Who should I see?
A question I'm often asked is "who should I see? Physio, osteopath, chiropractor, massage therapist, sports rehabilitator... what's the difference?" And it's a question that lots of people have tried to answer, with varying degrees of success (one of the problems with a lot of explanations is that people seem to compare osteopathy and chiropractic to hospital/NHS physiotherapy, rather than private musculoskeletal physiotherapy, which is the direct comparison to osteo or chiro). But I'm going to give it a go myself, and try to explain some of the differences, and give some examples of when each might be appropriate.
First of all, the difference between physiotherapy, osteopathy and chiropractic. This is a bit of a tricky one, as it sometimes seems to me that one of the biggest differences is the language we use. For example, the middle part of the spine, where the ribs attach: physiotherapists and chiropractors call it the thoracic spine, but some osteopaths call it the dorsal spine. We mean the same thing, though! And when you have loss of function in a joint, a physiotherapist will call it a "dysfunction", a chiropractor will say "subluxation" and an osteopath "lesion". Chiropractors often have X-ray machines in their practices; but unless there is a valid clinical reason for doing so, they shouldn't actually take an X-ray of your spine, as most "subluxations" can't be seen on X-ray.
Another difference is how often we like to see people, and for how long. In general, I prefer to see patients for an hour, and not more often than once a week for acute injuries or once a fortnight for more chronic ones, though there are some exceptions. However, I haven't yet met an osteopath who offers sessions longer than half an hour - and I know of chiropractors who offer 10- or 15-minute appointments, often several times per week.
There are, however, lots of overlaps. We are all professionals, regulated by our own professional bodies (physiotherapists by the Chartered Society of Physiotherapy and the Health and Care Professions Council; osteopaths by the General Osteopathic Council, and chiropractors by the General Chiropractic Council) and we all have a responsibility to keep up to date with the latest theories and techniques through continuous professional development (CPD). We are all manual therapists, using our hands to diagnose and treat injuries. We all do - or should - teach our patients exercises, so that you can help yourself to heal as efficiently and as quickly as possible. We are all able to mobilise and to manipulate (click) joints, though in practice I don't manipulate very often; and to treat muscles, tendons, ligaments and nerves; though my understanding is that chiropractors only treat the spine. And we are all professional clinicians, trained to diagnose injuries, even though the language and techniques we use to do so may be different.
Naturally, I think my way is best (otherwise I'd change it and do something else!) but that doesn't mean other clinicians' views aren't valid. Ultimately, I think it really comes down to the individual therapist rather than their profession: the question to ask (after a session or two) is, is this working for you? And really great therapists - of any type - aren't that common, so when you find one, hang onto them!
Graduate sports rehabilitators (GSR) are slightly different. They're also graduates, who have studied for undergraduate or, more recently, postgraduate degrees in sports therapy or sports rehabilitation. Unlike physiotherapists, they don't diagnose injuries; but they are able to work alongside physiotherapists to provide injury rehabilitation and exercise therapy: the "hands-off" part of physiotherapy, if you like. They can do this in a one-to-one setting or in a rehab class, initially using techniques such as yoga, pilates and specific exercises to restore control, flexibility and strength, before progressing to more functional, sport-specific exercises to help you return to full function. At Victory, our permanent GSR is Helen Murawska; she is currently able to provide one-to-one treatment and will soon be setting up classes at the new Foundry:east venue.
Finally, sports massage therapists use their hands to work on soft tissue (muscle, tendon, ligament and connective tissue) to improve its compliance and tone. This can help with lots of issues: recovery after training sessions, relieving niggling tight muscles, improving flexibility, helping to prevent injury and relieving stress and tension to name but a few. They are not (necessarily) graduates and can't diagnose injury, but their treatment can still be extremely beneficial. Again, we often recommend massage therapy alongside physiotherapy or rehabilitation therapy as they complement each other extremely well. At Victory we currently have two excellent sports massage therapists: Claudia Ferreira and Helen Murawska.
