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.
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.
In the past couple of years surfing has become more and more popular. Especially with people who previously would not normally have ventured out into the water. This is partly due to the advances in surfboard design. But also thanks to the current holistic approach to health and wellness, which surfing offers. There is a wide range of surfers now from the pro-surfer to the social surfer. And they are all jockeying for a spot in the line up.
Surfing itself is great fitness, as it conditions the entire body. A surf session will not only give you a cardiovascular work out, but a strength conditioning and core training session as well. It is an antidote to the modern way of life. The working adult spends far too much time sitting and stressing. Surfing offers the opposite. It promotes back extension to counteract the detrimental affects of sitting. And it is in an environment where you can switch off and relax without stressing about your worldly woes.
It may take some time to master surfing if you are a complete novice, but practice and additional exercise conditioning can help. Strengthening your upper body will help with paddling strength and technique. While conditioning your lower body will improve leg strength and agility.
A Biokineticist or Personal Trainer can help get you fit for surfing by designing an appropriate strength and conditioning programme. An exercise programme for surfing will normally consist of: Strengthening the back extensors, shoulders and legs; Core stability; Flexibility; and Plyometrics for pop-ups, turns and explosive airs. A Biokineticist can either design a strength and conditioning programme for your surfing or refer you to a surf conditioning coach who can.
High performance surf conditioning:
The nature of high performance surfing has changed. Elite surfers are now considered to be highly conditioned athletes rather than seasoned “beach bums”. The advent of the athletic surfer has resulted in a number of changes. There is now a lot more consideration into the planning and conditioning as a surfer. It is no longer adequate just to surf. Diet, Psychology, and Exercise conditioning all have to be factored into a carefully structured routine. A surfer’s performance can be vastly improved if a holistic approach to elite surfing is considered. A Biokineticist can offer specialist advice and high performance periodization programmes for elite surfers. Individual or group training sessions can also be arranged (in a gym or on the beach) following an initial consultation.