The Everyday Shoulder – 14/11/20

On Saturday November 14th, 2020, I am running my Everyday Shoulder workshop for the Queensland APA in Brisbane. Want to know what we will be covering, check out the video.

To register for this event, click here. You will access the APA Professional Development site where you can locate the fees, venue and other information. The event is open to APA member physios and non-member physios (who will need to open an account).

My interview with Fiona

To acknowledge the 2020 concurrence of Men’s Health Week and National Continence Week I was asked by Fiona Rogers of Pelvic Floor Exercise to have a casual chat about men’s health, how I got there, what I am doing and (at the end) to reveal a surprising and unknown fact about myself.

The conversation was recorded and is now available on Fiona’s You Tube channel. To view the 30 minute fig-side chat (we don’t do fires here on the Sunshine Coast in Australia so we did it by a fig) simply click on the link below.

And remember to go the distance to discover my surprise reveal…..

What to Wear to Work?

I remember way back when studying physiotherapy, it must have been third year when we went into clinical placements and I was assigned to St Vincent’s Hospital in Melbourne. I was so excited, not because I was finally being let-loose on unsuspecting patients, but because I got to wear a white coat.

No, not a coat. We had white lab coats for anatomy dissection and physiology labs since first year. This was a white jacket. It was like what my dentist wore – half length, button up front at the side which continued to the neckline. A proper medical, clinical, ‘I know stuff’ type of jacket. It must be like when med students are handed their first stethoscope to hang around their neck announcing them as a doctor.

The difference was that, once graduated, I never wore the white jacket again. Whereas medical students continue to wear a stethoscope for their entire medical career or until they become specialists. And not only in the wards, they wear their official ‘Doctor Scope’ to the café, to meetings, when driving home and even (while still students of course) on public transport. Just so they do not forget they are a doctor.

Apropos of that, I have been thinking of what physios wear when working in private practice. I have written about this before in relation to how you present yourself to clients, referrers, and staff as a function of what you expect to be paid. It is probably time to update that, but this article relates to the current pandemic situation.

Do you wear your street clothes while treating patients? Do you travel to the clinic, pick up a coffee, fuel the car, drop the kids at school and then start treating patients in the same clothing? Then return home via the supermarket, bottle shop, child minding facility and resume your domestic life in those same clothes? How does this fit with COVID level hygiene practice? Your hands might be clean due to repeated washing and sanitising, but how any times per day do you touch your clothing? And does your clothing contact patients or other equipment in the course of your work? Are you potentially bringing contamination from work into your home and family?

While not wanting to seem alarmist or paranoid, maybe it is time to consider separating our street clothes from our treatment clothes on the basis of hygiene or perceived hygiene.

A simple white jacket (or pastel blue or navy) over the top of street gear might be the simplest strategy. Wear it in the clinic for a day or so then launder (may need a few of them). Or a uniform that you change into on arrival and remove before departure from work. Or scrubs. Seriously, scrubs?

Scrubs are the new stethoscope. Wearing scrubs says, ‘I can save your life’. On the USA show ‘The Doctors’ the medicos wear scrubs to sit in a TV studio and discuss health issues. Physios working on the wards in many hospitals are now wearing scrubs. They come to work, change into these strikingly fashionable garments, do their day’s work, change out, bin them and head to the pub.

I am not advocating scrubs in a physio private practice, but then again – why not? They allow comfort and flexibility when moving from plinth to gym work and with clear branding (company) and name tagging they establish the professional role and associated behavioural expectations. Additionally, the time saved every morning when deciding what to wear would be considerable.

What you wear is up to where you work. It may be determined by climate, nature of the client base, image of the practice or simply historical habit. You may be instructed to meet a dress code standard, provided with a uniform, or just left to your own professional judgement. Now might be an opportune time to evaluate the role of your treatment clothes in the patient/therapist interface in terms of hygiene and protection for both you and the client. Don’t even start me on bandanas and footwear.

Foot & Ankle Workshop Brisbane

I am running my Everyday Foot & Ankle Workshop in Brisbane on Saturday July 25th, 2020 for the Australian Physiotherapy Assoc. This is a one day event covering common foot and ankle conditions seen in everyday practice. Things like ankle sprains, tendinopathies, hallux rigidus, plantar fasciosis and more. Also lots on decision making for orthotics and taping. Oh, so much taping. You will leave with a current knowledge of assessment and management strategies for the work you see everyday in the clinic.

This workshop is always popular and the feedback from physios in Australia, NZ, Ireland, UK and USA is always positive. It targets exactly the

For more information and registration details click here

This event is open to physios who are not APA members, but of course the fee is different. As you might expect.

