resolving your problems.

Giving you the potential to move

Wed, 21 Apr 2021 08:38:58 GMT

Movement can lead to pain but not in the ways we used to think. Following an injury, tissues recover from their inflammation and damage but quite often we don’t return to moving the same way.

Adapted movement strategies from the time of tissue injury can remain even when the tissues have healed and they can lead to pain, stiffness and weakness even thought the original injury has recovered.

Giving patients permission to move again, the best example being to bend your back, can have profound healing effects. I have had patients who bend their back fine but still have a fear of emptying the dishwasher because that was the source of their original injury. Similarly, there are people who do their exercises really well, but still haven’t returned to normal movement - such as getting out in their garden - post their initial incident.

Identifying the individual issues that matter to that person is the key to getting them better.

Through talking to you and assessing which tissues need flexibility, lengthening and mobilising and which tissues need waking up and strengthening, I can give you specific exercises. These exercises will give you the potential to move, but quite often people do their exercises, but still move with fear and unnecessarily guarded actions.

Movement exercises specific to your lifestyle your hobbies, your fears and your goals can be the key to resolving your pain and problem.

What to expect from video physio - and what I have learned during lockdown

183:766310543 (John Moore) — Fri, 12 Jun 2020 14:32:21 GMT

Vigorous research shows us that video consultations are as effective as face to face, offering high levels of patient and practitioner satisfaction.

Telehealth or video physio is just an innovative use of available technology to deliver a similar service, within the ease, comfort, convenience and safety of your own home or office. It may actually offer a better service for you with less anxiety, no travel and other benefits, such as being able to see you in your own environment, such as your office set-up.

Clinically, the same level of data protection and clinical note taking is applied. Payment can be made by cheque or BACS transfer. All insurance companies are supportive of video physio.

The end goal is the same:

To get you to understand your condition
Coach you in the skills to gain control
Give you lifestyle strategies to self-manage your condition

The process is similar and straightforward:

Get in touch - ideally by phone, but email and message can also work
Pre consult chat - to make sure you understand the video process, understand the COVID-19 safety issues and to make sure you are appropriate for video physio
Initial consultation - with a follow-up summary and personalised video and email/message
Follow-up sessions - these will vary on frequency and duration dependent on your needs, goals, time and available funding

Answering the video call is just like opening the door to my clinic. This session will be your initial subjective , in-depth consultation. I will listen to your story, ask questions to understand your pain and your goals. I will ask further questions to ensure no further investigations for more serious pathology is needed.

I will then guide you through a physical objective examination, including:

Specific clinical movements, such as forward flexion lumbar spine
Functional movements, such as go ahead and touch your toes or reach up to a shelf
Strength and flexibility tests as appropriate
Special clinical tests as appropriate to your injury
Self-palpation - getting you to feel your tissues and feedback to me

Then give feedback , educate and provide specific rehab:

I give you feedback and educate you so you understand your condition and remove any threats and false beliefs
Provide specific rehab at the correct frequency based on your severity, irritability, and specific injury
A video of your specific rehab will be sent to you for use as a referral tool. I have had only one patient in the last three months unable to access their video

Then arrange future follow-up sessions – this will be individually assessed.

What has the last three months taught me?

Don’t leave the window open as the cat may walk in!

The same level of professionalism can be maintained with video link, as long as you set up good protocols.

It has reinforced that listening to the patient is so much more of the assessment than the hands-on and physical assessment.

People can’t see your cup of tea if it’s behind the weights and stretch bands! However, the screen does show you so much more than you think as long as you can educate the patient to be further away from the screen than they believe they need to be.

If a patient holds their device and the screen wobbles, I get a headache!

Nearly all patients are a little pessimistic of the potential for success with video

physio. Nearly all patients are equally chuffed when it works really well for them.

Video physio is incredibly empowering for the patient.

It is still possible to empathise and care on FaceTime. Maybe it is the neutrality of the venue.

There is a certain level of convenience for patient and clinician that you get with video that cannot be achieved at the clinic.

Here are a few reviews from patients who have had recent video physio:

" Thanks John, as a reluctant patient, this turned out to be one of the wisest personal investments I have made.

The long term pain in my shoulder has reduced to a mere memory. I'm grateful for your professional 'do this to fix it' guidance. I needed that! Also, I appreciate your awareness of how best to convey important elements, I noticed you adapt as the sessions progressed. Many thanks for getting me out of a progressively deteriorating problem.” Martin

"Many thanks for your great services - I am much better now and did my run this morning without any more difficulty than usual. I hope that if I need your help again it will be in person, but it is useful to see what is still possible by remote consultation!"

Philip

Being kind to yourself

Thu, 09 Apr 2020 09:28:48 GMT

Stress and pain can be very closely related. Think of those phrases of ‘being wound up’, ‘stressed out’ or ‘uptight’. The biology of stress is very different to the biology of being relaxed. Our inner chimp is just one part of our brain that determines why and when and how painful something is. Some stress is good, but prolonged chronic stress can lead to many health problems.

In our current world the potential for pain driven by stress is an increasing one. I have developed skills that enable me to educate patients as to the source of their pain and address their underlying stress drivers.

Chronic stress will manifest itself in a number of ways. While some stress can be good for you; prolonged exposure will change your biology. Altered neurophysiology, elevated and reduced hormones and proteins, changing neural pathways are but a few.

Helping to understand the drivers of your stress and how it influences your pain can have significant benefits. By simply trying to reduce your stress drivers and reintroduce some more calming activities we can reverse the changes.

Your amygdala is your inner chimp; your self doubt, worry and anxiety driver and the more you worry, unfortunately, the better you get at worrying. Acknowledging this - even becoming friends with it - can be a great help.

By helping you understand your stress and your experience my goal is to remove the threat and begin your journey to resolving your problems.

Online video consultations can still get you better

Tue, 07 Apr 2020 11:55:11 GMT

Most people come for physiotherapy with a belief that I am going to use my hands to get them better and that it is going to hurt. Hands on is such a small part of what I do that the challenge of video link is one I find exciting and opens a whole new way to get patients better.

With the arrival of coronavirus affecting every business, it initiated a profound and potentially exciting change to the way we deliver physiotherapy and rehabilitation.

Video link face-to-face appointments have been approved by the NHS and all major health insurance companies. There is strong evidence-based research that so-called telehealth can significantly benefit a patient.

From a personal experience, I see this as a natural extension of how I have been increasingly practising during recent years. For me, the key to helping a patient is to listen to their story. Patients have the answer to a lot of their problems and by actively listening and carefully interviewing the patient, I can find out what is important to them and unlock their potential to getting better.

Whether it’s a two-week-old neck and shoulder strain, a chronic tendinopathy or an arthritic knee, as a result of a specific incident or a prolonged postural or emotional stress, these are all things I can help you with.

The process of specific graded exercises to lengthen or strengthen your body will give you the potential to move. Combine these with functional exercises to remove any adapted poor habits and add in a greater understanding of the drivers of your problem and you can see why physiotherapy through video links can still have a significant role to play in getting you better.

Recovery through listening, advice, education and bespoke targeted exercises and movement has always been the key to getting you better.