The daily Post

Kris Scaife explains one key exercise he used to take a patient from being unable to bend and reach past her knees to doubling her sit to stand speed and being able to lift from the ground again, all at the same time as kick starting her return to work process.

Enter Kris:

The patient we’re discussing today was diagnosed with an L5-S1 disc protrusion and at the time of the initial assessment was very stiff, very pain focused and like most who’ve experienced a significant injury, they were guarding a lot of their movements and had become very deconditioned and weak as a result.

Measures from the initial assessment showed that five repetitions to rise out of the chair during a sit to stand test took her 70 seconds, she wasn’t able to navigate stairs very much at all and she was unable to bend and reach beneath the knees showing a lot of limitations to her movement and functionality.

Where are they now:

At the 8 week mark of treatment we’ve been able to halve the time it takes to perform the 5 repetitions of sitting and stand with this decreasing from 70 seconds down to 34 seconds. She’s back to being able to pick pieces of paper up off the floor, she’s able to walk up and down stairs front on instead of using a two foot, sideways gait and discussions are now starting with her doctor to return back into her work duties.

What did we do?

One of the exercises we’ve used for this patient’s lumbar spine and back pain is the “Frog”.

The main idea of this is to strengthen and activate the lower core to help support the lumbar spine. During the exercise, patient’s are instructed to flatten the lumbar spine, take the curve out of the spine, and then maintain that posture pressing the lower back curve into the ground.

Patients are instructed to let the knees then drop to hip width apart and, keeping the hips stable, lift the feet so that the hips reach the 90deg flexion position with knees bent. This can be progressed further by engaging the upper body and starting to make circles with the arms.

To progress to more of a squatting movement pattern or squat based positioning we need to start with squatting to a bench, stool or chair and aim at something that’s at a comfortable range, not too low as you want them to have the strength to get back up once the hips and glutes are engaged, so working within a small range to start is important.

When initiating the squat movement I instruct patients to focus on moving their pockets back to allow the hips to “hinge” and then stand back up whilst driving through the heels of the feet and squeezing through the glutes to ensure it’s the hips and the pelvic musculature that are driving the movement and not the lower back.

Once this movement has been mastered then you can start to get them away from the bench, stool or chair and incorporate more realistic tasks such as those they’d perform at work or in their day to day home tasks.

Well done Kris Scaife!

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Throughout all exercise physiology programs, whether they’re instantly recognisable or slowly identified over the course of a few sessions, Yellow Flags will impact a rehabilitation program whether you like it or not.

Protection is natural

After experiencing some form of trauma, the body’s natural, in-built, response mechanism is to minimise further damage and protect the body at all costs. Hence why your hand will pull away from a hot plate without you having to consciously make the decision to do it. The body recognises that your conscious thought process takes valuable microseconds and instead of sending the nerve impulses all the way to the brain, the message will only travel to the spinal cord and back out to the working muscles to get that hand off the hot plate as fast as possible, even if the benefit is a few nano-seconds, to save you some unwanted pain.

So if the natural response of our body, when experiencing pain, is to minimise further damage it is therefore natural to limit our movements, wrap ourselves in cotton wool and take care at all costs. However, this can occur to our detriment if this behaviour goes on for too long. Muscles become deconditioned, we lose strength, the body adapts to this newer, poorer way of moving and we then place other structures at risk of damage.

What to do

It takes a skilled clinician to break someone out of this habit and help to form more positive behaviours, which still aim to protect the injured area, but encourage more “ideal” movement patterns and restrengthening rather than avoidance which will ultimately lead the client down the path of recovery.

The video above shows one way in which our EP, Biara Webster, is using some creative thinking and a little bit of fun to minimise protective behaviours and get the body moving again.

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Meet our Brisbane based Exercise Physiologist, Kris Scaife.

Kris is a lecturer at the University of Queensland where he teaches Exercise Prescription for Metabolic Conditions, Ageing and Cancer and well as being the go-to EP for the Oncologists at Greenslopes Hospital, Kris also provides his Exercise Physiology services to Specialised Health clients throughout the Brisbane metro area.

On the role of exercise during the chemotherapy / radiation therapy phase of cancer treatment, Kris says:

One of the big side effects that you get from cancer treatment is that it makes people feel really, really ill. So one of the things you do obviously when you’re feeling ill is you don’t do much and you become sedentary. And that leads into a cycle of fatigue and deconditioning.

