Victory for Men's Health

Posted by Nell Mead at 09:00 on 6 Feb 2012

Half a lifetime ago, I fell in love with a young man who used to like telling me about health and fitness.  Ever the observant girlfriend, I fairly soon noticed in his bedroom copies of popular magazine Men's Health: my amour's goal, it seemed, was to be a cover model. 

A short while into our relationship, however, his words of wisdom dried up.  This may have been because I began buying my own copies of Men's Health, reading them faster than he did (I had to sit through physics lessons; he at a couple of years older had an actual job) and then quoting the articles at him.  He had nothing more to say.  We didn't last long, and he never did become a cover model, which is a shame, as he had lovely abs.

Not being their target audience, I hadn't picked up a copy since then; but if you are a MH aficionado, you'll know that on a semi-regular basis, they set their journalists physical challenges, which they then have to complete and write about for the amusement and edification of their readership.  The current such challenge is for two ectomorphic journalists, both coincidentally called Ed, to compete for the most impressive "transformation" with a personal trainer.  In effect, the trainers are competing to make the greatest difference to their clients.

And this is how I came to meet Ed Reeves, or "Big Ed" as he is affectionately known to readers of MH.  Ed has been working with top Foundry trainer and former Olympian Sarah Lindsay since the start of January, trying to pack on enough muscle in three months to beat "Little Ed" Vanstone, who is himself working with MH cover model and trainer Olly Foster.

Big Ed somehow bypassed our usual pre-training musculoskeletal assessment; but given that he has never trained before, and with a pretty dodgy starting posture and various underlying issues, it wasn't a huge surprise to anyone other than himself when he broke down and found himself being poked and prodded by me and by Victory's osteopath Ray Yong.

I'll not go into details of what we saw and found - medical confidentiality being pretty important to both me and Ray! - but suffice to say that we were both able to offer suggestions of diagnosis and treatment.  Ray is a fan of acupuncture, and I'm a fan of the Sarah Key method; I think Ed would have been happy with either (and either would have been effective) but as Ray was heading home, I treated Ed myself.  And he seems quite happy with the results!

Having said that, Ed was lucky to recover so quickly.  If you are thinking of embarking on a new training regime, it really is sensible to get checked out beforehand.  I don't just mean the usual GP checkup for blood pressure, though if you're seriously out of shape, of course that is important.  But from an injury perspective, or rather from an injury avoidance perspective, it is worth getting a good pre-training musculoskeletal assessment with a therapist who is familiar with the demands of personal training and who will talk to your trainer.  Our assessments help the Foundry's trainers to personalise their clients' programmes, adding in specific corrective exercises and avoiding anything that's likely to be detrimental.  Most of our clients have relatively sedentary jobs, or jobs that involve repetitive movements - I've lost count of the clients I've described as "chair-shaped" over the past year - and corrective exercises, particularly using the back block as an "anti-sitting" device, really do make a difference and help them to avoid injury.

If you're thinking of starting a course of personal training, whether at The Foundry or elsewhere, it's worth getting yourself checked out. We're not the only option, but we're pretty experienced and we're happy to talk to your trainer - what have you got to lose?  Contact us for your 30-minute MOT!

Victory at The Foundry

Posted by Nell Mead at 08:00 on 8 Aug 2011

For us at Victory - well, ok, maybe just for me - today is a hugely exiting and momentous day.  And why, might you ask, would that be?  Well, partly because I left the Army exactly a year ago today.  But also because the lovely directors of The Foundry, Dave, Helen and Graeme, asked me a little while ago if I'd like to set up a proper rehabilitation centre in their premises.  So from today, Victory is officially a full-time entity, with two therapy rooms, in the one location - hurrah!

I, my dad and my lovely friends Claire and Jono have spent the weekend repainting the therapy rooms, and you'll also see logos appearing over the next few weeks and a bit more clinic furniture.  Dave's also suggested holding a launch party - definitely something to think about in the near future!

In the mean time, I'd like to introduce you briefly to a few of the characters you might meet when you come to Victory.  When I get a chance, I'll blog properly about each of them - this really is just a very brief hello.

