Ashwini Kamath: Hello and welcome to Brain Injury Bites where we provide help and advice for people after a brain injury. Hi, I'm Ashwini and I'm a trustee at Headway Warrington. I'm also a senior associate solicitor focusing on catastrophic injury including brain injury.
Brooke Trotter: My name is Brooke and I've lived with a traumatic brain injury since 2007.
Ashwini Kamath: We're absolutely delighted to welcome Colin Green today to Brain Injury Bites. Colin is a neurological physiotherapist at PhysioMatters in Oldham. Colin, would you perhaps like to introduce yourself to our listeners?
Colin Green: Of course, and thank you very much for inviting me to come and speak today. It's a pleasure to just get the message out about neuro rehab and brain injury.
My name is Colin Green. I qualified as a physiotherapist back in 1992 and worked in the NHS for eight years. And then started to think that there was perhaps a little bit more that I could do for clients and that we could do for clients and telling people that they'd achieve the potential when really there was so much more that could be done.
So my real interest is in longer term rehab, managing long term conditions. So I feel really privileged now that we've got a fantastic team that was set up in 2000. So we've been going 23 years now and we've got a team of 15 of us based up in North Manchester and we provide treatment across the Northwest for people who have acquired brain injury, so that may be traumatic brain injury, or stroke, or head injury, or Parkinson's, MS. So a wide range of conditions, but my particular interest is brain injury.
Ashwini Kamath: So you were in NHS practice beforehand, was that more on a general physiotherapy sort of route? And what brought you into neurological physiotherapy?
Colin Green: That's a really good question. Because initially when someone comes into physiotherapy, they feel they're going to be the physio for Manchester United. Everyone's going to be the physio for Man United or probably Man City now.
Ashwini Kamath: There are other football teams available!
Colin Green: When you first qualify as a physio, you do everything.
So you go around every three months on a different speciality. And I soon realised that the areas I wanted to work in were longer term rehab. So it was neurological rehab. It was amputee rehab. It was complex orthopeadic trauma. So quite soon I started to specialise, which is fairly unusual. But then over my eight year career, by the end of it, I was a Senior One, which would now be a band seven physiotherapist setting up a community neuro rehab service in Oldham, but it felt like it, you could do so much more. So yeah, in answer to your question, it is a general education to start off with and then you get more and more specialised. And I did my master's degree as well since that. I went back into study 15 years after qualifying.
Ashwini Kamath: Wow, okay.
Brooke Trotter: That's the problem with brain injury, isn't it? Because it can keep, I don't know how to say this, but with the NHS, they, you know, they can only take, due to, you know, funding restrictions and so on. They can only take you so far, but it's one of those things you can keep having treatment for the rest of your life, really, because it's something that you have to live with.
Ashwini Kamath: Yeah, it's not going away, is it?
Colin Green: Yeah, that's really good, Brooke. It is that ongoing, it is a lifelong condition and there are, there are different phases, which I'm sure we'll talk about later, different phases of treatment. But yeah, the problem doesn't go away, but a lot of the work is it's treatment, but it's also management of a condition - How do you manage your condition? How would you move forward with that condition? And certainly, my experience of when I worked in the NHS back in the past was from a kind of the initial acute setting when someone's in intensive care is fantastic. But kind of after that, people who've had traumatic brain injury don't really sit anywhere in the hospital.
So are they an orthopaedic injury? Probably. Are they a psychological - is there psychological components? Definitely. Is it possibly psychiatric elements of it? Yeah, there could be. Are there behavioural issues? Quite possibly. You know, are there wider family issues? Are there, and how are all these different conditions?... There may be respiratory issues.
So it's kind of where does that patient at that point, where do they sit in the hospital? And it was always quite a difficult thing for someone who had a traumatic brain injury, where do you put them?
Ashwini Kamath: Yeah, it's multifactorial, it's not a single issue, is it? And that kind of leads me a little bit to just for the benefit of our listeners, if you could just explain the difference, or rather what neurological physio is? Because I think most of us when we think about physiotherapy, you know, we do think like somebody's broken their leg, it's rehabilitating the mobility back into that or, you know, arm, whatever. But how do you work with patients with traumatic brain injuries? Or other neurological conditions?
Is there a sort of an interplay between what's going on in the brain and the sort of physiological issues?
Colin Green: Certainly, I mean, the big overarching heading for the kind of brain injury rehab would be multidisciplinary. That it has to be… If you're a physiotherapist treating someone on your own with none of the other professions, you're going to probably struggle.
And that's where we're really privileged now that in every team we work in, there is a multidisciplinary team involved, but yeah, coming back to the, I suppose you could split it into three phases.
