Archive: January 31, 2016

Help to return to work after injury

After suffering an injury, the thought of returning to work can seem like a mountain too high to climb. You may have spent time resting, having tests, receiving physiotherapy treatment, seeking the advice of a consultant or possibly having surgery. So what happens when the heat of inflammation settles and you are starting to think about returning to work?


It is well documented that work is good for health and that a return is often advisable as soon as it is safe to do so. This can mean that your symptoms may not have completely resolved at the time of returning to work.


There are few things that you can discuss with your line manager which may make your return to work easier and more successful.


Here are the most common supportive measures:


  1. Phased return of hours

Slowing down the return of hours can be very useful when returning to work after a musculoskeletal injury. This may involve working less hours per day or week for a short period of time, or perhaps mixing up time spent in the office versus time working from home. Phasing your return to work can help you return sooner than when you are 100% better, which allows you to reap all the benefits that working has on your health. The idea is that you would then return to your full contractual hours within a set time period. If this is something you think would benefit you then do speak with your employer as this may affect your pay if there is not a specific sickness absence policy or guidance outlining financial support with this.


  1. Shift adjustments

Shift workers who do a range of short days, long days and night working may need some temporary adjustments to the type and frequency of their shifts. After an injury it may be best to stagger out your shifts so that you have a break in between to allow you to rest and complete your exercises. Alternatively, consideration can also be given to the types of shift as more hands may be on deck to help with tasks in day shift, or some shifts may involve less of your aggravating activities.


  1. Duty amendments

Lastly, but equally important, is having a think about the types of tasks that are required at work and what you physically need to be able to do to complete them. For example, a desk based data entry role requires long duration of sitting or a pushing a wheelchair requires you to be able to push without pain.

Returning to work focusing on what you can do is a positive way to re-enter the work place. It may be sensible to avoid large volumes of tasks that you know aggravate your symptoms. This supportive measure should again be temporary to help you pace back into your work and gradually reintroduce the more difficult tasks.


All of the above strategies need to be discussed and agreed with your employer and it is best to be transparent and forward planning when it comes to what you feel you can manage. Often once you are back to work, you will be surprised as to what you can actually manage.


Here at Bespoke Physiotherapy we have post graduate training and extensive experience in return to work planning, so please do contact us if you would like to utilise our occupational health services.


Author: Clare Henson-Bowen, Director and Principal Physiotherapist

FREE help with work place stress!

What is work place stress?

Many of our patients describe stress as feeling that they are under too much mental or emotional pressure which leads to them feeling like they are unable to cope. The way we react to stress will vary from one person to another, what is stressful for one person may be motivating for another.

Stress can affect how you feel, think, behave and how your body works. Some symptoms that are linked to stress include:

  • Poor sleep health
  • Sweating
  • Loss of appetite
  • Difficulty concentrating
  • Feeling anxious or irritable
  • Low self esteem
  • Constantly worrying or having your thoughts race around
  • Experiencing headaches, muscle pain, or dizziness


So how common is it?

Work related stress, anxiety and depression is extremely common with over 440,000 cases in 2014/2015 alone. It accounts for 35% of work related ill-health and it is therefore a huge area of interest in occupational health. So pretty common …


What is stressing out our workers?

Stress is a very personal thing that can be influenced by a range of factors. Within the work place, the main factors contributing to work place stress, anxiety and depression are:

  1. Tight deadlines and work load pressures
  2. Too much responsibility
  3. Lack of managerial support

When thinking about how to deal and manage work related stress, it is useful to consider the factors which you feel may be contributing to your own levels of stress to see if they can be reduced or changed.


So what can be done?


  • Stress risk assessment

A really good starting point is for you and your manager to open up the lines of communication. If your manager is unaware there is a problem then it is difficult for them to help support you. Also, your manager may have observed some of the above signs and symptoms and may want to talk to you about these.


Employers have a duty of care to provide a safe working environment for their staff and should offer you a stress risk assessment. This will help both of you take a step back look at any work specific factors which may be contributing. A plan can be put together of any reasonable adjustments that can be supported to help you manage the levels of stress you are experiencing. It is always a good idea to meet again 2-4 weeks afterwards to review how things have been since the changes were implemented.


  • Support

Often just talking to someone, whether it is a family member, friend, colleague or GP, can help you understand the reasons for the way you are currently feeling. There are also a range of services available either via your work, GP or as a self-referral. For example, many employers now invest in staff wellbeing and have confidential counselling or employee assistance programmes. There is also counselling and cognitive behavioural therapy services available locally via your GP or as a self-referral. Check out your local IAPT service (Improving Access to Psychological Therapies) for more information.


