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The power of words!

The power of words!

May 21, 2024

Something I always try to personally remind myself when seeing a patient, is how important the use of my language and terminology is in providing them a safe, informative and hopefully, comfortable environment. I think it is fair to say that a large percentage of patient’s withhold some level of apprehension when attending a medical appointment, particularly that first meeting. For me, that first time with a patient is as much about building a strong and trustworthy relationship as it is providing a treatment plan or diagnosis. I am sure each and every medical professional has had those appointments where the time is up and nothing ‘objective’ or ‘physical’ has taken place. Instead, the time has been taken up by conversation, or possibly even one way conversation where the professional’s role has simply been to listen rather than talk. For me, this is still active treatment and often, very beneficial to the patient. On more than one occasion I have been glad to receive an email or contact from a patient with whom this has been the case, where they have simply said ‘thank you’ for giving them the time to tell their story and share their beliefs.

An interesting stat that I have always remembered is that 40-80% of medical information provided by healthcare practitioners is forgotten immediately. The greater the amount of information presented, the lower the proportion correctly recalled and furthermore, almost half of the information that is remembered is incorrect (Kessels 2003)(3). This amplifies the importance of trying to keep terminology simple and keep focus on the most relevant information for that patient. From personal experience, it is more often than not, also the negative information or language used by a health professional that the patient clings to and remembers. Linskins et. al (2023) (2) carried out a randomised control trial on the effects of negative language use of physiotherapists in the treatment of lower back pain. To no surprise, the findings were that the use of negative language heightened a patient’s state of anxiety, with higher rates of belief and concerns that their condition would last for longer. This is not to say we should be unrealistic in what a patient’s possible prognosis may be, however it is definitely an indicator that how we relay that information is key in how they may perceive their recovery or long term management of a condition. I personally always like to ensure a patient leaves their appointment having completed something ‘pain free’ or that they didn’t believe they could actually do prior to that session. It gives a great base for positive reinforcement and the use of positive language, hopefully giving them something to work with and focus on going forwards.

Through my own career to date I have been lucky enough to work with some fantastic doctors and physiotherapists and it is from these, that I believe I have been able to do my best in attempting to maximise my interpersonal and communication skills when face to face with a patient. I was recently asked by a physiotherapy student, what key pieces of advice I would give for taking an effective subjective assessment. My response was based round the following points:

  • Let the patient lead the conversation
  • Do not interrupt the patient when they are speaking – no matter if the clock is ticking
  • Make eye contact with them, not constant eye contact with your computer screen
  • Emphasise you are here as a tool for them, not as a solution – give the patient some self importance and responsibility
  • Do not make the patient feel hurried
  • Use simple terminology
  • address the negatives, but focus on the positives

Franx and Murphy (2018) (1) summarise the importance of language in a medical setting nicely. They state that ‘listening consists of following the lead of language, often along many strange paths, until a proper understanding is reached. In this way, a patient’s true background is opened that is required for an effective intervention.’

Reference List

 

  • Franz, B. and Murphy, J.W. (2018). Reconsidering the role of language in medicine. Philosophy, Ethics, and Humanities in Medicine, 13(1). doi:https://doi.org/10.1186/s13010-018-0058-z.

  • Fieke) Linskens, F.G., van der Scheer, E.S., Stortenbeker, I., Das, E., Staal, J.B. and van Lankveld, W. (2023). Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomised controlled trial in healthy respondents. Patient Education and Counseling, 110, p.107649. doi:https://doi.org/10.1016/j.pec.2023.107649.

  • Kessels, R.P.C. (2003). Patients’ memory for medical information. Journal of the Royal Society of Medicine, [online] 96(5), pp.219–22. doi:https://doi.org/10.1258/jrsm.96.5.219.

The power of words!

Musculoskeletal Disorders in Menopausal Women

May 8, 2024

Menopause causes a deficiency in oestrogen which can result in an increased risk of cardiovascular disease, cancer, cognitive decline, chronic obstructive pulmonary disease, diabetes, metabolic syndrome, depression, sleep disturbances, vasomotor symptoms, migraines and musculoskeletal disorders. The most common musculoskeletal disorders in menopausal women are osteoporosis, sarcopenia and osteoarthritis (Dijk et.al, 2015).

During the menopausal transition, there is an increase of muscle degeneration which can progress to sarcopenia. The decrease in oestrogen and testosterone leads to ‘neuromuscular junction insufficiency, myofiber loss, mitochondrial dysfunction’ (Buckinx and Aubertin-Leheudre, 2022) and reduced muscle regeneration.  These physiological changes increase fat deposits in muscle and increase the difficulty in achieving hypertrophy and maintaining muscle mass (Buckinx and Aubertin-Leheudre, 2022). The prevalence of osteoporosis in menopausal women is extremely high, as more than two million women have osteoporosis in England and Wales. After the menopause, prevalence rises with age from approximately 2% at 50 years to more than 25% at 80 years’ (Peto and Allaby, 2013) This is likely due to the osteoclastic resorption activity increases and the osteoblastic activity decreases, resulting in more bone being absorbed than being formed (Ji and Yu, 2015).