A New Men’s Shed for Remarkable Men

Today I had the opportunity to celebrate the opening of the new Buderim Men’s Shed here on the Sunshine Coast of Queensland, Australia. I have been a member of this Men’s Shed for many years where I chair the Health & Well Being committee. This involves organising the monthly health education events, delivering the annual health screening tests and supervising the fitness centre three mornings per week as the guys do their resistance circuit.

This Shed has almost 300 members all over the age of 60 with many well into their eighties.

My role today was to host the official opening ceremony which was conducted by two federal politicians alongside our Shed president, Barry Cheales.

The contribution of Men’s Sheds to the health and quality of life of older men is obvious when observing them in action and across a longer time frame. Research suggests it helps overcome post-retirement loneliness and lack of purpose, two of the social determinants of health.

I will include a photo of the new shed complex which is purpose-built and brand-spanking new. The members have raised funds and accessed government grants and other support from sponsors and supporters to construct their new shed. The next few weeks will see a gradual movement across from our previous shed, our temporary home since 2013.

No photo description available. Opening by Barry Cheales, Ted O’Brien MP and Scott Buchholz MP.

Impressive, yes? And so is the triple men’s shed. I can’t wait to set up our new gym circuit in the new space.



Slides: what happens when they don’t work….

It was an absolute catastrophe. I was on a weekend road trip doing a shoulder workshops for a group of physiotherapists in Wollongong (south of Sydney) on the Saturday, and in Newcastle (north of Sydney) on the Sunday. The venues were about 4 hours drive from each other.

My workshop was structured around (wait for this, it will date me) a slide presentation spanning three carousels. Remember them? The circular slide cartridges that dropped 35mm slides into a projector. These are in the days way before data projectors and PowerPoint.

Anyway, Saturday went very well, finished up and drove to Newcastle that evening. Got to the venue ready to set up for the Sunday event and the venue had done a great job, the projector and screen were ready, the whiteboard, chairs, coffee station all good. So I started to unpack…. only to find my slide carousels were missing. Well not missing as it turned out, just sitting back down in Wollongong. And 15 minutes to showtime for 50 participants.

I had no back-up plan. I couldn’t cancel the event as people had flown in or driven some distance. I went through the Kubler-Ross stages of loss: denial (they must be in here somewhere), anger (who forgot to pack them? what a disaster), bargaining (asking my assistant to retrieve them somehow for the after lunch session at least), acceptance (well, they are really missing) and finally onto resolution – I will do the whole day without them. I got through the five stages in about five minutes because I had to.

I never used those slides again. Never. Not because I didn’t recover them, but because it was the best day of teaching I had ever done. Robbed of my slides, all I had was me. So I told my stories, showed my techniques, discussed with the audience, jumped all over the usual program sequence to meet the demands of the group and received the best feedback ever.

Now, some fifteen years later, I still do a similar (updated) workshop for physiotherapists and I still don’t use any slides. Instead, I teach. I talk, demonstrate, joke,  listen, review, monitor, correct and encourage.

This teaching sure beats giving a great slide show.




It Changed Our Thinking

It must be at least fifteen or twenty years ago when I first heard the term ‘under-recovery’. Until then we had labelled chronic, repetitive microtrauma injuries as ‘over-use’ injuries. Believing that the tissues were damaged due to repeated, frequent overloading.

Under-recovery suggested that the loading may have been quite appropriate, provided the tissue (tendon, fascia, muscle, bone, sheath, etc) had sufficient time since the last loading cycle to recover.

The ability to absorb more loading was reframed from one of being too hard on the body, to instead being too impatient and not allowing the normal cycle of post-training stress recovery reach completion.

So we started managing the recovery cycle with the same diligence and vigilance as we did the work cycle of training. Not only did we reduce the injury stress, but it turns out the level of performance would often go up as well. Whether this was due to the change of cycles directly or due to the longer period of training possible because it was not being interrupted by injury is difficult to say, and possibly irrelevant.

However this was a short won victory for common sense. Once the coaches realised sports science could improve the quality of the recovery cycle they increased the frequency and intensity of the loading cycles to maximise training adaptations. Active recovery strategies led to increased loading cycles and the injury and burn-out complications reasserted themselves.

I find the same thing happens in a busy life of work, family, recreation and chores. When I raise the efficiency of managing my tasks I then see gaps into which I can add more tasks…

So, how are YOU doing? How is your RESILIENCE?

Resilience: the current buzzword in business training and life management is RESILIENCE. It is not new, just a rebadging of the ability to bounce back, to roll with the punches to pull yourself up by the boot-straps, and other meaningless babble.

But actually it is not so much overload as it is under-recovery in terms of not quite regaining your equilibrium between the challenges that life will inevitably throw your way.

Each of us will handle this in their own way. Maybe not a rational or appropriate way, but the way we have always used (habit) probably learned when our minds were most plastic (childhood and adolescence).

