In this BJSM podcast, BJSM deputy editor Dr Jane Thornton joins Daniel Friedman to discuss physical activity counselling.
Dr Jane Thornton MD PhD is a sports medicine physician and researcher currently based in London, Canada, and is an international advocate for physical activity. She has a wealth of international experience in the field of preventative medicine, with a particular passion for promoting physical activity as both prevention and treatment of chronic disease. Alongside a super impressive medical career, Dr Thornton is also a World Champion and former Olympic rower for Canada.
In Part 1 of this 2-part podcast, Dr Thornton discusses:
· Why physical activity is the single best thing we can do for our health
· The evidence for physical activity prescription in primary care
· The shared decision making of how to prescribe physical activity to patients
· How to talk about physical activity intensity with patients
Super Rugby is arguably the highest expression of rugby at club level in the world. Its next closest rival in the world of international competitive rugby at club level is the European Rugby Champions Cup (Heineken Champions Cup). Super Rugby involves teams from South Africa, Argentina, New Zealand, Australia and Japan. As the competition is conducted in multiple countries, teams have to travel frequently throughout the six months long season.
Travel is commonly perceived as “the” major factor affecting a team’s performance. Losing away games reduces the chances of finishing high on the ladder or hosting a grand final. Ultimately, it affects the team’s chance of winning. For example, through the 23 years of the competition, only six visiting teams have won the title and only twice has that occurred following international travel to play the final.
We set out to establish whether this perception was scientifically correct. To better understand the complex relationship between regular air travel and athletes’ psycho-physiological response and performance, we investigated the impact of travel on performance during the first 21 years of Super Rugby (1996-2016).
We directly monitored players from four teams following long-haul trans-meridian travel. The findings of our research show that long-haul travel influenced team performance. However, the away-match disadvantage is likely to be the main cause of these negative effects on match outcomes. Fatigue related to long-haul travel is suggested to have a larger impact on players’ individual performance when overseas.
The away-match disadvantageis a combination of factors, such as crowd support and potential officials’ bias that deteriorates the psychological and behavioural states of athletes, along with their performance, when a match is played away.
Although travel and the away-match disadvantage have a similar effect on all teams, when a match is played against a ‘weaker’ opponent, team statistics – like the number of carries, tackles and tries – are only minimally impaired, even following trans-meridian travel. Even if the technical skills and physical performance of players are not particularly affected by travel, playing away from home may affect tactical and strategic aspects of Super Rugby matches, and negatively influence match outcomes.
Jet lag and travel fatigue
There is ample anecdotal support that frequent travel can negatively affect travellers because of travel fatigue and jet lag. Travel fatigue is a state of weariness that accrues after a single trip and accumulates over time. Jet lag occurs when the circadian rhythms, which are the rhythmic pattern of all the physiological functions and systems of the human body, are not synchronised with the external clock.
This typically happens after rapid travel across time-zones. Jet lag is a common complaint reported by travellers crossing more than three time zones during their journey. Symptoms of jet lag include sleep disturbances, fatigue, changes in mood and a deficit in cognitive skills. All of these may detract from an athlete’s peak performance.
So how does this play out for athletes like those competing in Super Rugby?
Performance is complex and may be influenced by many different factors, including travel.
Over the history of Super Rugby it appears quite clear that travel, especially across multiple time zones, had a negative impact on the winning capability of the teams. However, travel fatigue itself had only a limited impact on team performance.
Super Rugby teams reach the match venue at least one day prior to the match and a full night of rest is usually enough to recover from the effects of travel fatigue. Similarly, crossing time zones appears to minimally impair performance. However, the direction of travel largely dictates the magnitude of this impairment: eastward travel is slightly more detrimental than westward travel. As such, for example, a team travelling from South Africa towards Australia or New Zealand will struggle more than a team travelling from South Africa towards Argentina.
This is because eastward travel requires a phase advance of the circadian rhythms while travelling westward requires a phase delay. Circadian rhythms are, on average, slightly longer than 24 hours and the human body shows a natural tendency to drift slightly each day. As such, it is easier to cope with a delay rather than an advance in time.
A number of specific strategies are commonly used by all teams to try and reduce the negative effects of travel. Compression garments can help in reducing travel fatigue and reduce the risk of cramping or even deep vein thrombosis whilst travelling.
Other strategies, mostly based on melatonin supplementation, can help reduce the effect of jet-lag upon arrival. Although these strategies help the team in successfully dealing with long-haul travel, team performance when overseas is still impaired.
Travel is an intrinsic feature of Super Rugby but travel variables are too many to control and therefore there is not a final solution to address all travel related issues. However, our findings suggest that, for the most part, teams appear to be successfully dealing with long-haul travel. Now they should focus on reducing the effects of the away-match disadvantage – for instance by improving players’ behavioural response when competing away from home or implementing different game plans.