So you've got the acute phase straight after your injury. So that's from ambulance to possible surgery, intensive care through to high dependency and going on to the acute ward.
So that would be the first phase and the next phase will be the sub-acute. So you're still in hospital, but looking at plans to go home. So what's… or to go wherever you're going to be going.
And the third phase would be that chronic phase, which I don't really like. I'd rather use the word long term - that you're looking at how to manage someone's condition.
And then you've possibly got a fourth phase of kind of adjustment and condition management in the longer term.
So if we discuss the acute phase to start off which is the intensive care, the physiotherapist there would be looking at, with their experience, spotting problems that could occur in the future So for me that would be… a big one would be preventing any contractures that are happening So if you're on intensive care, the priority is obviously to preserve life at this stage. It is to create the best, I'm going to use you as an example, the best Brooke to be able to work on in the future. So we need to make sure that all your limbs are moving, that you've got the range of movement in all your limbs, so that later on, there's something to work with. Because if you're really contracted at that stage, there's a lot of undoing.
Ashwini Kamath: Yeah. Just explain again, for the benefit of our listeners, when you say contractures.
Brooke Trotter: Yeah, I was going to say, explain for me as well”
Colin Green: Yeah, sorry! So contractures would be a soft tissue shortening. So a good example would be... It doesn't work very well on an audio podcast. But if I was bending my elbow, my biceps muscle, if I kept my elbow in that position, my biceps muscle would shorten in that position. So over a period of time, then straightening your elbow would be difficult.
So that's a really simple, simple idea. But where we find it most commonly after neurological damage is in the calf muscle. So if the calf, especially if someone's been laying on the back, they may have been ventilated and the toes are pointing down to the bottom of the bed. So the calf has been in a shorter position for a long period of time. If you then start looking at sitting, standing, walking in the future, if you've got a really short calf, your heel is not going to touch the floor. So you can prevent those problems or aim to prevent those problems.
Initially, after a brain injury, you often have a period of what we call flaccidity or where the muscles are very floppy. But over a period of time, as you have to do more and the demands on you are more, that floppiness or flaccidity changes to be in high tone. So it becomes tight. So rather than the muscles being floppy, they become tight. And that's where you can potentially get contractures at that stage.
Ashwini Kamath: So I guess the important thing is like early intervention to keep things moving rather than wait for it to become a problem and then try and resolve it.
Colin Green: Yeah. So we, at that stage we'd use stretches. So it might be that your physio or the carers or the staff are doing quite a range of stretches even before someone's conscious.
It may be that you have to use splinting. So that would be where a device is put on you or cast on you where like it could be a plaster of paris kind of cast -they're not quite plaster of paris, but that kind of thing that keeps your foot in a good position.
Yeah, so it stops your toes pointing down to the floor. It stops your calf muscle tightening and also in your arms, on your elbows. It may be that you have splints to keep your arms straight at that point. Really important for the future.
Brooke Trotter: So what happens then if the muscles go hard?
Colin Green: If the muscles go hard and if they go tight? It can be quite difficult to undo. It's much easier to prevent than it is to sort out later on. But if your muscles are tight and if it has gone from a tightness through to a contracture, which is something that doesn't move, it's kind of stuck.
Brooke Trotter: Is that permanent then?
Colin Green: Yeah, but there are ways of dealing with that in the subacute and chronic stage. So it would be things like, you might have heard of botulinum toxin injections, yeah Botox, but a bit higher doses injected into the muscles to relax the muscles and you would use that in conjunction with splinting, like we were saying where you put a device on to give the joints a stretch.
It would be positioning as well, so trying to avoid it happening in the first place. Sometimes, and we have some clients who have to have surgery in the future, but that has it's complications and it has it's pros and cons.
So, what do you remember, Brooke, about the really early days after your injury?
Brooke Trotter: Not a lot to be quite honest, but I tend to lean on my parents and stuff because they've got all the memories of it.
They were talking to me and my sister was saying as well that the physios came in when I was actually still in a coma and did quite a bit of work with me there. I'm not sure what they were doing, but I guess to prevent me just laying there and having no…
Colin Green: Yeah, that would be, that would be really good practice that if they were coming in, doing stretches, making sure you're positioned right.
And perhaps telling your parents, if they could help. Because it's quite a nice thing at that stage to be able to ask relatives to be involved because what else can they do? They feel quite helpless.
Brooke Trotter: Yeah, I think it was quite traumatising for my mum because I was still in a coma when they were doing it.
Colin Green: Mm hmm.
Brooke Trotter: So, that's what you think they were doing, just stretching my muscles?
