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Blog

It Depends…

Two words that seem rather…well, lazy. A bit lacklustre; indecisive. In a world that demands answers to be black and white, definitive and absolute, “it depends” doesn’t really sit comfortably with most.

However, there are very few things on this planet with ‘black and white’ solutions, and physiotherapy is no exception. There are a myriad of factors and reasons that can influence a condition, injury or treatment from one person to another; from prior expectations of what the injury or treatment is, to the way in which care is delivered as well as the varied lifestyles we all lead. For both clinicians and patients, this can be rather unsettling – and so from the black and white we seek, we fall into the many shades of grey (we’ve been told there’s 50, apparently).

Rest assured – this is a good thing; “it depends” is nothing to be feared of. As physios, we need to be more comfortable saying this. As people, we need to be more comfortable hearing this. It is, however, not enough.

At Inform Physio, we seek to embrace the landscape of ‘grey’ in order to deliver a tailored approach to your injury or condition management – understanding WHY it depends ensures that the right approach is taken every time.

After all, We specialise in You.


For more updates, head to our social media channels over on FacebookInstagram and Twitter.

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COVID-19

COVID-19 Action Plan

As mentioned on Monday’s update of our return to conducting Face-to-Face clinical consultations, Inform Physio have carried out risk assessments on all the services that we offer to ensure we can continue to provide these safely.

With great confidence, we can deliver the essential services of:

  • Clinic-based Physiotherapy Assessment & Rehabilitation
  • Home Visit Physiotherapy Assessment & Rehabilitation

This will be reviewed on a frequent basis subject to Government recommendations.

Sadly, until there is a vaccine or emerging evidence acknowledging immunity after confirmation of infection, it is nearly impossible to eliminate the risk. All our customers must make their own decisions based upon an assessment of their own risk whilst following all government recommendations. However, Inform Physio are confident that all necessary steps have been taken to significantly reduce any risk where possible, and are delighted to share this with you.

Making our clinic “COVID-Secure”

Please carefully read the steps below – it is essential that you are aware of, and comply with, the measures we have implemented in order to achieve and maintain a safe environment for our customers.

Patient Care Pathway – Online vs Face-to-Face

To establish the most appropriate pathway for us to support you without compromising your health, Inform Physio will arrange for a free telephone triage consultation. This should take no longer than 10 minutes and will consider:

  • Your current history of symptoms
  • Your previous medical history
  • Your overall health risk in relation to COVID-19 (including those “shielding”)

From this, we can identify whether an online for face-to-face consultation is the best way to approach clinically assessing your symptoms, considering any risks associated and ensuring compliance with the latest professional guidance.

Upon the outcome of the telephone triage assessment, we will then proceed to conduct our initial consultation online or face-to-face. During this assessment, we will explore your symptoms and overall health in greater detail along with any relevant tests, diagnose your condition or injury and provide advice on the most appropriate care and/or intervention to help you achieve your goals. This will include the prescription of a personalised digital home exercise programme emailed directly to you. 

Inform Physio wish to make it clear that online consultations are the preferred method of service in the current coronavirus situation. If it is felt online consults are the most appropriate solution, we will then continue to review your progress via online consults until government restrictions are lifted. Should it be agreed face-to-face care – either via clinic or home visit – is the preferred route, you will be read a ‘Risks Statement’ and asked to provide verbal (recorded) or written consent that you acknowledge the infection prevention and control measures implemented (including the level of PPE you and the clinician are required to wear, and the risks associated with close contact during consultations.

Once the appropriate care pathway has been determined through the telephone triage consultation, you will be directed to the appropriate online booking page. Inform Physio are unable to accept cash or cheque payments and will instead be taken from either our online booking platform (SportsInjuryFix) or our online shop. We request that all appointments are paid for in advance – your therapist will send across a link to make payment securely online.

Symptom Screening & Tracking

We require all customers to complete a COVID-19 symptom screen prior to any face-to-face consultation. This may be completed online – it is essential that we receive this before your appointment – or in-person with a recording taken via our clinic digital doorbell. Before entering the clinic (or before we enter the facility if a home visit), we will also ask to take your temperature using a non-contact thermometer before the consultation takes place as part of screening.

As part of your consent to treatment, we are obliged to contact you as part of any track-and-trace system – we also strongly recommend you use the NHS COVID-19 mobile / tablet application upon its release in accordance with recommendations from our governing union, the Chartered Society of Physiotherapy.

Appointments

To reduce the risk of close contact with other customers, we will not allow any customers in before the allocated consultation time. Please wait at the front door of the clinic and your Clinician will greet you at your reserved time. All appointments will be staggered to ensure we comply with social distancing restrictions. There will be no other clinicians working within the clinic during your consultation in order to abide by the current government recommendations; we will notify you of any changes to this.

Inform Physio politely request that you do not bring anyone with you to your consultation. Should you feel more comfortable in doing so, we require this to be kept to one person only; they must be present in the clinic room rather than the waiting area, be required to undergo the same procedure of the COVID-19 screening form, temperature recording and must also record their contact details as part of track and trace. This includes any parents or guardians for children under 16 as per our Child Protection Policy.

Inform Physio will remain paperless and continue to submit any correspondence including reports, invoices / receipts or exercises via email – please make sure we have your correct email address and monitor your spam folder.

Clinic Hygiene & Social Distancing

All customers must use the hand sanitiser provided upon entering and leaving the clinic and should refrain from touching anything whilst in the clinic. Our therapists will ensure that they wash their hands in accordance with guidelines before and after any clinical interaction. 