So - if you have an injury or are in pain, you should see a physiotherapist (or osteo, or chiro) for an assessment. We will either diagnose it ourselves; or if we think the problem needs further investigation (e.g. MRI or X-ray) or has the potential to require surgery, we will refer you on to a physician or a surgeon. If appropriate, we will carry out treatment ourselves, which may also include referring you to a GSR or sports massage therapist (though if your treatment is funded by health insurance, it may be more cost-effective to stay with physiotherapy, as not all insurance companies will cover rehabilitation and massage separately). If you are not in pain but feel you would benefit from some extra loosening or flexibility, then please go straight to massage therapy. And if you're still not sure... well, drop me an e-mail and I'll do my best to help!
Are you swimming comfortably?
Are you swimming comfortably? Then I'll begin. Victory’s sports rehabilitation therapist Helen Murawska is here to tell us a story about swimmers. Here’s how the story goes...
Chapter one: you’ve swum from a young age at a competitive level, put the training hours in for years to make your body move as efficiently as possible through the water. Your body adapts to what you ask it to do the most, and as you’ve spent years training it to move through water, it will be good at that. But let’s face it: humans weren’t made for water. Our natural habitat is on land, fighting the forces of gravity, ground reaction, and wind resistance; rather than aerodynamics and water resistance. However, through repetitive training your body’s become efficient and strong at this movement, but to the sacrifice and detriment of other movements (as all competitive sports do in some way).
Chapter two: as you get older, your sprint times get slower and your commitments to training change. Still an athlete at heart, you look for other sports to take up that better suit your lifestyle. You find yourself Googling local triathlon races and half marathons, which can be less time consuming to commit to, and more leisurely if necessary. However, being the half-amphibian that you now are, your feet don’t much like being repetitively pounded into the ground and your ankles aren’t so good at stabilising quickly on unstable terrain because they’ve been flapping behind you in water for years. Recent studies have shown that the most common pathologies for swimmers were ankle sprains, flat feet and other lower limb-related injuries. This is because your feet and ankles build strength via ground reaction force and being tested day-to-day to work for stability and strength. Notice how all toddlers have flat feet until they have done enough walking to build an arch in their foot? It’s the same for regular swimmers. The arch can become flabby because it does less push-off from the ground than land-dwellers’. The ligaments become lazier because when you’re in the water, they don’t have to stabilise you when you change direction at speed, as they would if you were on land.
Chapter three: you’re training for your first triathlon after work in the dark, when you misjudge the kerb. Your ankle ligaments are too weak to save your ankle from rolling into a sprain, the ankle blows up like a balloon and you have to pull out of the race. To make matters worse, ankle sprain is one of the most commonly recurring injuries you can do- so it’s something you’ll now need to watch out for constantly.
Here is your chance to change the story. I’m not suggesting that you shouldn’t swim, or even that you shouldn’t do repetitive sports, but you definitely should incorporate cross training into the specialised training, to limit your risk of both acute and chronic injuries. If you’re a younger athlete, reaching your peak, this will keep you there for longer. If you’re getting older, it will prepare you for whichever sports you may look into after your swimming career. If you’re a coach, you should get your swimmers doing plenty of land based training to work the movements that get overlooked when focussing on swimming. Choose closed-chain exercises to strengthen the smaller stabilising muscles at each joint, and mobilise into different functional positions. This will give the body a more all-round efficiency. It won’t slow you down in the water but it will limit the time out of training you’d have due to injury, and will help protect you from niggles if you decide to start training for a new sport.
Victory offers injury screening assessments that will help to show up your risk of injury. To book yours, or to get some great ideas on ‘prehab’ and injury prevention for swimmers, e-mail helen@victoryhealthandperformance.com.
Are you sitting comfortably?
"This is great! Can I just sit here for the next hour?" That's a question I hear several times a week, as newcomers to Victory sink into the rocking chair in my treatment room.
Why a rocking chair, I hear you ask? Well, to answer this, we have to go back to the principles of what backs like, and what they don’t.
You have 29 bones in the spine, of which 24 move freely. You have 23 intervertebral discs (there’s no disc between C1 and C2, just below your skull). Spines are designed for movement, not for staying still for long periods.
As I’ve blogged before, discs are built a bit like rubbery doughnuts, with a thick, tough outer ring (annulus fibrosus) and a more jellylike centre (nucleus pulposus). The nucleus is supposed to bear most of the weight, but this can only happen if there’s enough fluid in it – otherwise it flattens down, and you end up weight bearing through the annulus, which can lead to degeneration and pain. We can encourage fluid to flow into the nucleus if we regularly alter the pressure on the disc, leaning back and forth to stretch and squash different areas. Conversely, if we stay still for too long, even if we have “perfect posture”, the disc gradually compresses, with fluid draining out faster than it can flow back in.
