Treating the patient

If you are injured and want to use exercise as a modality it is important that you realise that the exercise does not treat pain directly.

Exercise may alleviate discomfort and improve functional ability.  But it does not “treat” the pain. Likewise, when you seek the advice of a Biokineticist or exercise specialist they should not have the goal of trying to “treat” your pain. They need to treat you. The patient. Not the pain. In the process of the exercise journey the pain may diminish. This is more often than not (depending on the condition) due to the exercises addressing the causative factors rather than just the symptoms/consequences of your particular injury.

Biokinetics Cape Town

 

Often practitioners and patients alike get stuck “looking down the microscope”. They are so focused on pain that they miss the factors that contribute to the pain.  Pain viewed from a “catastrophic model” perspective puts pain in the centre of attention. Something is wrong. There is a crisis, and the symptoms of that crisis need to be addressed immediately. And at a localised level. But you and your injury are more than just pain. Pain is complicated. It is multi-factorial. There are physical factors, biological factors, social factors, psychological factors, and even environmental/lifestyle factors.  For this reason the treatment approach should be multi-factorial. Causation rather than catastrophe.

Your treatment team needs to keep this in mind and work as a unit rather than as individuals. Each team member has a role to play in the management of your injury. Doctors / Physiotherapists / Biokineticists / Osteopaths / Chiropractors need to work in unison to meet your treatment goals.

Biokinetics Neil Hopkins

Voltaire was a philosopher in the 1700’s. He apparently wrote the following phrase: “Doctors/Physicians are like wizards/magicians, they enact trickery while the body effects the cure”. Given the right environment, and treatment approach, your body does the healing work. The therapists that you work with are privileged enough to be along for the ride. They may be highly educated/skilled, but your recovery is your responsibility and your achievement.

If you are injured and think that you could benefit from seeing a Biokineticist, speak to your Specialist / Doctor / Physiotherapist / Osteopath / Chiropractor, to see if you are a suitable candidate for Biokinetics exercise rehabilitation. Otherwise feel free to visit your local Biokineticist. If your injury is too acute, or in need of more physical therapy the Biokineticist will refer you to a Specialist / Doctor / Physiotherapist / Osteopath / Chiropractor for appropriate management and care.


 

References:

Microscope image: Techtimes
Pain image: PBS Newshour
Voltaire image: Amazing people

Biokineticist Cape Town

Should I see a Biokineticist?

There is often confusion about the role of a Biokineticist.

Ask any Biokineticist, it is their biggest frustration. People don’t know who they are, or what they do.

Granted, there are a lot of similarities to Physiotherapy and personal training, the two disciplines that are most frequently referred to when you mention Biokinetics. But they are not Physiotherapists, nor are they personal trainers. But they do fill the void between the two. The reality is that you can actually be seen by all three, at the same time (no, not the same consultation, but the same time period). Conjunctive care is possible provided that there is no distinct overlap of services. The best management of your injury/condition is a patient-centric approach, not an egocentric approach. Your needs have to be taken into account and for that to happen medical professionals and trainers need to play as a team, not as individuals.

Image 1) Team play: Below is an info-graphic of a hypothetical treatment team scenario.

Cape Town Biokinetics

So when can a Biokineticist help you?

The answer in terms of “time” on a timeline is quite contentious, particularly with the scope of Physiotherapy (Scope: Physiotherapy) and Biokinetics (Scope: Biokinetics) being discussed at the HPCSA (Health Professions Council of South Africa). The time frame also depends on the injury/condition.

Certain skills/services are not within the scope of Biokinetics and most likely never will be. As a rule of thumb the Biokineticist you see should provide you with exercises. Their primary role is exercise rehabilitation. In the scope of practice document reference is made to the role of the Biokineticist commencing when exercise is the primary modality of care. ie: when 51% of your session with a primary care giver becomes exercise you can start to consider seeing a Biokineticist.

When it comes to rehabilitation you as the consumer have the power to choose who you wish to see. However, it is important to know what is in scope and what is not. If you choose to see a personal trainer for injury rehabilitation and something goes wrong their liability cover may not come into effect as they are not qualified or insured for exercise rehabilitation. The same applies to Biokinetics, if you are seeing a Biokineticist and they are treating you out of their scope you may not be covered.

Image 2) Biokinetics? Below is a guide of how a Biokineticist can help you (please note that not all Biokinetics practices are the same)

Biokineticist Cape Town

Orthopaedic / Injury rehabilitation:

The branch of medicine that deals with the prevention or correction of injuries or disorders of the skeletal system and associated muscles, joints, and ligaments is called orthopaedics. You can see a Biokineticist for an orthopaedic injury, depending on the nature and severity of your injury.  You may require to have clearance from a Doctor/Physio/Chiro/Osteo before commencing your exercise rehabilitation. Each injury needs to be assessed on a case by case basis. If the injury is too acute the Biokineticist must refer you on/back to a Doctor/Physio/Chiro/Osteo.

