Week 5: The end but also the beginning

End of placement, beginning of a physiotherapy career

I am pleased to announce that I have finished my physiotherapy degree. It has certainly been a wild ride over the last 3 years. When I started the degree with my cohort in October 2019, little did we know what would happen five months later! None of us predicted that a global pandemic would interrupt – and very nearly derail – our studies. For the best part of 2020 and  2021, most our learning was carried out remotely. For such a practical course, learning how to do a physical assessment on Zoom wasn’t easy. There were times when I struggled for motivation while sitting in my room at home, and I know I wasn’t the only one who found it hard to stay focused.

How difficult it must have been, then, for the Sport for Confidence participants who derive so much benefit from getting out of the house, meeting other people and taking part in team sports. Covid took away so much of what we took for granted. Yet, we all adapted to the circumstances in our own way and we made the best of what we had. I’m confident in saying that everyone is glad to be back at the leisure centres. It’s not just the physical activities that are easier to do at the leisure centres with all the space and equipment, but it’s the social interaction, the physical contact and the whole sensory experience that cannot be underestimated. There is a place for virtual exercise classes, but the last two years have shown that most people prefer the face-to-face contact when given the choice.

One benefit of the pandemic is that we have all got used to doing meetings and activities online. Gab and I had regular catch-ups with Alana and Liz online, which was second nature since we have all become used to remote learning. This was especially important for Alana, who is doing her entire placement virtually. We’ve also had chats with members of inclusive and disability climbing groups across the UK, which might have been more difficult to arrange pre-Covid.

On our last day, Gab and I designed a booklet explaining hypermobility and plantar fasciitis to one of the regular participants at SfC. I remember doing something similar for one of my second year modules. With one of my classmates, I designed a leaflet and poster about a musculoskeletal condition, aimed at the lay (non-medical) audience. In the hypermobility and plantar fasciitis guides, Gab and I avoided using medical jargon or ‘scary’ language. In essence, we wanted to give a clear message of reassurance, that it is safe to continue exercising in moderation, and that pain does not necessarily equal damage. Gab and I recommended exercises and general advice such as avoiding prolonged static postures and using simple pain relief. I think that our physio skills were beneficial in creating the guides.

Overall thoughts

I enjoyed my placement with Sport for Confidence. As I’ve said in previous entries, this was not a ‘traditional’ physiotherapy placement but I believe that our time at SfC was beneficial for us as students, and our input also helped the OT’s and coaches at SfC. We found that there were several possible roles for physio’s at SfC, and we learnt about different ways in which sports and activities can be adapted for people with disabilities. It’s been a pleasure working with the staff and participants at the leisure centres, and it has challenged me to think about how to make sport more inclusive. A common theme amongst people I know (and some of the participants) was that they were put off by PE at school and believed that sport or physical activity ‘wasn’t for them.’ But sport can be fun! It can be inclusive. It can be adapted for people with a range of different needs. And it should be.

Basketball is always a big hit at Sport for Confidence.
When Cinderella played, she was always running away from the ball!

As a newly-qualified physio, I want to make sure that I am empathetic and personable to the patients I see. When someone walks through the door and says they have back pain or a sore elbow, I could do an assessment, make a diagnosis, give them a sheet of exercises and see them again in a few weeks. Or I could dig a bit deeper and ask them about their background stresses, worries and beliefs about their pain. I could even signpost them to a company such as Sport for Confidence if they want to do exercise with other people but feel anxious or unsure about how to start exercising. We have been taught about the biopsychosocial model of health, but I want to make sure I put it into practice.

Final note

I want to thank all of the OT’s, coaches, participants and carers who talked to us, engaged with us and shared their opinions and experiences over the last five weeks. Everyone made us feel welcome, at a time when we were unsure about what to expect from this placement. I would recommend this placement to any physio student who is open-minded and willing to embrace the uncertainty of a hybrid placement. Thanks also to Liz for her help and guidance throughout the placement, and to Jo for being our contact at the University.

Week 4: Climbing guide, presentation and overall thoughts

Welcome to Part 2 of my weekly Sport for Confidence blog. If you haven't read Part 1 yet, click here to read it.

Climbing guide and presentation

Throughout the week, I have been working on the climbing guide with Gab and Alana. I feel that we have worked well together. We had a meeting early in the week and came up with a plan and a list of tasks for each of us. I have been researching and thinking about the physical demands of climbing, the physical benefits of climbing, and exercises that will help a person to start climbing and make progress as a climber. Of course, there’s a difference between indoor climbing (bouldering) and outdoor climbing as well as free climbing versus harnessed climbing, so there isn't a 'one size fits all' approach. There are some general strengthening exercises that will benefit all climbers though. 

