Opening New Doors!

I have been really busy this week. Firstly, from finding out I have been offered a job at the QE, I have been house hunting like crazy.  I knew I wanted to live in Harborne because it was walking distance to the hospital, the area was great to meet other young professionals and with Gerard also living in Harborne, communication would also be easier regarding organisation of CPD courses.  The unfortunate thing is that because it is such a popular area, houses become available and go like hot cakes so I have struggled to even get a viewing on some. But I  have found one which is only a couple of mins walk from the high st and 15 min from the hospital which will be perfect. I will be living with a 2 girls and 1 guy which will be great to meet some new people (can’t wait to start a new adventure!!!)

So after I had been to the house viewing on Thursday night, after training with West Brom, I had to drive to Loughborough University. Through networking I had been given the opportunity to assist Steve McCaig at the England Cricket U19 Profiling camp. Steve is looking to complete his PHd on causes of throwing arm pain in cricketers. The work was expenses paid so I was provided with accommodation and food which suited me. Now baring in mind that on the Rugby camps I have been sleeping in the school dorms, I kind of expected the same for the cricket (which would have been fine for me as long as I have a bed and a shower). But I turned up on the Thursday evening about 9pm to be presented with a lovely hotel room, I was thinking by this point maybe cricket is the sport for me :-)!

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First day of the Camp I had to meet Steve at 7am at the ECB cricket centre. With Steve being an Ozzy it was difficult not to gloat about the previous ashes test but I soon recognised he completely backed the England team through and through. In the morning he quickly ran through the screening program and told me that we would only have 15 mins per player so it was going to be tight (I was thinking oh my god I hope I can keep up) . So the things we were looking at were(some were extras that needed to be covered for his data collection for his PHd pilot study): Scapula position at rest, elbow carrying angle, combined elevation, shoulder internal/external rotation, straight leg raise, hip rotation ROM, Sit and Reach and Knee to wall angle and distance. Steve wanted to know if any of the previous limitations predisposed players to certain injuries or arm pain.

The most common injuries seen in cricket are: Lower back pain, Side strain, Posterior ankle impingement, hamstring strains, lower limb tendinopathy and throwing related shoulder pain. From unpublished data Steve suggested that some of predisposing factors for injuries were.

  • Throwing arm pain- elbow : Reduced total ROM Gleno-humeral Joint and External Rotation on dominant side, reduced Combined elevation, reduced grip strength as a % of Body weight, strength shoulder internal and external rotn, back extension, calf raises.
  • General LBP: Reduced Back Extension and Side Plank times, L to R imbalance on Side plank, reduced Add Squeeze (Look up muscle slings that act on the pelvis to understand reduced adductor squeeze.)
  • LBP fast bowlers–Similar trunk muscle endurance scores but difference not as great, decreased Combined elevation, Dorsiflexion and Sit and Reach.
  • Posterior Ankle impingement: Reduced Dorsiflexion Rom and > L and R difference

So these were some of the reasons we were screening the players so we can look back in retrospective to see whether these limitations are the cause of problem and so players can be given appropriate management plans. Steve has been working in Cricket for about 9 Years so he was really knowledgeable of his sport. You become to realise that each physio at the top has their own ideas and clinical reasoning. At west brom there is a strict focus on prehabilitation, whereas England cricket would focus on physical Preparation. So I think when you get into the area you want to work in you have to ensure you make decisions about how you manage your players/ patients using your own clinical reasoning and judgement, whilst basing practice on evidence. I really enjoyed the first day of the camp because Steve took the time to explain his reasoning and provided some teaching on the Shoulder complex.

On the second day a lot of the drills in the morning were focused on batting, fielding and throwing. Each player was filmed using high speed cameras so their  technique and biomechanics could be recorded. Cricket is not necessarily a sport I follow but it was good to see a break down of skills and to see the difference between the spinners and fast bowlers. I was manning one of the cameras for the batting so I got a real close up of the players. In the afternoon most of our screening was based on muscle endurance so we were looking at Back extension, side planks, calf raises, bridges whilst the strength and conditioning coaches  also carried out other functional movement and strength tests. Again we were looking at imbalances and factors which may predispose players to injury. It was great to see that the physios and strength and conditioning coaches working closely together off the same page as I believe there is a real gap in everyday practice between health professionals and the fitness industry.

So what is in the pipe line for me now, well I am attending the CSP West Midlands Regional Network Meeting on Monday to see what is happening in the region. Regional network meetings are great for networking with qualified clinicians and most are very welcoming to students and new grads. Visit your individual region on the CSP website to see when their next meeting is.

http://www.csp.org.uk/nations-regions

After having so much backing for my blog there is a potential it will be promoted on the CSP website in the blog section so watch this space.

See some pictures below from the ECB Profiling Camp:

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Thanks for taking an interest in my blog, if you have any comments please feel free to leave them on this page or tweet me @LC_physio.

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Everything happens for a Reason!

So I have now written this post 3 times because things keep changing so quickly. So just to catch up on what I have been doing the last couple of weeks (I hope I can remember everything).

