[Philly]

Rob, first off I would like to thank you for taking the time to go through some topics. The journey always intrigues me, so I’d love to get an idea of what the academic path has been for you becoming a physiotherapist…give me a brief run through to start us off.

[Rob]

I started out with a degree in Sport Science and Health in DCU. While sport being my passion was what naturally attracted me to the degree, it was here I found a new appreciation for the ‘health’ component of both sport and life. This was a relatively new degree in Ireland back in 2000 with little job prospects in the field of sport science itself but it did give a foundation of knowledge to go on and specialise in different components of health and indeed sport.

Physiotherapy was the next natural step for me, where I could combine my knowledge of sport science with rehabilitation and exercise programmes for different patient populations and pathologies. I am still as passionate about the sport science end of things now as I was then and tap into that knowledge on a daily basis.

During my 11 years clinical work the profession has evolved massively. The days of patients attending a physiotherapist, lying on a treatment table and expecting a massage or having electrodes strapped to them for 30 minutes are over.

There is now a much more active approach to getting each patient back to optimal health, be that work or sport. The protocol now is to identify the problem, find out what is causing it and stop it happening again. The role is now almost preventative.

Whatever the condition or patient there will an element of strength, stability or mobility (sometimes all) incorporated into a home exercise programme to address whatever imbalances are identified during the assessment.

[Philly]

That’s an interesting point about the evolution of the role, 11 years is a long enough time to be able to reflect and be aware of it.

I’d be curious to hear if you’ve noticed any trends with clients and what types of problems you deal with day to day. We obviously sit a lot more than we used to, and the whole area of mobile phones and laptops would point toward forward head posture and rounded shoulders.

Has anything like this been apparent?

[Rob]

There are certainly anecdotal trends developing with our increased sedentary lifestyles. You hear the media every year talk about conditions like “text neck” or “blackberry thumb” in a similar way to how they speak about heavy school bags causing back pain with children.

But in actual fact there is very little evidence to support any of these claims. For example, there are actually studies showing that children carrying heavier school bags are less likely to experience back pain. What is likely the issue here is that children that may experiencing back pain has nothing to do with a heavy schoolbag but more likely to do with the amount of time they spend sitting per day watching TV and playing video games.

They are deconditioned and no longer robust enough when it comes to doing manual lifting.

It is this younger population that is the greatest concern for me. It is frightening the amount of kids that cannot complete simple movement patterns, have poor coordination and flexibility issues, that will go on and experience pain and injury as a result.

[Philly]

It’s definitely something I think is apparent across the adult population as well due to lack of movement and exercise. I know back in 2013 it was projected Ireland would have obesity rates of up to 89% and 85% in males and females respectively by 2030 if things continue the way they are, there’s a worrying trend there[1].

Is obesity something you’ve observed as a problem?

[Rob]

Well the statistics speak volumes here. In 1980 3% of Irish kids were overweight and 0% obese. None. Obesity in children did not even exist in 1980. Fast-forward 35 years. In Ireland in 2015 20% of 9 year olds are overweight and 7% obese.

Ireland is en route to becoming one of Europe’s fattest nations and again statistics will support this. But I think of more concern is our unwillingness to accept this fact. We brush it aside as scaremongering by health professionals and all of a sudden someone who is overweight becomes the norm, and someone classified as obese appears as though they may be carrying a few extra pounds.

The sheer weight is one thing but what we forget about is the other co-morbidities that go along with this, and this is certainly something that is becoming more apparent in clinic: Joint pain, soft tissue injuries, decreased quality of life along with more chronic illnesses. Diabetes affects approximately 382 million people worldwide, accounting for 8.3% of the world’s population, and continues to increase in all countries.

It is estimated that the number of people with diabetes will increase to 55% by 2035 (Brussels International Diabetes Federation 2013). In Ireland 854,165 adults over the age of 40 are at increased risk of developing, or actually have type 2 diabetes.

Another 300,000 adults between 30-39 are overweight and not meeting the recommended guidelines for physical activity putting them at increased risk of chronic ill health.

Several known risk factors are well established:

  • Lack of exercise
  • Overweight
  • Unhealthy Eating
  • Family History

Of these four known risk factors three are modifiable – two directly through exercise alone, another indirectly… so add exercise in to the mix and three of the four risk factors are eliminated (we can’t choose our family).

Yet despite the evidence exercise remains an afterthought for clinical medicine with just 39% of adults with diabetes being active (American Diabetes Association and ACSM 2010).

There’s some staggering statistics there regarding diabetes, especially because of the huge impact it has on the person’s health.