We also recorded a group presentation which we shared with Liz and our tutors. In the presentation, we shared our experiences on this placement so far, as well as our opinions on the possible role for a physio in SfC. You can watch the presentation here.

I think it has become clear that there is an emerging role for physios in SfC. They could work alongside OT's and coaches to assess new participants, screen for red flags and set collaborative goals. Physios can do risk assessments and give advice for managing injuries or pain. Working with individuals in the gym and devising an exercise programme would help to take some of the load off the OT's and coaches. Also, a physio in SfC could work with the local outpatient physio team to make sure the exercises are relevant to what the participant wants to do. 

"Ok, very funny! Who's hidden all the dumbbells?"
Source: Pixabay

These are my personal reflections for future practice as a MSK physio: 

1) Always think about different types of communication, including body language, tone of voice and expressions. Is the person truly understanding what I’m telling them? If not, can I say the same thing in a different way? Communication goes both ways. Am I truly understanding what my patient is telling me?

2) Be adaptable to changing circumstances. Think on the spot and don't be afraid to change plans if needed. For example, what if there isn't enough equipment? What if there are more participants than we were expecting? What if one or more of the participants cannot yet do the exercises that we’d planned? 

3) Make sure the goals and treatment plan are relevant to the person. If someone hasn’t done the exercises I’ve given them, think about why that might be. I shouldn't assume that they're being lazy.

4) Teamwork. Know my own scope of practice and don't be afraid to refer a patient on or ask another member of the team for advice. When doing a group project, make sure everyone in the team knows our common objectives, and then devise a plan before attempting to ‘just crack on with it.’

Looking forward

There has been a lot to think about in this blog entry. Certain aspects of this placement have been challenging, such as managing my own workload, dividing tasks with other students, and investigating how physios could fit into the SfC model. But I have learnt a great deal about people’s individual experiences with inclusive sports, and how physical activities have benefitted them mentally and socially as well as physically. It’s hard to measure and quantify how much confidence sport and exercise gives people in their lives, but the case studies show that physical activity in a group can be the gateway towards meeting other like-minded people and finding a new purpose in life.

When I start working as a physio, I want to make sure I am mindful that I am talking to a person with real thoughts, feelings, experiences and ambitions. I don’t want to be someone who just asks yes/no questions, comes up with a diagnosis and treatment plan, gives my patient a list of exercises and sends them on their merry way. The physiotherapy profession is always evolving and changing, and I hope that I will continue to change with the times and grow as a person. This SfC placement has given me so many experiences that I will remember for life - and it's not over yet! I've got three more days left, and I will make the most of those three days.

Week 4: Case studies, inclusive climbing and leisure centres

It’s come to the end of week 4, which means that I only have three days left on my placement with Sport for Confidence. I think this week has been productive, and I’ve enjoyed working with Gab and Alana. I can see a clearer role for physiotherapists in SfC than I did even a week ago, and in some ways it’s a shame that the placement has to end so soon.

Online meetings with disability and inclusive climbers

This week, we had online meetings with an inclusive climbing group and a disability climber. First, we spoke with Max from Not So Trad, an LGBTQ+ climbing group. After introducing ourselves, Max shared his personal experiences with the climbing community, and how Not So Trad has become more inclusive and diverse since it was founded. It was very useful to get an insight into the need for inclusive climbing groups and what they can offer. I’ve been thinking about how I can encourage people from marginalised groups to join a club in which they feel included and safe, to help them become active and reduce the risk of physical inactivity. When I become a fully-fledged physio, I intend to keep making connections with inclusive and diverse sports in the area (e.g. Colchester Kings RFC, an inclusive rugby club), so that I can signpost people to these groups when needed.

Gab, Alana and I also had an online chat with Clare Hands, a teenager who took up climbing after she experienced a life-changing stroke at the age of 13. We spoke to Clare and her mum about their experiences with climbing and how it has positively changed both of their lives. They told us about their local climbing wall, and the types of climbing equipment that can be used to help people with different disabilities. Clare's story is incredible. I am in awe of her persistence and her positive outlook towards life. Clare showed a remarkable level of bravery and determination to take up climbing, and her mum has been amazingly supportive all the way. Their story has inspired me to think about how important it is to know about local disability sports and to break down barriers that might be stopping people from being active.

