Episode 2

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“I actually think its a lot easier and more efficient, video consultations because you don’t actually have to leave your house and if people aren’t able to leave the house, if they’ve got young people to look after or their jobs don’t allow it, if you’ve got an hour spare it’s so much easier to have a chat over video consult than to go and travel and you don’t spend as much time with the physio and it’s a lot easier to discuss things you might not in an actual physio room”. 

Welcome to the episode ‘Empowered Beyond Pain’ podcast, proudly brought to you by Body Logic Physiotherapy. I’m Kevin Wernli, a physiotherapist and PhD researcher, and I’m joined by world leading physiotherapy specialists* and clinical researchers Professor Peter O’Sullivan and Dr JP Caneiro as co hosts. We’re based in Perth, Western Australia, and through this weekly podcast, we aim to make sense of science and bring evidence to your eardrums, to empower you to better health, and empower clinicians to provide the best care for people in pain.

Welcome to episode number two of “Empowered beyond pain”. It’s great to have you back with us, you’re proving to be quite the company so thanks for all the kind words on twitter and facebook, it means the world to us! In this episode Professor Peter O’Sullivan interviews elite cricketer, Baxter Holt, and they chat about Baxter’s expectations and experiences with physiotherapy delivered via telehealth. This interview highlights just how much can be done via telehealth. It also highlights a few points that often surprise people… like how physiotherapy can be delivered without having to put hands on people. We hope you enjoy episode 2 of “Empowered beyond pain”, is there more to pain than damage?