Sarah Harvey is my lovely PA.  She keeps me on track with all the myriad things I'm supposed to do but keep forgetting.  She organises the team's diaries and makes sure I don't double book myself and do remember to pay bills and invoice clients.  If you ever need to contact anyone about the administrative side of Victory, or to arrange an appointment, Sarah's your girl - e-mail her here.

Dr Victor Thompson is a clinical psychologist who specialises in sports and performance.  I met Victor nearly ten years ago when I became interested in sports psychology as a way of improving my results on the tennis court.  After four hours with Victor I won 20 tennis matches in a row, and I've been recommending him ever since.  At the moment, he consults with me on clients who have an emotional, psychological or stress-related component to their physical pain; so far this has been very successful and I look forward to being able to offer this service more frequently in the future.

Jake Thackray is a former Physical Training Instructor in the Royal Navy and is still a serving policeman.  He's been working at The Foundry for some time now as a specialist in sports massage and remedial therapy, and will continue his sports massage work with Victory.  At the moment he is mainly available on Monday evenings but over the next few months he will hopefully be around more regularly.

Busy bee Sarah Franklin is - by day - a fitness manager at Virgin Active Moorgate; but she is also qualified in sports massage therapy, and is available to see clients at Victory some evenings and weekends.  Although she has been working at The Foundry for some time, Sarah and I haven't yet swapped treatments (something I like to do regularly with all the Victory therapists) but I hear great things and am really looking forward to it.

Flight Sergeant Paul "Spot" Leppard leads the multidisciplinary Spines Team at the Defence Medical Rehabilitation Centre, Headley Court.  A qualified Exercise Rehabilitation Instructor (ERI), he also received his BSc in Sports Studies from the University of Wolverhampton in 2003.  He is available in the evenings and at weekends to provide exercise therapy for clients with back pain and spinal injuries.

Graduate Sports Rehabilitator Cat Cornwell is also currently working at Headley Court as a civilian ERI specialising in complex trauma.  She holds bachelors degrees in Sports Rehabilitation and Sports & Exercise Science, and is currently working towards an MSc in Neuromusculoskeletal Healthcare.  Last month she was also part of the Team True Spirit squad of Headley Court patients and staff to complete the Iron Man UK Triathlon.  With a very solid history of working with high level sportspeople including GB Women's Basketball squad, Cat is definitely the girl to take you from getting over an injury to being ready to start full-on personal training.  She is available in the evenings and at weekends.

Ryan Walsh is a former member of the Parachute Regiment and of the Army Rugby team - and is now a professional boxer - see him in action here.  He's a qualified Personal Trainer who has worked with Bath Rugby and was seen on the 2010/11 School of Hard Knocks series on Sky Sports One.  I've known Ryan since he was 17 and was surprised when he called to tell me he had qualified as a sports massage therapist; but even more surprised when he proved to be really rather good at it, with a good range of techniques and an instinctive touch.  You really can't teach someone to have good hands!

Former Royal Marine Phil McDougall is currently in the process of completing his Level 5 Sports Massage qualification at the London School of Sports Massage, and is due to start training at the British School of Osteopathy in September.  A thoughtful and instinctive therapist who is keen to learn, Phil will be available on Friday afternoons, and on other days by prior arrangement.  Given the famed rivalry between the Paras and the Marines, I'm intrigued to see how Phil gets on with Ryan...!

Capt Harold Ackroyd and Maj William Allen were the first two members of the Royal Army Medical Corps to be awarded the Victoria Cross.  Sarah suggested that we should name our therapy rooms in their honour - so we have.  For those who are familiar with Victory's layout, Ackroyd faces you when you reach the bottom of the stairs, and Allen is on the left.

Finally, there's Starvin' Marvin (on the right) - the leanest member of Victory.  He was named on 2 Feb after The Foundry held a Facebook competition.  He hangs around generally looking like a bit of a cool dude, and is always available to show you what bones look like and how joints should work.

The only down side to this is that - with not enough hours in the day - I'm having to give up my clinic at The Back Shop.  But the staff are great, and I still really rate the equipment they sell (particularly the Mobiliser!) and their ergonomic assessments, so I have no intention of losing touch with them completely.

