Our Team

 

 Graham Morgan, CONSULTANT PHYSIOTHERAPIST, BSc Physiotherapy, MSc Musculoskeletal Medicine, INDEPENDENt physiotherapist PRESCRIBER, INJECTION THERAPIST, MCSP, HCPC registered

Graham has been working as a Clinical Lead Musculoskeletal Physiotherapist for over a decade now, he is the Clinical Lead for our clinic and acts as a mentor for the majority of the team. He has studied to gain an additional masters degree in Musculoskeletal Medicine alongside his previous physiotherapy degree. His main specialty is management of complex spinal conditions and he continues to work full time in his advanced clinical practice role with the spinal surgeons in the local NHS trust. Graham is a Clinical Lead for the region in management of back pain. Part of his role within the clinic involves planning and implementing high level combined physical and cognitive therapies programs for people with persistent spinal pain, he is trained in cognitive functional therapy. Graham treats patients with longstanding lower back pain with or without leg symptoms, neck pain with or without arm symptoms, post operative spines and patients who may have developed neurological deficits. He is experienced at interpreting spinal imaging as well as recognising when imaging may be required to assist care. Graham is also an independent prescriber and an experienced injection therapist and is used to administering steroid and hyaluronic acid such as synvisc and ostenil to help patients manage chronic conditions.

Niall carter, CONSULTANT PHYSIOTHERAPIST, BSc physiotherapy, msc advanced physiotherapy, independent physiotherapist PRESCRIBER, INJECTION THERAPIST, MCSP, HCPC registered

Nial is one of the most qualified and experienced Physiotherapists in the region. We are very lucky to have him as part of our team. When he is not working at Consortium as one of our Clinical Lead therapists he holds the same role as Graham working as an advanced clinical practicioner in the management of complex spinal conditions within the local spinal surgical team. Nial is also a Clinical Lead within our NHS region in the management of persistent back pain. Part of his role within the clinic involves planning and implementing high level combined physical and cognitive therapies programs for people with persistent spinal pain. Alongside this, he is vastly experienced in managing a wide variety of other musculoskeletal complaints. In addition to his two degrees in Physiotherapy he also an independent physiotherapist prescriber aswell as an injection therapist.

clare haslam, CONSULTANT WOMENS HEALTH PHYSIOTHERAPIST, bsc physiotherapy, mcsp, pogp, hcpc registereD, MUMMY MOT PRACTICIONER

Clare is a Specialist Women’s Health Physiotherapist within the local NHS trust and has been for over 10 years. She is regional expert in Women’s Health, is a member of the special interest group Pelvic, Obstetric & Gynaecology Physiotherapy (POGP) and is a certified Mummy MOT practitioner. She specialises in treating a variety of women’s health conditions including pelvic floor dysfunction, overactive pelvic floor, pelvic floor weakness, pelvic organ prolapse, bladder and bowel dysfunction such as urinary incontinence, overactive bladder, constipation and faecal incontinence. Alongside this Clare will also treat pregnancy related conditions such as weak pelvic floor, obstetric injuries, rectus diastatis. As a certified Mummy MOT practitioner she offers specialist post natal examinations to help women recover after vaginal or caesarean deliveries (read more about this on our blog). Clares scope of practice also includes Male Health Physiotherapy for pre and post prostatectomy: including assessment, treatment and support with urinary incontinence and errectile dysfunction.

Abi Holt, CLINICAL LEAD MSK PHYSIOTHERAPIST, Bsc Physiotherapy, INJECTION THERAPIST, MCSP, HCPC registered

Abi has been working as a Clinical Lead Musculoskeletal Physiotherapist for a number of years now. When she is not working at Consortium she is one of the senior staff in the local hospital MSK physiotherapy department while she also works in the local emergency department assessing and managing patients with acute MSK conditions. She has gained extensive post graduate training in all aspects of MSK physiotherapy including Injection Therapy. She also has a special interest in treating spinal pathology, especially patients with chronic lower back pain. Abi works with Molly in heading up our team of Ossur brace fitters where they frequently fit patients with the Unloader One brace to help with knee osteoarthritis.

Gary Bradley, CLINICAL LEAD MSK PHYSIOTHERAPOST, BSc Physiotherapy, INJECTION THERAPIST, MCSP, HCPC registered

Gary is a Clinical Lead Musculoskeletal Physiotherapist and Injection Therapist. He supplements his work at Consortium by working in the East Yorkshire NHS services as a Team Lead MSK Physiotherapist. He has a wealth of experience having spent many years working within different facets of musculoskeletal medicine. He is skilled at seeing patients with hyper-acute injuries aswell as managing chronic conditions and long term rehab. Gary has extensive post graduate training, he spends time at the clinic implementing high level combined physical and cognitive therapies programs for people with persistent spinal pain, he is also trained in cognitive functional therapy.