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So thanks Baxter for chatting to us today you’re based in Sydney and I’m based in Perth and the great thing is with this mode of communication as we can have a chat to each other as if we’re kind of right next to each other but we’re not look before we have this conversation I’d love to get your bit of bit of background as to who you are and and what was going on for you a couple months back before you had your first video consultation with the physiotherapist yes I’m contracted witness roles the curricula I’ve been contracted with them for the last two years but I’ve had it back back to probably the last two years now and I kept playing through it for about 18 months until I couldn’t go any further and they got to the stage where the painkiller I was taking weren’t doing the job that I needed them to and I just had to put call it quits for a bit and but then so I saw a few different physios our physios at new so I was a doctor and then I was scratched going down the line of being booked into an operation the following Tuesday that was and then I got a call from can I ask you what the operation was and what it was for so as my L father s one disc that appeared to have a slight bulge that was compressing the nerve which was give me a heap of pain down the leg of that sciatic nerve pain and had you have any injections or anything for that so I had an injection and probably six months prior to how it was really bad probably pretty much full our season started yeah they gave me two weeks or a leaf and there was back to where it was that you said he had pain down the leg yeah so from that experience we sort of said well I didn’t work what else can we try and we tried six weeks of complete rest and that failed as well as probably worse than when I started you know and then yeah we were booked into it operator on the microdiscectomy just to shave the end of the disc yeah and then I got a call from the ex physio from your soils and said there’s this physio over in Perth do you want to give him a call before and then we go down the road of operation because that’ll push you back 24 months if you go down that road in what you actually want to do in your job in cricket yeah okay so how was the pain impacting on you at that point at that point I wasn’t sleeping I’d get to sleep probably about 12:30 1:00 a.m. in the morning and then I’d be up every 45 minutes every time I roll over I’d wake up and then if you don’t sleep it impacts your whole life really side the way I describe it was I didn’t have a life I was so in depth with all the pain I was going through and trying to continue playing cricket there’s sort of my life there is the first thing to you out the window and there was mainly how am I going to be up and able to perform in what I need to for the team as well okay so it was kind of stopping you from playing cricket but also impacting on just normal day-to-day stuff and any asleep yeah at that point you couldn’t you couldn’t really see a way out of that in terms of you know like any other strategies to manage it because you’ve had a fair bit of physiotherapy had tried the injections you had the scan that suggested that this finding was there and you’ve been told that surgery looked like was that was the most likely option for you yes so from what we went through from over the two years being bad the only sort of thing that was left in my opinion was to have it operated on okay good the information I got from other people I was thinking roll we’ve tried everything and the only thing that’s left for this and specific reason yeah okay video it was lucky that I had an excuse oh call me in so let’s try this one more thing before we go down that road interesting so as you know in the current Korova 19 climate video conferencing is the thing it’s become pretty big thing and there’s a bit of uncertainty I think for patients and for physios about how that works and I’m interested in your perception of what you expected but actually what was your experience with that how did it had it work for you how was it um solving even with a pretty open mindset because of the sale I was you know I was happy to try absolutely anything and however I had to do it to sort of make it work yeah and then yeah with the access to technology we got these days it’s amazing what we can do with it and you know especially being from different states I and countries in some cases you have that incredible access to different people yeah and so yeah we did that and I was lucky I had another physio with me in the room at the same time sort of you know helping with anything I found confusing but you know it was actually really good and I wouldn’t be in a state I am today without the video consultation so you talk me through what happened in the consultation yes I went to well our facilities and for Queen it was with the physio that I had and then we just got call with a feed over in Perth and and then we sort of went through it all and sort of sort of talked about my background and how bad my back was and sort of how I got to that stage and then the best thing about was how much he listened he really sort of took in what I was saying and and went down that road and I felt that was very helpful and then it sort of helped him get an understanding of where I was at and sort of how he was gonna go with it yeah and he sort of went in a lot more depth than what other physios and doctors had gone in previously with me in what kind of areas well he sort of dive into sort of more out of cricket perspective and sort of went down the life so like sleeping how much was affecting that how much was it affecting your current everyday life which was play the main thing yeah because in my line of work it’s very performance orientated yeah and so for someone to go down a different route and say oh how is it affecting your actual life and day-to-day life yeah and that was a big turning point and you know there’s just sort of the level II talk but that lovely listened as well yeah I felt like you listened a lot more than what he spoke about yep interesting and and was there any kind of examination that went with that as well was it just talking NASA after we sort of spoken got a brief background into it then he sort of made me stand up and with the access to cameras and Adi who was able to see how a movie asked me a few questions on ways to move and sort of run me through briefs on examination that he would do in his clinic but over the video consultations or run me through that and through the video is able to see just how bad it was and sort of the Whale I was moving what was actually causing that pain was different to what we expected yeah and what what did you learn through that process of being examined so here’s the analogy of I’ve been walking with a clenched fist it was long like so all the mast if you clench your fist all the muscles in your forearm completely sort of seized that type thing to protect all that yeah and because I had it for so long all the muscles in my back and core completely seized up to try and protect all that spine okay at the end of the day all the muscles you know it was actually causing me more harm than what the underlying problem was yeah right so okay by me reacting all the muscles that would sort of relief most of that pain I was in you know okay so then in terms of setting up a treatment plan for you obviously via video there’s no hands-on stuff right which is often what patients think physios do so what what kind of treatment did you get in terms of through video so the treatment sort of video was a lot more talking to Remy through a program that was easy to do wherever I was so their program I’ve got I still used today I can do it from in my bedroom in the lounge room to up the local part to a gym if need be and so it’s very easy to sort of conduct my program wherever I am at the time and you know whatever space I’ve got but he sort of went probably half now they consult was just talking through this program and discussing the ways to do these exercises and the things that you can do better and how you can do it better or ways that people can go wrong in the exercise as this new okay and that was probably the most important thing in talking through that stage yeah I got an understanding of how to actually do it and yeah if I was doing it wrong then he can see and sort of help me get it better okay because without having the help of the physio on hand you can sort of struggle in understanding where you know someone’s coming from yeah but it was it was that filmed Baxter as well because the beauty of video as you give film yes I’ve actually got a film Attell we went through that day and those blue exercises you know I I had another person there and he filmed what I was doing so I’m going to take it home yeah but you today you can set a camera up anywhere and yeah you just press record and was that helpful yeah definitely so on don’t have the greatest memory so for me to be able to look back on that footage and write down the exercises I went through you know that’s in a book on a whiteboard yeah or just look back at footage and makes it so much easier to try and remember it and you know throw it the way that it was actually prescribed yeah okay so and how helpful was that for you Mayers changed everything where I was sort of six months ago where they now – now actually got my whole life back and I 100% thinking that it’s because of the video consultation because without it I was booked in to have an operation on and I’m probably be lying in a lot of pain right now yeah okay and we said a lot of consultations or how many do you have so he had one initial one which was more the background information and so they’re seeing how I moved and then starting a program and then I probably had one probably four weeks later to see how I was going to see where I was at then and if we had any changes and then a few more exercises were added to that and then in all we probably had three three consultations and it was just seeing how I developed over that twelve fifteen week period and if there was anything the physio could see that I was doing wrong or you know that sign could be helped you know think it was a six week stage where I went through a cycle where at my lower back was really good my up from extending backwards it was still grabbing causing me a bit of pain you know and with the ability of the video consultation again he was able to see what I was doing in a little way that I could think with that straw and help it you know and it was solved in a matter of five minutes yeah okay so so actually that ability to examine wasn’t limited by the fact that you were looking I stayed away a couple of states away yeah okay so if you would I mean in terms of your situation now you’re back doing all the things you want to do and and in terms of your pain levels that’s not a major problem for you now so when I stopped I literally ‘can’t on my shoelaces or their everyday stuff so maybe added my job of keeping which is one of the harder ones you know forget it I remember one guy got into a squat I just clean get back out of it which for a keeper it just can’t be happening so I got to that stage right completely cancer but I was actually able to play the last three rounds of this season so I was out for four months and it took four months for me to go to not being able to do anything and literally anything to doing my job again awesome so if someone said to you you know what do you think about video consulting terms of a physio because they can’t put their hands on you and do the normal things that often people expect is yesterday what would you say that and a lot of future works not hands on treatment and you can do it wherever there’s still a very minor cases where these hands on stuff that you can do that at home with different objects like you got the foam rollers those days trigger point balls bands all that sort of stuff that you can write or manipulate all your muscles the same way if you don’t invest yeah all right so the value is something more than that then yeah definitely yeah so for me it officio overlooks what I do and tells me if I’m doing it right or wrong and especially with their background in anatomy and how the body works yeah it’s a little better than what I can think of so to have their opinion on how I’m moving and maybe ceasing I’m not yeah is more valuable than any hands-on treatment yeah okay it’s interesting so it’s more like a coaching role coaching your back to health rather than you know lying on a bed and having stuff done to you yeah yeah and what would you tell others so obviously you would say don’t see it as a limitation see it as an opportunity in this current climate because obviously one of the issues we’ve got at the moment is that people you know there’s a risk for some people to come to see a physiotherapist so there is risk and so a lot of practices are moving online and and to patients obviously there’s a bit of uncertainty is like well what would that be like because it’s not something they’ve experienced before what would you actually thing is a lot easier and more efficient via concentration because you don’t actually have to leave your house you can enter people that aren’t able to leave the house the certain different reasons if they got young children they go look after yeah well just their jobs don’t allow if you’ve got any our spare it’s so much easier to have a chat over a video consult and to go out you got a trial distance you don’t spend as much time with the physio I’m sorry I’m more time with the physio and it’s not easy to sort of discuss and you know talk about things that you might not in an actual feature room yeah that’s interesting and did you think there were any major limitations from it I don’t think sort of depends on how well the Fujio discusses what’s going on and so they’re you through the exercise I would say that’s the only thing is because he’s not there physically maneuver your body and if you have ways to try and get that movement going yeah if the physios I would explain it thoroughly and actually the participant sort of honestly saying I don’t understand that or I do understand it that would be the only thing but if you’ve got that trust and all honesty is by the biggest thing you know saying I actually don’t understand what’s going on here and the feejee are being able to so describe in depth of what you’ve actually got to do then I don’t think there are any limitations yeah it’s interesting just the hands-on stuff yeah so communication seems to be the key theme that runs through that whole process isn’t it probably indications the biggest thing and especially not be able to physically touch or be there in person I think communication has to be there otherwise yeah it won’t work is there’s still work but it won’t work anywhere near as good as what you want it to yeah that’s cool look thanks so much for sharing your story today Baxter and I wish you well in your down season and hopefully with this coronavirus will be a level where you can get back to enjoying the next season thank you thanks very much