There is an abundance of research illustrating the impact menopause has on osteoporosis and sarcopenia, however there is limited evidence on the impact of osteoarthritis on musculoskeletal disorders (Watt, 2018). However, Richmond et. al found oestrogen receptors in articular cartilage which potentially demonstrates a relationship between oestrogen and articular cartilage health. Zhang et al. discovered that oestrogen has a positive impact on cartilage. These studies illustrate there is relationship between oestrogen and cartilage however unable to identify an explanation for the clinical significance (Hame and Alexander, 2013). Lower back pain (LBP) is also more common in postmenopausal women than men who are within the same age group. This is most likely due to oestrogen deficiency causing postmenopausal women to have increased prevalence of disc degeneration; therefore, resulting in increased risk of spondylolisthesis and facet joint osteoarthritis. Also due to higher rates of osteoporosis in postmenopausal women, osteoporosis related spine fracture, especially at thoracolumbar junction, can cause LBP (Wang, 2017).

There is a wealth of research showing the importance of menopausal women participating in exercise to reduce the risk of musculoskeletal disorders and prevent the worsening of symptoms (Grindler et. al 2015). For example, Mendoza et. al found that exercise reduces osteoarticular pain in postmenopausal women with fibromyalgia or breast cancer (Mendoza et. al, 2016). Research suggests a combination of high impact exercises and weight training is optimal to increase muscle mass and bone density, alongside medical intervention such as hormone replacement therapy and supplementation. Metcalfe et .al found the combination of adding calcium, hormone replacement therapy and weight bearing movement increases bone mass density and muscle strength for post- menopausal women. The weight bearing movements included stair climber or stepping alongside resistance training and balance exercises to reduce the risk of osteoporosis, sarcopenia and fractures (Metcalfe et. al, 2001). Hettchen et. al 2021 also demonstrated the positive impact exercise has on early postmenopausal women with osteopenia or osteoporosis and disorders related to menopausal transition. The exercise regime included a combination of high intensity training, jumping sequences and velocity resistance training (Hettchen et. al 2021).  The evidence illustrates the importance of physical activity for menopausal women, however more research is required to see the impact menopause has on other musculoskeletal disorders.

Reference List

 

Working from home checklist

Working from home checklist

May 5, 2024

Photo by Ian Harber on Unsplash
Office jobs can often result in several injuries, including back pain and repetitive strains, to name a few. Now, in light of the pandemic, these injuries have been transferred from the workplace to home, with many of us now adopting the working from home life. The most prevalent injury in the workplace is back pain, with sedentary office jobs causing this to develop from long periods of physical inactivity, incorrect posture, and poorly designed workspaces.
Making the shift to working from home offers us an opportunity to address these injury risk factors and make work as comfortable as possible. But what do we suggest?
  1. Create an ergonomic workspace. The word ergonomic has been thrown around a lot in recent months and refers to a space designed for efficiency. This includes positioning everything you will need for your working day, whether that be pens, phones, or a water bottle, within an arm’s reach. How does this help prevent injuries? Well, if you can reach anything you need by reaching out your arm, there will be no need for you to lean and stretch, potentially causing strains. An ergonomic workspace also means adjusting your monitor height, ensuring the screen brightness is optimal and adjusting your desk and chair height to ensure maximum comfort.
  2. Choose the correct office chair. This is one of the most important points of the working from home checklist. The correct office chair can be the difference between back pain and no back pain. A good office chair will promote proper posture by having an adjustable height, an adjustable backrest, and adjustable armrests, alongside lumbar support and the ability to swivel.
  3. Practice good posture. Following on from a good office chair is practising good posture throughout the day. When sitting for extended periods of time, we often subconsciously slouch or lean, which can cause severe back pain if not corrected. Using correct posture reduces the gravitational pressure that is placed on your spine, improving comfort and reducing the risk of back pain.
  4. Take frequent short breaks. Short and frequent breaks minimise the length of physical inactivity during the day. Even if this solely involves standing for five minutes every hour and stretching your back and legs, this can have a profound impact on the incidence of workplace injuries.

If you are still experiencing back pain even after taking these suggestions into account, there may be something deeper going on, and it is worth you coming in to get this checked out by the team at Opus. An assessment from one of our sports medicine specialists may identify exercises and changes you can incorporate into your daily life that will ease any pain your are experiencing.

Why is sports medicine so valuable?

Why is sports medicine so valuable?

May 1, 2024

Photo by Gordon Cowie on Unsplash

Sports medicine emphasises the importance of physical activity in promoting excellent physical and mental health benefits, but by nature, there is an inherent risk of injury. Addressing both athletes and non-athletes, sports medicine works to bridge the gap between exercise science and medicinal practice for the prevention and treatment of sporting injuries. Sports-related medical practices can vary from strength and conditioning for injury prevention to treatments such as injections, rehabilitation and osteopathic manipulation. But why is this so important?