Right - that's it, I've said enough.  You've met the gang: what are you waiting for? Come on in and meet us: get in touch to book that appointment you've been needing for ages....!

Rewards for Forces

Posted by Nell Mead at 12:00 on 18 Jul 2011

An interesting conversation on Twitter the other day led me to contact Peter Raith at Rewards for Forces, a benefit website for serving and veteran members of the Armed Forces.

As you know, I used to be a Physiotherapy Officer in the Army.  It was a period of my life that I really enjoyed, and I'd recommend it to any young physiotherapist with a strong interest in sports and training injuries, as they offer superb opportunities for both in-house and external training with unrivalled access to physically fit and motivated patients to practise on!

Although I've obviously now left the Army and moved into private practice, I still have strong links with the military.  Many of my friends are still serving, and as I blogged recently, I'm still involved in getting the Mobiliser into standard usage in military physiotherapy departments.  As this post goes to press, I'm even in Aldershot myself, partnering former Papua New Guinea international Lawrence Tere in the mixed doubles section of the Army Tennis Championships!  Perhaps, to bastardise a common phrase, "you can take the girl out of the Army..." etc. 

At any rate, I'm still very sympathetic to the needs of the military patient - and conscious that nobody joins the Forces to earn a mint.  And as far as I'm aware, there aren't any physiotherapists working with the Armed Forces who practice the Sarah Key Method, which I believe is one of the most effective and patient-centred systems available.  So I'm delighted to announce that I'm now able to offer a discount to self-funding serving and veteran members of the Armed Forces of 20% off all physiotherapy assessment and treatment sessions.  All you have to do is to sign up to the scheme and present your Rewards for Forces card at your first session.

Membership of the Rewards for Forces scheme costs £12 per year, and at current Victory prices, our discount will give you £30 off your assessment and £20 off each subsequent treatment session... surely a no brainer?

I look forward to seeing you; please e-mail me to arrange a session.

Bloodgate physio free to practise again

Posted by Nell Mead at 15:18 on 14 Jun 2011

The debate continues over the striking off of "Bloodgate" physiotherapist Steph Brennan.  As I blogged before, Steph was struck off the physiotherapy register by the Health Professions Council (HPC) in September 2010 when he pleaded guilty to helping the rugby team for whom he was head physiotherapist, Harlequins, cheat by providing a fake blood capsule to one of the players on the pitch.  By this time, he had already been banned from working in rugby for two years.  In contrast, the pitchside doctor (who cut the player's mouth to "prove" that he had been injured) was deemed fit to continue practising by the General Medical Council. 

Steph - by all accounts a superb clinical physiotherapist - appealed to the High Court against his striking off.  The High Court agreed that he had grounds to appeal to the HPC; and last month the HPC (after initially claiming that the High Court had no jurisdiction) revoked its decision, imposing instead a five-year "caution period".

Since the HPC initially struck Steph off, there has been hot debate among physiotherapists as to whether striking off was the correct action for the HPC to take or whether it was excessive.  Some have taken the view that Steph failed to maintain the "high standards of personal conduct" which form a part of the HPC's regulations and that he therefore deserves all he gets.  My own view is that it was excessive: that Steph clearly made a stupid mistake to put Harlequins before his profession and his morals; but that the public (whom the HPC exists to protect) is not better served by banning this man from practising.  He has also shown very public remorse and has clearly been reflecting on his actions, having undertaken a series of lectures to physiotherapy students on the importance of medical ethics.  I am therefore very glad that the HPC has overturned its own decision.

However, I'll leave the last word to Steph, who feels that his case has highlighted not just the pressure that is faced by physiotherapists working in elite/professional sport but also the importance of withtanding that pressure and keeping a cool head under fire: "I want the profession, and most importantly sports physiotherapists, to learn from my mistakes.  Sports physiotherapy is a very different role for the physiotherapist than any other job in public or private health, but that should not mean we forget our standards of ethics and practice."

Why use the back block?

Posted by Nell Mead at 10:30 on 18 Apr 2011

I had an e-mail this week from a blog reader who asked whether the Sarah Key exercises I've blogged so far would be good for spondylolisthesis.

