you can hear your muscles, especially those in your hand. If you pop your thumbs over your ear openings and tense your fists you can hear your hand muscles ‘roaring’. This is essentially the individual muscles fibres moving over eachother as they are stimulated to contract – and is closely associated to what you’d measure from electrical activity in the muscle (EMG).

Muscles don’t contract as a single unit, but are formed of hundreds / thousands of fibres working in a co-ordinated fashion to deliver the desired force and range of motion of a joint. The more contracted the fibre, the louder it roars as it becomes stiffer.

Most up to date study for shoulders suggests advice is just as good as exercise interventions (with or without cortico-steroid injection).

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)00846-1/fulltext

FWIW I am a physio, I am a researcher, I also know a fair amount of what the professional body wants. The above study was a robust investigation delivered by an awesome team out of Oxford. So the hands on stuff isn’t always any better than a leaflet or a bit of a chin wag…

There is a paucity of robust evidence to support a number of things we as physios do in our day to day practice (same can be aimed at many AHP’s including Osteo), however, due to our breadth of specialities we work in we have some fairly decent evidence too in specific areas of practice (respiratory). I think the evidence for any intervention for musculoskeletal issues is less robust.

We as AHPs have a responsibility to provide clinically reasoned, evidence informed practice (as do all the others), and we follow the evidence where available and our clinical reasoning to determine the best approach from what we assess.

I think putting physios on a pedal stall and taking aim at Osteo / Chiro is a bit unfair. Sure they come from rather peculiar beginnings, but so did physio – remedial gymnastics anyone? Physiotherapy came about as an offshoot of nursing when they  were provinding massage therapy and didn’t want to be thought of as offering ‘other’ types of massage…

I think there are good and less good practitioners in all professions, and that’s why a number of people get hauled up before the HCPC, GMC, NMC etc for fitness to practice hearings and that’s why our professional bodies pay out a huge amount to provide personal liability insurance to members.

In all honesty, the main things to do with a lot of long term pain issues are to understand how pain works (i.e. pain does not always = harm or damage to the area that hurts), lose weight (if you are over weight), reduce stress, increase physical activity, find something that you feel works for you and that you like doing and keep doing it.

I have a PhD in physio, and have researched back pain for a number of years.

Unless you have neurological signs you don’t need a scan (in fact the likelihood is a scan will make your pain worse) or an operation, you may benefit from some pain education programmes (‘explain pain’ by lorimer mosely and david butler is a go to in the field),  you may need to strengthen some muscles and stretch others (although this may or may not influence your pain), i personally believe pilates and yoga are beneficial (although the evidence doesn’t support that), you should try to increase your activity levels as able.

Trying to pin pain to something biomechanical if you’ve had pain for longer than 3 months isn’t too useful, as in the majority of cases the tissue injury will have healed, and so other mechanisms are likely to be at play.

I have done it two different ways in different academic posts. Your contract is your friend, it states a 35 hour working week, most uni’s now offer flexible working to help their Athena Swan, and you want to take them up on the offer. You and I know there is an unhealthy obsession with Uni’s to try to make you do more than your role (committees, supervision etc) and so do loads of extra hours, and there is an unhealthy working culture.

In Oz i was routinely working 7.30 /8- 18.00 5 days a week without any breaks. Then we had a baby and realised that if i kept those hours on 4 days a week, i was still doing plenty over my contracted hours. I went down to 4 days and it was amazing. I found by shortening my working week i would still do longer days, but i knew on Friday i wouldn’t do a thing and could go for a ride, swim, beach etc.

When i moved back to the UK i wanted to keep that pattern and so got agreed it from day one, I also became a flexible working champion and joined a number of committees to help get support for others to do this…

I have now left academia but am working a 9 day fortnight and will likely go down to 4 days a week in a couple of months, as it is really beneficial for physical and mental wellbeing. My approach with HR is that i will work my 35 hours over 4 days on this working pattern, and i have met all of the criteria within my contract. In all honesty i find i’m more productive on a shorter week, as come friday i’m shattered and can’t be arsed!