The amount of pressure going through the discs is important – discs don’t like being put under sustained high pressure. Factors that increase pressure through the discs include:
- Your back muscles. The muscles that support the back have vertically oriented fibres. So when you make them work (for example, carrying heavy objects, or sitting unsupported), they compress the discs. They also compress the discs when they are in spasm, which is a normal response to pain. Spasm is when the muscles get stuck in a shortened position, and this will obviously exert increased pressure on the discs.
- Posture. Alf Nachemson's team published a study in 1981 whereby volunteers had pressure transducers inserted into their spinal discs, and, the level of pressure was measured in a variety of different postures. The lowest pressure was recorded when the subjects were lying flat, and the highest when they were bending and twisting (in this position, disc pressure was 400% more than when standing straight). Although this research is relatively old, it’s sound - and we can't reproduce the tests today because no ethics committee is going to approve the non-therapeutic insertion of pressure transducers into healthy discs these days! Much too risky.
- Excessive loading. This largely means carrying heavy objects, though there is some evidence to suggest that being significantly overweight may also contribute to back pain.
It is normal for fluid to drain out of the discs during the day (it’s common to be a centimetre or two shorter before bed, than you are when you wake up, because fluid flows into the discs overnight when you’re lying down and relaxed) but the more you can reduce this, and keep the discs hydrated during the day, the less likely you are to suffer from disc-related back pain.
So, how do you encourage the discs to keep hydrated? There’s a lot that you can do!
- Reduce the amount of time that you spend sitting down – get up and move and stretch. Big movements such as toe touching and using the back block cause significant pressure change across the discs, encouraging fresh fluid to flow in.
- When you are sitting, make sure you are supported, especially if you have back pain. This reduces the work the back muscles have to do - and thus reduces the compressive forces produced by those muscles. Nachemson's study showed reduced compression in people who sat supported (compared to standing upright, pressure was reduced by 40% in people who sat back with support) compared to those who sat without support (compared to standing upright, unsupported upright sitting actually increased disc pressure by 50%, and unsupported slouching increased disc pressure by 75%).
- Drink plenty of water. This is what keeps the nucleus plumped up; but it can only flow into the disc if it’s freely available in your body!
So, with the theory out of the way, I think rocking chairs are helpful to prevent excessive sustained loading in the discs because:
- Whether you sit back or sit forwards, the back of the chair follows you and provides some support – thereby reducing the amount of work the muscles have to do to support you: reducing pressure.
- They keep you moving: I defy anyone to sit still on a rocking chair for a long period. This keeps altering the pressure across the disc – admittedly, not nearly as much as it alters if you have a really good stretch; but still, it’s a help.
- They encourage you to sit back, which as we know decreases disc pressure by 50% compared to standing.
In summary, to keep your back as healthy as possible, I encourage you to find a chair that moves with you, rather than one that tries to hold you still. The comfy ones we use in Victory are the Ten Two (modelled above by The Back Shop’s Alan Sameiro) and the RH Logic 400 (which looks more like an office chair, although the rocking mechanism is the same as in the Ten Two) – but other models are available. The Back Shop (and their parent company, Back in Action) offer seating assessments and help you to find the most appropriate chair for you.
And if you’d like any more advice on how to fix your back, or how to sit comfortably, come on in and let us have a look at you, and give you some individual advice. Contact Sarah Harvey to arrange your appointment now!
Ch-ch-changes
You may have noticed the odd small change around this site lately. As Victory expands as a team, and as we have more ideas of ways to help people, so too our website is evolving and changing. So, here's a whistle-stop introduction to the new-look site.
First up is the homepage. We decided to be a bit more explicit about what it is we do, and at the same time to be a bit more succinct. So we've taken some blocks of text out, and added more pretty clickable buttons to take you to the most popular bits of the site.
Then there are three completely new sections. Victory in the Press came about as we started being asked to do interviews and give expert opinions. We like sharing the positivity and wanted somewhere central to put our external writing, plus radio and TV links.
