Resilience and capacity

In the end you have to have something that I give to give the disease as a price of recovery.

Not sure where I heard that but it makes sense.

The more fitness, the more muscle you have to give a serious illness, the more likely you are to come out the other side.

Professor Oliver (geriatrics) noted that he could guess someone’s probability of a safe discharge from the quality of their handshake. Firm, strong, reassuring. Weak, flaccid, concerning. A handshake conveys vitality, determination, strength, even psychological state.

Put the work in now so your future self can live to fight another day.

On: Bowls

Posted by The Camford Clinic

Imagine, if you will, 3 bowls. These bowls are inside you, one stacked above the other.

The first is your pelvis. Already described as a bowl, it supports and holds all above it.

The second is your diaphragm. Separating the organs in your chest from the organs in your abdomen, it forms the top of the abdominal cylinder and should move gently as you breathe.

The third is in your upper chest, at the top of your lungs and about the same level as your collarbones.

This being a conceptual experiment, fill them with water. Then, think about the way you are standing or sitting. Are those bowls going to overflow? Is the water going to run out of the front, the back, even the sides?

Stand easily if you can, weight distributed in the centre of your feet. Soften your knees and ankles.

Then, come up to the pelvic bowl. Tilt it forwards and backwards, until you find the centre, neutral position.

For the diaphragm, you can feel if it is forward or backward and correct.

Ditto the shoulders. Allow them to open, don’t force, allow. A subtle external rotation and lengthening of the clavicle.

Once reflected and considered individually, check in again with all three.

This is probably one of the quickest ways of achieving optimal posture smoothly, balance the bowls, check how they move when you breathe and then, get on with the business in hand.

Of course, if you need help balancing the bowls, can’t find a neutral position or are struggling to fix it in any other way, please book in, we are happy to help.

On: technology, tests and treatment.

Posted by The Camford Clinic

Listen to the patients history, they will tell you the diagnosis.

Possibly not entirely, as patients sometimes miss detail or forget timelines.

However, subsequent to a thorough history and examination, all other tests should be used to confirm or deny your hypothesis, including imaging and blood tests.

The problem comes when we, as practitioners or medical professionals, get distracted by new technology or training. This means we look at what we can do, not what we should do.

Ethically, one should do the least for the most benefit. So just because I can order a blood test doesn’t mean I should, if it won’t change my subsequent decision tree. And just because I’ve bought a shiny machine, the information it produces won’t necessarily fundamentally alter the treatment plan.

As for treatment itself, the gold standard therapeutic ladder must always be applied. Physical intervention, then medication, then surgical intervention.

Knowing how to apply this, when to step up and down, the precise tool and most importantly when to stop, is what we spend years training for and why the patient needs to select their practitioner with care and recommendation.

Only then will they find the person that understands and diagnoses their presentation, educates and treats it effectively and most importantly demonstrates how to prevent its recurrence.

Whoever you, as a patient, go to, don’t be taken in by the technology and treatment modalities, look behind the curtain, look at outcomes and be driven by the outcome.

If you think we can help, please do call, we have over 20 years of experience, in both NHS and private practice, to help you work with your presentation.

On: Rehabilitation / Prehabilitation

Posted by The Camford Clinic

The best way to recover from an injury is to not have an injury.

Other than the sort you simply cannot predict, the majority of injuries are caused by poor preparation or the inability to adapt dynamically to the situation.

Rehabilitation goes through three main stages.

Pain management
Ranging
Loading

First, control the pain. This is both passively and actively. Once the pain is a under control, it is a return of function, within that pain free zone. Optimise the range of motion, or activity that is available without causing excessive complaint. Finally, the loading phase, where we return to activity, initially graded and then competition.

This is, of course, a gross simplification of the tasks at hand, offers no insight into the variety of techniques considered, but is offered as a thought guide for the observer.

As stated at the beginning, the best rehab is prevention, through prehab. Prepare better, prevent problems.

Everybody has a weakness, a compromise point, or an area that appears to be less effective, so train those out to become more capable.

Seek professional input if you are prone to niggles, seek professional input for coaching if required and build steadily. Social media is not your coach, a search engine doesn’t replace a doctor.

You are what you do.

Posted by The Camford Clinic

They presented with a long history of shoulder and back pain, with occasional headaches, particularly in the evening. No other significant complaints, simply a tight and painful upper back, and shoulders, with a stiff neck.

After taking a thorough history and checking pertinent red flags, I carried out a suitable examination, looking at how they used their body, how it wanted to respond passively and actively.

And the thing was, other than the presenting complaint, there wasn’t much to be found. An anteriorised head posture and slightly kyphotic thoracic spine, but nothing much more than you might expect for a modern lifestyle. They exercised frequently, were not obese and tried to optimise their working posture when at a desk.

I treated what I found, and we addressed a few issues, but I was unhappy with their progress, as the complaint didn’t feel like it was resolving along the curve I expected.

Then it clicked. Whenever I went through to reception to collect them, they were playing with their phone. Head slumped forwards on the chest, looking down at the tiny screen and typing or scrolling away.