All the basics covered there…

We got through tonnes of cotton wool and warm water instead of wipes for bum wiping etc, but wipes would be fine too…

Nappies, nappies and more nappies, and those scented bags to jam as many into as possible…. just don’t breathe in when you tie the bag up…

Nipple cream for the wife if she’s breast feeding…

If you have a boy, i recommend making a miniature paper hat type thing out of jay cloths to cover their willy when you change their nappy… Our one would pi$$ for england when he was having his nappy changed, and if you aren’t careful it’ll be up your t shirt and in your eye before you know…

Bank as much sleep as possible, you’ll most likely need it.

Recharge your sense of humour, cos lots of things will come to test you in the next few months…

Remember to enjoy it, especially the cute little squidgy cuddles…

This was filmed round the corner from our house, Dexys Midnight Runners, come on Eileen!

https://www.youtube.com/watch?v=m-mnuNiXZ-0

get yourself to lidl (if you have one nearby)…

Pack of tortilla wraps ~80p

Tub of humus ~ 60p

Salad ~ 60p

Pack of Gosh falafel type things ~ £1.50

Squish it all in a wrap, roll it up and bobs your uncle. about 80p per wrap

I’d second the sage / breville barista express….

We bought one for our office in Sydney, and it got used fairly heavily by about 15 people. Didn’t miss a beat. You can set the shot volume, shot temperature, it has a decent steam wand that lets you do it yourself to get proper textured milk etc.

Was so good that 5 of us all went to buy one for our homes. I’ve had my one for about 3 years, its made lots of coffees, been shipped round the world and is still great.

We got ours on a decent discount at Bing Lee i think

I am really enjoying this at the moment. Light roast that is bright, fruity, and not too acidic. They post it out as soon as they roast it so it hasn’t been sat around for ages…

https://unionroasted.com/products/campus-3-limited-edition-microlot

we have a mountain buggy urban thingybob which we bought second hand in Oz. It is awesome for outdoors, running, walking, off roading etc but pretty big and a bit impractical for going in some smaller shops…. Build quality is awesome, they are cheap as anything second hand and you can buy loads of spares for them….

We use the mountain buggy nano for around and about town, it is tiny, packs down to nothing (hand luggage size for planes) and has a pretty decent recline on the seat. It is way cheaper than the babyzen

If you want super niche (and not particularly cheap), there is a place in Australia where i have bought a couple of wallets and a bag for the wife. I used to live nearish so would pop in to see them.

They are called Jones and Wright and they are traditional leather workers (he comes from a family of saddlers). They make handmade leather wallets (amongst other things), and you can select the leather (animal, colour etc), the stitching, dimensions, no. of card slots etc. The chap that runs it is a really nice fella, and i’m sure you could email him and see if he could do it all by skype.

But if you fancy a holiday, you could always pop to Oz 😉   they are in a beautiful little village in the southern highlands out of Sydney…

thank you Earl_Brutus, just got the email confirming postage! Wife will be happy to be back out on the bike in the rain!

Thank you everyone!

Sooty, thank you for your kind offer, but you can now travel to London on the 26th unencumbered! Earl_Brutus has posted me a wheel. I shall stick that one and instruct the wife to lock both wheels!

Thank you all!

Matt

Hi Nick,

Thanks for the pics and for looking at my plea! We really appreciate it. I’m hoping to tee up a QR wheel with sooty. Thank you for generosity, things like this make STW awesome!

Cheers

Marp

Hi Sooty,

Just checked with the wifey, she is fine to wait for the 26th, if it works for you to meet up? Whereabouts will you be coming into?

We are south, but head into London Bridge. Can easily navigate my way around though… Otherwise if it’ll be a pain in the a$$ i’m happy to pay for postage to save you time.

Cheers for this, we really appreciate it.

Hi Nickewen, Onehundrethidiot, Earl-Brutus and Sootyandjim,

Thank you for your awesome generosity! Please let me know what you have knocking about (either message on here or mattliston79 at gmail), and i’ll sort payment for postage etc

Any wheel would be greatly appreciated and will save the wife a load of ballache. I’ll make sure she’ll learn to lock it up properly next time and not use those crappy flex things..

