Are you Taking your Medication?

I often get exasperated people coming to see me. Being told by a GP to just take more painkillers rather than giving anything more substantial is a common cause of this frustration.

As a physiotherapist my initial reaction to someone wanting a practical solution to their problem, rather than just to carry popping pills, is a warm feeling and the thought of congratulating them on making the wise decision. That being said, ruling out medication altogether can be a bad idea. Knowing how and when it should be used as part of someones complete treatment is very important.

In this months blog I want to go over a few different types of medication, their uses, some common misconceptions and the role physio’s can play in advising on medication.

Everything is Not Equal 

Despite what the establishment will have you believe these days, not all things are equal. This also applies to medication. Here are a few of the main categories that I think are relevant in the work I do:

Non Steroidal Anti Inflammatories (NSAID’s)

The most common of this group is ibuprofen (you may know this as ‘Nurofen’ but don’t be fooled by the branding or fancy packaging, it’s the exact same thing but for way more money). Ibuprofen is most appropriately prescribed for problems with active inflammatory processes going on.

Following a line of logic, if an NSAID is making no difference to your pain, it could be a clue that your pain is not related to inflammation, and therefore may not be the right medication for your problem.

One misconception around this category is that they aid in healing and recovery of new injuries (such as a sprained, swollen ankle) by reducing the inflammation. The exact opposite is actually true. The inflammatory process is a necessary part of healing, by interfering with it, you can actually impair the recovery process, and end up with weaker scar tissue and a higher risk of re-injury. The knee-jerk reaction to pop a few Neurofen whenever you’ve got a strain or sprain is therefore not the right one. My opinion is to only take these when pain is more severe and affecting things like sleep and general movement, and if things aren’t improving with time or physiotherapy alone.

Corticosteroids


Similar in the previous category in that these drugs help to reduce inflammation. This can be in tablet form often used to treat respiratory issues, or more relevant to my area of physiotherapy; injections. ‘Cortisone injections’ are commonly used in ‘tennis elbow’s or ‘frozen or impinged shoulders’, but again, aren’t risk free. Repeated injections over time can cause weakening of connective tissue, which isn’t an ideal situation in structures like tendons that need to stay strong.

I do believe they do have some benefit in certain situations however, if someone is in excruciating pain and an injection can give a bit of short term relief, it can help someone get past a sticking point and move forward with their physiotherapy treatment.

Opioids

I like to think of opioids on a spectrum – ranging from relatively mild ones like codeine, to strong and powerful ones such as morphine. On the simplest level, opioids work by attaching to receptors in the brain, blocking pain signals.

Opioids can effect people in different ways, with some people finding profound effects from very low levels of medication, and others not finding any benefit from them at all. The same can be true of the side effects experienced; some people cope relatively well with minimal side effects even with the stronger types of opioids, and others find problems like nausea, constipation and drowsiness even with low doses of codeine.

This class of drugs highlights how individual we all are and how our bodies process things in different ways. This is why it’s important to keep your GP in the loop if you find things not working or experience side effects, as they may find you are better suited to a different medication.

Neuropathic Medication

In the context of pain, these drugs are used specifically to treat nerve related symptoms. If someone has raging nerve pain tracking down a limb that has not responded to the other medication types listed above, looking at some neuropathic medication is often appropriate.

This is the class of drug I think is most misunderstood as it is also prescribed for other unrelated conditions in other people. For example, I’ve had people come to me who’ve been prescribed Amitriptyline (which is also prescribed for depression), who are concerned the doctor thinks they’re depressed after reading the leaflet inside the box.

Nerve pain can often really affect sleep, so having something to help get a better night can make all the difference in starting to recover and breaking that pain cycle.

Muscle Relaxants

Muscle relaxants definitely deserve a mention. I often see people in very acute pain caused by high levels of muscle activity or spasm. With someone in this situation, I always see if I can get things to relax or ease off with various physio techniques, heat, exercises and activity changes, but sometimes a little extra help is needed.