Gary has always been driven to specialise in MSK Physiotherapy he is currently mid way through his Masters degree in advanced Physiotherapy. He is also 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 main focus is to empower his patients to be able to understand their condition and to manage it as effectively and independently as possible.

Tom Nozedar, SENIOR MSK PHYSIOTHERAPIST, MSC physiotherapy, bsc sports rehabilitation, mcsp hcpC registered

Tom is an experienced senior Musculoskeletal Physiotherapist. He works as a Senior MSK Physiotherapist within the NHS and is part of our in house Consortium MSK Physiotherapy mentorship program. Tom is an asset to our team, and can offer our patients a wide range of skills having initially graduated as a Sports Rehabilitator before returning to study and gain his Masters degree in Physiotherapy.

ShAFEEQ younus, SENIOR MSK PHYSIOTHERAPIST BSc Physiotherapy BSc, bsc SPORTS REHABILITATION, LEVEL 3 IN SPORTS MASSAGE THERAPY, hcpc registered

Shafeeq has a BSc degree in both Physiotherapy from Sheffield Hallum University and also a full degree in Sports Rehabilitation.

Aswell as seeing patients for Physiotherapy, Shafeeq also sees lots of patients for soft tissue work and he is often in high demand. His training and experience leaves him really well placed for any advice on pain, injuries and rehabilitation.

Shafeeq is a really valued member of our team having been with us throughout his training period on the Physiotherapy degree. He is now part of our in house Consortium MSK Physiotherapy mentorship program.

bart klimek, SENIOR MSK PHYSIOTHERAPIST, BSc Physiotherapy, bsc sports rehabilitation, level 3 in sports massage therapY, HCPC REGISTERED

Bart has a BSc degree in both Physiotherapy from Sheffield Hallum University and also a full degree in Sports Rehabilitation.

He is an experienced soft tissue therapist having graduated in Sports Rehabilitation a number of years ago from Hull University before then going on to become a fully qualified MSK Physiotherapist. Alongside his work at Consortium, he also works as an MSK Physio for the local East Yorkshire NHS MSK Physiotherapy team.

His sports rehabilitation experience as well as his physiotherapy degree leave him in strong position to manage a wide variety of MSK patients whether it be for soft tissue work/massage, or management of a variety of MSK complaints and sports injuries.

debbie robinson : senior rehabilitation therapist, associate member of the chartered society of physiotherapists

Debbie has been working as a Rehabilitaton Therapist for over 25 years. For the last 13 years she has been carrying out community home visits as part of the local NHS Physiotherapy and Occupational Therapy team. Her vast experience in orthopaedic rehab, care of the elderly and with amputees makes her a valuable member of our team who can offer these services to patients in their own home or care facility as required.

MASSAGE TEAM:

bart klimek BSc Physiotherapy, bsc sports rehabilitation, level 3 in sports massage therapY, HCPC REGISTERED

Bart has a BSc degree in both Physiotherapy from Sheffield Hallum University and also a full degree in Sports Rehabilitation.

He is an experienced soft tissue therapist having graduated in Sports Rehabilitation a number of years ago from Hull University before then going on to become a fully qualified MSK Physiotherapist. Alongside his work at Consortium, he also works as an MSK Physio for the local East Yorkshire NHS MSK Physiotherapy team.

His sports rehabilitation experience as well as his physiotherapy degree leave him in strong position to manage a wide variety of MSK patients whether it be for soft tissue work/massage, or management of a variety of MSK complaints and sports injuries.

To find out more about the Consortium Sports Massage service please use this link. 

PART TWO - Managing load to avoid injury: How to not wrap yourself up in cotton wool

Welcome to the latest edition of the CONSORTIUM CHARTERED PHYSIOTHERAPISTS blog. Thank you for reading part 1 of ‘managing load to avoid injury’... If you have not read it yet and want to reduce your risk of injury then please click here to do so!

This article has been written by myself (Chris John) and another fellow Physiotherapist and friend Rob Parkinson. Rob is highly skilled physio and works in elite rugby alongside running his own private practice in Gloucester called Pro Performance. You can follow us both on twitter @chrisjohnphysio and @properformrehab

After reading the first blog you will have summarised a few points:

• The optimal amount of load is best for getting fit and trying to avoid risk of injury. Overloading or under loading can result in an increased risk of injury (Dye, 2005).
• The acute to chronic workload load ratio is a useful method to monitor your training and ensure you are not over or under loading. The ideal ratio is 0.8 to 1.3 (Gabbett et al, 2016).