So, there you have it, episode 2 of Empowered Beyond Pain. Special thanks to Baxter for generously giving up his time, I look forward to seeing him catching nicks from behind the stumps for NSW very soon, although hopefully he drops a few when he’s playing against the WA Warriors when Cricket eventually resumes.

My takehomes were:

• Physiotherapy (and other health services) can be delivered by Telehealth and its a great way of empowering the patient to gain control and self-confidence in managing their condition. In the last episode we talked about a study called a systematic review, which summarises all the available evidence on a topic, and it compared the effectiveness of face-to-face compared to telehealth management for musculoskeletal pain and injuries and showed it was equally as effective and accepted by patients!
• That telehealth can work well as a stand alone, but it can also be helpful as a second opinion, even from the otherside of a very big country.
• That Baxters physio listened and explored a variety of factors that we know can influence pain.
• And finally that Baxter still had a thorough examination and a tailored plan to get him back to living, doesn’t sound like he saw telehealth as a limitation at all!

We finish each episode with our “To try today” segment which is designed to help you turn information to action, because we think the best way to learn… is to do. So for those that have pain, perhaps you can talk to your HCP about other avenues to provide care that may not involve hands on treatment. If you’re a healthcare practitioner yourself, maybe you can reflect on how you deliver care via telehealth, and practice with a colleague, giving each other constructive feedback.

Soon, we kick off a mini series of episodes related to osteoarthritis. It starts of with Professor Peter O’Sullivan interviewing a world leading professor and orthopaedic surgeon, and then our very own Dr JP Caneiro is interviewed by not-profit organisation “Arthritis and Osteoporosis Western Australia” where he provides us with an evidence-based, up-to-date ‘A-Z of osteoarthritis’. Later in the season, we discuss the 10 scientific facts every person should know about low back pain – including hearing from patients who have escaped the pain merry-go round. If you have comments or questions, reach out to us via twitter. Subscribe, rate and review and to help more ears hear this evidence, and feel free to share this in your networks. But for now, stay sane, safe and healthy, and remember to ask, is there more to pain than damage.

Please note, what you heard in this episode of “Empowered beyond pain” is strictly for information purposes only and does not substitute individualised care from a trusted and licenced health professional. If you would like individualised, high-value care for your pain, sports or pelvic health problem, head to the body logic physio website… and make an appointment. Theme music generously provided by Fervun, and Cash.*Peter O’Sullivan and JP Caneiro were awarded specialisation by the Australian College of Physiotherapists in 2005 and 2013 respectively.