Spondylolisthesis is a condition which affects 3-6% of the population in which one vertebra - most commonly the L4 or L5, at the bottom of the spine - slips forward on the one below it.  Left uncontrolled, it produces a more exaggerated curve of the low back, like those you often see in men with really big tummies or pregnant women.  The grade of spondylolisthesis is determined by an X-ray to see how far the upper vertebra has slipped - a grade I being a forward slippage of 1/4 of a vertebral body, grade II being half, and so on.  Surgeons tend to get involved with grade II+ spondylolistheses as the slippage is more likely to be a danger to the spinal cord.

There is a fair amount of evidence in the literature for strengthening the core muscles of spondylolisthesis patients, particularly the transversus abdominis which acts like an internal corset, and the multifidus which acts like the guy ropes of a tent to shore up and stabilise the slipped vertebra.  I'll go through some useful exercises for these in future posts as they are excellent for any form of instability, but incidentally this is one situation where I think exercise methods such as Pilates can be really useful.

As well as core exercises, I really rate the back block for spondylolisthesis patients.  Traditional physiotherapy extension exercises are carried out from the prone (face down) position, where the patient pushes up onto elbows or hands to extend the spine.  I don't use this for spondylolisthesis patients because gravity, as you can see from the top diagram, acts on the vertebrae to produce an anterior (forward) shear - exactly the same force that causes spondylolisthesis!  Lots of physiotherapists have therefore moved away from prescribing extension exercises to spondylolisthesis patients.

By contrast, however, the back block exercises are done in a supine (face up) position.  This results in gravity pulling the vertebrae towards a position of backward shear, as you can see in the lower diagram - and thus into a more neutral position away from the spondylolisthesis slip.

The effect of this tends to be (gradual, cumulative) better alignment of the spondylolisthetic segment, and also reduced muscle spasm and reduced pain.

Of course, not every case is that simple: longstanding spondylolisthesis problems often lead to altered muscle control and movement patterns, as you start to compensate for the discomfort of the injury.  Using a back block doesn't replace a proper assessment and treatment plan in every case. But if your physio isn't already getting you onto a back block, it might be something to discuss.

Please feel free to ask questions - either here on the blog or by e-mail - or get in touch to arrange an appointment.

Sarah Key Method - Back Block

Posted by Nell Mead at 14:00 on 9 Mar 2011

Time to get back to backs!

This exercise is another of Sarah Key's, and is great for stretching your low back.  You'll need what Sarah calls a back block; they're also known as yoga bricks.  Roughly the size of a house brick, they come in a variety of materials including wood, bamboo, cork and foam - I usually use one made of solid foam, though in an emergency I have also been known to use a hardback copy of a Harry Potter book!

When we spend all day with our spines in an upright position (sitting, standing, walking, running), gravity combined with our bodyweight squashes our spinal discs, and over the course of the day they flatten out a bit.  It's not unusual to be 2cm shorter at the end of the day than you were at the start.  Generally, the discs rehydrate and plump up again overnight when you're lying flat, but over time - with age, or particularly with injury - the flattening starts to have a greater effect than the rehydration, and you develop stiff spinal segments.

Sarah's theory is that this process is reversible if you regularly take steps to decompress your spine, and this is where the back block - coupled with the appeasing exercise I described before - comes in.

• Lie on your back on a firm surface such as the floor, knees bent so that your feet are on the floor, and feet and knees together.
• Squeeze your knees and buttocks together. Keeping them squeezed, roll up your spine, curling your bottom off the ground first, and - bone by bone - then your low back, mid back and upper back, until your weight is on your feet and shoulders.
• Bone by bone, roll your way back down again, trying to make the space between each bone as long as possible, and making sure that when you reach your pelvis, the left and right sides hit the ground at the same time.
• Make sure your knees and buttocks are squeezed together, and roll all the way up to your shoulders again, bone by bone.
• This time when you are at the top, slide your back block underneath your pelvis (NOT under your low back) and roll your bottom down onto it.  The block should be horizontally aligned and on its shallowest side.
• Slide (don't lift) one foot along the ground and away from you, and then the other.  Allow your ankles to relax and roll outwards.  Relax your calves, then your knees, then your thighs, buttocks, low back...
• Let your arms roll outwards so that your palms face the ceiling, and relax completely for a minute.
• Then slide one foot back up towards you, and then the other.
• Squeeze your knees and buttocks together, and roll your way up off the block (at first this may be sore; don't worry, this is quite normal and it does get better!)
• Slide the block out from underneath your bottom, and roll down just as you did before.
• Now do 30 seconds of the appeasing exercise, and repeat the whole thing three times.

