Leading the way in Whiplash Treatment with Chris Worsfold

As the months go by and the nights get longer and darker, things here at PhysioDirect go into overdrive. This time of year is always busy for us with a noticeable increase in referrals from insurance companies, asking for us to help people who have suffered from whiplash injuries. It could be a coincidence it gets busier each year at this time, or because the roads are more wet with poorer visibility, or because people are distracted thinking about what christmas presents they need to buy. Whatever the reason for this increase in whiplash injuries though, the latest Remedy House course up in sheffield titled ‘Clinical Whiplash and Neck pain’ couldn’t have been timed better.

This latest instalment in the Remedy House series was taken by the delightful southerner, Chris Worsfold. Chris has a wealth of knowledge and many many years of experience in the area of whiplash, and over the two days he imparted a great deal of this, cramming in loads of useful assessment tools and different approaches to treatment.


 

Is Whiplash Real?

To kick things off, Chris went over some of the work he’s done in the past providing expert opinion in cases that suspect false claims for whiplash. Although there may be some crooks out there that try and pretend they have an injury to get compensation, as a physiotherapist there is no doubt in my mind that this is a very real and debilitating condition. Chris made the quite remarkable point that some people on the legal side of this doubt the presence of whiplash altogether! I couldn’t help thinking at this point if these overly skeptical individuals felt this way, we should invite them to take part in some of the whiplash research being done. They would obviously be happy to sit in a car and get bumped from behind at 20 miles an hour and not have any concerns about these imaginary symptoms they won’t be getting over the next few weeks.


 

Expert Assessment

Chris Worsfold and Thomas Mitchell
Chris Worsfold and Thomas Mitchell

After showing us some slow motion videos of people being hit from behind at less than 10mph (which made me wince), Chris discussed some interesting points around vehicle factors, headrest position, the biomechanics of the crash, and which structures in our bodies were most likely to be injured. It turns out whiplash can cause a lot more subtle problems than just neck pain and stiffness. Here’s what we learned:

  • Check for altered muscle activity in the neck – Although research shows that muscles don’t change much in composition after a whiplash accident, the way muscle work can be affected. Muscles can be sluggish to switch on, and end up weaker (which might seem counter-intuitive, as it often appears that all neck muscles are very overactive). Chris went through some nice tests here to assess neck strength endurance, control and quality of neck movement.
  • Pay more attention to dizziness – With whiplash sufferers, a large percentage report symptoms of dizziness (a lot more than, for example, people with neck pain that wasn’t as a result of a road traffic accident). This is important. Although dizziness can be part of a cluster of symptoms that suggest something more sinister is occurring, more often than not, it’s a sign that there has been a disturbance to the sensory organs in the neck. One cause of this can be an impairment of the internal awareness of our neck and head’s position. Chris took us through a pretty cool assessment using laser beams and targets on the wall to see how well someone could get back to the a starting position when moving it with their eyes closed.
  • Get comfortable with prolonged eye contact – Vision is an often un-assessed sense that can be affected. Disturbances in muscles that control eye movement can contribute to dizziness and headaches. If someone is struggling to focus on the TV, or when reading, or when trying to use their peripheral vision, then this might be a sign that you need to investigate further. Chris went through some more great assessment methods to pick up these problems. This did however mean spending quite a while looking into other course members eyes.
  • The link between neck and eye movement – Our eyes and neck are designed to work seamlessly together. If you want to check for yourself, look at a spot in front of you and then try and shake your head from side to side. Notice how your eye’s stay focused on that point without any effort? This is all to do with one of the two main reflexes that help us coordinate our neck and eye movement. In a road traffic accident, these can be affected. Chris showed us some nice tests here where we fixed head position, and got them to move their bodies to one side. Testing eye control and looking for a change in dizziness from this rotated position can help identify if these reflexes are impaired.
  • Don’t forget to look at balance – Linked to all of the above, standing balance can also be negatively affected. A quick test checking how well someone can balance with eyes open and closed, with different foot stances can highlight problems here.

 

A More Thorough Approach to Treatment

Now being armed with a whole array of different assessment methods, and being able to pick up issues with neck muscle control and strength, eye control, reflexes, head positional awareness and balance, knowing how to work this into our treatments was the next step.

