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Online Consultations, the Challenges they Pose, and Some Useful Tips to Help with your Lockdown Inju

The switch to online consultations since lockdown has been challenging but ultimately very productive and has helped to improve my skills as a clinician hugely.

The switch to online consultations since lockdown has been challenging but ultimately very productive and has helped to improve my skills as a clinician hugely. In essence what an online consultation involves is initially an email/call/text from the patient describing what your problem is, a full injury history and a what your goals following rehabilitation from the injury. I will then ask for some videos to be sent through of some basic upper and lower body movements that allows me to assess where the problem might be originating from so that I can be as prepared as possible for when the consultation begins. The consultation is set for a specific time and all you have to do is click on the link sent to you via email at this time and you will be brought directly to the video consultation which is carried out using either Zoom. Initial consultations last 40-45 minutes and involve further movement assessments followed by demonstrations and prescription of exercises which will have the patient feeling better in session. A rehab programme will then be put in place and videos sent on to you so that you don't need to worry about trying to remember all the exercises gone through during the session! It helps a great deal when the patient has plenty of room to work with and some basic equipment (bands/light weights/steps) but this isn’t always possible and can be overcome easily enough. Good lighting in the room, a decent internet connection and a laptop rather than phone or tablet are also preferable for both the therapist and the patient.

Follow up sessions are a little bit shorter and cheaper due to the lack of need for an initial assessment and involves re-testing movements form the previous session and advancing on rehab exercises to the next level to allow the patient to move closer to achieving the goals outlined in their first email!

The obvious challenge with this style of consultation is not being able to be hands on with the patient. From an assessment perspective this means special tests and palpation are out of action so you have to rely heavily on your observational skills and ability to be creative to create tests that will stress the areas you want to stressed. This need for creative thinking and effective verbal and demonstrative communication I think has improved my clinical reasoning to no end and has been one of the major benefits personally of the lockdown situation. From a patient perspective the enormous benefit of the online sessions is the fact that you don’t become reliant on your physio/therapist/coach to ‘fix you’ every time you are in pain. This move away from relying on hands on treatment techniques will benefit the injury and performance management industry enormously. Patients will understand their pain and the reasons for it a lot better and be more likely to adhere to and contribute to the rehab plans put together to reach their goals!

Regarding the more common injuries I’ve been dealing with lately, there has undoubtedly been a huge trend towards overuse and repetitive strain issues. This comes as no surprise given the sudden burst in physical exercise that the country seems to have had since the beginning of lockdown. People who maybe did not have the most consistently active lifestyles while in full time work are using the time they have now to try and improve their fitness levels and for a lot of people the jump from nothing to 5km runs 3-4 times a week has been too much too soon for their bodies to handle. Similarly, athletes who were used to a regimented training schedule with their teams or coaches have now been forced to totally alter their training styles to fit with the lockdown protocols. This sudden shift in training emphasis and intensity has also resulted in areas of the body becoming heavily overloaded at intensities and volumes that they are not used to. The predominant tissues to get injured because of this sudden spike in training load are tendons. And for weight bearing exercise this has usually meant patellar (kneecap) and Achilles tendon issues with Achilles tendon pain being the most prevalent issue I have seen to date.

Managing tendinopathies can be a tricky business and tends to change from case to case. However, there are some nice tips that I can advise on which will help to kickstart the rehab process whether it is a hip, knee, or Achilles tendon issue someone has. In most assessments you get for a lower limb tendon injury you will have tests carried out to determine what potential deficiencies you may have in strength and mobility that may have contributed to the tendon becoming irritated (eg. Weak lateral hip muscles, poor lumbo-pelvic control, reduced ankle mobility or big toe mobility). Correcting these deficiencies is an important part of the rehab process but just as important is to gradually start loading the irritated and sensitive tendon once the initial pain has started to settle to a tolerable level. Early on this means performing ‘isometric contraction’ exercises designed to specifically load the affected tendon and my advice is to begin this process as soon as possible with any tendon injury as long as the pain intensity remains at or below a tolerable 4-5/10. For an Achilles tendon injury this might mean an exercise such as the one seen in this video:

Aiming to hold for 45 seconds this exercise loads the Achilles tendon nicely while also strengthening quads, hips and challenging your balance as well. On top of that, isometric exercises held for 45 seconds minimum can have a pain relieving affect as well!

For a patellar tendon injury you might start with something as simple as a wall sit as seen here:

Again aiming to get 45-60 seconds of a hold in this position will be very beneficial. As soon as you feel able then, try shifting more of your body weight over to the affected leg to really challenge and load that tendon back up.

For a lateral hip tendinopathy I like to use this side plank clam variation as a nice starting point for load:

The first video on this Instagram post for dealing with lateral hip pain demonstrates this exercise nicely. A 30 second hold in this position will have your glutes burning and working hard!

These isometric exercises are a great starting point for tendon overuse injuries and require little to no equipment which is even more ideal for our current pandemic situation. However it is important to note that this is only the beginning of the rehab journey as far as tendon pain is concerned. Gradually progressing and increasing the load while constantly monitoring pain levels is compulsory for tendon injuries and the best way to do this is with the advice of a therapist or trainer who can help you put together an appropriate plan to get you to whatever your ultimate goal is.

Lastly, I will just add that the best form of rehab is prevention! This might mean being more gradual with your change or increase in training so that you don’t spike too soon or beginning some strength training which will help to build some resilience to allow you be better prepared for whatever training you have in mind. Make sure to check out my website, Instagram or Facebook page for all kinds of tips on rehab, injury prevention and performance which will hopefully give you the bit of extra knowledge you need to manage your training goals!

Thanks for reading and stay safe!

Kevin Feely

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