Clinic Manager and Senior Physiotherapist, Owen Ledbetter talks with Able about how physiotherapy can put disabled people in a good position to start an appropriate exercise regime, leading to increased fitness and wellbeing.
Can you tell me a bit about your specific role?
I work at the fitness and wellbeing centre so it’s an all-encompassing gym with fully integrated medical clinic. We’re very lucky at Nuffield Health with the facilities that we’ve got and because of that we appeal to a wide spectrum of people from every age range and every part of the medical spectrum and ability spectrum as well. From a physio point of view, I end up seeing everyone from the elite tri-athlete to somebody with spinal cord injuries, and everything in between.
What are the main benefits of physiotherapy for disabled people?
We can work with an individual on their needs and goals. So rather than looking at everybody as disabled or able, it’s taking the time to sit down and talk to somebody to actually find out firstly, what their individual issues are and what they want to achieve and then coming up with an appropriate plan and set of goals, with ideas about how they can feasibly achieve them. We also help people to come up with goals that are realistic, because sometimes people want to do something that may be too far out of their reach at the time so it’s breaking things down and setting realistic challenges.
How do you go about tailoring it?
You could come to me with knee pain and ultimately your short term goal is to get rid of that knee pain but what I want to do is find out – if we took away that knee pain, what things would you want to be doing. I wouldn’t want to be just saying – “great the pain’s gone now, off you go”, when actually your goal is to be able to run a half marathon next year, even though at the moment we’ve just got you back to walking.
There’s a huge gap in between where you’re at and where you want to be. I would definitely tailor what we do to the individual, so we spend a lot of time talking to people and often people haven’t thought about what they want to achieve because they’re very much focused on the immediate problem. Your goal could be that you want rid of your back pain but actually we might want you to get to a point where you can sit for two hours without back pain. It’s looking at the bigger picture.
Presumably, pain can rob people of energy.
Pain in itself is debilitating. It drains you of energy, it drains you of motivation, it can make you feel lethargic and those pains can be anything from an acute muscular or joint pain to chronic long term conditions. We think of pain and injuries often from sporting injuries but it could be a postural neck or shoulder problem, lower back, muscular tightness or spasm from bring inactive or immobile.
Do you see many patients with postural problems that use wheelchairs? What general tips and advice can you give to them?
Obviously, it’s very important to make sure that people’s equipment is appropriate for them and is well fitted and well measured. Once you’ve got that sorted it’s about giving the appropriate advice to people in terms of what they can then do to help themselves within their situation.
When should somebody consider getting a referral to a physio?
You can look at it in two ways – you can be reactive and if an individual feels that they’re starting to get aches, pains, tightness and muscle spasm – restriction of movement that they didn’t have before then, obviously, a referral to a professional is needed to see if there’s anything that can be done from either a hands on point of view – traditional physiotherapy or from an exercise prescription or even medication and pain relief.
But you could also look at being a bit more proactive. (Thinking) “There is a risk of me developing a number of complaints and conditions from being less mobile I could get referred to somebody early on to try to prevent those things from happening”.
So the debate is between early and late intervention?
For me, early intervention is a lot easier because you’re not having to undo a lot of things, because you can then work with them and progress them, whereas when you see somebody further down the line, you’re already trying to battle the problem that’s there plus introduce new things to them.
How does the relationship between exercise and energy actually work?
There are loads of links. Exercising in general and any form of physical activity will lead to an increased level of fitness and muscular tone and control. This in itself will lead to the release of feel-good hormones, endorphins like serotonin and that makes the body feel good and gives you a boost of energy. If you have that boost of energy you’ll start to feel stronger and fitter and will mean that your daily tasks will become a lot easier to do and require less energy. Therefore you’re preserving your energy levels because it doesn’t take as much to get dressed as it would do if you weren’t as physically fit so it’s a positive cycle and it keeps progressing.
Should people find a comfortable plateau or concentrate on getting fitter?
It’s got to be an individual programme so it’s finding a level that’s appropriate for the person, so setting realistic goals and challenges. If I set you something that was out of your ability to achieve at the moment, it would lower your motivation because you weren’t getting there. That would then lower your mood and you would become more withdrawn. If I gave you something like a small, realistic goal and you achieved it, you could give yourself a pat on the back and feel good about it and we could go and give you something else to do. You get to see all of these little milestones of the things you’ve achieved.
As your mood and your motivation starts to improve – that again will start to have a positive effect on your energy levels and make you want to do more things whereas if you’re in that negative spiral of not being able to achieve something you’ll be less likely to want to be active.
So the physio and exercise advice starts as a specific intervention and then becomes holistic, encompassing lifestyle elements.
There are loads of other components with exercise that can help with boosting energy as well. Utilising something like being outdoors more so that you have more access to sunlight, which increases Vitamin D levels. Other things, such as finding an area where you can exercise to reduce the demands on the body, so I take a lot of people into the pool and do one-on-one exercise classes with them. Being in water you become a lot more weightless and less pressure goes through your joints. It often means that individuals can do a lot more than they would be able to do on land. Again, it means that you get a sense of freedom and achievement and you can exercise more without the constraints of gravity and not being able to move if you’re a wheelchair user.