IFOMPT 2016: warning…boring physio related blog!!

IFOMPT 2016: Glasgow

After my efforts at promoting the 2016 IFOMPT conference at Therapy Expo last year and a bit of persuasion over a pint from Rob and Jack (Physio Matters) I decided to bite the bullet, submit my abstract and apply for MACP funding!

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After having fractured my foot 2 weeks before the conference standing next to my poster for questions posed a bit of a challenge, but having braved the train journey and YHA on crutches I was rewarded with a fantastic two days of lectures and seminars, great company and thought provoking conversations.

The following are a couple of snippets from each talk that caught my attention:

Moving beyond exercises for the management of patellofemoral pain. Simon Lack, Brad Neal and Michael Rathleff.

A great start to my programme saw three knowledgeable and passionate researchers arguing the case for exercise, load management and gait retraining in the management of PFPS. Packed with high quality references and take home messages.

  • PFPS is prevalent and NOT self-limiting. 65% of adolescents still have pain after 2 years and 71% have stopped exercising.
  • Exercise should be individually tailored including neuromuscular activation, strength/endurance and strength training and progressed according to individual requirements of strength deficits and time under tension.
  • Load vs capacity to handle must be balanced: sometimes the problem is primarily load management.
  • Running is a skill and gait retraining can be very important in managing lower limb injuries.

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Expanding our effectiveness in patient education. Prof Harriet Wittink.

Really great talk highlighting the importance of health literacy in the two way interaction between medical professionals and patients.

  • Education was included in the patient bill of rights in 1996…it is only now that studies are showing support for pain education, why has it taken 12 years?!
  • Stop talking at your patients, get to know them. Treatment won’t be successful if your beliefs aren’t the same as your patients.

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Expanding our knowledge and skills in Cauda Equina syndrome. Sue Greenalgh and Emma Willis (expert patient)

Fascinating insight into the patient experience and tied in perfectly with the education and communication messages of the previous speaker. Fantastic research by Sue Greenalgh to highlight the importance of getting it right when CES is suspected.

  • It is important to lower the threshold for investigations: imaging is normal in 90% of patients with suspected CES and that’s OK!
  • Communication with patients is key: they are worried anyway so tell them what to be worried about and use normal language!

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First impressions of the consultation: expanding the power of communication. Lisa Roberts

Highlights some great work around first impressions, communication skills and shared decision making with real food for thought to improve practice…smile!

  • It takes patients a max of 92 seconds to tell their story. Can you “shut up and listen?”
  • Ask “do you have SOME questions?”
  • Challenge: to make every patient feel valued and special.

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The conundrum that is the shoulder: Expanding our ability to manage shoulder pain. Jeremy Lewis.

A barrage of high quality research to promote the effectiveness of exercise in the management of shoulder pain to take back to commissioners….fantastic talk!

  • There is nothing special about special orthopaedic tests!
  • There is no consistency between diagnostic imaging findings and shoulder symptoms.
  • Studies have consistently shown that exercise is as effective as surgery and can reduce the need for surgery by up to 80% for SIS, partial and full thickness RC tears.
  • Consider marginal gains theory: SSMP, exercises, nutrition, ergonomics, kinetic chain, education, health literacy, sleep and stress.

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Groin injury- Time to move forward. Alison Grimaldi, Claire Small and Jackie Whittaker.

This lecture spent a lot of time discussing systematic reviews that were inconclusive due to lack of evidence. After which the management and exercise strategies were based on expert opinion but seemed quite simplistic and out dated…maybe there could be useful knowledge transfer from what is now known about “motor control” at the spine and shoulder girdle to help researchers move forward with the hip and groin?

  • Poor quality studies highlighted in systematic reviews therefore lack of evidence around risk factors and movement quality in hip and groin pain.
  • Consensus statement classification system for groin pain: Weiret et al BJSM, 2015.
  • Exercise must be specific to individual deficits and focus on load transfer and muscle function across the pelvis. Incorporate open and closed chain exercises across multiple planes of movement: frontal plane, sagittal plane and axial plane.

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Expanding our understanding of entrapment neuropathies and neural pathologies. Annina Schmid.

This was my highlight of the conference! An amazingly presented lecture synthesizing clever science with pertinent clinical information that for me will be practice changing.

