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 for sporting injuries: Children

Children and sporting injuries

Injuries in sport:
It is important to note that all sports carry a risk of injury. The severity and frequency of injury varies depending on the sport, position played, amount of preparation building up to competition, level of competition, and the age of the “athlete”.

There are many predisposing factors for injuries in sport. Three major factors which affect the prevalence of injury in younger athletes are: lifestyle, seriousness/level of competition, and amount of preparation.

1) Effect of lifestyle and posture:
Lifestyles and economics have changed the way we raise our children. Kids are more sedentary then previous generations due to pressures at school, increasing technology (gaming consoles) and lack of access to safe play space. In the past children would cycle, run, swim, climb trees, and be outdoors. All of which helped with muscular development, co-ordination and posture. Now children are taking part in exercise and developing over use injuries, that are normally seen in adults. Young children are developing injuries like lower back pain and rotator cuff impingement, due to abnormal biomechanics (movement patterns) and muscle development.

2) Seriousness of sport:
Children don’t play anymore. There are fewer and fewer non-outcome based activities (like climbing trees). There is an increasing agenda of goal driven outcomes. Play to win. School sport, especially at younger age levels, should be about learning (skill driven) not about winning. It should be about learning motor skills in a fun and enjoyable way. Not about crushing the opposition and scoring goals.

Parental pressure and early specialization also have a large role in the incidence of injury. Childrens’ tiny bodies are getting overloaded by increased training demands and an increase in pressure from parents and schools. Kids are becoming sporting “specialists” at far too young an age. Swimming is a case in point where potential swimming “stars” are required to swim longer distances, more frequently (every day twice a day). The problem with this is that there is a direct relationship between rotator cuff impingement and the number of hours/distance swum. Combine this fact with the poor posture sedentary children have and the risk of injury drastically increases.

Parental pressure on the side of the field, and at home, also has an impact on the young athlete. Sport takes on a whole new dimension if a parent tries to take control of the child’s sporting “career”, and it is no longer fun. More and more parents have begun shouting at children, coaches and sporting officials. Parents should let the professionals deal with the child’s sport and conditioning. Children are very impressionable and will push themselves harder and further to win parental approval. Some children will even hide the fact that they are injured to avoid upsetting a parent. Parents shouldn’t try to live their sporting dreams through their children’s lives.

3) Preparation for sport:
Preparation for sport can be a double edge sword as too little may result in an acute (sudden) injury and too much may result in a chronic (overuse) injury. It is a fine balance which is easy to get wrong. Our provincial and national teams will have an entire coaching team to ensure the proper conditioning of the athletes. At lower levels this responsibility falls entirely on the coach. Most coaches will condition their athletes the way they were conditioned, with a no pain no gain approach. The problem is that science and conditioning has evolved. Proper planning is required especially with the change in modern lifestyle. Sedentary children need different conditioning to children of yesteryear who were out roughing it in the garden. Children are not mini-adults. They cannot do the same strength and conditioning as adults. They need special consideration and individualized conditioning. A conditioning coach or biokineticist needs to be consulted to avoid over-training and to prevent injury.

Recommendations:
• Correct conditioning is essential for sedentary children
• Do postural exercises and “prehab”
• Seek medical attention when your child is injured (don’t rely on the coach
to make a diagnosis)
• Don’t specialize too early (most of the top athletes today played a variety
of sports when they were younger)
• Let kids play and have fun (avoid the “wrong” kind of parental pressure.
Encourage sport and physical activity. Not a win at all costs attitude.)

What to do following an injury:
• Follow the PRICE recommendation (P – position, R – rest, I – ice, C –
compression, E – elevation).
• Seek medical advice (Doctor/Sports Physician, Physiotherapist, Biokineticst).
• Treat appropriately
• Do extensive rehabilitation to prevent future injury.
• Do “pre-habilitation” to avoid any other injuries.

Rugby Injuries:
Rugby is a physically demanding full contact sport, which carries a high risk of injury. There is an injury continuum ranging from minor soft tissue injuries to severe fractures. The most common injuries from lower level rugby games are the soft tissue injuries. Where there is blunt force trauma to a muscle or joint (most often the knee). These are relatively simple to recover from, and if not too serious can be treated conservatively. However, if the pain persists then you should seek medical advice from a Doctor or Physiotherapist. More severe injuries like fractures or concussions need to be treated by a medical professional as soon as they occur. These injuries are extremely serious and should not be taken lightly. With adequate preparation and conditioning the risk of injury can be significantly lowered. Basic strengthening exercises (using body eight) should be included over and above normal rugby practice. A Biokineticist should be consulted as to which exercises are the most appropriate for your child.

Soccer:
Soccer carries a lower risk than rugby as there is less contact. However it is still possible to sustain a concussion in soccer, so the sport should not be taken lightly. Medical professionals still need to be on hand to treat the more severe injuries. As in rugby the majority of injuries are soft tissue injuries. However, rather than blunt force trauma these injuries are in the form of muscle strains. The most common being the hamstrings or groin. Ankle injuries are also very common in soccer. The severity of the ankle injury will determine the treatment protocol and the best course of action is not to limp around but rather seek medical attention.

Swimming:
Swimmers can occasionally suffer from back pain, but the most common injuries are to the shoulder. Swimmers will often have poor postures due to abnormal muscular development and tightness. This predisposes them to abnormal biomechanics (or movement patterns), which in turn leads to over use injuries. Rotator cuff impingement syndrome can be caused from abnormal biomechanics and repetitive strain from hours and hours of swimming. A Biokineticist should be consulted for a shoulder assessment and pre-habilitation programme to prevent overloading the shoulder.

Running and Jumping injuries:
In recent years there has been a higher incidence of over use injuries in children across all sports. More and more research is indicating that activities performed in younger developmental years can shape and form the skeleton. This is not always a good thing as it can affect biomechanics later on in life. Adolescent bones are weaker than adult bones, and are often weaker than the tendons that pull on them. This results in over-use traction injuries, where the bone is forced to grow outwards at the site of tendon attachment. This causes bony deformities and in many cases pain. The most common locations for traction injuries are the heel where the Achilles tendon attaches (Sever’s Disease), or just below the knee where the Patella tendon attaches (Osgood-Schlatter’s Disease). These injuries are chronic injuries, in that they develop over time. However, painful acute symptoms usually present after a sudden increase in activity, such as the start of athletics season. The course of treatment is to rest (avoid the aggravating activity such as running or jumping) and do corrective exercises prescribed by a Biokineticist.