We ask all patients during home visits as well as those visiting our clinic to wear their own face covering. We can provide you with one at a cost of £2 should you not have any. All our team will be wearing a KN95 Face Mask for the duration of your consultation. For any part of assessment or treatment that requires breaching the current social distancing requirement of 2 metres, Inform Physio therapists will be wearing appropriate PPE in line with the latest guidance, including (but not limited to): Plastic Face Guard, Disposable Clinical Apron, Non-Latex Gloves.

Please always adhere to social distancing rules unless required to compromise as part of your consultation – this will be kept to a minimum and require extensive clinical reasoning on our part. Pay attention to any physical reminders on display including floor markings, posters, and display screen messages – Perspex screen barriers may also be in place for additional protection.

Additional time has been allocated to allow for extensive cleaning of all clinical and communal areas and any relevant equipment in-between consultations. All areas and items will be cleaned again at the end of the day.

All seating will either be wipeable (i.e. non-fabric or have with wipeable seating). There will be no soft furnishings or accessories present such as pillows and towels; we request that you bring your own pillow and/or towel for treatment consultations should you need either. Printed material such as patient information advice, magazines / books, or promotional material have been removed from public view. Water dispensers, vending machines or toilets will be out of use for visitors.

Implementing and abiding by the above measures will help to create the safest clinical environment with the lowest possible risk. We know this is a lot to take on board, but your co-operation will enable us to support you in your quest to improve your injury or condition.


For more updates – including a special announcement on Friday ahead of our return to face-to-face services – head to our social media channels over on FacebookInstagram and Twitter.

Categories
Blog

Ice ice…maybe?


One of the common questions we get asked in clinical practice is: “Should I use ice for my symptoms?” Today we’re here to find out during ice-olation (couldn’t resist, not sorry) – Say Yes to the Ice or, Ice ice…maybe?

The application of cold or ice therapy to assist with injury healing or condition management has been employed for many years. A lot of our patients recall the RICE and PRICE acronyms that have been used as a reminder of how to immediately deal with acute soft tissue injuries. For avoidance of doubt, this is: P – Protect, R – Rest, I – Ice, C – Compression, E – Elevate.

Some of you might have even watched PRICE graduate to POLICE, where Rest was switched to Optimal Loading in light of evidence that smart progressive loading of the injured tissues based on the symptoms tolerated by the individual lead to improved healing rates and quality.

One of the limitations of these acronyms is the idea that this only covers the immediate stages of an injury and doesn’t account for the short or long term management. Furthermore, and ironically enough, the evidence for the use of ice to manage these symptoms was…well, on thin ice.

In 2019, Blaise Dubois and JF Esculier launched an updated, evidence-based acronym called PEACE & LOVE which also considers the longer-term management of symptoms to maximise healing and recovery potential. We’ll talk through this later this week, but the most glaring and deliberate omission from this was ice. So why might it be a case of ice ice…maybe?

There are a growing number of research studies highlighting that using ice has the potential to negatively affect the natural healing process of tissues. By disturbing the initial stages of inflammation, this can result in poorly-formed tissue and an impaired recovery, regardless of the efforts of any rehabilitation programme. Consideration should therefore be given over whether ice is used in any immediate soft tissue management, even if for pain relief.

However, life is not always that simple. Sometimes injuries can be very painful and pain needs to be brought under control, either from the injured tissue or from the pressure of the swelling itself. The swelling around injured or damaged tissues can be thought of as the body’s own way to support a weakened structure. Think of an ankle sprain with less stability following a ligament tear – the swelling helps to provide some temporary stability.

Although anti-inflammatory medications such as ibuprofen are not advised within the first 48 hours (or at all if possible), ice could be one possible solution. Other pain relief medication can be used to help here such as paracetamol. But what if someone cannot take this medication for health reasons or personal beliefs?

This can change completely if we switch our focus from soft tissue injuries to people who have undergone some surgeries such as ACL reconstructions or joint replacements. Oftentimes, the swelling can lead to restricted motion. If this is not controlled properly, it might limit the success of the operation. There is need to restore motion as soon as possible for adequate loading of the tissues, and to progress through the various stages of rehabilitation.

Furthermore, people with inflammatory joint conditions such as arthritis may need to manage their pain and swelling is necessary in order to minimise the negative impact the condition has on their quality of living, taking whatever measures are available to them to help them such as ice.

So…should you use ice? The answer really is ice ice…maybe – it depends. Every person and every circumstance is different. We are here to present all options and help educate you on the benefits and risks of each one. Hopefully you can see some of the considerations that must be taken into account. If you are unsure and would like specific and detailed advice on how this affects you and your condition or injury, don’t hesitate to get in touch and ask us!

Core Reading:

Doherty C, Bleakley C, Delahunt E, et al. Treatment and prevention of acute and recurrent ankle sprain: An overview of systematic reviews with meta-analysis. Br J Sports Med (2017);51: 113-25.

Singh DP, Barani Lonbani Z, Woodruff MA, et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury. Front Physiol(2017);8: 93.

van den Bekerom MPJ, Struijs PAA, Blankevoort L, et al. What is the evidence for rest, ice, compression, and elevation therapy in the treatment of ankle sprains in adults. J Athl Train(2012);47: 435-43.

Vuurberg G, Hoorntje A, Wink LM, et al. Diagnosis, treatment and prevention of ankle sprains: Update of an evidence-based clinical guideline. Br J Sports Med(2018);52: 956

Yerhot P, Stensrud T, Wienkers B, et al. The efficacy of cryotherapy for improving functional outcomes following lateral ankle sprains. Ann Sports Med Res(2015);2: 1015.