  • Normal neurological examination and NCS are only testing thick, myelinated fibres (20%). In progressive, long term entrapment the small (thin, myelinated and unmyelinated) are degenerative (80%). Do not ignore 80% of nerve fibres…test mechano and thermal sensitivity!
  • Extra-teritorial symptoms come about due to proliferation of glial cells in DRG as a result of neural inflammation. Lower the firing threshlold of any nerves that converge in DRG of effected level.
  • Cortisone, surgery, splints and exercise are all helpful to reduce compression and neural inflammation.

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Individualised cognitive functional therapy compared with a combined exercise and pain education class for patients with NSCLBP. Mary O’Keefe.

A very insightful journey into May’s PhD experience starting with systematic reviews that highlight the lack of clinically significant differences between current interventions and culminating in some really exciting preliminary results of her individualised approach.

  • Listen to the patient’s story and conceptualise pain and coping strategies in a way that is relevant to them.
  • Expose people to their specific problems and help them to achieve mastery of activities.
  • Strive to achieve change and not just manage chronic pain!

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Expanding our assessment in manual therapy to include the vascular system. Roger Kerry.

Having heard Roger speak previously and a read a significant amount of his publications on this subject there was nothing new today to capture my attention (apart from a Murray mint and a large yellow duck!). I sensed some frustration from Roger throughout his usual quirky lecturing style that not a great deal has changed in clinical practice since Alan Taylor’s first publication on vascular assessment in 2001. This highlights the disparity between research and clinical practice and again begs the question “why does dissemination take so long?”

  • Vascular dysfunction may present as pain as only manifestation: initially somatic progressing to ischaemic.
  • In exercise induced vascular dysfunction (external iliac artery endofibrosis in cyclists) a small degree of stenosis could be significant.
  • Physios should be aware of CAD classification model, cardiovascular risk factors and take blood pressure readings.

My overall impression.

A very well organised conference with a fantastic variety of speakers. It’s great to see IFOMPT embracing the questions around the mechanisms and value of manual therapy and entering into scientific debate and expert opinion in order to move our profession forward to the benefit of all involved.

After having some doubts about travelling up to Glasgow I reluctantly got on the train home Wednesday night gutted to be missing out on the final two days of the programme.

Thanks to the amazing social media team I have been glued to Facebook and Twitter for the last two days enjoying pertinent slides, great twitter chats, insightful interviews and was even treated to some video footage of the legend that is Brian Mulligan…his up beat enthusiasm and total conviction in his techniques are clearly very powerful tools!

References (from presentation slides).

Crossley K. et al (2016) Patellofemoral pain consensus statement. Open Access.

Barton C. et al Gluteal muscle activity and patellofemoral pain syndrome: a systematic review.

Dolan K. et al Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: A randomized clinical trial.

Rathleff M. et al Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain: a cluster randomised trial.

Neal B. et al Runners with patellofemoral pain have altered biomechanics which targeted interventions can modify: a systematic review and meta-analysis. Gait and Posture.

Neal et al The effects and mechanisms of running retraining in the management of patellofemoral pain: a feasibility study.

Ainpradub et al Effect of education on non-specific neck and low back pain: a meta-analysis of randomized control trials.

Todd (2015) CES

Greenalgh S. et al (2015) An investigation into the patient experience of cauda equina syndrome.

Roberts et al Measuring verbal communication in initial physical therapy encounters. Phys Ther 2013; 93(4): 479-491

Chester E. et al Opening clinical encounters in an adult musculoskeletal setting. Manual Therapy 2014; 19: 306-10

Lewis J. Rotator cuff related shoulder pain assessment, management and uncertainties. Manual Therapy 2016; 23: 57-68

Kuhn et al Effectiveness of PT in treating atraumatic FT RC tears: a multicentre prospective cohort study JShElSurg 2013

Whittaker J et al Risk factors for groin injury in sport: an updated systematic review BMJ 2015; 49:803-809

Schmid A et al The relationship of nerve fibre pathology to sensory function in entrapment neuropathy Brain 2014; 10: 1093

Schmid A et al Effect of splinting and exercise on intraneural edema of the median nerve in carpal tunnel syndrome-an MRI study to reveal therapeutic mechanisms.