Victories is stories about people we've helped. This includes testimonials that people have written for us, and case studies that we've written. We will generally keep the case studies anonymous but we get permission before writing them. If you would like to write us a testimonial, or would like us to write up your case study, please do drop me a line. At the moment we have two case studies published - one about a man with knee pain (patellar tendinopathy) and another about a man whose performance improved with the addition of massage, plus better range of movement and better focus on recovery.
The third new section is the Kit page. People are always asking us where they can find the equipment we use in our treatment sessions. The answer is that we sell most of it within Victory - and you'll get slightly better prices if you buy directly from us. However, it's not convenient for everyone to take kit home from Victory, so for people who need bigger or more cumbersome toys, we've signed up as affiliates of the places we buy most of our equipment from. Please click on our links to buy your kit directly from our suppliers - it won't change the price you pay, but it gives us a tiny commission and we'll be very grateful!
There are more exciting ventures in the pipeline - we're opening a new treatment room in the next couple of weeks at East London RFC in West Ham, starting rehab classes in the city and out east, and setting up an online booking capability - but I'll explain those as we go. Watch this space!
Notwithstanding the changes, we are of course continuing to offer physiotherapy, sports massage, sports rehab, acupuncture, performance psychology and performance nutrition in Liverpool Street! Please contact Sarah Harvey to arrange your next appointment.
Victory in Dubai
Not content with working for Victory, providing pitchside cover for Ealing Trailfinders RFC, and competing in CrossFit, the lovely (and really quite tiny) busy bee Helen Murawska (centre) also plays rugby! Although she's currently taking a break from the sport, she couldn't resist when she was offered the chance to play in the awesome Dubai Sevens. Here's how she got on...
Having taken a ‘sabbatical’ from playing rugby for the last few months, when the opportunity arose to play in the Dubai Sevens I couldn’t say no. The team I was playing for - The Pink Babas - get invited to numerous Sevens Tournaments and make it an annual affair to travel to Dubai to play in this World Series event.
I was promised good things about the tour, and it did not disappoint. For a rugby fan, it is the perfect trip- hot sun; watching elite Sevens; playing against international teams; having a dip in the stadium’s own pool between games!
Our team wasn’t the only pink thing out there: as we were queuing to leave the stadium on day 2, the heavens opened for the first time in a year and a half (typical!) and we found ourselves stood in the Desert in a torrential storm with pink lightning! And when I say torrential, people were stood indoors with umbrellas up as the rain was pouring through the ceilings!
However, that didn’t deter people. The organisers expected around 120,000 supporters to the event and it certainly seemed to be that popular. There were over 160 teams within the tournament including various Men’s, Women’s and Veterans’ Pools. Jason Robinson was fronting one Vets team, with the likes of Martin Offiah and Henry Paul, with Bradley Wiggins himself as their water-boy!!
I couldn’t decide if the most surreal moment was meeting Bradley Wiggins or when people were coming up to me asking for my picture and autograph! It was great to see so many people interested in the Women’s Sevens competitions and we had so much support and positive feedback from neutral fans, many of whom had never seen any Women’s Rugby before.
We also had a day or so to experience the tourist side of Dubai - namely its shopping mall which boasts an aquarium that you can Scuba Dive in, and the dancing fountains which were very impressive. It certainly made a difference to most of our UK Sevens tournaments which involve camping or a Bed and Breakfast!
The Pink Babas reached the semi-finals on the last day, which was a tough battle in the heat between two British teams. We had a lot of support from the crowd but couldn’t quite secure the win. However, we have already planned to be back next year, with some silverware in our sights!
Along with the increasing popularity in Sevens as a spectator sport, and therefore increasing funds, many of the teams now have a strong support network. This is important to see leading up to the Sevens World Cup and 2016 Olympics. Working as a pitchside rehab therapist at Ealing Trailfinders rugby club I have seen my fair share of nasty injuries and players needing lengthy rehab. So whilst us folk in the Rehab world obviously hate to see people get injured, it’s great for the players to know that their health and career longevity is being taken seriously.
If you play a contact sport such as Rugby, then you need a therapist who understands the rigours and demands of the game. Our therapists Nell Mead (physiotherapist who worked with Army and Combined Services rugby teams for years, followed by School of Hard Knocks with Scott Quinnell and Will Greenwood) and Helen Murawska (sports massage and rehab therapist for Ealing Trailfinders RFC, and played for Richmond FC and the Pink Babas) have lots of experience getting contact sports athletes up and running again. Do get in touch if you need help either with returning to play after injury, or keeping your body in the game for a few more seasons!