• Calculating your acute:chronic ratio will help prepare you for competition, improve your performance and should decrease your risk of injury.

My previous blog explains how to use this in a very simple way and is relatively easy to remember. However, the disadvantages to using a simple version like this is that everybody is different. Some of us are tolerant enough to be able to drastically increase our training and not end up getting injured. Some will find the opposite and only need to make small changes and often end up with problems. Some amount of this you cannot control, it will just depend on how you were put together and is simply the way you are. However... there are other factors that will influence how quickly you can progress.  Things like your past medical history, age, weight and previous training levels will all have some influence. Using the simple acute to chronic workload ratio that we previously described in part one unfortunately does not account for any of these factors. The other downsides of keeping to a very simplistic model is that it is also very objective as it focuses purely on distance or volume of training and doesn't take into account how hard you went.

For this reason I present to you a more advanced way of calculating your training progression and I will go on to explain this below.

THE ADVANCED VERSION

Uses Rate of Perceived Exertion (RPE) (ie 0 no effort, 10 maximum effort)

Calculate your time spent training into units ie. (RPE x number of minutes you undertook that activity for)

You then CALCULATE THE TOTAL FOR THE ENTIRE WEEK

So what is a rating scale?

The ‘Rate of Perceived Exertion’ is a well-known tool in the world of professional sport that is used to measure how the athlete perceives the intensity of workload given (Brito et al, 2016).

THIS CAN BE a game, running, cycling, training, strength and conditioning session, gym session and so on…

The Table below shows the Rate of Perceived Exertion scale. 

(Borg, 1982)

So how do you work out your acute:chronic ratio using RPE?

You multiple your RPE by the training session time in minutes

(RPE x training session time = units)

EXAMPLE: A 30 minute gym session was an intensity of 7/10 (30 x 7 = 210 units)

You then use this to work out your total units for the acute and chronic weeks

ACUTE LOAD DEFINITION: The sum of load over 7 days

CHRONIC LOAD DEFINITION: The average acute load over the previous 4 weeks (or however many week you chose)

The following example demonstrates how you would calculate the total volume of units for one week of training

you then use this to work out your figure to see if you are in the safe zone or whether you are at risk as demonstrated below 

SO LETS RECAP THE BENEFITS OF USING THE ADVANCED VERSION

• It takes into account internal and external factors as YOU score how YOU feel after that specific session (Coutts et al, 2004).
• How YOU progress is then specific to you only (Abbiss et al, 2015). For example, using a prescribed marathon website training program will provide you only with a generic protocol. It is not designed exactly for YOU and does not take into account any of the factors that will affect how quickly you can progress in comparison to someone else.
• You are in then in total control of your own programme; progressing yourself in a SMARTER way, trying to ensure you always work in your ‘sweet spot.' This will leave you better prepared for competition and less likely to get injured (Gabbett, 2016).

So remember, train hard…but train smart!

Thank you for reading.
 

Back pain during sitting? Will spending money on a fancy new desk chair help?

Changing your chair to an often more expensive 'back friendly' one is a traditional tactic in trying to tackle lower back pain. Chair type and sitting posture is a topic that patients frequently ask us about during consultations. There is no doubt that office based jobs that involve prolonged periods of sitting can be known to commonly aggravate preexisting lower back pain (source). However... interestingly... it seems highly unlikely that occupation roles involving prolonged sitting are actually an independent cause of lower back pain! (source)

Should we recommend special chairs? Are you wasting money? What does the research say?

Use of chairs with lumbar supports

There is mixed opinion on the use of lumbar supports. Some studies have found that chairs with lumbar supports provide relief (source). Others have found that using a back support reduces muscle tension (source). Other authors have reviewed the literature and decided that there is little evidence to support modifying chairs to reduce lower back pain (source).

What about chairs that create tiny movements in your back as you are sitting?

This is generally referred to as dynamic sitting. There is some support for using dynamic sitting (source) to help promote micro movements in the spine while sat e.g using gym balls and also using kneeling stools (source) to promote more extension of your back whilst sat. However... some argue that while these types of seats may reduce back pain they often create symptoms elsewhere in your body. There are also conflicting reports as to whether spinal muscle activity is either increased or decreased.