Injury prevention

Exercise is one of the best things we can do for our body; however, injuries are common and can often impact our daily lives. The most common causes of sports injuries are improper or poor training practices, wearing improper sporting equipment, being in a state of poor health, or incorrectly warming up and stretching before participating in exercise or sporting events. Sports medicine focuses on preventing injuries through education and by:

  • Developing a fitness plan that incorporates strength training, cardiovascular exercise, and flexibility/mobility,
  • Addressing any underlying issues that may result in recurring injuries,
  • Ensuring you use the correct equipment and perform exercises in the correct way to prevent injury,
  • Encouraging participation in adequate rehabilitation following a sports injury,
  • Looking at alternative treatment options, such as regenerative medicine, if you suffer from recurring injuries at the same site. 

Shorter recovery times

Returning to sports following an injury can often be a lengthy and difficult process; however, having your recovery overseen by a sports medicine specialist can significantly improve this process. Physical therapy is a crucial component of sports medicine and assists recovery in the following three ways, shortening recovery times:

  1. Provides pain relief. The first priority following injury is to reduce pain and discomfort as much as possible as this often limits your ability to move freely and use your muscles. Physical therapy techniques, including taping, electrical stimulation, and ultrasound, can assist in reducing this pain in the short-term, shortening the recovery process whilst you focus on rehabilitation.
  2. Improves mobility. If an injury arises, you are often immobile for a period of time which can have a drastic impact on your mobility. Sports medicine can help you regain this lost mobility using strength exercises and stretching, enhancing your recovery. Moreover, if needed, our specialists may suggest the use of crutches to help promote movement in the short-term.
  3. Avoids unnecessary surgery. Surgery is the final option if all other recovery techniques have been exhausted, as it can often be career-ending for athletes or result in lengthy recovery periods. Sports medicine may prevent surgery by offering injury prevention. However, if surgery is still required, sports medicine is crucial in recovery. 
Our team of sports and exercise medicine experts at Opus will work with you to rapidly assess, diagnose and plan your treatment and rehabilitation. Get in touch to find out more about how our expertise and skills can assist you in your treatment and recovery.
Why exercise is good for your joints

Why exercise is good for your joints

Apr 29, 2024

Photo by Towfiqu barbhuiya on Unsplash
It comes as no surprise that exercise has an endless list of benefits for our body; it reduces the risk of heart diseases, helps maintain your blood sugar and insulin levels, improves your mental health and mood, and increases strength and flexibility whilst reducing pains and combatting fatigue. However, the benefits of exercise for our joints is often overlooked.
The most common example of the advantages of exercise for our joints is in people with arthritis. Let’s look at this in more detail.
Arthritis is a common condition that results in substantial pain and inflammation to the joints, with over ten million people in the UK alone suffering from this condition. It can affect people of all ages and is categorised into different types depending on the location of the inflammation. The most prevalently discussed types of arthritis are osteoarthritis and rheumatoid arthritis, both of which we provide treatment for at Opus. We discuss the types of arthritis in more detail here.
During exercise, people with arthritis and joint pain describe a significant reduction in their pain alongside a notable increase in their range of motion. But how does physical activity exert these effects? Below are five benefits that exercise yields and how this is advantageous to the joints:
  1. Synovial fluid lubricates the joint. Each joint in the body is surrounded by soft tissue, also known as the synovial membrane, that is capable of producing fluid. This fluid acts as a lubricant, enabling the bones at each joint to slide past one another in a smooth motion. During exercise, the circulation of this fluid is increased and, therefore, reduces any pain at the joint.
  2. Blood flow increases. During physical activity, our heart increases at a much faster pace. This results in an increase in blood circulation throughout the body, including at the joints. This exposes the synovial membrane to an increased and steady supply of both oxygen and nutrients.
  3. Joint-repair genes are switched on. This is a relatively unresearched area; however, studies have shown that genes play a significant role in joint repair, with these being activated by physical activity and joint movement.
  4. Cellular waste is removed. During exercise, a process called autophagy is triggered. Autophagy refers to the biological process in which damaged cells are broken down and removed. The build-up of these cells at the joint can often cause severe pain and limits movement; therefore, ensuring these are removed can instantly decrease the pain experienced.
  5. Increase in muscle mass. It is no surprise that exercise strengthens muscles, ligaments, and tendons in the body; this includes those surrounding the joints. When these elements are strong, they behave like a brace, protecting the join from harm. Moreover, physical activity also increases your overall range of motion, enabling your joints to withstand more pressure.
At Opus, we can assess the root cause of your joint pain and recommend specific sports medicine-backed exercises to lessen this discomfort. Beyond this, we also provide regenerative treatments that may provide long-term pain relief. Get in touch to discuss how we can assist you on your journey.