A short course of muscle relaxants properly prescribed through the GP can often help people turn a corner, and start to get more out of their physio treatment if they are really struggling.

A Few Words on Paracetamol


As this is probably the most common medication we all come across, so I want to make a few points on it. Because paracetamol is such a mild medication, people often think it has very little effect inside the body. This mis-understandings of it being not being harmful can lead people to have a blasé attitude towards it. If paracetamol is taken more frequently than the recommended 4 hour gap, it can have a very harmful effect on the liver. So make sure you don’t underestimate it!

On the other side however, paracetamol does need to be taken consistently to get some base level in the bloodstream, so if you’ve got a more chronic constant pain, then try to follow the doctors advice on when to take it. Paracetamol also has a synergistic effect with other medication, so taking it alongside some other medications can be more beneficial.

Final Thoughts..

A good knowledge of types of medications, when they’re appropriate and how they work is essential as a physiotherapist. A growing trend now within the physio community is training to become an ‘independent precriber’, which takes this knowledge a stage further. This is definitely something I’m considering doing, as I feel we are often better placed to assess peoples physical symptoms than GP’s and therefore give the right type of medication along with the right advice. An added bonus here of course is the reduction in pressure on GP practices which I think everyone would be grateful for! Thats it for this month, stay tuned for our next update! 

The Part After Surgery You Haven’t Considered

The last few weeks have been challenging. Unexpectedly my dad fell and broke his main thigh bone clean in two. After the initial shock, paramedics, ambulance and subsequent surgery my dad was given the disheartening news that he would be off his feet for a good few months, with a long and slow recovery period where he wouldn’t be able to do much at all.

My father is someone who rarely sits still and always on the go. To him the news he would have to rest for an extended period was probably worse for him than the pain of actually breaking his leg.

As a physio I always see this kind of injury from a professional point of view. I think about what practical things I can suggest to make things easier at home, what exercises I can give and give about my plan going forward session by session. This time however my first thoughts were not about the rehab. Instead my mind went straight to what my dad was actually going to do to fill his days with.

Thinking without my physio hat on, I have tried to come up with a list of different activities for my dad to do, to help pass the time in between home exercises, eating and sleeping. Having done this, I thought I would share it incase you or someone you know is sat twiddling their thumbs without much to occupy themselves with. So here we go..

Box Sets

Having given up on trying to teach my dad how to use Netflix on his new smart TV, dusting off the old 24 box sets has proved an invaluable boredom killer.

Podcasts

If you have a niche interest like gardening (or classic cars in my dad’s case), chances are there’s a podcast out there for you. Podcasts can also be a great free learning tool. If you wanted to, say, learn more about history in this forced down-time then a podcast like ‘Hardcore History’ could be a great starting point to find new topics or areas to look into.

Alternative Exercise

Having an injury doesn’t always mean you have to do absolutely nothing physically. If you’ve broken a leg there are heaps of upper body only exercises you can do either at home or in a gym (even an upper body bike for cardio) to work up a sweat and keep some form of fitness going.

Learning a New Skill

Along the same lines as the podcasts, modern technology has provided such easy access to so much information and eduction, it’s never been easier to teach yourself something new. There are so many online courses or tutorials that if you wanted to learn to paint, invest in forex or even how to set up an online business, you can find all the information you need. Getting my dad to do this however may be a bit of a stretch…

Catching Up With Old Friends

Social media has meant it’s never been easier to reconnect with people you’ve lost touch with. When you’re busy rushing around it’s easy to let things slide with people you’ve been close to. Viewing your recovery period as an opportunity for this kind of stuff can certainly make the time more tolerable.
 

Final Thoughts..

As someone who’s not a huge fan of trying new things, I’m dubious how many of these ideas I came up with my dad will decide to act on. I’d still however like to think that theres a good balance of activities here for most people to keep occupied and positive whilst recovering from similar injuries.