The problem is, modern expectations are that we are constantly connected, with rewards and punishments meted out by both the device and other people if we do not respond to its electronic siren call. I am as guilty as the next person, at instinctively checking and wasting hours.

It was this small, but frequent behaviour that was causing, in this case, the shoulder pain. Looking down was loading the back of their neck, the shoulders were coming in to support the arms holding close and everything matched when I mimicked them.

However, other than taking the phone away from them, there wasn’t a direct intervention I could do, so instead we discussed possible mitigation strategies, to reduce the automatic reaction, shorten the time spent interacting and change the posture, things that have been shown to work.

Following the rules of three, I suggested:

Switching on greyscale. This, interestingly, makes the device far less stimulating, but still allows you to work effectively. It also helps increase battery life on some devices.
Clean up the home screen and put apps that distract in a folder so you don’t see them first
Turn off notifications for social media applications

The point was simply to create a brain pause that allowed for a moment more reflection before the action, rather than create a wholesale change that would more likely fail.

Having created this awareness and put in some simple measures, we were both very happy to see that the treatment was then far more effective and the presenting issues resolved.

After they had left, I reflected in how the simple actions we do can have profound impacts and that, as practitioners of every discipline, we need to continue to look at the whole person, not just the complaint.

The basics of positive mental health

Posted by The Camford Clinic

Firstly, if you reached this via a random search on the internet and are feeling stuck, buried under unmanageable pressure, in a corner or suicidal, breathe.

If that is you now, if you have a plan, if you’re looking for ways to end your life, if it’s so dark that the relief of knowing how is a comfort, stop. Please. Call a mate, phone Samaritans, if you think you’re going to OD or have, get yourself to A&E.

If you need to self harm to relieve the pain, to give you something to focus on, try ice cubes. Squeeze them in your hand and feel the burning cold. Put down the sharp blade and open a window.

When we, as professionals, talk to people who’ve cut or attempted suicide after we’ve stabilised them, they almost all regret it. Most attempts are a cry for help, to get attention, to put down the enormous burden, to ask someone to take over, just for a while, to deal with the crap life has handed you.

If this is you, I’m sorry. I have no idea what demons you’re fighting but I do know that so many have been there before you and there is a solution, somehow. But the never ending darkness is not it. There are charities who are there to support you, pathways in place to show you that, however dark it is now, there is a way forward.

Please note that this is not about mental illness. This is not about PD, psychosis, mania or depression. These are the kind that leaves you debilitated and requiring professional assistance. For those who have such things, it is important that the rest of us do not stigmatise them, help support them in any way and be conscious that we are all a few steps and some genes away from their situation.

For the rest of us, who live every day with our own mental health, it is thankfully starting to become more commonly talked about in recent years. The typical English attitude of stiff upper lip and crack on is slowly becoming more less expected, but the underlying causes of poor mental health is less commonly discussed.

Positive mental health is much more of a holistic approach, a way of recognising that body and mind are inextricably linked, that we can influence those around us and by intercepting negative trends, and that we may be able to prevent or minimise darker times.

The sketch above shows the basic pyramid of mental health.

Positive health choices are obvious in retrospect. Avoiding drugs that effect mental state (alcohol, cannabis, tobacco, illicit chemicals), taking regular exercise, maintaining a healthy weight, getting sufficient rest.

Regular life patterns play a more subtle role. We all have a circadian clock, a biological rhythm that governs eating, sleeping, and even more complex processes. But we also have a human need for regularity. For work, for seeing friends, for doing things we enjoy. If we neglect this, or it is removed from us, we soon notice its absence.

Positive relationships make more sense. We have all had relationships that drag us down, that make us feel less than we like to be. These can be personal, romantic or work, but their effect is pernicious and corrosive.

We can tolerate shifts in any one of the points for a period of time, for example poor health choices by eating too much, drinking too much or not resting enough, but if we also have a few unsupportive or negative relationships and no regular life pattern then we are in a slippery slope to poor mental health.

Mental health is a gift to be nurtured, shared and to be grateful for.

80:20

Posted by The Camford Clinic

There is an idea called the Pareto law. This says that 80% of the work takes 20% of the time. It can be used in almost any situation, from business management to problem solving, personal training to writing a book. I use it to illustrate a patients recovery plan (and will try to cover this in a post soon).

I also think it applies to our area, not just in terms of treatment processes, but in terms of techniques.Far too many people don’t use their training, expertise and experience sufficiently when working with clients. Instead they fall back on what they know works and do the same thing for everybody. (80% of problems can be solved with 20% of our skill). But every body is not the same. Each client is unique and each time we see them they have changed.

From a therapeutic perspective, this means that we need to reassess and reinterpret them each time, not just do the same thing and hope it will work.

When carrying out a fitness program, this also stands. We can draw up a framework for the series of sessions but need to be flexible enough to modify it as necessary. We should and need to concentrate on what they are saying, how they are responding and whether we are achieving their goals. In either mode, we especially need to take into consideration current research and thinking to ensure we are up to date with what the experts are doing. As with every other part of life, we need to remember the loop: observe, think, apply. Only then will we be doing the best for our clients and ourselves.