Sports injury

Pandemic Lessons Learned - Dealing With Uncertainty

 
man holding questionmark sign over face
 

Pandemic Lessons Learned - Dealing With Uncertainty


Dear all, I hope that you are safe and well and I think it is just about ok to still wish you a very Happy New Year! 

In June I wrote a blog post with the title “Looking after our mental health in challenging times”. At that point it looked like we might be nearing an end to the pandemic or at least there was some movement in the right direction. Six months later we find ourselves in a national lockdown and it is almost a year from when this first started.  

There is no denying it, this has certainly been a challenging time for a lot of people. Work adjustments, parenting challenges, relationship dynamics changing, social life alterations, sport and exercise modifications and so much more has meant we have had to adapt in the most unexpected of ways. When something is also out of our hands and the changes are enforced upon us, it can seem more challenging as the locus of control is external rather than internal.  

For today's blog post I thought it would be useful to discuss some of the lessons learnt and how we can approach the current situation to best manage life around us. Here are 3 main lessons we can learn:

Lesson 1- Control The Controllables

 “ You cannot control what goes on outside. But you can always control what goes on inside.” Wayne Dyer.

 In life we have a choice to make which although can seem reductionist and too binary, it can serve to let us control how we see life events happening. One is to see them as happening TO us and the other is to see them as happening FOR us. The former places us in a path of accepting that the events which occur which are not initially perceived as positive are almost there as a form of punishment. We demonise the event and see only the struggles we have faced and what we have lost. The latter mindset gives us a sense of opportunity and curiosity. No one can control this virus 100%. Our attempts with all the measures in place , vaccines, lockdowns etc serve to maintain, reduce and hopefully bring closer and end to it. But,  the virus is way more powerful than we are and will live it life as it sees fit. 

We can accept the situation as it is and learn to find elements in our life which we can take more control of,  or we can waste time and energy on gathering even more information, reading more news, hypothesising as to what may or may not happen with the virus. What becomes of the latter? There are thousands of people out there whose job it is to do this, the scientists, doctors and researchers who are paid to spend their time doing this. And yet we get drawn into joining them to feel some level of control over the situation when in reality, not even the experts have the answer.

If we spent more time focusing on what we could control we would undoubtedly have less anxiety, less fear, more time for ourselves, more energy to pursue meaningful endeavours which would serve our own personal development and overall health and wellbeing. Sure, we need to know the basics and what big changes have happened, but other than that, could it be that the time spent mulling over the uncontrollable could be better spent controlling our inside world?

 

Lesson 2 - Adaptation Not Abolition

“The key to success is often the ability to adapt.” - Confucius.

When something gets taken away from us or becomes more of a challenge we can approach the situation with 2 points, fixed or growth. The fixed mindset can tell us things like: 

  • Well that's it, I can't do that anymore so I’ll stop completely until this is all over.

  • If I can’t do it like I did before then I’ll just stop it altogether.

  • I’m all or nothing so I’ll wait until I can give it my all again.

  • It’s pointless just doing a little, the benefits won’t be enough.

 

I have heard similar principles being said over that least few months. People who, for example used the gym regularly, altogether stop as it’s not accessible. Or people who have less time now to dedicate to their rehab stop. It is our job as clinicians to help you find ways where you can adapt and not abolish all the things you used to do. There has to be a level of acceptance of the status quo and a willingness to adapt in spite of it. Having the above mindset allows you to have ready made excuses as to why you can’t continue doing at least some of the things you did. A growth mindset has the following dialogue:  

  • Ok. This has happened, what is possible for me instead?

  • I can’t do that anymore, but what could I do?

  • Even a small step is bigger than no step at all.

  • The skills I learn now could improve my old skill when I get back to doing that.

 

Let’s take playing tennis as an example, which has at times not been possible. If you were to take all the components of playing tennis down, what could you still work on and perhaps even improve? Perhaps you know that your footwork isn't the best at times. Buy a speed and agility ladder and work on that for a few months, that would no end help your game! Perhaps you've had that niggly shoulder whilst serving that you can't shake. Spend some time working on the strength and stability of that shoulder to allow you better performance when you're back.