Indoor bouldering is just one type of rock climbing, but it's easily accessible to most people.
Source: Pixabay

Basildon

Gab and I visited Basildon Sporting Village, which is where Sport for Confidence started. We spoke with Lyndsey, the director of SfC. Not only has she grown SfC from just one participant to where it is today, but she told us a moving story of her own experiences and struggles with the healthcare system. She emphasised how important it is for Allied Health Professionals (e.g. PT's, OT’s, speech & language therapists and dieticians) to keep persisting with so-called ‘difficult’ or ‘awkward’ patients. Lyndsey very nearly lost her ability to play netball as a result of a rare disease, but it was the OT’s and physios who got to know her personally who made the most difference to her recovery.

At Basildon, we spoke to some of the regular participants who attend both an MSK physio clinic and SfC. They benefited from the MSK appointments because the exercises they have been given are relevant to the activities they enjoy at SfC. I can see how important it is for physios to give people exercises that are relevant to the activities and tasks that they want to do. A generic, bland sheet of exercises will soon find its way underneath a mound of paperwork, but a personalised exercise plan incorporated into a sport is much more likely to be successful.

As a side note, I have to say that Basildon Sporting Village has an amazing athletics track!
Source: Pixabay

Colchester & Chelmsford leisure centres

Gab and I visited the sports centres in Colchester and Chelmsford again. In Colchester, we helped a participant in the gym with her individual exercise programme. We were able to talk through her exercises and adjust them as appropriate. I can see a clear role for a physio here, as it would take the load off the OT’s and coaches.

Multisports was good but we had to make changes to the basketball activities. Two people in my team were wheelchair users who had limited use of their legs, and two other participants had limited verbal communication and required a lot of facilitation from their carers. We adapted the games by using a big soft ball instead of a hard basketball, so that the participants could propel the ball with their feet. This made the whole session so much more enjoyable and rewarding. In future, I will always think about ways to adapt exercises and activities, e.g. using different equipment or changing the objectives of the game to make sure that everyone in the team benefits from the activity.

Part 2 of this week's blog entry will be up very soon!

Week 3: Halfway review, reflections and tennis

 Thursday: Halfway review and working from home

Thursday was another virtual day. In the morning, I had my halfway review with Liz. I thought that we had a good discussion about the placement so far, and I was happy with Liz's feedback. I have a clear idea of what is expected from me and the other students for the next two weeks, although I think we need to be honest with our educators and make sure we don’t take on too many projects, given that the placement is so short. Going forward, I will include a deeper level of self-reflection in my blog articles, as this is something which I have avoided so far! 

Over the next two weeks, I will also try different forms of adaptive communication such as Makaton when needed. A recent BBC article on Makaton being used in the special Olympics football team caught my eye. I plan to pick up some Makaton over the next couple of weeks. Even if I don't use it on this placement, there's a fair chance that Makaton will come in helpful at some point in my physio career.

Another learning point for me is how to approach and build up a rapport with people online. When asking people about their experiences with adaptive sports, we should remember to get to know them as people first. After all, we're designing projects for real people with life stories, hopes and ambitions. Liz reminded me of the #hellomynameis campaign. As healthcare workers, it's easy to dive straight into an assessment, but we shouldn't forget the human element behind communication. We're finding out why people have chosen a particular exercise, and how it gives them confidence in other areas of life. I know I wouldn’t appreciate being sent a long list of questions from someone who hasn't tried to get to know me. This is something I'll bear in mind going forwards.

I spent some time arranging online meetings with members and participants of various snooker and climbing groups. We were very kindly invited to meet a climbing group in Cumbria for a pint and a climbing session. It's a shame that we're so far away from the rugged cliffs of Cumbria! I would always be up for a climbing session and a pint, but I think a Zoom chat is more realistic!

I'm not sure if this is Cumbria but it looks mountainous!
Image sourced from Pixabay

Friday: Chelmsford

Gab and I went to Chelmsford on Friday. This is our third visit to Chelmsford, and we feel, like in Colchester, that we are building up a good rapport with some of the regular participants. Friday’s classes included an introduction to group exercise (a small class with seated resistance exercises), a big boccia session and multisports. Tennis and ping pong were on the menu for multisports, and I think it worked well. I’m far from being the best tennis player myself, but I gave one of the participants some individual practice. He also tends to lose concentration and gets distracted very easily, so I encouraged him to stay focused. He did much better when he was focused on the task at hand.

Game, set and match!
Image sourced from Pixabay

Also, at the end of the group exercise session, one of the participants asked Gab and I for advice on managing pain. She is a wheelchair user and finds that she experiences elbow pain when using her wheelchair. We gave her some general advice on simple pain relief (e.g. heat and cold packs) and remembering to stretch and do regular arm exercises to avoid prolonged static positions. I think our physio education on pain relief and activity modification came in useful here.