Taylor A Vascular assessment in musculoskeletal examination Physiotherapy 2001;87(6)282

Rushton et al International framework for examination of the cervical region for potential CAD prior to orthopaedic manual therapy intervention Manual Therapy 2014;19(3):222-8

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The Wall

On saturday the 18th June I ran Rat Race THE WALL!!

A 69 mile ultra race from Carlisle castle to the Milenium bridge in Gateshead. My lovely friends at Helsby running club bought me the entry for my 40th birthday last August…thanks guys!!

I was brought up in Newcastle and Northumberland and the race actually goes through the estate where I grew up and where my parents still live. I love this part of the world, the bleakness and remoteness of Hadrians wall country is truly breathtaking and I have been looking forward and training hard to give myself the best chance possible of completing this epic challenge for months. Imagine my annoyance to pick up a niggle in my left foot 2 weeks ago! Flitting between a diagnosis of bone bruise, stress fracture and inflammed tendon I was unable to run for more than 5 minutes in the 2 weeks running up to the race. At 6.45am saturday morning I was close to tears in the grounds of Carlisle Castle when after changing shoes at least four times I could still feel the pain with every step…a bit of a daunting prospect when there’s 69 miles to go! My ever supportive husband Chris knew not to offer an opinion, just a hug, a packet of Naproxen and the promise of a selection of trainers and a car at mile 7 in case of an emergency!

The race sets off along the banks of the river Eden and we were blessed with blue sky and sunshine. The first few miles I found a way of running without pain but by mile 5 I was starting to struggle, I limped past Chris at mile 7 ignoring the bag of trainers and the car! After an uninspiring road section we at last hit the countryside on the run into the grounds of Lanercost priory 15 mile check point.

 

Out of Lanercost is another road run with a large section of climbing up to the Wall at Birdoswald, our first glimpse of Hadrians masterpiece! By this time I’d realised that the least pressure on my foot was to run up the hills and walk/shuffle down, much to the amusement of my fellow runners who were, without exeption of the opposite opinion!

Through Gilsland and Greenhead and a timely handfull of jelly babies from the lovely Davis family and I was actually starting to feel OK. Really into wall country now came some fabulous off road sections through Walltown quarry and a couple of little hills that wouldn’t be completely out of place in a fell race, taking in the scenery and enjoying the peace and tranqulity of the surroundings definitely helped to take my mind of the pain in my left foot and the cramp in my right leg!

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I was actually really enjoying myself at this point and knowing I was only 2 miles from the next check point and my amazing support crew gave me a huge psychological boost. I got slightly distracted at this point and followed a male runner into the corner of a field to observe his toilet stop!!

Next stop Cawfields Lake: 27 miles down, massive cheers from my family and friends, a bottle of flat coke and a swarm of Northumberland midges!

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Thoughts at this point:

  1. My foot hurts
  2. My good leg keeps cramping up
  3. I CAN get to the next check point at mile 44
  4. If I don’t finish I will never wear my race T-shirt!
  5. My foot hurts
  6. If I can get to 44miles there’s only a marathon left!
  7. I am actually really enjoying myself
  8. There’s a lady up ahead I reckon I could catch if I push on a bit!!

So despite my Mum’s best efforts to persuade me into the car I decided to carry on, if for no other reason than to get away from those hungry midges!

The route then follows the Roman Military way, through Vindolanda and coach laods of Dutch and Japanese tourists and what seems like the longest, straightest roads on the planet that eventally lead to Newbrough and Fourstones.

The family in the middle of nowhere with the steel drum, my Mum and Dad with Charlie and the pit stop at Settlingstones were the only distractions to miles of plodding along a tarmac ruler surrounded by absolutely nothing!