 If you dig a little deeper into things, the space and time we have been given can serve as a powerful vehicle to allow you to upskill. It sounds so basic but I often say to patients “Ok, so you can't spend an hour in the gym anymore, can you spend 15 minutes doing a HIIT class?” They often respond with “Well what will that do?”. “ More than doing 0 minutes will” I say. In times such as these, sometimes we have to appreciate that maintaining and ticking over is just fine and that is way more conducive to just stopping.

  

Lesson 3 - Finite vs Infinite 

The infinite is in the finite of every moment.” - Zen proverb.

Life can be divided into things which are finite and infinite. Films, sports, a working day, a song, a train journey, a holiday, all these things have a start and an endpoint. It’s easy to conceptualise this and place ourselves in that time frame. What you notice about these things is that they are just that, they are things or events. What isn’t finite in life is our emotions, our development, our intellect, our wisdom, our growth and our experiences of life. It’s very easy to approach this pandemic and more specifically the virus itself as a finite thing. Whilst at some point, yes, Covid-19 will cease to exist, there will not be an end to viruses as a whole for now, or at least perhaps ever, in the life existence as we know it.

 I feel that at the moment so many people are placing such emphasis on dates, numbers, restriction changes to this that they approach it with an end in mind. Like other things in life, if we lead with expectation over appreciation of agreements then this can set us up for disappointment. If our expectations are met (let's say the news aligns with what we hoped for), we gain a momentary sense of relief and some level of freedom may come with it. But what next? Do we then start to set higher expectations? What if they aren't met? What if there is a u-turn like there has been so many times? Do we then continually just ride this rollercoaster of emotions ranging from elation to stress and worry? What actually changes?

 Something which can help in these situations is to actually place yourself way ahead in the future, several years even. Think about a conversation you might be having with someone who either lived through this or perhaps didn't, a niece or nephew or a grandchild.  Hopefully that conversation could go along the lines of “Remember that time when everything was really weird and we had to wear masks and everything was shut, how strange was that? But here we are, still living life.”

 This, like many things, will be a memory in years to come. It will have its place in history like other events. Check in with what is present to you and how the moments you have during this time are approached with a sense of openness and optimism. Ask yourself this one power question to keep present and focused: “How can I approach today different or better than I did yesterday and how will that keep me focused on the infinite approach to feeling and experiencing a different appreciation for the now?”

Thank you for taking the time to read this.

Alex. 

Alex is a physiotherapist with Physio Remedies and also a Life Coach. He works with people to gain greater awareness in any aspect of their life they may be struggling with by allowing them to explore what might be possible with more clarity in their goals and ambitions. Ultimately he aims to provide opportunities to people to lead a more fulfilled and extraordinary life by unlocking their fullest potential. You can get in touch with him at alex@alexmanoscoaching.com and follow him on Instagram at @alexmanoscoaching.

8 Tips To Master Your Mindset Through Injury

 
head and mind jig saw puzzle illustration
 

8 Tips To Master Your Mindset Through Injury


I hope you are all safe and well and are hopefully coming out of this period in a good place. Although this time has been challenging for many, it certainly has given us some space to reflect on many things which hopefully will serve you well moving forward. 

Today I wanted to talk about how to manage your mindset through an injury. This is such a crucial part of overcoming an injury, and in fact, can be the difference in the time of recovery and also the success of the recovery. Injuries are difficult to deal with as they stop you doing the things you love doing or even more practically can stop you from being able to manage normal daily activities. There is a huge three way connection between the mind, the brain and the body. As an analogy I like to think of it like this. Imagine an oil refinery, the petrol and a car. The oil refinery is the mind, the petrol is the brain and the car is the body. 

Processing     →     Fuel     →     Performance

Oil refinery     →     Petrol     →     Car

Mind     →     Brain     →     Body

Ultimately what we fuel our body with, physically, mentally, emotionally, spiritually, will determine the performance of the car. I know first hand, both having being injured and also having seen 1000s of injuries, just how a person’s mental attitude can help. When I worked in professional football, what amazed me was the difference in how players coped with similar injuries and how this impacted on their recovery. Although we can’t cheat physiology, healing and anatomy on a grand scale, we can certainly change it by altering our brain physiology which has an impact on our perception of pain and function and can lead to a quicker and more successful return to full health. 