There are alot of studies, research and evidence now that state that trying to stay as active as you healthily can, enables you to stay stronger and healthier during the active treatment phase and enables you to cope and endure quite intensive and quite harsh treatment protocols. So keeping the body in as best condition as possible is very important to allow you to get as much treatment possible and improve the potential outcome.

On conducting exercise programs with clients who are post-chemotherapy and are aiming to increase their resistance to fatigue:

The first question I generally ask is, “how are you feeling today?”. It’s all about the delivery of education, “when you’re feeling like this, this is obviously the amount of exercise you can tolerate.” Clients will often push themselves too hard when they’re feeling good and they’ll do very little when they’re feeling bad and this will then exacerbate the “boom / bust” cycle and it’s really about providing the education around teaching their body to tolerate the intensity and use a graduated approach to increasing their activity levels.

One client I’m seeing at the moment has esophageal cancer and had radiation and chemotherapy through the October-November period, leading into a November surgery. So he spent his time in the lead up to surgery coming into the gym two or three times a week aiming to get as strong and as fit as he could.

He’s been back at work, on reduced capacity now, since about March-April. So that was, three months after being in hospital to being back at work. For him to go from the nature of the surgery undertaken at the end of November to get back to being in the office in March, was a great outcome for him.

To discuss how Specialised Health may be able to help your customers click here

To refer a customer with Cancer to Specialised Health click here

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While this story will be most relevant for the CTP insurers out there, the Rehab Providers that are working in the CTP space and those who are working with a client who’s had an amputation, the lessons learnt in this rehab process can be wide and far reaching.

Our Western Sydney Exercise Physiologist, Sebastian Cruzado, has been working with Farrell Steyn, a 76 year old (yes, in the video above i do say he’s 78… sorry Farrell) gentleman living in the heart of the western suburbs of Sydney, Mt Druitt. Farrell’s happy with us sharing a little bit about his story and for us to show a little bit of vision captured throughout his programme and after being involved with Farrell myself in the earlier days of his strengthening program I wanted to write this article to focus on not so much the amputation itself, the injury that he sustained, the rehab that followed or what we’ve been doing with him but more talk about Farrell himself and the attitude that he’s applied, which has been a constant throughout Farrell’s life.

Born in the 1940’s and growing up in the racially charged environment of South Africa in the 50’s and 60’s, Farrell is someone who should look older than he is. At 76 years old he puts most 40 year olds to shame with his strength and power. After being a self-confessed trouble maker in his teens, Farrell hasn’t touched a drop of alcohol for 40 years and has instead devoted the better part of his life to the Church and helping others find their way.

A builder, concreter, tiler and all-round handyman, Farrell has been physical throughout his whole life. He looks strong, he looks fit and he moves better than most 76 year olds, let alone a 78 year old that’s had an above knee amputation.

As Exercise Physiologists, when we preach to people the benefits of staying strong, fit and functional it can often feel like an insurance policy, something that costs you in the short term in terms of energy and time to prevent against an illness, injury or disease that may never occur. However, testament to a life lived based around physicality and movement, when Farrell experienced this latest significant setback in life, the thing that has helped him through the rehab process is the work he did before the fact. Applying a great attitude to the rehab process the same way as he has lived his life, being strong and active.

Despite multiple bulging discs in his lower back, unrepaired torn rotator cuffs in each shoulder and now an amputated leg, Farrell continues to put others to shame with his abilities.

Continue to remind your clients to stay strong, stay active, stay functional, it will pay off.

To get to know our EP, Sebastian Cruzado better, check out this video here

AND, make sure you “Like” our Facebook page here for more insights into how we’re using Exercise Physiology to improve outcomes for all of our customers

For another example of a huge outcome achieved by Mark click here

AND, make sure you “Like” our Facebook page here for more insights into how we’re using Exercise Physiology to improve outcomes for all of our customers

If, like me, you find yourself sitting for big chunks of the day to write reports, make phone calls, sit in meetings, drive to appointments etc etc etc, then, like me, your hip flexors are going to be firing up and pulling your pelvis into what we call an anterior pelvic tilt.

The hip flexors are in an ongoing tug-of-war with the hamstrings and glutes and when the sitting position causes the hip flexors to tighten up and the glutes to lengthen and shut off, the hip flexors unfortunately win the battle every day of the week.