Thank you all! We are indeed in London (well we work there), and the wheel was nicked from outside Guy’s Hospital

If you see anyone trying to flog a knackered old front wheel (formula hub i think), with an old on-one tyre on it, ask them what the hell they were thinking!

Legend, thank you!

If it works, please PM me your details and i’ll TF the dosh over,

Shermer is right. Epley manouvre will only sort Horizontal canal BPPV, so is always worth ensuring this is the correct diagnosis. <span style=”font-size: 12.8px;”> </span><span style=”font-size: 12.8px;”>I presume you had a positive hallpike for that ear?</span><span style=”font-size: 12.8px;”> </span><span style=”font-size: 12.8px;”>Who diagnosed the BPPV? GP or have you been to see anyone else? </span>

Epley isn’t particularly bad (essentially lying down, then rolling onto your side, then tummy, other side and then sitting up).  You might feel a little dizzy in the first instance (lying flat with head tipped) as this is the provoking position, causing movement of the little crystals that are floating about freely in the inner ear. This should be short lived (up to a minute). If the manouvre has been successful, you might feel a little funny for a few days afterwards as the balance system adjusts to any change in function, but then again you may not.

The other precautions following the manouvre (sleeping with extra pillows, avoiding extreme head positions for a week etc) are fairly sensible and easy to follow.

I too have that Breville! Have had it 3 years or so, and it hasn’t missed a beat, even after being shipped back to the UK when we moved home…

We had one at work that was pretty well<span style=”font-size: 0.8rem;”> used (20+ cups a day), and it never missed a beat for the 2.5 years i was there..</span>

Our fiends run a lovely little campsite called birds and bees just outside of Saxmundham in Suffolk. It’s set on their old dairy farm out in the country, only has a small number of pitches and has a pub down the road (short walk / wobble on the bike on quiet country lanes). Really quiet, chilled campsite and fires are allowed. We stayed there for a week last year and it was amazing…

Do’t think there is any water there though, but you aren’t far from the coast (Southwold / Dunwich)

a second for weber q. We take ours camping, use it most nights throughout spring / summer, have moved it from Oz to here and it hasn’t missed a beat.

Can cook everything on it from fry ups to roast dinners…

If you want to do it the official coffee **** way….

Weigh in dry coffee
Weigh out extracted coffee
Measure time – time to pressurise, time to first coffee pour, time to end of extraction.

Ideally wanting to hit 1:2 doe coffee in:out
Ideally 9-11s for time to first coffee out
Total shot time (from start to finish) of 23-27s

If you under extract your coffee you will taste a bit bland and have a short finish, it will lack sweetness and may taste sour or have a salty taste.

If you over extract it will taste bitter and astringent.

Lots of fiddling to be had to get it right – when i lived in Aus one of my lab mates was a Barista and set up our work coffee machine and my home one. We used the same beans at work and home so no fiddling….
Different story now i’m back over here and am only recently settled on a coffee i like..

I am tempted by their 130 quid lawnmower, 40v battery, charger and with a 3yr guarantee ….

Is the Ferrex stuff any good?

Talbot sunbeam? but with a wonky nose?

<blockquoteNo one is suggesting going to see any old ortho surgeon, they do specialise.

Why pay twice? Get a review from the top of the tree and work down rather than risk miss diagnosis or pay twice. A private consultation should be approx £150-£250. If the consultant determines its not a bone/skeletal issue then crack on with physio>

I don’t think i agree going to a consultant orthapod straight away is always the best approach… i’ve seen my fair share of patients that haven’t been referred for physio after seeing an orthopaedic consultant for an issue they’ve had (where the evidence would suggest that conservative management and exercise are the best interventions). Also, there is quite a large body of evidence now suggesting some orthopaedic interventions are no better than conservative management (e.g. physio / osteo / chiro for knee OA, low back pain), and in some instances are no better than sham surgery.

I think ortho is great for some things, but conservative management approaches (ie. non-surgical management) are probably better to be explored first, and the people to do that would be the heathcare professionals who provide those interventions (whether that be a podiatrist / orthotist / physio). Or if you want to see a medic, i would look for one who has a decent amount of paediatric experience.