Next week

Next week will be my last full week with SfC! It's become a bit clichéd to say 'time has gone by so fast' but it's true. 4½ weeks for a physio placement isn't long at all. I'll make sure I continue to get the most out of my time with SfC. Gab & I will visit another leisure centre (Basildon) next week and the three of us will crack on with our project work.

Week 3: Visits, chats and projects

It’s come to the end of week 3 of my physio placement with Sport for Confidence (SfC). Like the first two weeks, my days have been a mixture of virtual work and visiting local leisure centres. 

Monday: team meeting and getting on track with projects

Monday was a virtual day where I did some research for the project that I’m doing with Gab and Alana. Looking back at the beginning of the week, I think we were still a bit confused as to what the finished product should look like. We had a chat with Jo (our supervisor at Essex Uni) who suggested that we speak to Liz to clarify what we need to do by the end of the placement. She recommended that we draw up a GANTT chart or something similar, to make sure that the three of us know what we’re doing and when. I'm not exaggerating when I say that GANTT charts strike fear into my very soul, but the idea of coming up with a weekly plan and dividing tasks between us is a good one. I think if I was to tackle a group project again, I would make sure that we’re crystal clear in knowing what we need to do early on, so that we can plan our time, divide tasks out each week and meet at the end of the week to check that we’re all managing okay with our tasks.

Tuesday: social chat and Zoom chat with Lucy

Tuesday was another virtual day. I was a bit worried that I would lose focus, but it turned out to be a useful day. We joined a social Zoom chat with Sophie (OT), Charlie (OT assistant) and one of the regular SfC participants. The chat was quite structured, which I thought worked well, because it gave everyone a chance to contribute. We also had a chat with Lucy, one of the OT's who works in Canvey. It was interesting to hear about the differences in demographics in each area. Lucy was open to the idea of physios working for SfC, which is one of the things we're investigating on the placement.

Wednesday: Colchester

We spent Wednesday at Colchester leisure world. We're getting to know the staff and some of the regular participants. I was happy to see some of the regulars approaching us and initiating conversations. This will be good for practising their social skills. In terms of physio intervention, Gab & I helped a participant in the gym. He's a wheelchair user who recently fractured two ribs. We came up with modified exercises to work his upper body muscles without putting pressure on his ribs. The last thing we wanted was for him to be in agony! I feel we put our physiotherapy skills to good use here.

Source: Pixabay

We also designed and led the warm-ups for boccia and football. Leading the warm-up gave both of us confidence, and it was also a great opportunity for us to put our physio skills into practice. The coach, Toby, appreciated us doing the warm-ups and the participants seemed to enjoy the difference.

One of the participants, who I have developed a good rapport with over the last 2-3 weeks, came in complaining of pain on the inside of his foot. There was another participant last week who told us his arm hurt when he swam, but we found that group exercises appeared to distract him from the pain. I carried out a brief assessment with the participant who had foot pain - essentially to rule out red flags. I was satisfied that his pain didn't indicate anything serious so I encouraged him to take part in the sports, but to take breaks if he needed to. He said his pain was no worse at the end of the session. I will use that experience to think about how to assess people with pain in the future.

We finished the day with a football session, which involved a series of drills in small groups followed by short football matches. After the football session, one of the participants said that he felt excluded from the game because other people were not passing to him. My observations were that everyone was included, but in future I will make sure that I try to pass the ball to the less confident players to give them a chance.

Click here to read part 2 of my weekly blog entry

Week 2: Snooker, climbing and general thoughts

Snooker and climbing project:

On Thursday, Gab and I visited a bouldering wall. This is my local climbing wall in Colchester, so I already know some of the staff who work there. We spoke to one of the staff members about his experiences with inclusive or adaptive climbing. He said that he considers climbing to be an inclusive sport and that Paraclimbing is becoming popular. At the Colchester climbing gym, there is a regular climber with learning disabilities who climbs with his carer. Some of the walls would be difficult to access for wheelchair users due to the lack of ramps, and the staff member says that he doesn't see many climbers with physical disabilities, but not to say there aren't people with 'hidden' disabilities.

Whike we were there, we went for a climbing session! As we were climbing, we were thinking about the activity analysis for bouldering, and whether it would be suitable for SfC participants. It would be unfair to make a blanket statement along the lines of: 'SfC participants can't do bouldering.' There's no such word as can't! However, our thoughts are that bouldering without harnesses or equipment would be difficult due to the level of supervision that would be needed for most participants. Bouldering is demanding on the body and it requires a good level of strength, endurance, coordination, flexibility, balance and planning. 