Why I Find it Hard to Enjoy Films

Listening to a recent interview with famous astrophysicist Neil deGrasse Tyson got me thinking. He was joking about how he always analyses the films he watches to see if they’ve got the physics right. He noted how this had been picked up by the media following his comments on Twitter about inaccuracies in the film Gravity, and how some of it just couldn’t happen.

As a physio I’ve found something similar; my profession spills over into the things I watch..

Batman.. Ruined.

This became apparent whilst watching one of my favourite film trilogies. The Batman Dark Knight series directed by Christopher Nolan. I remember my eager anticipation for the last film in the series, and my excitement going to see it. This excitement, however, was slightly spoiled by my physio mind..

In the scene after Batman’s fight with Bane beneath the city (where Batman seemingly gets his back broken). Bruce Wayne lies crippled in an exotic underground prison, only to be strung up by rope from the ceiling to have his ‘protruding vertebrae’ punched back into place.. Miraculously after a period of time hanging from the ceiling.. He can walk again! Although I knew it was only a film (featuring superheroes), I couldn’t help from thinking about the anatomical impossibility of what I’d witnessed.

The Car Chase Frustration

Ok, so a one off irritation?.. Unfortunately not. My physio mind interrupts me frequently when watching a common feature of action/thriller movies; the car chase. Something that tickled me during all of the Bourne films; watching each car chase as Jason Bourne races through the streets, down steps and over jumps. I couldn’t help but think as his car collided with the side of pursuing police car what grade whiplash he might suffer from on the Quebec scale.. The over-analysis didn’t stop there; as the following scenes left me thinking how he might be far too stiff to roundhouse kick the villain if it’d happened in real life.

Recently this over analysis was brought to the forefront of my mind again, whilst watching a new addition on Netflix; the film ‘Bleed for This’. A film based on a true story about boxer Vinny Pazienza who suffered from fractured vertebrae in a car accident, only to return to the ring to win a world championship. Although this may sound wrong.. this time I was pleasantly surprised to find the injuries sustained matched the apparent severity of the accident on screen.. Terrible I know.

Not All Bad!

It didn’t end there. I also struggled to find fault with the recovery process. The physio within actually cracked a smiled at Vinnys determination to recover, and how the film showed him training with his external, steel neck brace (that was bolted to his skull) still in situ. As someone that likes to work round problems rather than use them as a reason to ‘rest up’, this appealed to me greatly.

Perhaps due to it being based on real life, this film was different. So just a one off?

Racking my brains, it turns out there were quite a few of these examples. From Hank getting mowed down in Breaking Bad, struggling emotionally and pouring with sweat learning to walk again, to Leonardo DiCaprio being mauled by a bear in The Revenant and nearly dying, to using bits of wood he found lying about to help him rehabilitate his own broken leg.

The Hollywood Factor

Although these examples undoubtedly used some poetic license make them more entertaining, a common theme that appears (and that I probably enjoy more because I’m a Physio), is the visible struggle and fighting back against the odds back to normality.

Watching these stories of recovery has certainly helped provide some fresh motivation for my work after the credits finished rolling. Going to work the next day, I’ve found an extra burst of enthusiasm wanting to help people push that bit more to get that little bit better than they thought they could.

The flip side of this ‘Hollywood factor’ is how it impacts on the people that come to see me. Many people have seen the same things on TV and in movies and assume it’s going to be a straight simple path back to recovery. The reality, however, is much less glamourous. Treatment can often be slow, tedious, repetitive with disheartening steps backwards every so often, which can often be a hard pill to swallow.

Final thoughts…

Even though it’s comforting to think that Neil deGrasse Tyson also watches films through the lens of his profession, it’s probably not a good habit to have. I think I might give films a break for a bit and go play outside.

What is Pain?

 

As a physiotherapist, the majority of work we do is centred around reducing pain. Yes, we also look to improve movement, strength, balance, coordination and general function, but all this is usually linked to trying to reduce pain as a primary goal. As a therapist then, it helps a lot to understand what pain actually is. A short answer might be anything that causes you to say “ouch!”, or anything that simply causes suffering. Pain on the most basic level is just a warning system alerting us to danger, but looking deeper, it is a much more complex phenomena that I think warrants a better, more thorough explanation.