In terms of a treatment timeline you can see the Biokineticist for the initial consultation and programme and then decide on weekly training based on the nature/severity of your injury, as well as your compliance to exercise rehabilitation. It may be necessary to see the Biokineticist more frequently in the early stages of rehabilitation and then slowly wean off into independence. Please note that it is not implicit that you see the Biokineticist weekly. You can visit them sporadically provided that you are compliant with your exercise rehabilitation programme.

Chronic disease risk reduction and reversal:

The treatment timeline for chronic diseases will be different to orthopaedic injuries. Due to the nature of the illness/disease you may require ongoing guidance. This does not imply weekly sessions and a huge financial burden. You can see a Biokineticist sporadically or join a group class. However it is important to stress that just going for the initial consultation will not be sufficient. Once off sessions are not beneficial as you will need guidance and someone to monitor your progress.

High performance and general conditioning:

Athletes who are injured, have been injured in the past, or who just need planning/guidance can see a Biokineticist. A Biokineticist can assist with a structured exercise programme and plan, no matter what level of competition or the nature of your sport. The Biokineticist can address the athletes needs with supervised sessions or comprehensive exercise programmes. The Biokineticist is not your coach and will never replace the role of your coach. They are there to mentor and guide you as part of the training team.

The general gym goer can see a Biokineticist if they have not trained in a long time and need guidance to navigate the complexity of the gym environment. The Biokineticist is not stealing from personal trainers, the Biokineticist is there to work along side trainers for guidance and input. You can start with the Biokineticist and progress to the trainer once you have improved your fitness and strength.

If you are a seasoned gym goer and you struggle with the occasional ache and pain you can see a Biokineticist to work on form and technique. The Biokineticist can give you input on injury advice and injury avoidance. They are more like a mentor that you touch base with when the need arises. If you have an acute injury the Biokineticist may refer you on to a Doctor/Physio/Chiro/Osteo.

Fitness assessments:

You can see a Biokineticist for a fitness assessment depending on your medical aid and medical aid rewards scheme. The goal of the fitness assessment is obviously to get points so that you can enjoy the rewards. However, it can be so much more. It is a window into your current health and well being, and a starting point for Biokinetics training. The Biokineticist can use the information from the assessment to assist you with your training goals. Unfortunately this is not part of the fitness assessment itself. It is a stand alone service that will require you to come for a follow up consultation (with cost implications).

Million dollar question:

With so many people offering the “same” service it is hard to decide. It is best to do your homework on your individual condition and whether it responds with exercise. Sometimes ego’s get caught up in the referral process on both sides. But you as the patient have the right to choose who you would like to see. The burden of care rests with the individual therapist/trainer to know when they are out of their depth. Most people will benefit from seeing a Biokineticist, but there are some people who will need additional care before they start. The best thing to do is to ask. Reach out to your local Biokineticist/Doctor/Physio/Chiro/Osteo and see if you are a suitable candidate.

The best advice is to keep well and keep exercising.

 

 


Image acknowledgement: alumni.ctksfc.ac.uk

Biokinetics: Return to running safely.

Biokinetics APP review: C25k

Biokinetics and return to running:

One of the most frequently asked questions from a running patient is: “when can I run again?”. This APP assists the return to running process in a somewhat objective way.  The running load (distance, as well as walk to run ratio) is controlled quite strictly to ensure that there is a lower risk of overuse injury. It is a very dull process for a runner, but it is worth the time you invest.

From sitting on the couch to running 5Km:

“C25K® is the easiest program to get beginners from couch potatoes to 5Km distance runners in 8 weeks. Over 5 million people did it! Tailored for first time runners.”

This is a great programme for patients that are wanting to begin running and / or for patients returning from injury. If you follow the prescribed running / walking intervals you will be progressed safely to 5km.

“The proven C25K (Couch to 5K) program was designed for inexperienced runners who are just beginning an exercise routine.The plan’s structure prevents new runners from giving up and at the same time challenges them to continue moving forward. C25K works because it starts with a mix of running and walking, gradually building up strength and stamina to fully running 5Km.”