Improve the way you move
Fitting in beautifully with my post on how to avoid Resolutionitis, our sports massage and rehabilitation therapist Helen Murawska (right, with women's champion Samantha Briggs) was at CrossFit's London Throwdown tournament last weekend, where - in conjunction with GLC2000 - she talked to CrossFitters about injury prevention and treatment, and showcased our Pre-Training Assessments. Here is Helen's story.
Last weekend saw the 2nd year of The London Throwdown - a UK-based CrossFit tournament which begins as an online open event and is whittled down to the top few successful participants to compete at the live event.
As a keen CrossFitter myself, I was more than willing to accompany GLC2000’s stall on the day. GLC2000’s glucosamine supplement is very popular amongst the CrossFit community as an aid to joint mobilisation and joint pain relief.
My role on the day was to perform postural and movement screenings, and offer advice on any injuries or niggles for the spectators and competitors alike.
CrossFit athletes (as with athletes of any other sport!) find that joint pain is a common ailment. Great posture and technique are a good start; but even then, the repetitive loading you put your body through can eventually take its toll if prevention and recovery are not maximised. Pain can manifest in varying joints depending on your own movement patterns.
After their screening, I was able to send people away with a better idea of how they were moving from day-to-day, and what that could mean in terms of their injury risks. I gave them ideas to improve shoulder mobility or hip range and, coupled with some important stabilisation exercises, they’ll be able to improve and maintain movement patterns - and therefore technique and safety in the long term.
If you’ve had pain in a joint or muscle for a week or more - it’s an injury. If you haven’t taken a direct blow to the area (yes, I’ve missed my target doing box jumps too) then it was probably avoidable. How long did it keep you out for; or how much did it limit you going heavier, or faster? What if you can avoid the next injury that’s looming in your shoulder when you work overhead, or that slight pinching in your hip when you squat?
Now, there’s no need to become paranoid about injury, but it makes sense to give yourself as much chance as possible to avoid a problem that you’re vulnerable to by improving the way you move. This will mean spending some time increasing range at any specifically tight joints, then performing low load exercises to stabilise this new range. You can do this alongside your current training programme. Accompanied by good hydration and complementing your diet with glucosamine or chondroitin-based supplements, this is by far the most effective way to reduce joint pain, improve mobility, and therefore get stronger in the long term - whilst still training.
Think you don’t have time for it? You’ll have plenty of time when you’re forced to spend a month out, resting your strained tight hamstring that you didn’t address earlier!
If you want to improve the way you move in order to reduce your injury risk, we can help! Contact us to book a one-hour pre-training screening for some individual advice; and for a great supervised group flexibility workout, why not try Helen's Supple Steel class at Foundry:East?
Integrated Victory
I am delighted and hugely excited to announce that we have a new member of the Victory team: the lovely sports therapist and acupuncturist Claudia Ferreira. Originally from Brazil, where she was an international-standard swimmer for 12 years, Claudia joins us from her clinic Integrated Physio which is sadly having to close because the council are knocking down her building to create a new retail unit.
A very experienced therapist who has previously worked in clinics at Harley Street and Liverpool Street areas, Claudia offers an interesting mix of treatments which we are calling Integrated Sports Massage. Her skill set includes traditional sports massage, but where appropriate, she combines this with visceral manipulation (treatment of the internal organs such as the liver and stomach) and acupuncture. Claudia holds a BSc (Hons) in acupuncture and a Diploma in Sports Therapy. She is registered with the British Acupuncture Council; which means that if your health insurer has authorised you to receive acupuncture, then they may well cover your treatment with Claudia.
Claudia and I were introduced a few months ago, after two city-based friends were discussing their injuries and their respective marvellous therapists (!), and realised that we worked within 200m of each other. Claudia’s patient knew that Integrated Physio would inevitably have to move, and my client thought I might be a good contact for her. So, we met for coffee and exchanged treatments. It was immediately obvious that Claudia would be a huge asset to Victory, and I have been nagging her to join us ever since!
Claudia is currently available at Victory on Mondays, Wednesdays and Fridays, between 12 noon and 7pm. You can book a session with her either via Sarah as normal; or you can contact Claudia directly, either by e-mail or on 07950 742417.