NB - any discomfort you feel on curling up off the block should fade quickly and should improve over the first few days of practising this exercise.  If it is too painful, or remains significant for more than a week of doing this, you should discontinue the exercise and get your back assessed.  (Of course, I'd recommend that you see a Sarah Key-trained physiotherapist...)

Thanks to the lovely Graeme Marsh for posing for these pictures at The Foundry.

Shoulder pain - an underdiagnosed dysfunction

Posted by Nell Mead at 14:00 on 18 Feb 2011

This post is triggered by Dave Thomas of The Foundry, who commented yesterday on Facebook following a therapy session with me that “if you haven’t had your subscapularis walked on before, it’s a treat!” It seems to be a relatively unusual technique, but one of my favourites, and this is why.

The subscapularis (aka subscap, to rhyme with hubcap) is a triangular muscle which sits between the ribs and the shoulderblade (scapula) – its name meaning literally “below the scapula”. With its base covering the entire of the inside edge of the scapula, it narrows to a tendon which attaches to the inner part of the humerus (upper arm bone) and the shoulder joint capsule. Its role is to twist the arm inwards (place your hand on your stomach and try to push through to your spine: you’re using your subscap) and to pull the humerus forward and down when your arm is raised, thus preventing your shoulder from dislocating.

It’s one of the four muscles that make up the rotator cuff, (the others being supraspinatus, infraspinatus and teres minor, if you’re interested!) but far less frequently torn than the more vulnerable supraspinatus and infraspinatus. Probably because of this, it’s a muscle that’s often ignored by therapists when treating sore necks and shoulders, but in my view that’s a mistake. Good subscap function is essential to good neck and shoulder function, and I have a few theories as to why this is the case.

One theory is the effect that subscap has on the ribs. As I’ve mentioned, subscap sits between the ribs and the scapula. Normal shoulder movement depends on the scapula being able to glide freely over the ribs. When muscles are sore, they tend to tighten up and develop trigger points – isolated areas of muscle spasm; and subscap is no exception. It’s my belief that tightness and/or trigger points in subscap can be partly responsible for dysfunctional movement of the scapula over the ribs. This in turn places excessive strain on the rib and shoulder joints, leading to pain in the upper back, neck and/or shoulder.

I believe that another problem with subscap trigger points is the effect these have on blood flow and nerves. I suspect that when a muscle is tight, its spasmed fibres affect not only each other, but also other local structures such as blood vessels and nerves. In the case of subscap, this could – theoretically - affect the axillary (armpit) artery and the ulnar branch of the brachial plexus – the nerve that goes down to the inside of the elbow and the ring and little fingers. It’s certainly noticeable that patients often comment that they feel odd sensations in these areas, as I release their tight subscaps; or that once I’ve finished, they feel a rush of heat to the area (increased blood flow?)

Releasing the subscap is pretty tricky to do on your own. I often use my heels to release subscap in my patients – most therapists use their fists or fingers, but it’s hard to do that without jabbing your patient and causing more discomfort than necessary. If I have to release your subscap, I’ll ask you to lie on your back with your hand behind your head. This brings the edge of your scapula out to the side of your body, and I can then fit my heel between the edge of your scapula and your ribs, and use my bodyweight to stretch and massage the subscap, gently and rhythmically until the spasm subsides.

Not only does this tend to release the subscap spasm, it also frequently seems to relieve neck pain and increase in rotation at the neck, which is a great side effect. I’m not sure whether this is also due to better rib mobility, or whether there is some sort of chain reaction going on whereby the subscap release causes a release in the levator scapulae – any bright ideas gratefully accepted!

After I’ve released your subscap, I’ll show you how to stretch it yourself, using a chair, Swiss ball or yoga brick, so that you can maintain the improvement at home. 