C25K (LINK)

Download the programme:

C25k (APPLE)
C25k (ANDROID)

Image: Fatboyruns (LINK)

Below is a visual representation of the walking to running ratio:

Image: Reddit (LINK)
 “The journey of a thousand miles begins with a single step” Lao Tzu

Biokinetics App review: Muscle Trigger Point Anatomy

APP review: Muscle trigger point anatomy

“Discover the source of your pain” – Muscle trigger point anatomy by Real Bodywork (LINK)


Muscle trigger point anatomy:

The Muscle trigger point anatomy App is an anatomy reference for the most common trigger points and referral patterns for over 70 muscles. Muscle trigger point anatomy is a great App for Biokineticists, Physiotherapists, Osteopaths, Chiropractors, Therapeutic massage therapists, Physical therapists, students, or patients wanting to discover trigger points, locate the source of muscular pain, and learn about muscle function.

Content: 
The App features 100+ trigger points with their corresponding referral patterns. Each muscle includes the visual referral pattern and point location, plus a written muscle action, referral and comments for each muscle. You can choose to view each muscle individually, or use the zones view to see all the muscles that refer into a specific area, a great help in discovering the source of pain.

Recommendations:
As a stand alone tool this App is limited. But if it is used as a guide in conjunction with the advice from your Biokineticist / Physiotherapist / Osteopath, it can be very useful. Please ask your therapist for their recommendations.  Your Biokineticist / Physiotherapist / Osteopath can illustrate which trigger points are most relevant to your condition and prescribe the correct self directed soft tissue release (SDSTR).

Download:
This is a paid for App that can be downloaded from either Google Play Store or Apple iTunes.

Download the APP:
Muscle trigger point anatomy (APPLE)
Muscle trigger point anatomy (ANDROID)

Review:

Biokinetics Product Review: Rogz Asteroidz

Rogz Asteroidz for Self Directed Soft Tissue Release (SDSTR)

The Rogz Asteroidz is a pet toy that can be purchased at most pet stores. It is popular with pets… but also with Biokineticists, Physiotherapists, Osteopaths, Chiropractors, and Physical therapists. Either as a tool to be used in the patient-practitioner session, or for homework use. Using the Rogz Asteroidz for self directed soft tissue release (SDSTR) is a way to empower patients in the treatment process. Patients can use the ball to treat themselves when they are unable to see their practitioner due to time, travel, or financial constraints. The Asteroidz balls are superior to most other SDSTR balls available on the market because they are light weight, have a medium density, and are able to “adhere” to vertical and horizontal surfaces due to the asteroid pock marks.

Rogz Asteroidz Ball (LINK)

“Soft enough not to hurt your dog’s teeth, but firm enough to bounce. The lightest, bounciest ball in the cosmic universe.”

Rogz Asteroidz sizes:

Ball size matters, just as much as placement.  Be prepared to buy more than one ball to target different areas.

AS01 Small 49mm
Small ball application:

  • Very tight muscles.
  • Very intricate angle of application.
  • Scapula / shoulder.
  • Mid thoracic erector spinae
  • Forearm.
  • Lateral lower limb.

AS02 Medium 64mm
Medium ball application:

  • Very tight muscles.
  • Less intricate angle of application.
  • Scapula / shoulder.
  • Tricep.
  • Bicep.
  • Forearm.
  • Lateral lower limb.
  • Calf.
  • Quads.
  • TFL.
  • Glutes.
  • Piriformis.

AS04 Large 78mm
Large ball application:

  • Deeper muscles.
  • Muscles that have “graduated’ from the two smaller Asteroidz balls. “Softer” muscles.
  • Easy angle of application.
  • Tricep.
  • Bicep.
  • Lateral lower limb.
  • Medial lower limb
  • Calf.
  • Quads.
  • Glutes.
  • Piriformis.
  • Hamstrings.


Choice of ball:
The question that us often asked: “surely a harder ball is better?” – The answer is no.

Durometer is one of several measures of the hardness of a material. Hardness may be defined as a material’s resistance to permanent indentation.

The higher the Durometer the more resistant to change. The more resistant to change, the more likely it will result in bruising and negative net-effect.

The Rogz Asteroidz is NOT to be mistaken with Rogz Gumz (LINK)

Rogz version of Durometer: 
Rogz uses a Durometer called a Bitometer. It is the strength and durability of the ball. Rogz use different Durometer rubbers/plastics for different pet applications. For bighting, bouncing, floating, or a combination.

Rogz Asteroidz “Bitometer”:  Medium
Rogz Gumz “Bitometer”:  Hard

Application:
Ask your Biokineticist / Physiotherapist / Osteopath to advise you on:

  1. If you are a suitable candidate for self directed soft tissue release (SDSTR).
  2. Which areas would benefit from SDSTR. See post on Muscle Trigger Point Anatomy (LINK)
  3. What techniques you should apply with SDSTR.
  4. Which tools you can use to assist with SDSTR.
  5. How frequently you should use SDSTR.
  6. What contraindications you should watch out for.