Last week I attended my first training session with West Bromwich Albion, which was more of an induction to get to grips with how things were run. I was working with a physiotherapist called Mel as Nathan the main man was called out with another player in hospital. As a physiotherapist I was involved in the Prehabilitation of players during their warm up, this involved:

  • Sport specific skills including proprioception some of the exercises included were:
  • Hopping to four points with one foot, at each point volleying a football back to the feeder on inside foot, laces and knee/volley. On the return to the middle point the player had to head the ball.
  • Using a wobble cushion dribbling the ball to four cones whilst standing on one foot.
  • Jumping onto wobble boards with cushion upmost. Jumping two feet and one foot.
  • Foam Rolling, quads, hamstrings, ITB, gastroc’s

It is important to encourage injury prevention within the academy and to illustrate its importance. The activities involve challenging core stability and sports specific proprioception. I really enjoyed the session as I haven’t had the opportunity to work on prehab before and I think me and Mel were both thankful for the extra pair of hands as more players turned up than usual. Having enough physiotherapists to players is key to ensure form is correct throughout.

There is now good evidence that a prevention program consisting of a mixture of: Balance training, landing with increased flexion at the knee and hip, controlling body motions especially in deceleration and pivoting manoeuvres, can significantly reduce the number of ACL injuries. So for these players who are at the start off their careers it is vital to educate them on the use of prehab (Brukner, 2012).

http://www.peterbrukner.com/acl-injuries-preventable/

Since my induction I have been on my first proper session which was fantastic. Again the session focused around Prehab at the beginning, some of the exercises we used were:

  • Hopping on one foot onto 6 wobble cushions in a line.
  • Hopping onto on a wobble board cushion side up, jumping onto the ground same foot and then bounding a mini hurdle.
  • Using an agility ladder each player tied their legs together with an elastic band and side stepped through the ladder.
  • Hopping over hurdles in a zigzag pattern and volleying a ball back to the feeder.

We then were able to follow up certain players who needed specific rehab which was great to learn about some sport specific. Next week I will be leading on prehab with another physio and will be assisting with injury prevention screening using Functional exercise movement patterns. So I will follow up with a post on this.

With regards to job interviews I have had two recently, one for Bank work with Nottinghamshire Healthcare NHS trust and one for a private company called APOS Therapy. So first for Nottingham, I really was feeling a bit deflated about NHS interviews but I knew it was an opportunity for interview and although it was bank it covered all the rotations I wanted so I knew I had to give it everything. The night before I organised my CPD folder to match the person spec for the job (but of course they didn’t look at it…. Sods law) but anyway, I went in to the interview feeling a lot more relaxed than previous ones (I think it was because I was a bit half-hearted about it all… but it somehow calmed me down). The questions I got asked were:

  • Tell us about your biggest achievement to date?
  • How do you cope with stress? And how does it affect you personally?
  • Tell us about a time when you didn’t meet a deadline? What were the repercussions?
  • Why this trust?
  • What would you assess objectively for a patient with anterior knee pain?
  • How would you go about assessing a patient who has been admitted following a fall? What would you need to know subjectively? Objectively? And what would your management plan and goals be?

There was a few more which have slipped my mind.

From previous interviews I have realised the importance of not getting your hopes up.  On this interview I ensured I paused and composed my thoughts before speaking and I provided comprehensive answers for the two clinical questions. I got home that afternoon and looked at my phone; I had two missed calls from an unknown number followed by a voice mail. It was the therapy lead asking if I could call her back….. So of course I did and was subsequently offered the position! I was so ecstatic, the job was close to home and they were very positive with my feedback which was a real confidence boost. Of course I accepted the offer and then tried to prepare for the next interview still grinning.

Apos Therapy is a fast growing international company which focuses its treatment on correcting biomechanics by wearing some special boots. The product is fantastic and has had some great reviews see website for more information: http://apostherapy.co.uk/en/home . The interview was ok but it did demonstrate the simplicity of my knowledge for biomechanics but it was very interesting. Apos Therapy are very good at investing in people and providing intensive training but I was concerned as a new graduate that specialising to early would not help me to develop my hands on skills as a physiotherapist. So I decided that although I had got through to the second stage of interview at this time the job was not going to work for me, but if an opportunity arose at a later date it would definitely be something I would consider.

So I had decided the Nottingham job was for me and even though I had secured some bank work at Walsall healthcare. Nottingham would mean I could save some money. But then you will never guess what happened next….. Me, Gerard Greene and Tom Astley were just about to head out for drinks in Harborne (about 9pm) when I got a phone call from an unknown number. It was Janet Hallam from the QE ringing to say they could offer me a fixed term contract until the end of January, which could become more permanent if funding became available. I was in complete shock!! So I said I would call back in the morning! Of course I took the job it was the place I wanted to work for from the start and even if nothing comes of it, it is 6 months of NHS work on my CV J!!!

So although I have written this post three times due to circumstances changing, I can honestly say that everything happens for a reason! So hopefully my future blogs will now consist of my experiences as an employed graduate!! On a final note who’s to say networking won’t get you anywhere. Next weekend I will be working with England U19’s Cricket to assist with their injury prevention screening so hopefully this will open even more doors.

Thank you for taking an interest in my blog, feel free to comment or tweet me @lc_physio.

Pictures from the final Rugby Camp at Ellesmere College:

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