One of the points Chris made whilst introducing the topic of Whiplash, was that historically, it’s something that has not responded too well to treatment. However the treatment methods that seem to show the most promise, are linked to the stuff we’ve looked at above. Here are a few idea’s we looked at when trying to put together an individual treatment plan for someone:

  • Strengthening – One of the most useful tools at our disposal is a progressive strengthening program. We looked at some interesting exercises involving weights and bands attached to the head. It might look silly but don’t let that put you off doing it. A more general approach to strengthening around the shoulder and neck can also be of great benefit.
  • Visual and balance work, head position awareness retraining – Linking all the things we looked at in assessment, Chris took us through ways for patients to retrain visual issues, balance and neck control. We looked at ways to combine treatment of several of these issues at once, how to progress that treatment, and how to link it to someones everyday life. An example we used was a footballer having to receive and kick a ball from his left side, having to retrain his neck movement whilst tracking the ball with his eyes. This provided possibly one of the more memorable moments of the course; watching Remedy Houses’ Thomas Mitchell with a laser on his head, wearing goggles trying to balance with a narrow stance whilst twisting his neck.
  • Taping – As an adjunct taping can be helpful in offloading some of the tension from whiplash.
  • Manual therapy techniques – Some of the more traditional manual therapy techniques still have a place. Chris showed us some of the things he likes to use with his patients to help ease pain. At this point when looking at a technique digging into the deeper layers of muscle on the back of the neck, Chris was amazed by the robustness and high pain tolerance of the northerners in the room.

 

To finish things off Chris took us through a few case studies of people he’d treated, detailing what he’d done with them and the result he’d found. Seeing how it all fit into his clinical practice was helpful to give a bit more real-life perspective on all the theory and practical stuff learned over the weekend.

A course review wouldn’t be complete without mention of the catering, which consisted of outstanding hot meals provided by the local Italian, which kept everyone full and focused throughout. All in all the weekend was a resounding success, with heaps of great gems for everyone to take away and start applying the very next day.

Give the gift of pain relief!

Why not treat someone to a sports massage this Christmas to ease their winter aches and pains?

Vouchers now available from our clinics.

Happy Festive Season!!

Technology and Our Health

Last month saw the launch of the new iPhone 7, and although in my eyes it seems like they’d just given the old phone a paint-job and removed a useful headphone socket, apparently it’s still a revolutionary step forward in technology. The massive hullabaloo that’s usually associated with a new iPhone release did however get me thinking a bit more about the world of technology from a health point of view. Have advances in technology been a positive or a negative? How will the technology of the future affect us?

As the cogs in my mind slowly started to turn, one of my first thoughts was of the increasing dependence on smart phones, tablets and computers in our day-to-day lives. I personally can recall a few cases of young individuals coming to see me with back pain, neck pain, and headaches simply from over-use of their smart phones and computer games. With the youngsters in question, pain had developed simply from just spending so long in one position doing NOTHING but playing on games for hours on end every day. Some simple advice on getting up and moving around, along with the groundbreaking idea of going outside to play for a change saw some quick improvements. I am of the opinion that young bodies are extremely resilient and adaptable, and as long as they continue to move more and exercise then they shouldn’t suffer long lasting ill effects. People have, after all, craned their necks down to read papers for centuries without a massive epidemic of neck pain, so on balance, the dependence on smart phones shouldn’t cause greater problems provided we all remember to move.

Are New Innovations Making us Lazy?

Technology is always moving forward, and companies have embrace it to create new products, and continue growing and making profits. In this pursuit of better and more advanced products there seems to be this over-searching for solutions to problems that don’t exist. To use an example; in the past people used to walk everywhere, this took ages, so we learned how to ride horses, which took a little less time but also ages. To help us get places quicker we invented cars and planes, which now means we can be in a completely different country in Europe in less than a few hours. Those kind of inventions have helped our civilisation greatly.

Now that a lot of these big problems have answers, we seem to be working into smaller and smaller niches to find minor issues to fix that aren’t actually a problem at all. A few examples of this are having voice control for your TV, so that you don’t have to press a button on your remote control, or car key sensors instead of having to reach in your pocket and press a button to open your car door. Taking that a step further, the idea of self driving cars; another innovation that just takes control and effort away from us, so we can sit and do nothing. Virtual reality headsets are another invention an that allows us to see things without ever moving from our armchairs. Things that we might otherwise have to experience the old fashioned way, by actually travelling somewhere and doing something.

I realised the above rant probably makes me sound like a grumpy old man, but it’s led me to think the more we use technology to make every part of our lives easier, the less we will actually have to do. My (possibly slightly irrational) concern is that in a hundred years time, we could turn into the people from the Disney film WALL-E who’ve evolved to never move!