[Philly]

I watched a presentation from the incredibly smart Stephan Guyenet about 12 hours ago (so this is quite lucky), but he references a study that showed with a modest intervention of reducing calories and increasing exercise that ‘weight loss was the predominant predictor of reduced diabetes incidence… for every kilogram of weight loss, there was a 16% reduction in risk for pre-diabetic or obese subjects’.[2]

It appears a legitimate preventative measure is a case of implementing an exercise regime and reducing calories to a level which promotes weight loss.

Moving to a different section of the population – I’d like to cover the issue of inactivity and muscle wastage in the older clients, is this something you’ve encountered?

[Rob]

There is a misconception out there that because of my love of sport and background it is mainly sports injuries I deal with. This couldn’t be further from the truth. The majority of my work is with every day injuries across a broad range of populations from children to the older patient.

The oldest patient I am currently treating is a 98 year old lady; a lady whose mobility has decreased due to a bad bout of ill health but is determined to regain as much independence as she can through strengthening and balance exercise. I find her absolutely inspiring and invigorating to deal with as she has such a positive outlook.

Much like any athlete going through rehabilitation following surgery she is following similar principles and steps to getting back to as strong and independent as she can be in reaching her own goals.

With increased ageing come increased risk of muscle wasting, or sarcopenia*. And this process starts much earlier than we might think. Onset can be from mid adulthood but accelerates much quicker from 60 years of age onwards.

Like grey hair, male pattern baldness or wrinkles some of this wasting is unavoidable but the rate at which it occurs can be delayed through strength training.

With ageing populations this can mean increasing lower limb strength which in turn will improve balance reducing the risk of falls and hip fractures in the elderly, a leading cause of mortality.

Yet strength training is still something that probably isn’t prescribed enough by health care professionals.

There is a culture of wrapping the older patient up in cotton wool to protect them when they really should be exposed to some resistance training to enhance quality of life and injury prevention.

[*clicking on the word ‘sarcopenia’ will bring you to a TedTalk from Dr. Brendan Egan on the importance muscle retention throughout life]

[Philly]

I think it incredibly inspiring to hear of someone so determined to make positive changes at 98, it’s food for thought for those who are a lot younger, yet neglect these things.

I’d be interested to hear what advice you have across the board for all ages. What should people be doing to increase their quality of life, durability, and longevity in life?

[Rob]

What I live by and advise patients` is a long-standing quote by George Bernard Shaw: “We don’t stop playing because we grow old, we grow old because we stop playing”.

And while the word “play” may be replaced by “exercise” as we get older, play is what it starts out at as a child. There are so many misconceptions when it comes to exercise; that it is bad for your joints and you will suffer later in life.

Some of this may stand to be true with some contact sports but running in particular gets bad press. Yet research will state that there is no link between running and onset of early degenerative changes in knees or hips.

That’s not to say there won’t be degeneration, of course there will, but no more than those who don’t part-take in regular exercise, and in fact in most cases it may even be the opposite.

At various stages of your life there will be different exercise regimes that suit you best.

Life will throw obstacles such as work or family but while one sport or activity may not suit some there will be an alternative that will.

The key is to find the one you enjoy most and make time to fit that into your life.

[Philly]

I love that answer, very well put.

So you’ve told us what you advise your clients to do, but I always believe that as health professionals we should ‘practice what we preach’. On a final note, give us an insight into how this has applied to you across the years.

[Rob]

I spent my youth immersed in team sports, both GAA and rugby during school and university but it was when I joined the real world of the work force that I began to struggle with juggling team sports with working late evenings which is the nature of my work.

So, in 2009 I signed up to some 10k’s which lead to ½ marathons, soon after I was signed up for the Dublin marathon and have done it every year since along with other ultra-marathons and endurance events.

For me running best suits my life.

Work is one thing, but when trying to fit exercise around a young family it becomes even more problematic.

You cannot beat the luxury running affords you to be able to squeeze in an interval session in limited time along with a longer run maybe early some morning.

 

As regards the future, I definitely plan on continuing to run but already as the clinic grows I’m probably not getting out as much as I used to (or would like to).

I’m probably yet to strike that right balance to get back to running PB’s but I have to be realistic too with my specific situation at the minute. I am also yet to master the art of nutrition while being busy.

I think that is important for any exercise regime or goal setting – Be realistic. 6-7 days of running per week was fine for me with no children, even with one child I managed it, but now with 2 small boys and a busy practice 3-4 is a more realistic target.

[Philly]

Rob, thanks so much for your time on this. You’ve put across some really valuable information with these answers, I really enjoyed chatting and I think anyone reading will find it valuable.

Both Rob and myself would encourage you to partake in regular exercise, stay mobile and move around more if it’s something you can improve on.

Do this to stay healthy, promote longevity and improve your quality of life as you get older.

If you made it this far, thanks for reading!

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3827424/

[2] https://www.youtube.com/watch?v=2xh8jb2euQ0