When there’s nothing else to distract you the pain returns and I was thankful to run along with a chatty scouser who showed me pictures on his mobile phone of his recently broken foot….in other words Jane, just man up and stop moaning! This sign also made me smile ALOT:

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Approaching the main check point at Hexham (44miles) I started catching up to some of the people that had left me in their wake earlier on in the day. I was feeling strong and managing to run in some sort of speed shuffle kind of way along the cycle path to Tyne Green. I went to school in Hexham and know this next section like the back of my hand, the path along by the river is tree lined and grassy and was lovely soft ground after miles of tarmac slapping! Massive shouts of “come on Mummy” greeted me as I ran past the park and into the check point. My supporters were back and I made the most of a good rest stop with soup and corn beef hash pie while changing to road shoes and sharing out my left over jaffa cakes with the kids! After big sweaty hugs and encouragement from my non-running friends and family who quite clearly think I have a scew loose, I was off! Less than a marathon to go….I was full of renewed confidence that the wall was going to be well and truly smashed!!

I have been running along the Beaufront Road between Hexham and Corbridge on my own since I was about 14 and sometimes familiarity is not a good thing as it seems like a long way when you know every inch of the road….”feel like some company Duck?” Two blokes from Derby ran along beside me and we chatted all the way to Well Bank when the familiar shouts of “Come on Mummy!!” greeted us. Charlie and Dad ran with me through the village to my Mum who was sitting outside a pub, in the sunshine, drinking Prosecco!

The next leg through Ovingham, over the Tyne, along the riverside and back over the Tyne again to Wylam and the cottage where George Stephpenson grew up was very enjoyable and we were soon at 60 miles…woo hoo!!

I hit the 62 mile check point in desperate need of a brew and a bit of chocolate and again the pitstop crew did not disappoint! On leaving Newburn there was 7 miles of cycle path between me and the Milenium bridge and I was on a mission! By this point I could no longer feel my sore foot because everything hurt so much but there was no stopping me now…err except for a little boat of tourists on a cruise up the Tyne!

When the bridge finally lowered there was a mad dash the last 50 meters to the finish line for a curly wurly and a medal!

I couldn’t be more chuffed with a 15:02:53 especially with a bad foot and would love to have another crack at the wall injury free. Met some great runners along the route who really kept me going and my friends and family were definitely the best support team going…particularly Chris who carried a shopping bag of various trainers that I never used, a total of 195 miles backwards and forwards along Hadrians wall!

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Hats off to the competitors, marshals and pit stop supporters still out on the course for up to 25 and a half hours, it must be hardcore out there in the dark! I am feeling a little worse for wear today but enjoying watching day time TV in my Rat Race gear and wondering whether to take the opportunity of a early bird entry for The Wall 2017!

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Athletics: a sport of cheats or champions?

In light of the recent press relating to the arrest of former IAAF president Lamine Diack I have been angered into writing a long overdue blog! Diack, who is accused by French police of accepting more than €1m in exchange for covering up positive drug tests has been president of the IAAF for the last 16 years and has only recently been replaced by Sebastian Coe.
I have a slightly macabre fascination with doping in sport, I think partly fuelled by the desire to understand what would motivate someone to go to such great lengths to win by cheating…surely in your heart of hearts you must know that you aren’t a real winner?
To me, endurance running is the gold standard of athletic events, the pure and straight forward act of just running is a joy to watch. Let’s face it, it’s a sport we can all relate to. Anyone can put on a pair of trainers and run, how many other sports can you race side by side with the world’s best (metaphorically speaking of course!)?
I believe that doping in sport can be systematic and cultural and requires a bottom up approach, as well as shining examples from the top to change the behaviour and beliefs nurtured in young athletes. Let’s hope Seb Coe does a better job of this than his predecessor!

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I have been a part of the UK school games medical team for the past 3 years and as a result have become a UK anti-doping advisor. The ethos of the school games is to educate the athletes of the future about the challenges of competing in a multi-sport environment with a huge emphasis on anti-doping. The education and presence on the UKAD (www.ukad.org.uk) team throughout the games is fantastic and all athletes are given the tools, knowledge and support they need to lay the foundations of clean sport. 100% me (www.100percentme.co.uk) is a UKAD campaign to support and educate athletes on their responsibilities to train and compete clean.
The information is out there and it’s not difficult to find. People working in elite sport whether athletes or support staff have a responsibility to follow the rules. WADA and the IAAF on the other hand have responsibility to enforce the rules and failing to do that is what makes me so angry!! There will always be people stretching the rules for marginal gains and science will always be advancing ways to improve human performance, there is sometimes a fine line between performance enhancement and out and out cheating (but that is a whole other debate in itself). Unfortunately, I suspect that there will always be people prepared to cheat their way to the top. That in itself doesn’t make me angry, ultimately they are just cheating themselves. But if WADA and the IAAF and other international sporting bodies cover up cheating and don’t enforce the rules then by default they are condoning the cheats, rewarding the cheats and punishing the honourable, hard-working, clean athletes out there while sowing small seeds of doubt in my mind about who is clean and who is not…and that is what makes me ANGRY!