Below are 8 tips for managing the energy that goes into overcoming your injury. No matter how big or small your injury is, there is always a place for improving the overall well being of your mind to help your recovery. 

1. Accept and don’t blame - At times of course, our actions may have been a factor in our injury. If we suddenly did something we were completely unaccustomed to then yes, we could look back and say ‘Oh why did I do that?!’. This is ok, but rather than blame ourselves, we should use it as a lesson for the future. We don’t set out with an intention to injure ourselves! We most often have good intentions, to be healthier, fitter, stronger etc, and this enthusiasm can overlook the fact that our body was perhaps not prepared for that change. Accepting that it has happened and moving on to deal with it as best as possible is key. 

2.  Don’t compare - No two injuries are ever the same and they are certainly not the same in how they present in different people. It is important to stay present to your injury and focus on that and that alone. You can certainly draw on experiences of previous episodes you may have had or people you know who have had similar but use that as a check point rather than a strict comparison. You may judge your progress negatively if you compare it to others who have recovered quickly. Stay in your own reality. 

3. Goal setting - This is a really crucial area and it is up to you and your therapist to come up with short, medium and long term goals. The most important of these are the short term goals as they will keep you present. At the start of your rehab your therapist should know what your ultimate goal is as this differs for everyone. Short term goals however are the key to keeping momentum going. You should establish a set of what we call process goals and then little tests you have to pass before you can move onto the next stage of rehab. This really is more for your therapist to do and then give you the exercises to reach those milestones but it’s really important to understand how these process goals will move you closer to your long term outcome. In the back of your mind, have that long term goal in sight, but each day focus on the tasks right in front of you. This is what will cause the mini shifts day in day out and before you know it you’ll be closer to your dream destination!

4. Clean language - The way we describe our injury and how we visualise what is going on in our body is really important. Unfortunately, it is not just patients who use inappropriate language when describing injuries. Therapists can also fall into habits which aren’t beneficial to an a understanding of the pathology of the problem. There is a lot of fear which can creep into a patient’s mind when they are spoken to in language which serves to, at times, catastrophize the problem. Depending on the injury of course, examples of such words are ‘unstable, broken, inflamed, tight, flared up, out of place’. Now in some instances, it may be appropriate to use some of those terms but a lot of the time it just isn’t scientifically right. The two most common misconceptions I hear are “My ITB is tight’ and “My back is out of place”, both of which aren’t really true! Speak to your therapist to gain a good understanding of what’s going on and use better language yourself in describing it. It can be a real game changer in moving forward with your rehab and altering your mindset. 

5. Visualisation - The power of visualisation is very real. You may have seen the images of F1 drivers mentally practising the circuit prior to getting in the car, tennis players getting into the zone during breaks, dancers working through routines in their heads etc. This constant mental imagery closes the gap between the thought and the action and allows the two to be more whole. This can work in rehab too. There are studies which show that adding visualisation can help the recovery from injuries. Sitting there and visualising healing taking place, picturing a healthy joint, muscle of whatever is injured, and looking positively at the recovery can aid both pain and also function. It is almost like a mini hypnosis which can be so powerful. It may sound odd, but talking to your injury verbally for a few minutes a day can help with recovery. 

6. Breathing - Similar to number 5 this is a really simple technique that we can use. The reason breathing properly and mindfully is so important is the effect it can have on the physiology of our body. Although you won’t notice the immediate effect of, say, breathing for 5 minutes a day on your rehab, over time the change is real. Breathing helps to regulate cortisol levels, the hormone which is released during times of stress. Regardless of where the stress is coming from, cortisol will be elevated in this state. During injury, stress may go up. Exercise has the effect of releasing your happy hormones: endorphins which can counteract the stress hormone. So, if your exercises routine has been disrupted and this balance of hormones has been affected, taking just 5 minutes twice a day to focus on some breathing techniques can really help regulate stress. You can try diaphragmatic breathing, box breathing, alternate nostril breathing - there are many forms of breathing out there. Please make sure that you are in good health, have no associated heart or respiratory conditions, are not pregnant and do not have other health issues that could be a contraindication to doing some of these techniques. 