I have watched a case study involving a teenage girl who had suffered a severe stroke, who was able to climb with harnesses and support post-stroke. Our thoughts at this time are that harnessed climbing would be a better option than unharnessed bouldering, depending on local facilities.

As a side note, my triceps still ache three days later!

This week, we have been contacting inclusive and adaptive climbing and snooker venues. I’ve contacted the CSP (Chartered Society of Physiotherapists) DisAbility and LGBTQ+ networks to see if anyone knows of any inclusive or adaptive climbing centres. Several members responded, and gave me the details of local inclusive climbing groups that they know about. So far, I’ve contacted a number of disability and LGBTQ+ friendly climbing companies and venues, so hopefully I’ll hear back from them soon! Snooker is proving to be more of a challenge, but Gab and I might visit some local snooker venues to see what provisions they have for people with disabilities. Of course, it would be a shame not to have a game of snooker while we're there!

General thoughts:

Week 2 has given me more insight into the range of sports and activities that SfC can offer. I’ve also thought more deeply about activity analyses for sports such as boccia and climbing. Based on the processes that are involved in carrying out these activities, I’ve thought about the safety aspect of climbing. Bouldering might not be feasible for many of the regular SfC participants, but there may be some participants who could attempt bouldering after a screening tool followed by an exercise programme to work on strength and balance. I think that physios could play a role in designing exercises for people, which use specific muscle groups to allow them to progress to a new activity.

Also, we felt that we helped the participant in the gym by giving him cues for good form and by progressing his exercises. There is a potential role for physios here.

Next week, we will be designing a boccia warm-up that focuses on balance, with modifications for wheelchair users. I’ll also be having two virtual days so that the three of us can work together on our projects. I can't believe the time is going so quickly!

Week 2: Leisure centres (re)visited

I’ve finished week 2 of my placement with Sport for Confidence. Gab and I split our time between visiting leisure centres and working at home for our group projects. We’ve been working online with Alana to find information for our projects on inclusive climbing and snooker. Alana has been able to visit and contact local places in Bristol, which adds some extra strings to our bow (not that we’ve practiced archery yet!)

Colchester:

On Monday and Wednesday, Gab and I visited Colchester Leisure World, where we met Sam and Sophie, two of the OT's who work for SfC. We helped out with the sports and activities, which included boccia, dance, football and multi-sports. When it comes to boccia, some of the participants are incredibly accurate with their throws! Don't underestimate anyone.

Sam recommended that we read the ‘activity analysis’ page of the SfC boccia booklet and make a note of the different aspects and processes that are involved in playing boccia.

A performance analysis involves determining the demands of an activity, the range of skills involved and the meanings associated with the activity. I paid attention to the activity analysis for boccia while we were playing the game, and I thought about the ways in which the game can be modified. People with limited use of their upper limbs can, with the help of their carer, use a ‘slide’ to move the ball. Alternatively, people can kick the ball. Some participants need prompting to remind them to take their turn. The space between the participants and the hoops / jacks can be decreased if needed.

We will use the boccia performance analysis as a guide for our climbing and snooker projects. Also, a possible role for physiotherapists is to suggest modifications or even certain exercises for individuals who are finding it difficult to throw the ball due to a neurological or musculoskeletal condition. We can also suggest balance exercises as a warm-up as suggested by Sophie, because boccia does require sitting balance.

While we were in Colchester, Gab and I worked with a participant in an individual gym session. He already has a set gym programme which he manages himself. We watched him carry out his exercises, paying attention to his form and technique, and we thought about how to progress his exercises. We suggested a couple of small modifications to his technique, to protect his spine, and we progressed some of his exercises. I think this is an area which physiotherapists can help with SfC. Movement analysis and exercise progression is a key component of physio, and I felt that Gab and I were able to contribute in a meaningful way.

Return to Chelmsford:

On Friday, we returned to Chelmsford. The first session was an introduction to group exercise class, which is a seated class that is geared towards people with physical disabilities or limited mobility. Last week, we practiced boxing which the participants liked – although my boxing partner said she felt sore the next day! This week, we practiced ball skills and boccia. I think this class works well because it’s a small group, and the fact that the exercises are different each week adds variety to the class.

We also did basketball, which involved a series of drills in small teams followed by two matches. I have been really pleased to see that the team sports are very inclusive. The staff at SfC are excellent at making sure that everyone is included in a match, and the participants enjoy the challenge of playing a match. It is true that there will always be a wide range of abilities in each game, and some players will naturally tend to dominate. However, we made sure that the other players had a chance to dribble and shoot so that they weren’t left behind.