Returning to Activity Post Lockdown
- by Matthew Ross
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- 27 Jul, 2020
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Never has it been more important to look after our health and wellbeing. The government lockdown that was implemented at the end of March 2020 turned our lives upside down, affecting millions of people in multiple different ways. Some people sought to increase their activity levels, finding ways of keeping fit by taking up activities such as jogging, running, brisk walking and cycling, while those of a certain age or with underlying health conditions were encouraged to isolate to reduce the risk of transmission.
Thankfully, almost 4 months on, restrictions are slowly starting to lift as the reduction in transmission continues. People who have been shielding will soon be able to go out and facilities continue to open. As we start to emerge into this ‘new normal’, reports suggests that during the period of lockdown period has had an impact on our health in a multitude of different ways. There are incidences where people report pain after rapidly increasing their activity as a way of keeping fit, while others while those who have been advised to shield may have encountered deconditioning as well as potential psychological effects such as anxiety and depression which can play a large role in pain perception in a whole host of musculoskeletal conditions.
What Can I Do?
Movement and exercise is important for our physical and psychological wellbeing. However we need to be mindful in the ways we approach our chosen activity to prevent overuse injuries such as tendinopathies.
Research is continuing to examine the multidimensional impacts of COVID-19. A study by University College London report a sudden spike in reported exercise at the beginning of lockdown, with 4 in 5 people report performing regular physical activity which has remained constant since. This also correlates with a more recent study from the University of Brighton that highlights a rise of musculoskeletal injuries associated with leisure activities from 15% to 28%.
There a number of useful tips and strategies that can help reduce your risk of injury as we start to emerge from lockdown. Should you wish to engage in more exercise, it is always worth consulting with a health care professional first should you have any concerns.
For those wanting to start an activity as a means to keep fit, ensure that you gradually increase your activity over the coming weeks. An example of an excellent graded exercise programme is the ‘couch to 5k’ for runners or the ‘couch to 30 miles’ for cyclists, many of which can be found online. Gradually increasing your exercise and activity appropriately stimulates cells within various tissues, encouraging adaptations which in turn help your body become stronger as well as improving your cardiovascular system.
For those who have had a significant reduction in their weekly activities, for example those have been required to shield or those who were highly active pre-lockdown, their tissues would have gone through a period of deconditioning. A paper by Bogdanis in 2012 highlighted that this reduction in activity and adoption of a more sedentary lifestyle has a significant impact on both muscle strength and mass, particularly in the larger anti-gravity muscles such as the gluteal and quadriceps . This is reinforced in a paper by Narici et al (2020) who notes the beginning of significant muscle atrophy within 5 days, with approximately a 10% loss at 30 days and 15% loss at 60 days. Therefore it is important to understand that as restrictions start to ease, your body will find it difficult to immediately return to the sort of intensity that you capable of pre-lockdown. Start off slowly, with shorter distances or lighter weights, and continue to develop over the coming weeks.
If you are aware that a task that will require significant effort, then you can break this activity down through a process called ‘pacing’. Set yourself a time limit and have a short rest in between the activity to allow the tissues time to recover and avoid the acute overload of tissues.
However some injuries, niggle, aches and pains are unavoidable in your attempt to get fit and physiotherapy can help you get back on the right track. By helping identify the problem, providing education and management strategies as well as a specific and tailored exercise programme to help facilitate your recovery, I can help you get back to the activities you enjoy sooner, pain free, and with the confidence and knowledge to help reduce your risk in the future.
Kinesiology tape (K-Tape) is a form of therapeutic elastic tape which has been commonly used by various healthcare professions. The developers hypothesise that the tape has similar thickness and elasticity similar to human skin can be used to help offload, stabilise and increase or inhibit muscle contraction based on the way it is applied. However, results of clinical trials have often been either inconclusive or conflicting, highlighting the need for further research.
Shoulder Impingement Syndrome is a common shoulder condition which is theorised to be a narrowing of the subacromial space ultimately affecting the subacromial bursa, supraspinatus tendon or both. However, research is now highlighting that such mechanisms may not be present and the term ' subacromial pain syndrome' is now used more widely.
K-Tape has often been used to help treat people which such shoulder complaints, and previous studies has looked an patient reported outcomes such as pain and disability - however very studies look to examine the physiological change at the shoulder change following the application of tape. A study by Lyman et al (2017) looked to 'evaluate the underlying physiological effects of the elastic therapeutic taping methods on the subacromial joint space in healthy individuals by using musculoskeletal diagnostic ultrasound'
Study Design
48 people were recruited for this study, 24 males and 24 females, with ages ranging from 18-59 years with NO history of shoulder pain in their dominant arm. An ultrasound machine was used on each participant to establish their baseline acromialhumeral distance. The shoulder was then taped in 1 or 3 ways:
1) Taping of supraspinatus from origin to insertion
2) Taping of anterior and posterior deltoid from origin to insertion
3) A combination of both
Following the application of the tape, the participant was instructed to rest for 5 minutes before the acromihumeral distance was measured to note any difference.
