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Our staff

 

 

Graham Morgan, BSc Physiotherapy, MSc Musculoskeletal Medicine, MCSP, HCPC registered

Graham has been working as a musculoskeletal physiotherapist for nearly a decade. He has studied to gain an additional masters degree in musculoskeletal medicine alongside his previous physiotherapy degree. His main speciality is management of complex spinal conditions. This includes recent and long term spinal pain, lower back pain with leg symptoms, neck pain with arm symptoms, post operative spines and management of patients with neurological deficits. He is experienced at interpreting spinal imaging as well as recognising when imaging is appropriate. Graham is now an experienced injection therapist and is used to administering steroid and hyaluronic acid such as synvisc and ostenil to help patients manage chronic conditions. His other interests include rehabilitation of anterior knee pain and chronic tendinopathies.

 

Niall Carter, BSc Physiotherapy, MSc Advanced Musculoskeletal Physiotherapy, MCSP, HCPC registered

Niall qualified as a physiotherapist in 2004 having previously studied sports science.  He has worked locally for the NHS since 2004 during which time he has gained in depth experience in a variety of specialties.  He has held various senior posts in the NHS that have given him experience of managing patients with complex musculoskeletal conditions and neurological conditions such as stroke, multiple sclerosis and Parkinson’s.  He also works for a private provider of NHS surgical services as a Spinal Extended Scope Practitioner.

He has completed an MSc in Advanced Musculoskeletal Physiotherapy and as such is a skilled manual and exercise therapist.  He specialises in the management of complex spinal conditions, working in spinal surgical clinics and also providing physiotherapy for patients both post-operatively and as part of their conservative management.  As such he has a balanced viewpoint on the management options available to people with spinal problems.  In addition, he has particular interests in cervicogenic headaches, sacroiliac joint pain and lower limb tendinopathies.

 

Danny Brunton, BSc Physiotherapy, MCSP, HCPC registered

Danny has been working as a qualified physiotherapist for over 10 years. During this period he has gained vast experience in musculoskeletal physiotherapy, building a broad understanding of medical presentations. Alongside his physiotherapy degree he has completed additional masters level modules.

As a Clinical Lead Physiotherapist, his main interests and skills have developed around the management of knee and ankle injuries/conditions. Danny has developed his assessment and treatment skills over a long period of time by working in clinics alongside the area’s leading ankle and knee consultants.

Other special interests of Danny’s include the management of post-operative patients such as Anterior Cruciate Ligament Reconstruction (having written locally used post operation guidelines), treatment of acute/chronic tendinopathies, management of soft tissue injuries and the use of Maitland mobilisation techniques and rehabilitation with the aim of return to sporting activity and hobbies such as running.

Chris John Bsc Physiotherapy, MCSP HCPC registered 

Chris is a Specialist Musculoskeletal Physiotherapist that specialises in shoulder pain and has a special interest in sports based physiotherapy. Alongside his work at the Consortium clinic he works in professional rugby for Hull FC as a 1st team physiotherapist.  Aswell as working at the elite end of rugby league Chris has vast experience in professional football, rugby union and the NHS. Chris believes strongly in the importance of planning effective loading programmes in order to decrease the risk of getting injured during sporting activities. His expertise lies specifically in managing shoulder and sports based injuries.  In addition to his degree in Physiotherapy Chris has embarked upon a Masters in Sports and Exercise Medicine in Leeds. Chris also has an advanced trauma medical management qualification endorsed by the Royal College of Surgeons. 

abi holt bsc physiotherapy, mcsp, hcpc registered

Abi is a Senior Musculoskeletal Physiotherapist. When she is not working at Consortium she is one of the senior staff in the local hospital MSK service. She has extensive post graduate training in all aspects of physiotherapy but had a special interest in treating spinal pathology, especially patients with chronic lower back pain.

MASSAGE TEAM : RACHEL MARSON (Sports Massage Therapist LSCP assoc)

Rachel is a highly trained massage therapist and is vastly experienced. She caters for both top level athletes and for clients who simply want to de-stress, relax and enhance their overall well-being. To find out more about the Consortium Sports Massage service please use this link. 

Tissue Regulation

Perhaps the best way to introduce this topic would be to pose the following questions..

Why do some runners demonstrate a poor style with limbs thrown all over the place with no obvious control yet they can continue uninjured?

So how are these lucky individuals able to continue to exercise pain free while many people with better style and form continually run into strings of injuries?

It seems clear therefore that injury does not solely relate to style, biomechanics or perfect alignment.

Each of us has a certain amount of capacity in our tissues to tolerate stresses and loads. Some may have a huge amount of leeway (the sloppy runner who is injury free) and others very little (the perfect runner who is always injured). Some people may be able to suddenly and drastically increase their training loads without injury, while others only have to make the most minimal of changes and they run into trouble. As a general rule of thumb however large changes in activity does seem to be a precursor to injury. The concept of tissue regulation and capabilities of tissues to tolerate load is not something new, in fact it was first described by Scott Dye an American knee surgeon in 2005 (Source).

The model that Scott puts forward should have huge influence in the way we treat patients today. We feel this is a very important concept for the majority of our patients to understand and we have tried to explain it in its most simple terms. 