Colin Green: Yeah. Yeah. So sometimes it can be quite painful and some people who come out of a coma remember some of the pain of the stretches. Yeah, physios would have been coming at least daily.
Brooke Trotter: You get all those stories don’t you of people remembering what's happened in the coma, and they can see a white light and all that, but I can't remember anything.
Colin Green: Nothing that dramatic was it?
Brooke Trotter: Nothing at all!
Ashwini Kamath: Probably just as well!
Colin Green: But more, or quite often, you'll hear someone saying the first thing they remembered. I saw someone yesterday and the first thing they remembered was three months after their injury and they woke up in the rehab center.
Brooke Trotter: That's pretty much exactly what I remember, yeah. About three months after, yeah.
Ashwini Kamath: So you were saying in the acute phase you look at management of, you know, making sure that muscles are being used and stretched and so on to avoid contractures.
Are there any other things that you would be doing at that stage? Or is that kind of the main priority.
Colin Green: No you'd also… it depends on the unit, but sometimes you'd be looking after a respiratory function. So if someone's being ventilated, you'd be involved in their kind of breathing exercises, perhaps some suction, working alongside the intensive care nurses in terms of maintaining airways.
Ashwini Kamath: And just explain why suction is important for our listeners, if you wouldn't mind.
Colin Green: Yeah. When you are being ventilated in it, especially quite often after an injury, you may have broken some ribs. So it will be difficult for you to take those deep breaths, especially some of the lower rib fractures.
So it tends to be that the bottom of your lungs get full of rubbish at this point. So yeah, the top part of your lungs are getting aerated well up here, but the bottom can, you can get a bit of gunk. So…
Ashwini Kamath: Technical term there!
Colin Green: Yeah, technical term! You get sputum on there, which… But then you need to be able to get rid of that because it makes your lungs much less effective.
Ashwini Kamath: And I suppose there's also, it's managing risks of chest infections.
Colin Green: Yeah. And that's where the dieticians come in as well. And the speech and language therapists in terms of managing. It's a little bit later on, but managing diet, because at this stage you may have a problem with your swallow. So it may be that if you take in any oral diet, that it's going down the wrong tube.
So you don't want that lying on your lungs. So suction sometimes, we would use to get rid of that stuff while you're still asleep on the ventilator.
Brooke Trotter: It's quite grim that though, isn't it?
Colin Green: It's a long time ago thought, isn't it?
Ashwini Kamath: So after you treated a patient in the acute phase, how would the physio journey change in the subacute phase?
Colin Green: Yeah, so in the subacute, so I would say that's when you're out of kind of medical danger. So when you're, and you... Like you said, you, you start to develop more of a consciousness of where you are, of what's going on, of what's happened to you, and you're at this stage, you would often be still looked after, so you still are being transferred…
This is probably the time where you start to remember things, so it, you may be having to be hoisted you know, from the bed to a chair, you may be unable to sit. So we'd work on how you do those transfers, how you sit, how you stand how you do that transfer from bed to chair, bed to toilet. And those kinds of things are really important at that stage.
And it's quite often, I would say the probably heaviest workload for a physiotherapist in terms of manual handling, you know because you may have very little active movement to keep yourself sat up and you may get fatigued very quickly in terms of if you sat out in the chair, it might be for 10 minutes and that's enough to be able to go back to bed.
This probably seems a long way ago…
Brooke Trotter: I do you have sort of memory of that? When people were saying, you know, don't walk and stuff, and I was like, I think I was just confused at the time, like what are they talking about, I can’t walk, of course I can walk, and I walked, which this is not again, not good for audio, but I walked to like the corner of the room where there was a, you know, those hospital chairs. And so I'd walked, which would probably be about 10 paces and it was waddling, you know, just sort of staggered and more or less collapsed in the chair and I remember being absolutely exhausted from doing that.
Colin Green: Mm hmm. So was that a positive experience?
Brooke Trotter: I think it was, yeah. You just didn't really understand like why I was, I mean because I was… Luckily, I’d got into the gym before my accident, and I still have sort of memories of that. I thought I'd be, you know, I thought I was as strong as I was. And I suppose it was like a big element of shock that I wasn't, and people were telling me, you know, just, you know, be careful, and you know, I didn't really like to be told that, and I, just in sort of frustration, I got up and walked, and just, yeah, I just remember having to, having to go to bed after that, because it was just so exhausting.
Colin Green: You’ve brought up some really good points there, because there will have been quite a lot of work that happened before that memory. So before your memory there. So you've already described that you were sat in a chair. That you were able to get out of a chair. That you were able to stand up. That you were able to move across. So there would have been work on how did you sit? How did you manage to get from the bed into the chair? So there's all those parts of work prior to it.