Outcome
These more granular results demonstrate that taping of the anterior and posterior deltoids has a statistically significant effect. In contrast, neither taping of the supraspinatus alone nor taping with both techniques increased the measured distance at a statistically significant level. In every case, the measured space increased after taping. The measured effect was larger in women than in men.
My View
This study highlights that taping the deltoid muscle can improve the subacromial space when examined under ultrasound and could be a useful form of adjunctive treatment when helping people with shoulder pain and alongside a comprehensive rehabilitation programme. However, this study was performed in healthy subjects and further research translating this research to those with shoulder pain to examine whether there are similar outcomes and whether pain and disability improves as a result
Source:
Akshay Date & Luthfur Rahman (2020) Frozen Shoulder: Overview of Clinical Presentation and Review of the Current Evidence Base for Management Strategies, Future Science OA, 6:10, FSO647, DOI: 10.2144/fsoa-2020-0145
Frozen shoulder is a common condition which occurs in approximately 2-5% of the population with a peak incidence between 40-70 years of age. It is characterised by varying levels of pain and limitation in range which is more common in women and can occur in both shoulders in roughly 20-30% of cases.
While frozen shoulders are normally self limiting, symptoms can continue for a number of years with varying levels of pain and functional limitation and in some instances may never fully resolve.
There are 2 reasons why people can go on to develop frozen shoulder:
· Primary : The most common presentation where pain and limitation are noted however without an underlying cause
· Secondary : Frozen shoulder can occur following trauma, shoulder surgery, prolonged immobilisation, diabetes, thyroid disease or other autoimmune disorders
Pathophysiology and presentation
The reason as to why people develop primary frozen shoulder is still not full understood, however research has shown that the joint capsule that surround the shoulder becomes thickened and tight with evidence of inflammatory cell within the capsule with some suggestion of an autoimmune cause for primary shoulder pain.
It is proposed that there are 4 stages of frozen shoulder that is demonstrated in the table below. Ther onset of symptoms however can be gradual over a period of months with symptoms being poorly locaused and reported as a deep ache, with night pain being an common feature. On examination people usually demonstrate good rotator cuff strength and no specific tenderness on palpation however a marked loss of range of movement, partiucuarly into rotation. As frozen shoulder affects the joint capsule, any form imaging such as an x-ray is normal but can helpful to rull out any other types of pathology.
For some, people with lower back pain report symptoms that can be felt into the leg. More often than not, people who experience such symptoms have either been told or report that they have 'sciatica'. However, over the years sciatica has been used as an umbrella terminology to describe ANY pain felt in the leg when actually there are several reasons this may occur, two of these causes are:
- Neuropathic Pain: Defined as 'pain caused by a lesion or a disease of the somatosensory nervous system'. In other words, back pain associated with a disc herniation, which causes compression of the nerve leading to symptoms down into the leg
- Nociceptive Pain: Defined as ' pain that arises from actual or threatened damage to non-neural tissue and is due to the activation of nociceptors. Nociceptors are triggered by mechanical, chemical, or thermal stimuli arising from all innervated structures’. In other words, pain that arises from another structure around the lower back but not associated with nerves.
These two studies attempted to examine movement patterns in people with and without lower back pain, as well as how changing thought patterns around their beliefs can help their pain and function.
Exploring lumbar and lower limb kinematics and kinetics for evidence that lifting techniqueis associated with LBP (Saraceni et al 2021)
People with chronic lower back pain usually report difficulty in bending forward, in particular when attempting to lift anything heavy. This study attempted to review biomechanical movement pattern differences in manual labourers with and without chronic lower back pain (>5 years).
What they identified was that those with lower back pain used a different lifting technique when compared to those without lower back pain. Those with back pain performed more of a slower, 'squat' type lift, with a greater knee bend and straighter lumbar and thoracic spine as well as greater peak knee forces when standing. Those without lower back pain performed the lifting task with a quicker, more stooped like posture with less knee bend.
Their conclusion was that the common assumptions around lower back pain associated with movements and the forces produced during a lifting task were not observed and brings into question the current belief around safe lifting.
From protection to non-protection: A mixed methods study investigating movement, posture and recovery from disabling low back pain (Wernli et al, 2021)
This mixed method study design examined the benefit of Cognitive Functional Therapy (CFT) in people with chronic lower back pain (CLBP). 12 people were interview at the start of the study, identifying their beliefs about their back and the 3 movements and postures that they find most provoking. A course of CFT was delivered over a period of 12 weeks, where participants were interviewed afterwards to review their movements and their perceptions of their symptoms.