Tissue homeostatis original.jpg

OPTIMAL LOADING - sensible appropriate loads at the right intensity, speed and position with the correct amount of recovery will in time improve the capability of that tissue to tolerate load. No different from training for a marathon, take it too quick and you run the risk of injury, take it too slow and you waste time. It is a balancing act.

UNDERLOADING/SUBOPTIMAL - e.g complete rest! This will create the reverse effect and decrease the tissues capability to deal with load, as it would when you take time out injured. This can result in malnourishment, pain and pathology. The same principle applies with overloading. This is why we will try to avoid at all costs and will very rarely prevent you from having to stop participating in your activity.

How do you know if your exercises are pitched into the right zone for you?

If you can tolerate your current exercises/training load or activity in a pain free manner, with no flare up of pain on the second day after exercise then you are likely to be working within a capable zone for that tissue.  Be careful though as it is common for tissues to flare up 24 hours later. This can often be due to a latent production of an inflammatory chemical called cytokines.

No pain, no gain in the majority of cases is therefore not applicable what so ever!

What is the ideal?

Theoretically it is best to remain working at the upper limit of your optimal zone. Loading OPTIMALLY and allowing correct progression and recovery time will increase the capability of that tissue to deal with a task in a healthy manner.

What to do if I'm injured?

You will need to work in a lesser zone and then slowly build back up again. Even injured joints can function very well with certain activities. Examples of this can be using swimming and cycling where there is less direct impact yet you can still maintain strength and movement without continuing to overload and worsen your injury.

In summary, your tissues don't take well to sudden changes. Changes such as increases in training need careful grading. Think of your tissues like employees, if you drastically change someone's job role overnight without prior warning, you will have outrage and backlash on your hands. If you make small changes and are appropriately prepared it will make for a smoother transition. This is an especially important principle when dealing with patients chronic pain, they may well need to take much smaller steps and take them over a much longer period of time.

Exercise prescription is therefore something that should be taken extremely seriously. It is not just a case of picking exercises, giving them a go and quickly abandoning them if they don't give you the results you want. Exercises and training regimes must consist of OPTIMAL loads and need to be sensibly and accurately applied. The volume and intensity of your exercises needs to be monitored in order to be able to progress and regress them appropriately. The principles we have discussed here about regulating tissues must be applied in order to ensure successful recovery.

Thanks for reading 

Are you a victim of misleading medical imaging?

It is only natural if you have a problem to want to resort to some form of imaging to try to identify a cause. From a patients perspective this is understandable, for patients, it makes logical sense. Unfortunately, as with most things there is far more to consider here as we will go on to explain... Patients are misled by imaging so frequently that we feel it is very important to cover this topic early on. 


ARE SCANS USEFUL? 
Absolutely this is a yes, they are key to many things. This is not a one sided argument about the problems we encounter with misleading images however. Obviously scans are essential for surgical planning, identifying major/serious pathology, fractures, lesions and dislocations etc. 


Will my scan ACCURATELY identify my problem? 
It is very common for scans to show abnormalities that do not relate to a person's symptoms. These findings are often purely radiological incidental findings! Our clinicians interpret images in daily surgical clinics and constantly encounter these issues when analysing the hundreds of MRI and Ultrasound scans we come across a year. We find ourselves often explaining to patients why it is that their MRI scan shows a huge disc prolapse clearly compressing a nerve on the right side but yet their symptoms are only on the left! 

 

FACTS AND FIGURES


SPINAL MRIS
48% of 20-22 year olds with absolutely no back pain or any issues had at least one degenerative disc seen on their scan, at least 25% had a disc bulge showing. (Source)

40% of individuals under the age of 30 and 90% of people over the age of 50 have disc degeneration, yet they are pain free. (Source)

One study found 98% of men and women with no neck pain had degenerative changes seen on their MRI scan. (Source)

 

SHOULDER ULTRASOUND SCANS
20% of pain free adults had a partial rotator cuff tear on MRI scan with 15% showing a major full thickness tear! For those people over 60, at least half have a rotator cuff tear they never even knew about. (Source)

 

KNEE XRAYS
If you x-ray a normal population of adults with no actual knee pain, at least 85% of the x-rays taken will show arthritis. (Source)

In one study, 48% of professional basketball players were shown to have cartilage damage on their knee MRI scans, none had any pain. (Source)
 

WHAT DO WE TAKE FROM THIS? 
Degenerative changes are simply normal. What we see on our scans, often does not represent reality. There is no need to worry if your scan shows certain changes, they are not necessarily associated with pain. If you allow your images to mislead you, theoretically you could end up in higher amounts of pain for longer amounts of time.

Don't get us wrong, as previously mentioned, where appropriate, imaging is an important part of a patients care. Our clinicians at consortium rely upon images to make surgical decisions in conjunction with the surgeons we work with. What is essential is that a patients symptoms directly correlate with the symptoms that they present with. Both us, and patients need to make sure we do not get side tracked with purely incidental findings. Next time you somebody tells you that your discs are worn out or your shoulder is torn then I hope you can see there is no reason to immediately panic! It is absolutely feasible for patients with worn out joints to function at high levels with no symptoms. 

Thanks
The Consortium Team