  • Mindfulness apps

The concept of mindfulness is becoming so popular.  This helps you to pay more attention to the present moment – to your own thoughts and feelings, and to the world around you – can improve your mental wellbeing. There are some excellent apps now out there, such as Headspace, which are FREE to download and use. Give them a try today!


It is extremely important to recognise that stress can affect any body and you are not alone. It is key to talk to those around you about how you are feeling so that support mechanisms can be put in place.


At Bespoke Physiotherapy, we often see a how stress can impact upon your physical health and well being. We always help our patients recognise any emotional or psychological factors that may be affecting their recovery and ensure we include these in our goal setting and treatment plans.


NB/ This blog piece discusses mild stress, anxiety and depression however, please do seek immediate medical attention should you have feelings and / or plans of self-harm or taking your own life.



Further reading…


Labour Force Survey. Work related stress, anxiety and depression statistics in Great Britain 2014/15


NHS Choices. Stress, anxiety and depressions: Mindfulness.


IAPT Services

Musculoskeletal injuries among medics

Work place stress, long shifts and poor workstations have all been linked to musculoskeletal disorders so is it any wonder our medics often pull the short straw when it comes to these injuries? Sound familiar?


Of course it well known that musculoskeletal disorder are extremely common, especially in health care workers, but what about specifically the medics?


In our clinic we often see a range of injuries impacting medics because their roles are so variable and demanding it does not take much to knock them off course. For example, a lower limb football injury preventing them walking endlessly through ward rounds or a chronic neck complaint that makes bending over a surgical patient for hours on end mission impossible.


But what are the most common injuries in medics?


The most common musculoskeletal complaints we see in medics are typically neck, low back and shoulder complaints. Let’s look at these in a little more detail:

– Neck complaints – In medics this is normally postural related tensions which are exacerbated by prolonged awkward postures and high levels of stress during their working role. The thoracic spine and base of the neck become stiff and the surrounding muscles tighten, resulting in symptoms of pain and reduced movement.

– Low back pain – This of course affect 1 in 3 adults but medics are constantly spending long hours on their feet and hot desking around the hospital in chairs not set up appropriately. This results in high prevalence of non-specific mechanical back pain amongst medics.

– Shoulder injuries – Shoulder impingement is the most common shoulder complaint we see in medics and occurs when the rotator cuff tendon becomes inflamed as it travels within the subacromial space. Medics experience pain and weakness, especially with overhead and loaded activities.


Normal tissue healing plays a large role in injury recovery, but why are medics prone to acute injuries not settling down or developing gradual persistent pain conditions?

Well a large part of this comes down to the environment and working demands often placed upon medics.


Here are our top 3 tips for managing musculoskeletal injuries in medics:


  1. Ensure you seek a full musculoskeletal assessment for rapid diagnosis and clear understanding of how best to manage aggravating activities. The sooner this is completed the better, to avoid acute injuries becoming persistent pain complaints.
  2. Engage in physiotherapy treatment and exercise based rehabilitation. This needs to take into account your work and life commitments to help you keep up with the programme.
  3. Adjusting your working role can be useful for a short duration to help you rest from the main aggravating activities to allow symptoms to settle. For example, pacing ward rounds, clinics and desk based working.
  4. Get clued up on how best to set up your chair and desk so that when you use a work station you can quickly spend 30 seconds making it comfortable to you.


Bespoke Physiotherapy specialises in working with medics for large range of acute musculoskeletal injuries and long term health conditions. If you would like to speak to us to see how physiotherapy can help you – please feel free to contact us

Flying long haul this winter? 4 tips for trouble free travel

Sitting in Dubai Airport halfway through a long haul flight back to London I thought this was a good opportunity to pen down some simple tips to help people get through long flights. Looking after your body on a long haul flight can seem a challenge, but it is really very simple. Here are my top 4 tips.


Keep Hydrated

Make sure you drink a decent amount (of water!) during a flight. The pressurised cabin of an aeroplane provides for a very dry and dehydrating environment. Don’t wait for the cabin crew to come around if your thirsty – press the assistance bell.


Get into the zone (time-zone that is)

One of the biggest things to overcome in long haul travel is jetlag. Traversing multiple time zones in a single day really plays havoc with your body clock. One simple way to assist with your body’s transition and is to change your watch to the time zone of your destination as soon as you get on the plane. From that point forward throughout the flight operate as if you were in the time zone of your destination. This means trying to get some sleep if it is night-time, or trying to stay awake if it is daytime at your destination. Make sure you pack some earplugs and an eye mask to help with this.