<No disrespect to Physios but You would be better investing in getting an opinion of an Orthopaedic Consultant if you think it’s an issue.>

Horses for courses really, orthopods certainly have their areas of expertise, but for a first look i wouldn’t think they would be the first port of call. You would want a more generalist (paediatrician with orthopaedic/ MSK and rheumatology experience), rather than any old orthopaedic surgeon. Children and adults are very different…

In my opinion, paeds physios are cheaper and would typically point you in the right direction if needed…

(- I was a physio and so may be biased. My wife is a paeds physio and works with lots of highly specialised medics, i doubt any of whom see adults)

https://www.youtube.com/watch?v=mhGx7xeyNp8&t=2611s

If you were going to pay to see a private physio, rather than going to an expert running physio, invest in seeing a paediatric physio. It may be that your boy is hypermobile and could do with some strengthening….

There are a few private paeds physios around, but you will want to check they have decent MSK or rheumatology experience and not be neuro experts (many private paeds physios are more tailored towards neuro-disability).

+1 for hunt for the wilder people and The Way Way back

Of the same ilk – little miss sunshine

I did a similar thing to TJ’s mum, needed some oystercatcher skulls for a project but unfortunately they were all fully intact (including the rest of the bird). I boiled them up in the lab, it started to smell pretty funky so i went out for a walk and a cup of tea to give them time to boil properly. On returning, the smell that hit me when i opened the door to the building was very interesting (i.e. revolting), and worryingly i was about 30 meters from my lab. I then got collared by the lab manager who gave me a proper b0llo0cking for releasing the disgusting smell that had permeated the whole building, and for having buggered off and not stayed in the lab.

That smell was bad, but not as bad as the patient i had who had grown his own population of maggots in his foot. Wet gangrene is not a smell i miss. I do not miss the smell of that vascular ward…

Congratulations on the new baby!

I can only reiterate what has been said above. There is no magic trick to get them to sleep, well if there is i haven’t found it! Little baby trying to work out what the hell is going on, they were previously cosy and warm in mums tummy, and now they aren’t, on top of that they don’t good sustenance on tap. Kepp in mind how little their stomach is, it can’t hold a lot of milk and needs to be topped up regularly, so unfortunately that means feeding in the night (and the day).

Your baby will start to get the hang of night and day in the not too distant future, and will likely start to spend slightly longer periods awake for playing in the day, and wake to feed in the night. Playing won’t be what you imagine play is – but it will be interaction with you / mum. Try to be consistent in the night time by keeping sound low, lights dime etc, and try to stick to a routine (bath and chill before bedtime).

I do remember our boy loved to be swaddled, the tighter the better as he was a wriggler. As soon as the he was wrapped up he would nod back off to sleep.

Sounds easy doesn’t it? We did all of that and more, our baby is 18 months and still doesn’t sleep through the night! I have just given up on expecting to sleep for a whole night and make sure we have lots of coffee! So i have no bloody idea how to do it!

Don’t listen to any of your nct peers about what their baby is doing right now, they are all different and have their own ways of settling. I am deeply distrustful of anyone who says their baby sleeps like a dream!

Try to enjoy the cuddles and snuggling time as much as you can, try not to stress (easier said than done), and just try to work out a way to function as well as you can. Try to give each other a breather from it all, I used to make the wife go for a swim when i got home from work so that she could de-stress and have some time away from the house.

Good luck!

we have fttp here which was integrated into our apartment block.

We use hyperoptic as our supplier, they are pretty cheap compared to all the others and great service. We pay £27 pm for 200mbps up / down

Andy, the problem is you can’t easily find out what is causing it…. especially if it is persisting (scans are not really the way forward here). There are a number of different theories / popular ideas that change over time (e.g. muscle imbalance, core strength, tightness in any number of muscles, posture), but i don’t think any of them are predictive for causing pain. I think finding a way to manage it that works for you is the best approach, and whether that is addressing tightness, strength, activation etc will work out as you progress treatment.