So.., obviously a mixed bag of opinions and outcomes...

So what do we recommend you should believe and what should you actually do?

Interestingly...if you read the studies mentioned/referenced so far it is clear that they have many limitations! Perhaps the most common criticism we can make is that the researchers seem to only trial the use of one particular chair for all types of back pain. When we assess people's spines in the clinic each one can be very different. Some have flat/straight backed postures, others have over exaggerated curves. We would treat each type of back pain with different types of physiotherapy, so why don’t we apply this same principle to picking chair types? Surely there should be types of chairs that suit certain types of spine!

One of the most recent papers looking at this specifically is by Mary O’Keefe and her team in 2013 (source). They looked at trying two different types of chair on one particular sub group of back pain patients (people whose symptoms were worse with bending and better with straightening).  The first chair they trialled was a traditional office chair with supportive back rest keeping you relatively still (type of chair you would get through your occupation heath dept). The second chair however was one that sloped forwards providing a small dynamic element and a straighter spine when sitting. Interestingly... this group of back pain patients experienced significantly less pain when sitting on the sloping chair. This essentially means that those with worse back pain in bending are better sat with a chair tilted forward in order to increase their extension (arching of their spine) and that for those whom have pain that is worse when they extend (arch) their spines will be better sat in a chair promoting a bent/slumped posture.

Perhaps the main lesson we can learn from this is that there may be some value in investing in specifically designed chairs...but...only ones that are matched to your spinal type. the current approach in occupational health departments seems to look only for a generic norm, assuming all spines and symptoms are the same... it is unlikely therefore that this will work .

You may be best to seek a spinal assessment from a physiotherapist or medic that can match your back type to a certain chair type and work out what is best for you. It is also widely acknowledged that lower back pain has a variety of underlying components. Simply addressing the mechanics of sitting on its own is likely to only effect a small proportion of the underlying causes of most people’s back pain. It is therefore likely that looking at sitting postures in isolation will never really be an effective measure.

If you think this article will be of use to people you know then please share and follow our facebook page. Our main aim as a clinic is to provide you with the highest levels of evidence based care that we can. This is why we read and continue to bring you heavily referenced articles to help you stay healthy!

Thanks for reading

The Consortium Team

So you have back pain - do you actually need a MRI?

This video is another fantastic resource and an absolute must see for any patient with lower back pain 

It provides some good examples of where a MRI scan is needed and where, as in many cases, it can distract you from getting better 

Should you present to us with symptoms that require a MRI scan to be performed, then this is something we can arrange for you quickly and have it reviewed by our spinal surgeon 

If a scan is not be needed then we can focus immediately on the most important thing, getting you better 

Thanks for reading

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. 

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

Hello! Welcome to our blog...

So this is our first ever blog as Consortium physiotherapists.  We have known for a long time that we wanted to open this clinic and have spent a lot of hours discussing the ideas and principles behind our service.  

We want to provide a forward thinking evidence based approach in a completely open and honest way.  We are passionate about our profession and believe that we can provide a huge amount of expertise to boost the quality of care in our regions private physiotherapy sector.  It is important to us to empower our patients, promote activity and avoid using the long established passive treatments that unfortunately still haunt many private physiotherapy practices across the uk.

We want to utilise this blog as a way to educate our patients about recent developments within our field. We will be including posts that focus on providing valuable advice and information, dispelling many of the traditional myths that we find are still being fed to patients on a day to day basis. 

We also want our customer experience at Consortium to be comfortable, convenient and enjoyable. For that reason we have spent a lot of hours considering how we want our clinic to look and feel inside. We are renovating what will be our clinic site as we speak and let's just say it has been a labour of love. Anyway, the diggers have now finally cleared out, the excavation is complete and we are starting to see some exciting progress! The building itself is a pretty old one, with a good amount of character so we intend to make the most of this and keep its style traditional but with a modern edge. Inside there will be two large private clinic rooms, a comfortable waiting area with reading material, TV and Wi-fi for customer use (some home comforts are always good). 

Outside we have a large spacious private car park, accessed through a private gated entry for an easy parking experience. We hope to be ready to see patients early in 2016. There is quite a bit of extra land on site so once up and running we also plan to build a well equipped gym to aid aspects of our exercise therapy and movement analysis.

So that's an update on where we are at the moment with Consortium. Now that you know a bit about us as a group,  next time we'll share a bit more about us as individuals and let you know what each of us will bring to the service.  We hope you'll join us to read this from time to time and feel free to share your comments, they are always welcome.

Thanks,
The Consortium Team