If you're having problems with a shoulder, please e-mail me for advice or for an appointment.

Bloodgate physio wins high court appeal

Posted by Nell Mead at 16:00 on 3 Feb 2011

Moving back to the theme of HPC sanctions, do you remember Bloodgate?

On 12 April 2009, Harlequins rugby player Tom Williams was taken off the pitch by the team physiotherapist, Steph Brennan, with blood pouring from his mouth.  As he approached the Harlequins' bench, Williams grinned at his teammates, arousing such suspicion in Quins' Heineken Cup opponents, Leinster, that the Leinster team doctor requested to see the injury at the end of the match.

The problem was that there was no injury: Brennan had carried a fake blood capsule onto the pitch and Williams had bitten it in order to fake an injury which would allow him to be benched in favour of another key player.  In a panic, Williams approached the Harlequins' team doctor, Wendy Chapman, and asked her to cut his lip, so that he would have an injury to show the Leinster doctor.  Initially, she turned down his request but eventually gave in to the pressure and made a cut with a scalpel, as requested.

Following an investigation, the Rugby Football Union discovered that there had been four other incidents in which Brennan had facilitated the fake blood injuries.  He was banned from working in rugby for two years, while the chairman Dean Richards was banned for three years and the player, Tom Williams, for 12 months, reduced to four on appeal.  

Chapman, the doctor who had deliberately cut her patient, was initially suspended by the General Medical Council (GMC) but the suspension was lifted in August 2010 when the GMC decided that her fitness to practise was not impaired.

In contrast, Brennan, the physiotherapist who had facilitated cheating but who had not injured a patient and whose physiotherapy expertise was not in doubt (at the time of the scandal, he had been about to take up a post with the England rugby team) was struck off by the Health Professions Council (HPC), meaning that he could no longer work as a physiotherapist. 

As I'm sure you can imagine, this was pretty controversial, certainly within the physiotherapy community - a super-hot topic of debate on online physiotherapy forums.  Some felt that striking off served him right for cheating; more felt that the rugby ban was enough of a punishment in itself and an online petition asking the HPC to reconsider has so far gained 1175 signatures.

I think I agree with the petitioners.  Steph Brennan was clearly wrong to provide Tom Williams with a blood capsule, so the ban from rugby is fair; but his actions were not in any way dangerous.  The HPC's own Indicative Sanctions Policy states that a sanction such as striking-off is not to be used to punish wrongdoing, but to protect the public.  I'm not sure how striking off an experienced and well-regarded - albeit misguided in this instance - physiotherapist who has done no harm, is a move towards public protection.

Last week, Steph Brennan's lawyers successfully argued that his actions had not merited a sanction of such "gross severity" and Mr Justice Ouseley at the High Court ordered the HPC's Conduct and Competence Committee to reconsider the case.

Currently, the HPC are refusing to do so, saying that the striking-off order is not open to legal challenge.

So, should Brennan have been banned altogether from practising his profession - or just banned from rugby?  It's an interesting debate - what do you think? 

Sarah Key Method - Appeasing exercise

Posted by Nell Mead at 16:00 on 31 Jan 2011

Moving on from last week's diversion - back to the back pain!

This exercise from legendary Australian physiotherapist Sarah Key is suitable for virtually anyone's back, and is the first exercise I teach my patients who have low back problems.  The key is to be very subtle with your movements - in this instance, less is definitely more.  The idea is to gently appease the low back muscles and coax them out of spasm, muscle spasm being the body's natural - but in this situation unhelpful - response to pain.

If you jerk or move too forcefully while doing this exercise, you are likely to stimulate the stretch receptors in the muscles, which could potentially make the spasm worse.  But if you can keep your movements smooth, and "under the radar" of the stretch receptors, then it will really help to soothe your back pain.

• The first step is to lie on your back on a firm surface - a folded blanket on the floor is fine, or in my therapy rooms I use a yoga mat.

• Pull your tummy in gently, as this supports your spine, and bring one knee up to your chest.  Hold the knee in the same hand - i.e. if you have lifted your right knee, hold it in your right hand.