Wearable Gadgetstech2

In an effort to try and embrace technology to promote health however, companies such at Fitbit and Jawbone have filled the gap in the market by producing wearable monitors that track you through the day. They monitor things such as heart rate, sleep quality and step count. On the face of it, this sounds like a great way to track and measure our stats more easily, but evidence for the actual effect of these devices improving your health and fitness is still quite limited. In my opinion people may become complacent and think if they’re hitting their step-count for the day then they don’t need to go out and do any other exercise, or if they do go to the gym they might focus on getting their step-count up on the treadmill, rather than having a more varied workout which would have a much better effect on all-round health and fitness. I do however encourage and support any technology that at least encourages us to think more about being active. With no pun intended.. its a step in the right direction.

The Benefits of New Technology

Technology has made a great difference to our health in some areas if we look wider afield. The advances in some of the ergonomic equipment in modern factories for example has enabled workers to reduce the repetitive physical heavy lifting, and reduce the injuries associated. Improved wireless connectivity has meant there is now more opportunity for normally cubicle-bound office workers to be more flexible, working whenever and wherever they want. This gives the option of moving around more and taking more breaks, which can help counter the bad effects of being static for too long. In the more forward-thinking parts of Europe, technology such as the sit-stand desks has become more standard in every office, to give employees the option of sitting or standing to work through the day.

Improvements in medical technology is another area of great benefit. In recent times we have started to see trials of robots in the operating theatre which can perform amazingly precise and complicated tasks a surgeons hands would not be able to replicate. Something that should lead to much higher success rates from surgeries, with reduced scarring and improved recovery times. Developments in fields such as stem cell research have also started to see what would be once thought of as science fiction; the growing of replicate organs to replace our failing ones. This means people in the future have the possibility of organ transplants without the need for drugs that stop our bodies rejecting the donor organs.

Technology in Physiotherapy

Technology has played its part in physiotherapy diagnosis and treatment over the years. The use of MRI scans as a tool to help diagnose musculoskeletal problems has had a debatable benefit (as I have discussed in a previous article on back pain), but advances in imaging technology does mean that its easier to pick up things such as cancer more easily. Equipment such high definition 2D and 3D recording equipment, force plates and motion sensors used in the assessment of running has been of great assistance when trying to break down and analyse the complexities of human movement.

The use of technology in physiotherapy treatment is something that has moved in and out of fashion. In decades past there was a rise in the popularity of electrotherapy as part of treatment. It’s initial popularity, as with any new treatment, had a ‘novelty factor’. The shiny new ultrasound machines with flashing lights and beeps were very popular with patients, but as the years have passed and more research has been done, a lot of these fancy gizmo’s are now only a very small part of a physio’s toolkit, and I don’t see them playing a bigger role in the future.

In summary, the advances in technology seem to me at least, to be a bit of a mixed blessing. And although we are probably unlikely to have an epidemic of neck pain caused by smart phones, the perceived need for technology to remove all effort from our daily tasks may not be that great for our health. On a positive note, advances in technology in the workplace and medical field have done and will continue to provide benefits. As a physio I’d say I’m a bit skeptical about some of the advances in technology in our field, but I shall try not to let my inner grumpy old man take over, and keep an open mind to the future innovations that could help the profession.  

Phil Rippon: Nottingham Panthers and PhysioDirect Physio

Having spent some time over the last few years working in one of PhysioDirect’s more northern clinics, in the old mining town of Mansfield, I have had the pleasure of working alongside Phil Rippon. I will always remember my first day working for the company, starting off in Mansfield. I arrived like an eager beaver; early and slightly nervous as anyone does on their first day, waiting in the carpark for the place to open. Phil turned up a few minutes after me a look of what can only be described as complete exhaustion on his face. My first thought was “oh dear god, I hope they don’t work me as hard as this guy”, but as I chatted to him later that morning, my initial worries about PhysioDirect were eased as it emerged that Phil had only had a few hours sleep the previous night, having travelled back from near Scotland with the Nottingham Panthers ice hockey team.

The other week Phil hobbled into work equally exhausted after completing the great north run, but in spite of his tiredness, he has kindly agreed to give some of his time to answer a few questions around the interesting work he does at the Panthers, and a little bit about the work he does here at PhysioDirect.

To kick things off, I thought I’d find out a bit about Phil’s journey into physiotherapy.

Phil Rippon Nottingham Panthers Physiotherapist
Phil Rippon Nottingham Panthers Physiotherapist

B: So Phil, I know we’ve talked a bit about this before but tell me a bit about yourself, what made you decide to become a physiotherapist?