New Year's Resolutionitis
Every January, most of us start to reflect on a season of goodwill and gastronomic overindulgence, and to resolve to “do something” about our newly acquired lipid layer of insulation against the cold. “Doing something” often means deciding on a fantastic new year’s resolution to join a gym, hire a personal trainer (at Victory, we recommend the lovely PTs at The Foundry!), get fit – and lose 3 stone by summer.
By February, most of us will have given up. Sometimes this is a willpower or motivation issue (in which case, you may want to give the lovely Dr Victor Thompson a shout!) but equally, I’m sure every manual therapist reading this will recognise the dreaded symptoms of Resolutionitis.
Resolutionitis is a condition you may acquire if you write exercise cheques that your body simply can’t cash. For example, you may have tried to increase their training volume too quickly (experts recommend increasing your training volume by no more than 10% per week). Or, you may have overstretched yourself (either by physically reaching too far, or lifting a weight that’s too heavy) – perhaps forgetting that you’re not 21 years old any more, and that your middle name isn’t actually Peter Pan.
However, Resolutionitis is something that we at Victory can help you to avoid – or treat, if necessary.
Before you start your training regime, come and see us for a musculoskeletal screening. We will look carefully at the range of movement in all your major joints and the flexibility in your major muscle groups, checking for symmetry and comparing the range you have, to the range you need to exercise safely. Different types of exercise require different ranges of flexibility; but as an example, if you want to run, we’ll focus on your pelvis, hips, knees and ankles, whereas if you want to swim, we’ll focus more on your shoulders. We can then either clear you to go ahead with your training, or recommend specific exercises or treatment to help you if you have issues that might affect how well you respond to your exercise plan.
Or, if you’ve already come down with Resolutionitis, let us help you to fix your injury and put you back on the road to recovery. Manual therapy (physiotherapy, osteopathy or massage) can help to release excessively tight joints and muscles, and then our super rehabilitation therapist Helen can take you through a programme of remedial exercises (in a one-to-one setting, or - coming soon! - as part of a class) to help restore your stability, muscle balance and strength.
So, let’s resolve to make 2013 the year you don’t come down with Resolutionitis – come and see us instead! Contact Sarah Harvey by e-mail or on 07702 808303 to book your appointment now.
Surgical Victory
Victory’s rehabilitation therapist Helen Murawska and osteopath Andrew Fung recently enjoyed an instructive day observing Mr Sam Singh, the eminent Orthopaedic Foot and Ankle surgeon, at work in the London Bridge Hospital. They came away impressed by the professionalism of the surgical team as well as the skills of the surgeon. Andrew picks up the story.
“Once surgery begins, no one is allowed to go beyond here and no one is allowed to touch the surgeon or the scrub nurse” explained Verona the scrub nurse, pointing to an imaginary line on the floor and at Mr Singh - who was hard to recognise, covered as he was by multiple layers of disposable sterile cladding.
Helen and I were in an operating theatre at the London Bridge Hospital to observe Mr Sam Singh, a Foot and Ankle surgeon whom we had met a few weeks previously at an event to launch the hospital’s new Orthopaedic Services programme.
Neither of us had entered an Operating Theatre before – at least while conscious – so our excitement was tinged with a little apprehension. “Will there be loads of blood?”, “What if the patient flat-lines?”
Our febrile imaginations were way off the mark. Instead we discovered the atmosphere within an OT to be relaxed, normal and quietly efficient. It actually felt like a regular workday, a fact that we found impressive and reassuring.
Today we were observing three procedures; an arthroscopy (keyhole surgery) to remove osteophytes - bony growths - that had developed around a patient’s ankle after a lifetime of playing football; another operation to remove bony growths on the upper surface of a patient’s feet; and finally we were to witness a foot re-construction.
“This keyhole surgery is difficult and takes a lot of practice, I’m definitely much better now than I was 10 years ago!” exclaimed Mr Singh as he expertly manipulated the ankle strapped to his body and peered at the monitor to see what the keyhole camera was looking at now.
With one hand he controlled the camera inside the ankle joint and with the other a rotary cutter and snipper to cut away the bony growths that were causing the pain and swelling. On the screen the contrast between the smooth, iridescent, healthy cartilage and the disorganised damaged tissue was very apparent.
