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July 4, 2020 News

Martin Lock, MCSP BHSc BSc

One of Guernsey’s most well-known and experienced physiotherapists, Martin Lock, has recently increased his hours with GTG. Having shared his hours between Queen’s Road Medical Practice and GTG since 2008, we are delighted to have Martin now base his time solely with GTG.

Clinically, Martin has a broad knowledge of many sports and has a special interest in spinal and persistent (chronic) pain. He utilises his skills from acupuncture through to manipulation during treatment sessions. He sees exercise prescription, education and clinical evidence being important to good management.

He is part of the multidisciplinary Pain Team and directly supports the Pain Consultants at the Medical Specialist Group.

In life outside work, Martin enjoys outdoor pursuits from the mountains to the sea.

Martin is available for private appointments via booking and is covered by all major health funds.

To make an appointment, please call our lovely reception team on 01481 232 900.



July 4, 2020 News
Physiotherapists can help improve a patient’s breathing.
theskaman306/ Shutterstock

Julie Broderick, Trinity College Dublin and Catherine L. Granger, University of Melbourne

Most people who contract coronavirvus (COVID-19) recover. But about 14% will have a severe infection, and a further 6% will become critically ill. Research shows 16% of those hospitalised need an intensive care bed – often for prolonged periods of time. Some will need to be placed in a medical coma on a ventilator.

During this critical period, specialist physiotherapists will remotely monitor patients and decide if they’re needed to help a patient’s respiratory function and physical recovery by looking at factors such as a person’s oxygen levels, blood test results, lung scans, and following discussion with their colleagues.

Here are some of the problems that physiotherapists can assist with when people are in hospital with COVID-19.

 

Low blood oxygen

People with severe COVID-19 infections suffer from low blood oxygen. Patients with difficulty breathing because of the virus will have worsening lung function and won’t be able to circulate oxygen properly to the body’s essential organs.

In moderate to severe cases of COVID-19, prone positioning (lying face down) is recommended. Lying face down for hours at a time can increase oxygen levels in the blood. This is because it helps match air to blood supply in the lungs, and also opens up areas of lung tissue to allow more gas exchange.

Often, this treatment is used when patients are still critically unwell due to COVID-19. Moving the patient in and out of prone positioning requires a large team of specialist staff which can include physiotherapists. Physiotherapists may also recommend other positions, such as side lying, to assist lung function depending on the patient’s condition.

Physiotherapists can be involved in the treatment of people using non-invasive ventilation, or may in some cases suggest or set up this equipment to improve lung function.

Non-invasive ventilation is a form of breathing support that doesn’t involve inserting a tube into the airways. This is usually done through a face mask, or a “helmet”, which can limit droplet spread of the virus.

However, the use of non-invasive ventilation in treating COVID-19 is still being debated. Research indicates that non-invasive ventilation did not work well for people with other types of viral illnesses such as the Middle East respiratory syndrome (MERS), which might mean there may be a high failure rate in COVID-19. Early intubation (placing a tube in the airways) and ventilation is often preferred for severe COVID-19.

Non-invasive ventilation can work for some patients with a less severe infection, especially if they’re not considered suitable for more intensive forms of treatment, or if ventilators are in low supply.

 

Mucus in the lungs and difficulty breathing

While many people with COVID-19 have a dry cough and don’t have problems with excess mucus build up data from one Chinese study reported that 34% of patients with severe COVID-19 had excess mucus. This build up may happen after being admitted to critical care.

For some people very unwell with COVID-19, physiotherapists might deliver ventilator hyperinflation to mimic larger breaths, or use a flexible catheter to suction mucus out without the need to disconnect the person from the ventilator.

Patients can also be taught breathing exercises to help them cough up mucus on their own. Those experiencing breathlessness or difficulty breathing can be advised about positioning, relaxed breathing techniques, and about modifying their daily activities.

However, some breathing techniques used to clear mucus will result in coughing. This may spread coronavirus, so physiotherapists will need full personal protective equipment. A negative pressure room (where air can’t be circulated outside the room) is also useful for preventing further virus spread.

 

Weakness

A big focus of physiotherapy during the pandemic will be to get patients moving as soon as possible. But this can only happen when the patient is well enough.

This can start with simply getting patients to move their arms, legs and body in the bed. Physiotherapists will closely manage vital signs such as oxygen levels, respiratory rate and blood pressure to ensure movements are safely tolerated.

Exercises like sitting on the edge of the patient’s bed can help them build up strength.
JOKE_PHATRAPONG/ Shutterstock

Rehabilitation will also vary depending on the patient’s condition. Tiredness or fatigue is reported in about 40% of patients, so physiotherapists will pace activity and potentially see patients more often for shorter treatment sessions. It can be hard sometimes for people to comply with treatment due to factors such as delirium causing confusion and anxiety, so remembering and building on prior sessions may be affected.

For those with severe infections, even the smallest movements can be exhausting and cause rapid drops in oxygen levels. Rehabilitation will be carefully planned and progress gradually to the patient sitting on the edge of their bed, standing, marching on spot, and walking, depending on how well each is tolerated.