Recognising your resilience is compromised is the first stage of avoiding burnout, depression, anxiety or other such failures of your coping mechanisms. Taking action and seeking assistance is the next step. Action and time to allow your recovery cycle to prepare you to step back into life’s fray.

Looking on from outside, you may not fully appreciate the range or depth of others’ overloading and risk judging them harshly for what you perceive as failings. Really, really try not to do that. It is not helpful for either of you. Ask how you might help (not fix, just help) them share the load. And if you are part of the problem, get out of the way without taking it personally (tough ask).

Finally, keep an eye on each other – your loved ones, your family, your team mates and employees. Your professional colleagues, teachers, students and most importantly yourself. Be mindful of how others are coping and dealing with their loads before you dump some of yours.

Bedroom TV & Body Weight Gain

A recent study suggests having a TV in a child’s bedroom significantly increases their likelihood of weight gain in the subsequent four years. Perhaps setting them up for a lifetime of battling excess weight.

The study published in JAMA Pediatrics confirmed previous studies linking a bedroom TV to increased risk of being overweight.

Read the study abstract here:

The lead author, Diane Gilbert-Diamond, spoke with Reuters Health and pointed out the TV saturation rate in adolescent bedrooms (71%) and and suggested a responsible parent should remove it to help children get a healthier start in life.

The mechanism of action is not clear with possibilities including disrupted sleep patterns (correlates with weight gain), increased exposure to convenience food advertising and prolonged inactivity periods.

Good luck removing the TV from your teenagers bedroom I say. In fact, the best strategy may be to lead by example and remove any TV from your own bedroom first. Who knows what other benefits might accrue when you have to make your own entertainment…..



Drink, Chew, Breathe

Experiencing gastric reflux or pain is very unpleasant and can be a health risk over time. Changes occur to the lower end of the oesophagus as stomach acid provokes changes in the lining of the lower gullet (Barrett’s Oesophagus). Having experienced this I gave some thought as to how I could manage it without the prescription medication (proton pump inhibitors such as Zoton, Losec or Somac). The answer turned out to be very simple: Drink, Chew, Breathe.

read more

Healthy is the new Safety

While giving a presentation last week as part of National Men’s Health Week, it occurred to me there were parallels between safety culture in the workplace and the strategies of healthful living. I wonder if my men’s health education work would be more ‘sticky’ if I pursued this line of thought by helping men to adopt the safety cultures they are immersed in at work as a tool for managing their physical and mental health more effectively.

For example, the concept of ‘procedural drift’, the phenomenon of  what happens when nothing happens. Detailed industrial safety protocols provide guidance to avoid injury and death, and are usually followed to the letter when commencing a new task or process.  However, with time the workers may start to take some shortcuts in the interest of perceived efficiency (or laziness), safe in the knowledge that no injury or death has befallen them. They start to drift from the procedures as written.  This can be minimised by regular safety audits and training. But humans being human, and the laws of entropy, suggest the drift will start again.

Here is an example from agriculture. A primary producer I know told me when he started working with a particular chemical he followed all the recommended safety procedures when transferring the chemical from drum to dispenser.  He gloved, masked, used a well ventilated space and had a hose handy for any spillage. With time, however, the mask, gloves and hose were gradually dispensed with as he never had any problems… until. But that is another story.

Lifting technique is another example.  Following my workshops on manual handling, it is apparent the workers think and act differently when lifting. For a while. Then they tend to drift back to their previous habits because, well, nothing felt any different with the new procedures.  Interestingly, those workers with a history of back pain or injury tended to continue the new approach longer than those who had never experienced difficulty.

So back to men’s health behaviours. Whether it is dental checkups, nutritional advice, activity guidance, relaxation or mindfulness training, any fresh information or behaviours may well gradually morph back into previous habits because there is no observable short term benefit. Think about gym memberships – the reason for enrolling persists long beyond the regular attendances because no short benefit is seen.

Health outcomes are not short term benefits. Just as health failures (heart disease, cancer, kidney failure, lung disease) are long term outcomes of poor decision making; health improvement is a long term outcome of better decision making. Procedural drift makes it very difficult to experience the long term benefits of behaviour change because of the short cuts and failure to follow the program.

Regular audits and training in the form of check ups with your health professional, information or activities to reinforce the message and the benefits and maybe even utilising a health coach to keep an eye on you and hold you accountable (the personal equivalent of an Occupational Health & Safety Officer) will improve your chances of success.

All the best,

Craig Allingham
Sports Physio and Health Educator

PS: Just as nagging from your boss won’t improve your attitude toward safety procedures, nor will nagging from your life partner improve your attitude toward better health decisions and behaviour. Just saying, that’s all.