At the end of the 12 weeks, 11/12 people had reported significant improvements in their pain and function, enabling them to return to their usual activities and in some instances (7/12 people) not think about their back pain at all. The authors of this study identified two groups for both before and after the intervention which I believe is extremely useful:
Before Intervention
- Non-Conscious Protection - A lived experience of being stiff, restricted, tense, locked or seized up
- Conscious Protection - Tense, guarded, careful and cautious movements and postures due to belief of structural damage / vulnerability, fear and worry of damage, pain, future +/- diagnostic uncertainty
- Conscious Non-Protection - Purposefully relaxed, fluid, free movements and postures that reduce pain and increase function (including integration into valued activities)
- Non-Conscious Non-Protection - Automatic, natural, relaxed, fluid, free movements and postures secondary to positive experiences that disconfirm or violate previous beliefs, worries or expectations, and individualised education about their condition and the meaning of pain
So, if you are experiencing long term lower back pain, speak with me today on either enquiries@mattrossphysiotherapy.co.uk or 07814 717577 to see how I can help.
I look forward to hearing from you!
Matt Ross
Recently. the UK Government announced changes to their guidance and laws on how to manage the COVID-19 Pandemic. According to the recently published 'Living with COVID-19', regular asymptomatic testing and required self isolation should you test positive has been removed. However, the UK government still recommend:
- Wearing a face covering in crowded and enclosed spaces
- Testing if you do develop symptoms (the NHS still suggest that a temperature, loss of sense of taste or smell and a new continuous cough are the most common signs)
- Stay at home if you are unwell
- Regular hand washing
The current recommendations the Public Health England Infection Protection and Control Teams is that PPE shall continue within a healthcare setting until advised otherwise. Therefore Matt Ross Physiotherapy shall continue with:
- The wearing of full PPE
- Strict cleaning procedures both before, after and inbetween patient appointment times
- Sufficent gaps in between patients to ensure adequate social distancing
While facemasks have not been mandatory for a while now, the clinic has a broad range of clients from different ages and diffent medical conditions and I have a duty to ensure everyones safety during this time. I therefore kindly request that all clients continue to wear a face covering whilst on the premises (unless medically exempt or for any other valid reason).
If you feel unwell, please do not attend your appointment and notify me so we can arrange at your earlies convenience
This guidance will be reviewed on the 1st April 2022. Many thanks for your continued support.
As a result of increased demand I am delighted that the clinic has changed it's opening times to enable more people to receive the very best physiotherapy in Chelmsford. The clinic times are as follows:
- Monday to Wednesday: Closed
- Thursday to Saturday: 8.30am to 6pm
- Sunday: 10am to 4pm.
- Emergency appointments may be available at request - please contact directly.
Kind regards
Matt Ross
Your health, safety, and well being are of huge importance to me at the clinic and I will continue with:
- The wearing of full PPE
- Thorough cleaning between customers
- Gaps between appointment times to ensure that you do not come into contact with other customers.
- Personal lateral flow testing 2 times per week.
If you require physiotherapy and are still concerned about attending a face to face clinic then don't forget that I still offer home visits and virtual consultations.
Thank you for your continued support and understanding and please stay safe.
Kind regards
Matt
These annual Healthcare & Pharmaceutical Awards, organised by Global Health and Pharma, recognises the tireless work undertaken by companies, individuals and initiatives that contribute towards promoting the physical and mental welfare of those in need of support and I am delighted to be acknowledge by the GHP judging panel.
Since the opening of the clinic back in 2018, I have always ensured that those who required physiotherapy treatment received the very best, evidence based and holistic interventions, making sure that people fully understand their condition and how to work together to aid their rehabilitation and I'm confident that over the coming years the clinic will continue to go from strength to strength.
Lastly, thanks to all my friends and family for your continued support throughout this journey and to all my clients, old and new, for your kinds words and trust over these last few years.
Matt
Matt Ross Physiotherapy will continue to follow strict and thorough cleaning protocols to ensure the health and safety of everyone. This includes:
- Temperature check and hand sanitiser on arrival
- With one clinic room this ensures that you will not come into contact with anyone else other than the clinician
- Full PPE worn throughout the consultation
- Following the 1 meter+ rule where able
- Lengthened time between appointments to enable through cleaning of the clinic
I understand that some people may require physiotherapy services and are unable to attend as they are concerned about the current situation or currently shielding. You'll be pleased to know that there are a number of different options available:
- Telephone and Video consultations
- Ask the Expert Q&A section
- FREE lockdown exercises
Stay safe.
Matt
Matt