Professor Andrew M Stewart (Victoria University), Professor Robert J Aughey (Victoria University) and Associate Professor Nicholas Gill (University of Waikato) co-authored the research on which this article is based.
We recently came across this great video from physiotherapist David Pope where he looks at “Tennis Elbow”:
In this video, you’ll discover three key research-based tips to help you get your lateral elbow pain patients on track, including:
How to make sure you’ve got an accurate diagnosis, and you’re actually treating lateral elbow tendinopathy rather than another presentation
Treatments you need to avoid like the plague, that will lead to worse outcomes – Specific exercise instructions you can use with your patients – how much and how often should they get stuck into their strengthening exercises?
People with shoulder pain who expect physiotherapy to help them are likely to have a better recovery than those who expect only minimal or no improvement, according to our latest study. We also found that people are likely to have a better recovery if they are confident they will be able to continue doing things that are important to them, such as socialising, hobbies and work.
Shoulder pain affects people of all ages and can become persistent. Injury and overuse are common causes of shoulder pain, but sometimes the cause is unclear. It can disturb sleep, interfere with work, leisure and everyday activities like washing and dressing. Exercise, prescribed by physiotherapists, is an effective treatment for shoulder pain, but not everyone benefits from physiotherapy.
Researchers from the University of East Anglia and the University of Hertfordshire in the south-east of England, together with local physiotherapists, wanted to find out more about the characteristics of people who benefit from physiotherapy compared with those who continue to experience persistent pain and disability.
Knowing the outcome is important for people with shoulder pain as it helps them decide whether or not to pursue a course of physiotherapy.
Our study, published in the British Journal of Sports Medicine, included 1,030 people attending physiotherapy for musculoskeletal shoulder pain in 11 NHS trusts across the east of England. We collected information on 71 patient characteristics, such as age, lifestyle and medical history, and clinical examination findings before and during the patients’ first physiotherapy appointment.
A total of 811 people provided information on their shoulder pain and function six months later.
What surprised us was that patients who had said they expected to “completely recover” as a result of physiotherapy did even better than patients who expected to “much improve”.
The most important predictor of outcome was the person’s pain and disability at the first appointment. Higher levels of pain and disability were associated with higher levels six months later. And lower baseline levels were associated lower levels six months later. But this relationship often changed for people who had high “pain self-efficacy”, that is, confidence in the ability to carry on doing most things, despite having shoulder pain.
Another surprise finding was that people with high baseline pain and disability, but with high levels of pain self-efficacy did as well as, and sometimes better than, people with low baseline pain and disability and low pain self-efficacy.
First study of its kind
This is the first study to investigate patient expectations of the outcome of physiotherapy for shoulder pain. Earlier research shows that high patient expectation of recovery predicts a better outcome following physiotherapy for back pain and neck pain, and a better outcome following orthopaedic surgery.
On a similar note, this is the first study to show that higher pain self-efficacy predicts a better outcome in non-surgically managed shoulder pain. Previous research has shown that self-efficacy predicts a better outcome for a range of other health conditions. Also, people with higher self-efficacy are more likely to do the home-exercise programme suggested by their physiotherapist.
If you have shoulder pain, there are several ways to increase your pain self-efficacy. Work with your physiotherapist to understand and manage your symptoms. Practice your exercises together and ask your physiotherapist for feedback, including how to adjust your exercises to make them harder or easier. Finally, make sure you discuss what you want with your physiotherapy and the activities that are important to you.
With the explosion of cycling as a leisure and competitive sport, wrist injuries are on the rise and physiotherapists and occupational therapists are having to spend an increasing amount of time treating patients with these injuries.
The team from Baton Rouge Physical Therapy have prepared this short video for demonstrating simple exercises for improving Range of Motion (ROM) of the wrist.
Don’t forget that you can use our 3D Joint ROM toolfor measuring Range of Motion (ROM) of the wrist in real-time.
The world of physical therapy / physiotherapy is constantly with new techniques and research.
We came across this interesting TEDx talk by Vinita Chandra Mody who is the founder of Stroma Physical Therapy, a boutique practice in New York City.
Vinita decided to open her own practice when she developed a following of loyal patients who attested to the benefits of her unique therapeutic style. She founded ICT by Stroma™ which is a vascular, neural and myofascial technique after years of working with patients and sensing body pulses and their link to symptomatic relief.
Interested in developing your physiotherapy practice in 2019 and looking for tips on how to achieve your goals?
In this podcast Jamey is sharing his practice freedom methodology to practice owners all across the country who are looking for financial prosperity and a better quality of life. His book, The Practice Freedom Method: The Practice Owner’s Guide To Work Less, Earn More, And Live Your Passion, has been an Amazon #1 best seller.
In this episode:
-How to establish a clear vision and find the why behind your goals
-Why comparisons to others will keep you small
-The importance of sharing the narrative behind your practice with your team
-Planning and budgeting for the bottom line that aligns with your goals