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The reputation of athletics is clearly at stake here but I urge you to have faith in the UKAD system and the people who work tirelessly to promote a systemic culture of clean sport in this country. When I think about the athletes of today who inspire me to run I have no doubt in my mind that I am right to keep putting my trainers on and being proud of the champions of my sport!

helenc helsbyfell  steveway colins

lauraweight  jjengland

Just a few of my champions…you get the idea!

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A day in the life!!

Chester Chronicle Oct 2015

Chester Chronicle Oct 2015

I was asked to be interviewed for this feature by the team at Join in UK. A great charity organisation striving to get people involved in sport at all levels.

They connect prospective volunteers with suitable roles in the sporting community, for more information check out: http://www.joininuk.org

If you want to ‘join in’ with me come along to Castle Park, Frodsham Monday’s at 9.30am (term time only) or Helsby Comunity Sports Club Wednesday’s at 6.30pm…see you there!

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The Olympic torch!

Having a revamp of my blog and decided I couldn’t possibly send this post to the “trash” for ever…still brings tears to my eyes!

16.06.2012: what a very proud day for the Betts family! Dad had been chosen to fulfill a life long dream and carry the Olympic torch. He was one of a few Sport England torch bearers, selected for his 40 year crusade to bring volleyball to the masses of the North East of England!

getting off the bus!

Just in case we weren’t emotional enough, Mia Rathband blind folded in memory of her Dad passed the flame to my Dad. What a brave and inspirational 13 year old she is, apparently she hadn’t even told her family of her intention to experience the torch route as her late Dad would have!

Kissing torches

Dad ended up running the whole length of Seaburn sea front, straight past his child hood home where Gran, who is 96 next week, has lived for 71 years!

As we all struggled to keep up with him trying to take pictures, we soaked up the atmosphere of people waving and cheering. I had to stop and remind myself that this was a once in a life time experience and that we are so unbelievably privileged to have a loved one deemed worthy of carrying the Olympic flame on it’s journey from Athens to London.

Dad is a huge supporter of the Olympics and is reveling in the enthusiasm that people are showing for the torch relay. It would do him really proud if the London Olympics inspires people watching around the country to try a new sport….you never know volleyball might be the sport for you and your family!

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The Barefoot Revolution: Part 2. Go on take your trainers off!!

Just in case you missed it first time round!

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Once again big thanks goes to guest blogger Anne ‘Wildbare’ Rosbottom for her personal insight into the transition to barefoot running and the benefits she has reaped as a result. I have had a bit of a blogging void over recent months and the news that Anne is heading down to London to embark on her own training as a bare foot running coach has inspired me to get back on mission to spread the word! Hopefully, anyone reading this will feel inspired to learn more and maybe even take of their shoes and have a go!!

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Why run barefoot? by Anne “Wildbare” Rosbottom

About me: I am a long-time runner who has spent the last 2 years transitioning to a barefoot running technique. I have no specific qualifications to support the writing of these articles but they are probably no worse than the rest of the rubbish out there!

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Four Villages charity donations

Helsby running club

A big thank you to everyone who opted to donate their refund from the 2015 Essar Four Villages Half Marathon to our charity partners.

We’re delighted to announce we’ve been able to donate over £25,000 to local groups involved in the race and our two local hospices, Halton Haven Hospice in Runcorn and the Hospice of the Good Shepherd in Chester. We’ve already had fantastic feedback on the difference this money will make to these organisations. So a big thank you again.

We’re now planning for 2016 and are making some changes to try to ensure the weather doesn’t beat us again. As you may remember, we asked all 2015 entrants if it should be moved to later in the year. Around 1,500 entrants responded and over 70% wanted it to remain in January.

We’re pleased to let you know next year’s race will take place on Sunday 17 January…

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