7. Be adaptable - In some instances we have to accept that an injury may force us to reconsider what we can do going forward. I personally know how this feels.  After having had several ankle injures, I have now accepted that I can’t do the things I did 10 years ago which is ok and I have since found new things to help and also keep my enthusiasm up for exercising despite not being able to do exactly the same things. Re assess your current exercise routine, be open to trying things you haven’t tried before, understand that our bodies do change with age - what may have previously worked for us may not be serving us as well now. I am a big believer in having variety in your exercise, unless of course you have a very, very specific sport or event which requires you to train very specially. For example, it would be counterproductive for a 100m sprinter to suddenly take up lots of yoga as they actually rely on an element of stiffness to produce power over a short space of time. Train your body in different ways to ensure good balance of strength, flexibility, power and fitness. 

8. Make sacrifices - Ultimately it comes down to how important an outcome is to you. Your ultimate goal and your lifestyle have to be aligned if you want to see the best and quickest results. Not only can our brain not comprehend conflicting thoughts, nor too can our body. What do I mean by this? Well, if you want to lead a healthier lifestyle and yet keep telling yourself that you love fast food, your brain will become confused and so too will your actions. Similarly, if your goal is to ski after a knee injury and your physio has set you a programme of going to the gym 3 - 4 times a week, choosing to go out socialising on two of those days instead is not going to produce the results you need. It may sounds common sense but it is often not common practice. Your daily habits will, over time, produce the results you want. It’s that simple. Be prepared to sacrifice some things, perhaps only for a while mind you, to focus on what matters most at the time. 

I hope that these points have been useful in identifying some areas you could work in to optimise your rehab. I am a huge believer in mindset and how it affects the body and paying attention to the above can really help shift you in the right direction. 

If you would like to find out more about any on the above then please feel free to contact me at alex@physioremedies.com.

I wish you well in your rehab and I appreciate you for taking the time to read this article.  

Stay healthy, stay strong!

Best wishes 

Alex. 


Words by Alex Manos.



What Does My Physio Think About: The Most Common Injuries We Treat

 
neck shoulder pain
 

What Does My Physio Think About: The Most Common Injuries We Treat

Do you ever wonder what your physio thinks about your favourite forms of exercise or whether your health or lifestyle choices are a good idea? In the fourth of a series of blog posts entitled “What Does My Physio Think…?” we asked our physios and therapists “what is the most common injury you see in clinic?”

And here are their answers:

Our specialist spinal physio Shari says:

“In order:

  1. Lower back pain

  2. Neck pain/headaches

  3. Shoulder pain

  4. Knee pain

  5. Mid-back pain

  6. Ankle pain

  7. Hip/groin pain

  8. Elbow pain, and lastly

  9. Hand injuries.”

Emily, our soft tissue therapist, triathlon coach and athlete personal trainer, comments:

“As a soft tissue therapist:

  1. Knee pain and achilles problems from tight quads and calves in runners

  2. Rotator cuff issues from incorrect stroke in swimmers

  3. Above all, the most common injury is shoulder and neck pain from sitting at a desk!”

Stuart, our specialist knee and foot & ankle physio says:

“Patella Femoral Joint Pain (PFJP) - injuries associated with the patella or kneecap.”

Physio Paul, who specialises in sports injuries, says:

“Necks and shoulders.”

Physio Nick, our shoulder specialist physio, unsurprisingly says:

“Shoulders!”

Injury Of The Month: Football Injuries

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Injury Of The Month: Football Injuries

The football season is now well and truly under way both at professional and also amateur level so we've asked our physiotherapist Alex Manos, who specialises in the lower limb and hip & groin and used to be the First Team Physio for Crystal Palace FC, to give us the guided tour of common football injuries and how to avoid them:

Football Injuries

Having worked in professional football for most of my career, the injuries I see there are no different to the injuries seen at the local football pitch on a Sunday morning. So here is some information on common injures seen and advice on how to ensure the best possible recovery and reduce the risk of re injury.


Preparation

Even at amateur or weekend warrior level, it is still important to prepare as well as possible. A good level of prior conditioning, both strength and cardiovascular fitness wise, will reduce the risk of injury. Working on lower limb strength and stability and also increasing running endurance by using running drills or alternative forms of cardiovascular fitness such as the bike or circuit training will improve both performance and reduce the risk of injury.