Working with quick and precise movements, Mr Singh conversed constantly with the team around him:
“How is the last patient?”,
“You see this? It’s a loose body and could cause the ankle to seize but that is far more common in the knee”,
“We’ll need a Radiographer for that re-construction later, please call X-Ray”.
“Right that’s him done. I’m pleased with that. He’ll be on crutches for 2 weeks but can weight-bear in about 4 days.”
Mr Singh, a Cambridge and Harvard graduate, was an informative and irrepressible host, clearly respected by his team. His long-time chief scrub nurse, Verona, later confided – “I always know when he is annoyed because he stops talking!”
During a quick break for coffee, Mr Singh debriefed us and stressed the importance of the team and keeping surgical procedures moving at a decent clip. “I don’t like gaps between patients. It’s important to keep my day running a bit like a production-line. Then it’s safer because every member of the team stays focused.”
The second procedure was less interesting - shaving bony growths from the upper surface of the tarsal bones - but it demonstrated the physicality of orthopaedic surgery. Mr Singh pointed out the structures that he was avoiding as he guided a surgical tool resembling a chisel, that a nurse struck with a hammer, to carve away at the bony structures.
All along he kept up the conversation: “Only 1 in 7 of my patients proceeds to surgery. If we can manage a condition another way then we will, but it’s the part I enjoy most - it’s relaxing!”
His comment got me to thinking of the number of patients that do not go under the knife and how important the role is that we therapists play.
For our last hour we watched Mr Singh re-construct a foot after an old bunion operation had started to fail. It was the most intricate operation of the day requiring the breaking of the bone to straighten the toe and the replacing of an old screw. “It’s both functional and cosmetic as it stops it rubbing against the adjacent toe” said Mr Singh to us and to the surgical fellow who had cut short his train journey home to come and assist.
Mr Singh and the younger surgeon also broke and re-set two other metatarsals that had become inflamed due to changes in the foot structure. We left them as they discussed their final patient; a complex re-balancing of the ankle and foot.
All in all it was a fascinating day and a terrific first-hand insight into the surgical process. The teamwork behind the surgery also got me to thinking about our post-operative role in that team because as therapists we can help to make the link between successful surgery and the progression to pain-free function.
Helen and I would like to thank Mr Sam Singh and all his team for the opportunity to observe them at work and hope to get the opportunity to work with them in the future.
To book an osteopathy appointment with Andrew, please contact him here or call him on 07958 704935.
Move with Helen at Foundry:East
Exciting news – we’re expanding! You may be aware that our friends at The Foundry opened a new venue last month, in addition to their flagship City location in Artillery Lane. That new venue is Foundry:East, at East London RFC in West Ham. And now we’re joining them. Starting this Friday at 7am, Victory’s massage and rehabilitation specialist Helen Murawska is running a new functional flexibility class at Foundry:East, called Supple Steel.
In this class, Helen will be helping you to mobilise your joints in order to improve your range and positioning during functional movements. This will help to reduce your risk of injury at each joint (normal, full range of movement is pain free), and improve your whole power output.
She will also be discussing the importance of controlled mobility during exercise, and looking at how this translates to a healthy gait pattern and posture in the long term.
The first functional movement Helen is going to focus on is the loaded squat – probably the most important metabolic lift there is. So what are you waiting for? You can sign up online here – and check out a few of the other Foundry:East classes while you’re at it!
Supple Steel is free to attend on Friday 16 and 23 November - and is included in the Foundry:East all inclusive Steel membership fee; otherwise, classes are priced at £15 for an individual class, or packages may be booked. Contact Helen for further details of class content, or The Foundry for further details of prices and membership. Please click here to book your class.
Blog for Victory
Hi, I'm Nell Mead. I'm a former Army physiotherapist and I specialise in sports medicine and back pain. This is my blog, where I write about issues that are on my mind. Some of these are about issues that are specific to particular injuries or medical conditions but I will also be updating you on events occurring inside Victory and in the wider world of medical rehabilitation. I also publish guest posts by Victory's other therapists whenever I can persuade them to sit still for long enough to write something!
When we're not writing, we're offering appointments at The Foundry in Liverpool Street. We'd love to see your comments on our posts - and we'd love to meet you even more, so do pop by and meet the team.