• Keeping your tummy pulled in, bring the other knee up to join the first, and hold it in the other hand.

• Cross your ankles, and drop your knees apart, still holding them in your hands.  Let your tummy relax.

• Producing the movement with your hands, move your knees gently back and forth, left and right, until you find that your weight is over the sore part of your back.  This is where the muscles need to let go.  Oscillate your knees gently and repeatedly over this area - I describe this to my patients as "ironing the spine" - for a minute or two until the muscle relaxes and the pain subsides.
• After a minute or two, use your hands to bring your knees back to the middle, pull your tummy in gently, and then lower first one foot to the floor and then the other.  Rest for a minute or two and then repeat twice more.  
• On the second and third repetition of the exercise, you may find that the sorest spot in your back has moved a bit.  Hunt around until you find it; but remember to keep the movements subtle and gentle.

If your back is really sore, you may need to do this exercise very regularly, perhaps as often as every hour at first.  Some people also find that heat is helpful, so you may also want to try using a hot water bottle on your back (obviously, all the usual precautions apply here: please don't burn or scald yourself!)

If you can't relieve your pain by yourself, then of course please do e-mail me for an appointment.  I am at the Foundry on Mondays and Tuesdays, and at the Back Shop on Wednesdays and Thursdays.

Thanks to my lovely model Graeme at The Foundry - the cheque's in the post!

Trust me, I'm a doctor...

Posted by Nell Mead at 12:00 on 20 Jan 2011

I was going to demonstrate a simple exercise for back pain today, but I've just seen this article in the Daily Mail online and it's taken priority.  Normal service will be resumed very soon!

To summarise, it seems that this chap "Dr Charles Ahme" - a 50-year-old football referee with an online first aid qualification - set up a "physiotherapy and sports injuries practice" in Levenhulme, Manchester.  Wearing a white coat, he asked female patients to strip naked and then massaged them, in some cases indecently.  He wasn't investigated until a GB athlete visited his practice for treatment and realised that his practice wasn't exactly standard.  She reported him and he is now apparently "facing a lengthy prison sentence".  Good.

OK, so where do I start?  How do you choose a physiotherapist, or in fact any healthcare practitioner?

• Word of mouth is a sensible place to start.  Ask around: if your friend or colleague has seen a really good practitioner, the chances are that they may be able to treat you well, too.  Most of my patients come to see me because one of their friends has recommended me.
• Check their website - most good practices have one these days, and you should be able to get a feel for what's available: does the therapist offer services you think you will need, and do you like the tone of the site?  If you like what they write, the chances are that you will like the therapist.  Good rapport between patient and therapist is an excellent first step to successful treatment, as if you trust your therapist, you will relax and the treatment will be more beneficial.  Most websites will also include testimonials from past patients and, provided that these are genuine, they will also give you an idea of the therapists' areas of particular expertise.
• Chartered status is no guarantee of quality, but it does at least mean that the therapist has been received the training that they say they have, and that their insurance and qualifications are up to date!  You should check that your therapist is registered with the Health Professions Council.  Physiotherapists should also be registered with the Chartered Society of Physiotherapy; any private physiotherapist registered here or here is a CSP member.
• Instinct is possibly the most important thing.  Don't automatically trust the therapist who wears a white coat!  We are programmed to do this, but as Stanley Milgram showed in his famous experiment, someone who wears a white coat (or other uniform or clothing that denotes professional status) is not necessarily what he seems.  The therapist should greet you, make you feel at home and always explain what they are about to do to you, what you are doing and why they are doing it.  You should always be able to ask questions, and if you feel uncomfortable at any time, tell them so and they should stop what they are doing immediately and discuss it with you, modifying any treatment so that you are comfortable with it.  If they don't, or if you are not happy with the treatment in any way, let them know; and if you're dissatisfied with their response, you are perfectly within your rights to raise your concerns to the Health Professions Council who will investigate.

Please don't get taken in by a bogus therapist!

For an appointment with Nell (a totally genuine Chartered Physiotherapist with years of experience treating musculoskeletal injuries!) please contact us or send her an e-mail.  She is available at The Foundry on Mondays and Tuesdays, and at The Back Shop on Wednesdays and Thursdays.