When this battle is lost, the knock on effect is the pelvis being pulled forward and the lumbar vertebrae (which sit immediately above the pelvis) getting pulled forward along with it causing a shearing (sliding) force on the discs. The lower back muscles then fire up to try and combat this and you’re left with an overused and painful lower back region.

This stretch will be painful but performed twice per day for 2-3 min at a time will end up being your best friend.

Let me know how you feel once you try it out.

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I thought that it would be timely considering that it’s starting to get a bit colder, to talk about the benefits of a warm up and how using a warm up can boost performance and essentially speed up a rehab process.

The attached video was filmed as a Facebook Live so if you didn’t catch it there the first time around go over and “Like” our Facebook page here and you’ll be able to jump in straightaway, ask as many questions as you’d like and I’ll answer them right there and then!

When starting the conversation about a “warm-up” let’s talk about what happens if you don’t warm up correctly. Here are the 3 top issues you’ll be creating if you don’t warm up correctly:

1) You’re placing structures at risk. Structures that aren’t ready for movement, structures that may not be designed to take load through them or they’re more there as a stabiliser such as a ligament or muscle tendon and if we load these inappropriately because we haven’t warmed up the prime movers properly, we’re at risk of injury and loading these smaller structures.

2) We’re going to have sub-optimal performance because we’re not going to be using the prime moving muscles that are designed to do the movement. We’re not going to use muscles that have as much force capability so we’re going to have poor performance.

3) Unfortunately, you’re wasting your time. If you’re not using the right muscles, if you’re not causing the right structures to adapt, you might as well come back another day and have another shot at it as you’re going to use your time much more effectively if you’re warming up and getting the right structures ready and perfomring the exercises the right way.

If we do warm up correctly, what do we get out of it?

1) Well firstly, you are at a much, much lower risk of developing an injury. If you have the right structures working, the right muscles firing and your body is held in a nice position, you’re going to be at a much less chance of causing an injury.

2) You’re going to have better performance. You’re going to be using the muscles that are designed to do that certain movement

3) You’re going to build more strength and you’re going to speed up the rehab process. Faster muscle adaptation occurs when you’re doing things in a more optimal movement pattern.

What do I think are the main components of a good warm up? Two things I think about. One is mobility. Mobility is basically getting joints moving through a nice range of movement. The second thing is activation. If you go for a run, you’re going to ease into it, you’re not going to sprint straight away and if you’re in a strengthening programme, you’re not going to want to throw a heavy weight on the bar or a heavy weight on the machine and go to a hundred percent straight away, you’re going to ease into it and you’re going to slowly introduce the structures responsible for the movement to the weight.

Let’s get mobile, let’s get active, and enjoy the benefits of being able to produce much greater force and therefore, getting through your rehab a bit quicker.

In today’s video I wanted to talk a bit about training and education and the importance as an EP of being a really good educator for our clients in order to elicit better results.

A lot of the time our clientele don’t necessarily have a strong background in training or in exercising and the concepts of strength training, conditioning, movement pattern training, functional movement etc etc, they’re super foreign concepts to a lot of our clients. So, the importance of being able to translate those pieces of terminology or these theories into relatable and understandable concepts is really key to achieving good outcomes and helping them understand what the point is that they’re doing the exercises and what they should be expecting as a result of doing them.

On more of a personal note, this concept was reiterated to me recently. I was lucky enough, and I’m sure June would be happy with me mentioning this, to sit in on an internal AMP training presentation that June Khaw delivered to the AMP Case Managers where she used a “buy-in” technique to get engagement from the audience. June knew her audience, knew who was in the crowd and knew them on a personal level so she incorporated a technique, which I think was just really cool, where she would give a gift or a reward for people that would answer a question and it was a gift that was on a personal level with the audience member. What it did was really help them to engage in that training session because it made it relevant to them and it was personal to them. It was just one of the training presentations that I’ve been privy to recently that really hit home with the audience and I heard afterwards from a lot of the guys there that it was one of the better training presentations they’d been to as well.

The key takeaway i took from this is just really focusing on the importance of knowing your audience, knowing who you’re chatting to and knowing what makes them tick in order to be able to deliver your information or your education in a way that makes it resonate. Such an important point to remember with everything you’re doing as an exercise physiologist when aiming to educate your clients and get awesome results.

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