Fitness for football


Football is a mixture of aerobic and anaerobic fitness as it can involve both short and long bursts of activity. If you are thinking of improving your fitness levels for football, training should replicate this. For example, you could do interval running session sessions on the treadmill or outside running.

For longer type runs, box to box runs are good where you run from the front edge 18 yd box to 18yd box and then very lightly jog to the goal line, turn and start the run again on the edge of the box. These would be at about 70-80%, 3-4 sets of 6-8 runs with a rest of 2-3 minutes in between sets is good.

For shorter drills then cone work which incorporates shuttle type runs or change of direction drills can be done. As the speed and intensity is higher, ensure a longer rest between runs and sets so you can work at maximum speed.

Circuits or what is commonly known as HIT (high intensity training) is a great way to work the entire body from a strength point of view and also gain cardiovascular benefits to give you a better engine during matches.

Focusing on lower limb stability exercises such lunges and squats will also help with fitness, power, speed and reducing injury risk.. A lot of force goes through the legs so having strong, balanced legs with good ability to safely change direction will help prevent injuries.


Common injuries

Muscular injuries are common as people often reach maximal sprint pace for prolonged distances and as there is kicking involved, it is an additional risk factor. Joint sprains in particular to the ankle and knee are also prevalent. Here are three common injuries:

 
  1. Hamstring tears – the hamstring is made up of three muscles at the back of the thigh. Hamstring injuries are very common in football. They typically occur when players are sprinting and when the hamstring is changing its function from shortening to lengthening. Players will report feeling a tearing or maybe even a popping sensation in the back of the thigh. This will lead to pain, reduced mobility and in moderate and severe cases there may be bruising and swelling.

    These injuries need rehabilitation and won't just get better with rest. The muscle needs to be adequately strengthened for a safe return to sport. Mild strains can take as little as two weeks whereas severe tears could take up to three months if not more. Once you have had a hamstring tear the risk of re-injury is higher so it’s crucial to do the appropriate work to reduce the risk. A physio can help direct your rehab and ensure all the boxes are ticked. This would be a combination of flexibility and strength work and also then implementing some specific running drills.

  2. Groin pain – groin pain is a very complex area but is very common in football. The complexity arises from the fact that there are many possible sources of groin pain in athletes and footballers. The hip joint, the pelvis, the lumbar spine, the muscles around the hip and groin and also the abdominal area can all be a source of injury and symptoms. Quite often there is also more than one pathology, or if not then the original injury can lead to other imbalances which then give rise to a secondary problem.

    One of the most common misdiagnoses is one of repeated ‘groin strains’ as muscular injuries. Quite often these strains are not actually muscular and the pain originates from the hip joint. An accurate diagnosis is key to providing the right type of treatment to this area and with a thorough subjective history and detailed physical examination, a physiotherapist will be able to determine the problem areas. There may be times where physiotherapy alone is not enough and further intervention such as an injection or surgery may be required but the first thing to do is be properly assessed and referred on for further investigations or opinions if needed. Some groin injuries can become chronic and very difficult to get back from so the sooner they are dealt with the better.

  3. Knee sprains – the knee is vulnerable to injury in football due to the nature of repetitive twisting and turning and contact. Two of the injuries which are seen are Anterior Cruciate Ligament and Medial Collateral Ligament injuries (ACL and MCL respectively). Both injuries can be a result of contact or non contact mechanism but will involve the knee being twisted beyond its normal range which causes ligament damage. ACL injuires usually require surgery whereas MCL injuries (unless very severe) are more often rehabilitated without surgery.

    The recovery following ACL reconstruction is a minimum of six months but typically will be 9-12 months. Minor MCL injuries can recover in six weeks and more severe tears can take three to six months. These injuries require lots of rehabilitation to build the strength back around the knee and other joints. The ligaments provide stability to the knee so any disruption to this weakens the knee and it’s crucial to regain maximum strength and stability before returning to sport. A physiotherapist will guide you through the appropriate stages in rehab to try and return to your previous level of activity.

If you have picked up an injury related to football or want some advice on any of the above or anything else please feel free to call us on 02030 121222 to book in with one of our physiotherapists.

Words by Alex Manos.