The purpose of the lock-down in South Africa is to promote social distancing by enforcing isolation. The lock-down is intended to limit the spread of the virus and to prepare the health system to cope with the increased demand on resources.
Biokineticists are registered medical professionals with the Health Professions Council of South Africa (HPCSA). Registered HPCSA medical professionals fall into the “essential services” category during lock-down. As a result biokineticists may treat patients that are in need of assistance provided that i) the treatment is in the patient’s best interest, ii) the lack of treatment (withdrawal of treatment) would have a deleterious effect on the patient’s health and well-being, and iii) the treatment would not bring the health of the greater community into jeopardy.
Unfortunately there will never be a “business-as-usual” scenario. Biokineticists, however, are allowed to use their clinical judgement with regards to the patients they treat. Face-to-face consultations should be reserved for individuals who require essential treatment to assist with their condition / prevent their condition from getting worse. Other patients are encouraged to use telehealth wherever possible.
In the event that your condition warrants a face-to-face consultation then the biokineticist is required to adhere to strict principles that ensure your safety. Safety directives and protocols issued by the Minister of Health, the National and Provincial Departments of Health or any other South African healthcare authority will need to be followed.
In summary, there needs to be an assessment of the risk-benefit ratio during the COVID-19 lock-down. Only patients that would be negatively affected by the lack of direct supervision can be seen for face-to-face biokinetics sessions. Telehealth biokinetics sessions are recommended for all other scenarios.
Cape Town has some of the most magnificent trail running routes, and trail runners in Cape Town are spoiled for choice. From Table Mountain and Tokai (Silvermine), to Somerset West, Franschoek, Paarl and Stellenbosch and further afield towards the Cederberg and Matroosberg regions. There are trails for all levels of ability (technical single track for advanced runners and jeep track for beginners) which is why the sport has boomed over the last few years. There is also healthy trail running competition with numerous trail running races on the calendar (check out www.trailrunning.co.za or www.runnersguide.co.za).
Trail running and your body:
Anecdotally trail running is often seen as kinder on your body when it comes to overuse injuries. It is believed that there is a greater risk of overuse injury (eg: Patellofemoral Pain Syndrome) with road running and more acute injury (eg: Lateral Ankle Sprain) risk with trail running. However, not all trail runners sustain injuries and if they do they are not always acute injuries. A discussion on the detail surrounding the types of injuries and the mechanisms involved are not part of the scope of this post, but if you would like more information here are a few journal papers of interest:
Many trail runners actually present with overuse injuries as a result of overload. Overload has many guises: too much too soon, too far too soon, too fast too soon, too steep too soon, etc. The concept of “too much” can be manged with better planning, better conditioning and a bit of patience. It is seen as the “Goldilocks principle” you need to find balance (from the story of Goldilocks – not too hot, not too cold, it is just right) . As a trail runner you need to find the amount of volume and intensity that is “just right”. This is done through correct training and the proper planning of your training calendar.
Cross training for trail running:
Adding in some cross training in the gym, or at home, can compliment your trail running. Cross training is not meant to be a substitute for running but rather as a means of cross conditioning and balancing your body. As a trail runner you can join a local gym to take advantage of the cardio and strength training equipment, as well as the pool for your recovery days. The reality is that not many trail runners enjoy the confines of a gym but the reward can be worth it. From stronger legs for the hills, a more resilient back and knees for the downhills, and enhanced cardio for the endurance.
From a home routine perspective there can be some simple exercises that you can add to your trail running tool kit. These can easily be done at home as part of a daily routine. These five essential exercises can help improve your trail running and keep you more “balanced” as a trail runner:
Single leg “dead lift”
Click on an image for a description of the exercise.
Neil Hopkins Biokineticist Adductor stretch for trail runners
Neil Hopkins Biokineticist Ankle stability for trail runners
Neil Hopkins Biokineticist: Quadriceps flexibility for trail runners
Neil Hopkins Biokineticist RDL for trail runners
Neil Hopkins Biokineticist: Hamstring strength for trail runners
Biokinetics sports conditioning and injury management for trail running:
The exercises above are pretty generic and are not designed to make you invincible. They are a value-add to compliment your trail running programme. If you have an injury, or if you feel that you need a more comprehensive programme and a face-to-face consultation then you should reach out and make an appointment with a professional in your area. You can make an appointment with a physiotherapist or biokineticist in your area to discuss your injury concerns.
If you would like to make a booking or if you want to find out more information on biokinetics please feel free to complete the information below:
Telehealth and telerehabilitation for the COVID-19 lock-down.
South Africa went into a COVID-19 lock-down on 26 March 2020, following a directive from President Cyril Ramaphosa. The lock-down period prevents non-essential medical professionals from working with patients in a face-to-face context. However, the Health Professions Council of South Africa (HPCSA) has modified the online consultation guidelines to allow practitioners to consult with new, and existing, patients using telehealth. Telehealth in this context includes “telerehabilitation” by means of end-to-end encrypted video messaging. These digital consultations will only be allowed during the COVID-19 lock-down, and allegedly will revert to the pre-lock-down guidelines as soon as the Presidential directive ends.
If you are feeling confined during the lock-down and want to work on unresolved injuries, then a telehealth consultation followed by some telerehabilitation could be a solution for you. This lock-down period may actually provide you with an ideal opportunity to work on any unresolved injury issues or give you a chance to improve your physical health. Doing some exercise rehabilitation may also provide you with a means of killing boredom and maintaining your sanity.
If you are injured, or want to work on your physical health, you can contact a biokineticst or physiotherapist in your area. Otherwise reach out to a physiotherapist or biokineticist that you have a good working relationship with to see if they are offering online consultations. If you are not a suitable candidate for telehealth, or telerehabilitation, you will be asked to wait until after the lock-down has ended, or referred on for a face-to-face consultation if your condition is serious and warrants immediate care.
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.
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.
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.
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.
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)
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.
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.