PrinceJohn – Sorry to hear about your partner. Advising some increase in rest is a good place to start, this should be interspersed frequent movement (as able), so no bed rest. It would also be worth investigating whether there are any things that help ease her pain (any specific body positions, swimming / floating in the water or being in the bath, TENS etc). A visit to a recommended health care professional (e.g. physio) with a lot of MSK experience is worth it, they will provide advice and tips for management and will likely be able to do soft tissue work / mobs / manips to free things up a bit in the short term.

The thing for your partner to keep in mind, is that her back is, in all likelihood, structurally fine (if the GP was worried then your partner would likely have been referred on for scanning very quickly). Your partners central nervous system has gone into a protective mode in response to the initial injury (this is what produces the intense pain she is experiencing). What she needs to do is start to provide herself and her CNS that the injury is healing (it has bee about 6 weeks, so under normal tissue healing timelines some healing would have occurred depending on the type of injury). A way to do this is by slowly increasing movement and being more active (this would be advised and under the supervision of a healthcare professional), thinking more positively about her back and trying not to worry that it will fall apart (it won’t). Over time, the central nervous system will realise that everything is ok that there is little threat of re-injury, and will switch off the alarms! This typically takes up to 3 months so it is in part about being patient, and not trying to worry when it is taking a long time to heal.

Highpeak,

The current thinking is that by having an x-ray or CT unnecessarily (i.e. you have no focal pathology that makes it an emergency), and you are shown to have degenerated discs, OA of the spine, degenerative disc disease, reduced joint space etc all of which are actually totally normal and associated with being age over 25 (ish).

These ‘degenerative changes’ are not thought to be associated with pain (see Brinjikji W, Luetmer PH, Comstock B, Bresnahan BW, Chen LE, Deyo RA, et al. Systematic literature review of imaging features of spinal degeneration in asymptomatic populations. AJNR Am J Neuroradiol. 2015; 36(4):811-6), and it is a current failing in how many people (including clinicians) approach pain that we still use a very old, biomedical model of pain in that we think pain = tissue damage.

This is not the case, and there have been lots of studies to show this. In fact the international association for the study of pain (IASP) definition of pain is ‘An unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.’ So it is an experience, i.e. it is produced by the CNS, not simply an output of sensory information, and it is related to actual or potential tissue damage. So pain can be generated without a noxious stimulus (e.g. in CRPS people can have inflammatory responses by thinking about moving their affected hand, not even moving it).

And here is the rub….

If you have a scan following a back injury when you didn’t need it (i.e. you had no serious focal pathology – here we mean things like signs of cancer or cauda equina syndrome). Then your central nervous system has been given information that your back pain is very serious (you were sent for a costly scan) and therefore should be protected. On top of this, you will be reported to about the condition of your back where you will be told a list of things that appear to be wrong with it (disc protrusions, degenerative disc disease, OA etc).This information is likely taken on board by the CNS and makes it more hyper aware of how fragile it appears to be and that it should be protected further. This, in conjunction with what is going on in your life at the time, how you cope with pain, your health beliefs, what your treating clinicians have said to you, your previous experience of pain etc, all come together (we still aren’t 100% sure how), to produce this experience we call pain.

If you didn’t have the scans, you would have had 2 less threatening inputs into the mixing pot, and would have received less ‘diagnostic’ detail (which is likely irrelevant). In our current understanding of pain, that in all probability will reduce your likelihood of experiencing pain that persists beyond its expected course.

phew that was long…..

Hope that makes sense, but that is a basic run down of about 25 years of quite complicated research. If you want to learn more there are TED talks by a bloke called Prof. Lorimer Mosely, (we have done some work with him), he is a great bloke and a very good scientist/ clinician. He can explain it way better than I…

Sorry TJ, you’re a little off the mark.

Cochrane reviews state SMT is no better than other recommended therapies for acute or chronic LBP. More recent systematic reviews (not cochrane) indicate it may produce modest improvements in pain and function, and that SMT is better than simple mobilisations.