Maximise your comfort

We all know that aircraft seats are not the most comfortable things in the world, and that can mean you get to your destination with neck or back pain that can really interfere with your trip. Packing a neck pillow is essential and placing the small pillow provided by the airline behind your lower back will place your lumbar spine in a more neutral posture. Also, pack your own headphones. It doesn’t matter if they are over ear or in ear, generally speaking they will be infinitely more comfortable and than airline headphones.



Keep Mobile

This is the most simple of all. Humans are not designed to spend long periods in static posture – we are designed for movement. Get up once every hour that you are awake on a flight. Go to the bathroom or go for a wander down the aisles. It might not feel like much but you’ll feel a lot better on the other end.


Check out the blog next week for more useful tips on travel and exercising in different conditions.


Jon Castle

Bespoke Physiotherapy

Back Pain Mistakes – Clare Henson-Bowen

Clare Henson-Bowen (Director and Principal Physiotherapist at Bespoke Physiotherapy) specialises in complex persistent pain injuries (i.e. those that don’t get better as expected!) – So we wanted to ask her if there any mistakes she sees patients making when managing their back pain. Here’s what she had to say…


The most common of back pain is classed as ‘simple’ non-specific mechanical back pain and this usually clears up in around 4-6 weeks. There are definitely ways to help speed this along as well as some unhelpful things that can slow down and hinder recovery. It can be frustrating for patients when their symptoms do not improve so it’s crucial to find out how acute phases of pain are managed. If not managed well, the back pain can struggle to settle down and patients can move in to more persistent stages of pain.


The 3 most common mistakes I have seen patients make when managing mechanical back pain are:


Wrong level of activity – Trying to get out of bed or down to lace your shoes can be mission impossible when you have acute back pain but the old method of taking off your front door and lying on it completely still for 1-2 weeks has been put to bed . So patients are often torn between the ‘keep moving’ and the ‘you should rest up’ advice. So how much is too much or too little? Our spines do like to move so it is always best to keep moving within your pain levels. Non weight bearing range of movement exercises (I.e. those completed whilst lying down) can help you do this without causing your pain to increase.

Depending on your work activities and hobbies you may need to tailor down the amount you are doing for a couple of weeks until your pain allows you to return to normal activity. When in this stage, returning to normal activities should be paced so that your back can gradually get used to the physical demands you want to place on it. Generally speaking, remaining at work is best for recovery and prognosis so it may be worth speaking to your manager to see if your work activities or hours can be temporarily changed to help support you to stay and / or return to work.


Not taking a holistic approach to understanding pain – The human body is a complex thing and when understanding pain it is vital that not just physical contributing factors are addressed. The biopsychosocial approach to managing pain is well researched and used now by most physiotherapists. This means not only looking at the physical sources of pain but also the social and psychological factors which can drive and amplify pain. The most common psychological factors we see when working with back pain is low mood and anxiety. Sometimes this is an old or pre-existing concern for the patient, or a new thing that has developed after the back pain started. Either way, it is super important to recognise the influence that these can have on the way we feel pain to help us treat all factors involved. Many of my patients have progressed extremely well once these areas are addressed and treatment underway.


Lack of diagnosis and fear of the unknown – A large proportion of back pain is classified as this non-specific mechanical back pain which means that no definitive diagnosis is attached to the pain you are experiencing. This classification of back pain is described as a ‘tension, soreness and/or stiffness in the lower back region for which it is not possible to identify a specific cause of the pain. Several structures in the back, including the joints, discs and connective tissues, may contribute to symptoms’ (NICE Guidelines 2009). Many patients I see feel they would benefit from investigations such as x-rays and MRI scans however these are often not indicated and have actually been shown to negatively affect overall prognosis in some patients. The decision to investigate back pain further needs to be carefully discussed with your physiotherapist.                              


So you have been avoiding all these common mistakes but you continue to feel like you have a knife twisting in your back?


If you haven’t already sought the advice and treatment of a physiotherapist, then now if definitely a time to get that ball rolling. There may be other reasons why the back pain is not settling down and this needs a full physical examination and treatment plan. Patients with non-specific back pain should be offered treatment plans focusing on self-management, exercise-based rehabilitation, manual therapy and / or acupuncture. If the patient is in the more persistent stages of pain, then treatments should focus on reducing pain and its impact on the patient’s day-to-day life, even if the pain cannot be cured completely.



NB/ This blog article only discusses non-specific back pain so if you are experiencing other types of back pain then please discuss with your GP or physiotherapist. If you experience any red flags associated with back pain (i.e. trouble controlling your bladder or bowel movements, numbness in the groin area, foot drop symptoms in both legs) then please seek urgent medical attention.