History Lesson. Stay with me.

Throughout history pain is something that has baffled many a deep-thinker. In the very old days (this article probably won’t win any historical accuracy prizes) pain was thought of as something external, that happened to us as a punishment from God. In the centuries after that a chap called René Descartes came up with a new theory; that pain was something you experienced internally. This theory evolved over time into the idea that we had an independent sense of pain. Pain was felt through ‘pain receptors’ which sent signals to the brain telling us when we’re injured. The intensity and type of pain was thought to be directly linked to size, location and severity of the injury. Seems like a perfectly logical explanation? Well, not quite.

 


Not everything is quite as it seems..

In more recent times scientists have recognised that the level of pain experienced is not always proportional the the injury sustained. To use an example, if you imagine a boxer being punched repeatedly in the face, the damage being done, and how they are able to continue to function and focus with seemingly little pain response. Compare that to stubbing your toe on your bedside table whilst walking to the loo in the night, the boxer is probably sustaining far more tissue damage but the pain response from your big toe could seem far more intense!

How we perceive the intensity and severity of pain is to do with how the brain interprets the signals it receives from the sensory nerves. How the brain interprets the signal depends on a whole host of factors such as our internal biochemistry, the external environment, our past experiences and expectations.

One of the most prominent researchers of pain science in modern times, the very eloquent and witty Lorimer Moseley, explains this far better describing his experience with pain whilst out walking in the outbacks of Australia. The TEDx presentation he did a few years back (link here) is his story, which brings you nice and unto date with how we currently understand things.

 


 

Persistent pain

Persistent (or chronic) pain is the most interesting (and perhaps the most debilitating) part of this topic that we deal with as therapists. Lorimer Moseley touched on it at the end of the youtube video, pointing out how pain can change over time. This is because the nerve pathways are ‘plastic’, meaning the more a pain signal gets passed through a nerve, the stronger and more efficient that signal can become. I like to think of it as upgrading a rickety old set of train tracks with an old steam engine into a high speed railway with a bullet train running down it. The end result can be stronger pain signals that get set off much more easily. On top of this, our ‘threshold’ for pain can also become lowered, meaning we experience pain in response to a stimulus that normally would cause no problems. As a result, things such as cold metal on the skin or even light touch could become excruciatingly painful.

“Pain is experienced in the person, not just the brain”

With all this work into pain science being focused on the brains involvement, its important to not get too carried away and think its ALL about the brain. Mick Thacker, another prominent figure in the world of pain science, tells us that pain is something the person experiences more generally, and its not just isolated to the brain and associated nerves. Changes and reactions can occur through a number of the bodies systems including the immune system which can all influence our pain response.

 


 

Sleep and Stress

Following on from the idea that pain is part of the person as a whole, lifestyle factors such as sleep and stress can influence our pain levels. Not getting enough of restorative (deep) sleep can influence the hormone balance in our bodies and effect recovery. If we are fatigued due to lack of sleep, our perception of pain may also be greater. This may become a vicious cycle where pain affects sleep, which makes you feel worse, which then affects sleep more, and so on. This dysfunctional pattern can be something that contributes to the persistent pain mentioned above.

Acute stress should be considered a normal part of life, and can be helpful in certain situations, but chronic stress (sustained stress over long periods of time) can have a more negative effect on our hormones and increase our sensitivity to pain. Stress (like sleep) can be a significant factor in persistent pain, so monitoring pain levels and seeing if that relates to a stressful period at work for example, can be useful.

 


 

Understanding the subtleties of pain can help us as physiotherapists get the most out of the people we see. Being aware of, for example, someones past experiences of injury, can help us provide a more individualised treatment program set at the right level. Knowing to keep an eye out for factors such as stress and poor sleep, and having the tools to deal with them, means we can deliver a much more thorough treatment for those people that need it.

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.

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.