Patients hospitalised with COVID-19 are more commonly people who are older and have underlying conditions, such as kidney problems, high blood pressure, diabetes, coronary heart disease and obesity. Some patients can also develop lung and kidney, cardiac and liver damage while in critical recovery. All of these factors influence their ability to recover and physiotherapists must carefully judge their rehabilitation.

People may also develop post-intensive care syndrome, which can develop after a critical illness. People commonly experience problems with their physical function, mental health, or cognitive ability. Where possible, physiotherapists will help patients make a full physical recovery so they can return home. Physiotherapists will work alongside a team to help patients during rehabilitation.

Since recovery and rehabilitation take some time, using technologies such as “tele-rehabilitation” or other forms of remote physiotherapy can help patients return to good health even after they’ve left the hospital.
The Conversation

 

Julie Broderick, Assistant Professor, Physiotherapy, Trinity College Dublin and Catherine L. Granger, Associate Professor of Physiotherapy, University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.


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July 4, 2020 News

You’ve been following a training plan for months now and with 4 weeks remaining before race day you should be planning your final long run. This is your last chance to get some big miles under your belt before you start to taper.

If you’ve been sticking to a training plan, great, keep it up. This blog is designed to help you approach your taper period in the right mind-set.

 

Tapering improves performance

Tapering is an essential part of marathon training preparation, but why do we do it? If you’ve been building towards marathon distance, why would you want to reduce your training load as the event approaches?

The simple answer is that science show us tapering strategies can improve performance by up to 6%! It’s a proven strategy to ensure peak performance by reducing training fatigue.

The taper is all about transitioning from the preparation phase of training to being physically and psychologically ready for competition.

 

Getting the load just right

Reducing your training load during a taper is a great way to reduce accumulated fatigue, however, reduce the load too much or in the wrong way and you risk undoing some of your hard work!

There are 3 main components to training load that need to be considered:

  • Intensity (how hard you’re working)
  • Volume (the length of your sessions)
  • Frequency (number of sessions per week)

Research shows that intensity is the key element to maintaining your training induced adaptions and preventing negative effects of a taper. This means you should still be running hard during your taper. You should maintain a similar ‘rate of perceived exertion’ during your runs to what you were aiming for during the pre-taper phase. If you’ve been doing interval training or stairs sessions too, these can remain high intensity.

When it comes to training volume it has been shown that this component can be markedly reduced without negatively affecting performance. By reducing total training volume by 41-60% you can maximise your performance gains. This should be the focus of your taper. In other words, make your runs shorter.

Frequency is the final variable of training load and it represents how many runs you are completing in a week. Most of the research in this area shows that reducing frequency during a taper neither improves nor decreases performance. However, maintaining routine is important so it’s usually recommended to uphold a similar number of runs each week.

Basically, to get the most out of your taper you should maintain the frequency and intensity of your runs, but you should reduce the distance by about half over the taper period.

 

Duration of the taper

Most taper periods are between 1-4 weeks long. The perfect taper period is individual and depends on how hard you’ve been pushing yourself in the weeks before tapering. If you’ve pushed your limits and you’re feeling exhausted, perhaps a 4-week taper would be best for you. On the contrary if your training has been a bit patchy you may only need a couple of weeks.

Perfecting the duration takes experience and a good ability to listen to your body. For most of us however, around 3 weeks seems to be the sweet spot between optimising performance and avoiding the negative effects of de-training. For now, it’s probably best to stick with what’s in your training plan.

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Enhancing your recovery

Some of the finer details you should consider during your taper:

1. Reducing muscular fatigue

Massage and compression garments are the two main modalities that come to mind here. There’s little evidence that massage and compression garments can improve performance for marathon runners, but there is some to suggest they may help with recovery. My advice is that if you’re not keen on using either I wouldn’t bother. If, however, you are someone who swears by either massage or compression garments then that’s a great reason to continue doing the things that work for you.

Massage can help reduce soreness after exercise, so Guernsey Therapy Group will be at the finish line providing post-race recovery massages. Come and see one of our physios after the race for massage and advice.

2. Sleep

This is where most of your rejuvenation will come from. If you struggle to sleep at times a warm shower before bed or meditation could help you to get those important extra hours.

3. Nutrition and hydration

It goes without saying that nutrition and hydration are critical for successful preparation. Starting a race with poor hydration or low glycogen stores will have significant consequences for your ability to perform or even finish the race.

Match your macro-nutrient intake to your training load and keep your urine light yellow to clear.

 

Managing injuries

“Patch it up, fix it later”, is how the saying goes. Many runners run with pain and can carry on just fine. The taper period gives you a little extra time to get some symptomatic relief from your injuries while you wait until after the race to get them addressed properly.

If you have any concerns, Guernsey Therapy Group are your go-to physios for all running related pain. Your physiotherapist will be able to diagnose and treat your pain and get you back on your feet again in no time. Give us a call on 232 900.

Disclaimer: The advice in this blog is general in nature and may not take into consideration your personal circumstances. Always consult your health care provider for diagnosis and treatment.

 

About the author:

Mitch Hamer – Specialist MSK physiotherapist

Mitch is a runner and a physio. He’s the lead MSK physiotherapist for Guernsey Therapy Group, Team Physio for the St Jacques Vikings rugby team and has represented Guernsey internationally for Touch Rugby.


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