P: I guess it came from an early age when I remember looking through biology related books with my mum and grandma (both were nurses) and gaining an interest how the human body was made up and how it moved etc. Then as I went through school, biology was the one lesson I looked forward to and excelled in. I was pointed in the direction of physiotherapy when I met a careers advisor at school.

B: Awesome, it seems like it was a natural path for you. Did you always plan to work in professional sport when you decided you wanted to be a physiotherapist?

P: When I finally decided to be a physio I tried to gain as much experience as possible in various areas of the profession. One of these was with the physio department at Notts County FC. I really enjoyed watching how the physio’s worked and how they got players ready for upcoming games. It was a very intense atmosphere and very fast paced but it was where I could see myself working. After qualifying I worked with a semi professional team in Newcastle for a few season alongside working in the NHS and I really enjoyed my time working with both.

B: So you liked to keep busy right from the start! All the initial sports work you did was in football, how did you end up working in ice hockey for Nottingham Panthers?

P: Well I decided I wanted to move back to Nottingham, and when I came back I started working for for PhysioDirect. A colleague there, Scott Poundall, was already working for the Panthers as their therapist. We worked together for a while at PhysioDirect and also on a Sky Sports programme called ‘The Masters’ which was a five a side competition for ex professional footballers that was held throughout the country. Initially I helped out at the Panthers when Scott wasn’t available (which was probably once/twice a season). When Scott went back to university I was asked to be part of the medical team on a regular basis….that was 3 years ago and I have enjoyed my time there since.

B: Tell me a bit about the work you do at Panthers. What are your main responsibilities as their physiotherapist?

P: The job depends upon where we are playing that day, if I’m working a home game then I have to be at the rink in the morning as we have a light pre-game skate as I have to oversee the training session incase of injury. After the training I’m available to any players carrying niggles/knocks for assessment and treatment or wanting a ‘flush’ (a type of deep tissue massage that releases the tension in the muscles). Game time begins approximately 2 and a half hours before face-off when players that are needing treatment prior to the game come to see me. We also have a sports masseuse that comes to home games to help out. During the game I’m rink-side to offer medical support for any on ice injuries (thankfully we don’t get many that are serious). If it’s an away game then the role is pretty much similar just without the pre game skate in the morning.

Phil Rippon
Nottingham Panthers Medical Team

B: What are the best and worst parts of working in professional sport?

P: The best part of working in sport; be it pro, semi pro or amateur, is being part of winning games and trophies and it always gives the team and staff a buzz when we get the right results. The panthers have been successful over the past few years with winning league, play-offs and challenge cups over the past 4/5 seasons which has enabled the team to represent GB in European competitions across Europe. On the other side of the coin, the worst part has to be the loses. No one likes losing! However with the games coming thick and fast there’s little time to dwell on the defeat.

B: Nice, I suppose you’ll feel the ups and downs as much as the players. Keeping all the players injury free must be a big part of the winning formula though? When they do get injured, what are the most common injuries you tend to see and treat?

P: There is such a wide variety of injuries I’ve seen over my time with the panthers ranging from serious injuries such as broken ribs, punctured lungs and concussions to not so serious strains and sprains of muscles and tendons. The most common injuries I have to treat are around the ankles, knees, shoulder and neck.

B: Going back to keeping players injury free.. Can you tell me a bit about the kinds of pre-hab and testing/training you do with the players to help with this?

P: We have a real MDT feeling to the medical side with myself and Scott, a chiropractor, strength and conditioning coach and sports massage therapists to help deal with the prehab. When players come into the country from North America they have to biometric tests done before they can get their visa. As a club we use a bunch of body measurements and test to highlight weaknesses or mal-alignments and then we work to help correct them during training camp.

B: That is a theme you see across all successful professional sports teams I guess; everyone on the medical team with working towards the same goal, with good communication helping keep each player at their best. Finally one last quick question and I’ll let you get away; does the work you do at Panthers influence your work here at PhysioDirect? If so, how?

P: I guess it does influence my work as I have had a few clients with undiagnosed concussions and I was able to direct them to the right place, and knew what procedures needed to be followed. Deep down under the skin we have the same body make-up wether we are pro hockey players or a company director, we just use our bodies differently.

B: Great, thanks for your time Phil. Definitely some gold nuggets there for anyone interested in working as a physio in high level sport or just interested in what goes on behind the scenes.

Thats it for another blog, if you want to see Phil in action you can always pop down to the Nottingham ice arena, as he will be rink-side most matches. If you’d like to book a private physiotherapy session with Phil at our Mansfield Clinic, call our admin team on 0115 956 2353 and they will be happy to book you in with him.