Exactly. That’s why i said

‘pretty much all types of modern intervention bring about similar responses at the population level’

and

‘in that recovery period try to work out what works best for you to control your pain levels’

When looking into the evidence there is no magic bullet that cures / heals LBP. Its finding what works for you, what provides best value for money (for individuals and healthcare providers / insurers) and what has the least likelihood of causing harm. As long as your osteo / chiro isn’t old school and doing risky manouvres (such as cervical manips) then in all honesty there probably isn’t a huge difference between approaches. The more important thing is that if you think it will help you, then in all likelihood it will have a better chance of helping than if you don’t think it will help.

TurnerGuy…

Yeah, long term use of NSAIDs isn’t advocated. But in the short term, acute window (2-4 weeks) if they provide symptomatic relief they are worth considering. Then again, the evidence of their impact on reducing pain compared to placebo is marginal.

Chiropractic and osteopathy both have relatively shonky histories, and depending on the practitioner may or may not follow best advice (but then Physio’s can be just as off target too). Chiro and Osteo are probably a bit more manipulation happy then Physio, and are happier to use cervical manipulations (which have been associated with stroke, and vertebral artery dissection). Depending on the practitioner though i think the end product may not vary, but the clinical reasoning process they followed to get to that outcome might be pretty different…

My personal opinion is no two backs are the same, and different people respond to different things and different approaches. In weighing up the evidence pretty much all types of modern intervention bring about similar responses at the population level… whether that be core strengthening / pilates, education, manipulation.

At the moment, we still don’t really know why back pain persists, and why some people get better when others don’t. We are pretty sure in most cases it isn’t down to any mechanical deformation (as there are many, many people with awful looking back scans / x-rays who have no pain and have never had pain), so the mechanical argument has been debunked, and also it seems as though people who have scans and x-rays tend to have a worse prognosis than those that don’t have them. This is why the guidance has changed to only scan when absolutely necessary (potential for serious problems such as spinal cord compression, tumours etc) as the risk outweighs any potential benefit in most cases.

The best current advice is to try not to stress about your back too much. Your backs are very strong and designed to last you more than a lifetime. Things don’t slip out of place very easily (there is a lot of muscle, connective issue and ligaments around the back). In most instances it will get back to normal in 6-12 weeks, and in that recovery period try to work out what works best for you to control your pain levels. For some that may be swimming or yoga, for others it might be a gentle walk or a slow bike ride. Try to keep as active as you can, take painkillers if you need them (but avoid the opiates) or try TENS, try not to sit still for too long, try not to avoid doing simple things for fear of making your back injury worse (obviously within limits, i probably would advice against starting lots of heavy lifting if you weren’t conditioned for it in the first place).

They aren’t that reliable (compared to an ECG), as they are designed to filter out noise etc and only detect the R wave. You should be able to download the raw data files which will give you the individual R-R intervals across the period of exercise (this is how the apps work out heart rate variability).

However, these aren’t a clinical grade ECG, and will not show you the trace, so apparent missed beats (i.e. large gaps in R-R interval) may just be the algorithm junking the data as it didn’t meet the criteria for selection, the chest strap went funny etc. So if you want to see the trace to identify missed beats, the only way to do this is with a proper ECG.

I was rubbish at swimming, same as many other folk here. Went to lessons again (two rounds) to get back some technique. That helped a bit but was still pretty splashy, hopelessly inefficient and stamina wasn’t great….

Then moved to Oz, where we had a pool and i could commit to swimming every day, probably an hour a day or so. I used pull boys, kick floats and paddles for different drills so you can work on different elements of the stroke. A lot of it is about learning to feel the water, when the catch is working (when it isn’t), when my my legs are being draggy and just learning to relax into my stroke. I am pretty proficient now and can happily swim up and down for an hour or so (i don’t really bother counting lengths as i always forget what number i’m on).

For me it is about where and how how to apply effort. I imagine front crawl as being about reaching up for water, grabbing a big handful and chucking it out behind me, like an exaggerated pull when climbing a ladder. Efficiency is about how much water you grab and how far you throw it behind you rather than how quickly you windmill your arms. My legs don’t do so much (unless i’m sprinting), they just keep my body position in the water.