Brooke Trotter: That I just don't remember. Yeah.
Colin Green: But what's really interesting is that, as you've said there, I was told not to walk. Can you think why you were told not to walk at that point?
Brooke Trotter: I just can't remember, really. I don't know if anybody specifically said to me, don't walk. I was just like, it was not… That might be my mum and dad, I don’t know.
Colin Green: Because when I qualified, they used to say, you were… We used to stop a lot of people walking right early on. You'd be saying, Please don't do that. Please don't. And it was because they weren't doing it perfect. So we didn't want bad movement patterns to be reproduced. But we'd go around the ward saying, No, sit down you, sit down, don't get up, don't get up. Don't, you'll spoil everything that we've done, you just stay there. And obviously now we’ve realised, that's an unrealistic expectation. That people have to, after hospital, have to go and live in the world and they'll do whatever they like. So, but your safety may have been a prime concern there.
Brooke Trotter: I'm sure it was, yeah. You just don't like to be told that you can't do something! I was 24 at the time, you know. I didn't really, didn't really understand. I remember people telling me what had happened to me, but just not really believing it. And I thought, not that they were lying to me, but they were just like, I just, I thought that they'd got the wrong end of the stick or something and just not really understanding why I was in this hospital.
Because I'm from a small town, Scarborough, and people were saying hospital. So to me, I've only ever known one hospital, it was Scarborough Hospital. So I always assumed that I was in Scarborough Hospital, and they took me once downstairs, outside at Hope hospital it was called then, but it’s Salford Royal and just being really confused and like...
Colin Green: Did you wonder where the sea had gone?
Brooke Trotter: Yeah. And just like, what's going on here?
Colin Green: We're not in Scarborough anymore!
Brooke Trotter: No absolutely not, so urm.
Colin Green: No, but that's... Why would you know where you are? Because probably a room in Scarborough Hospital would be very similar to a room... It's only when you go out there that the disappointment starts.
Brooke Trotter: I had this memory of, because I was in hospital, I'd done this stupid thing. I'd jumped off a hay bale a couple of years before and I'd broken my ankle. And I spent the night in, I was having an operation, I spent the night in Scarborough Hospital. And I'd, in my head, that I was in the same room or very sort of similar part of the building anyway because, to look out the window, I couldn't really see much, you can only really see the sky. So I just kind of assumed that I was, assumed that I was in there and then yes, to be taken outside. It was quite a shock to me, but you know, obviously pretended I'm not shocked, all was fine. [00:19:20]
Colin Green: But that's a common kind of experience that you're saying about feeling that this… either it isn't happening to you or it's another orthopaedic kind of, I've just broke something, which we quite often have with clients, but we really have it quite a lot with relatives who think it's just something else that's broken. It's another broken leg. It will get better. And it might be that you've got broken bones and they will get better.
But I try with our clients to reinforce quite early on that you will be different. This will always be different. It doesn't mean it's going to be bad but it will it will be a… we had Brooke one before the injury and we've got Brooke 2 now.
Brooke Trotter: I just didn't, yeah, just confusion, just didn't really understand what had happened and obviously now I've, you know, got the benefit of hindsight of, you know, all that stuff I've learnt about it and I've read about it and stuff, but then I just, I just, just confused and I just thought at first, you know, am I visiting somebody in hospital because I didn't really feel like anything was broken or anything, you know, I was obviously in no plaster, you know, plaster casts, and it was just… All I can just only think I can describe it as a massively confusing time with obviously pretending to know what's going on and…
Colin Green: And this is a time where we get lots of falls. So people think no, I'm fine, off we go… bang, or I could do that, crash... you know, and because the very fact of someone having a lack of awareness means their attitude to risk is very different because ‘there's nothing wrong with me’. So obviously I can go up and do this. And it's a long journey to kind of accept what's happened.
Brooke Trotter: I fell pretty badly in hospital actually. In the middle of the night, I got up and I stood up on my bed. And obviously there's a bed guard, isn't there, that comes to the side. And I tripped over the bed guard and I'd fallen, I'd fallen on my elbow, which luckily nothing was broken, but it's still a bit, it's a little bit dodgy now, but…
Colin Green: But you'd had 24 years of nothing being wrong. To wake up one day and I'm not quite as mobile as I used to be, then your brain initially thinks No, I can still do that’ and that's why you have the accidents.
Brooke Trotter: I think what probably happened was I woke up and I needed the toilet and there was these guards on so I probably tried to climb over it. Looking back that's probably what happened but then again I don't have a clue what happened so...
Colin Green: Yeah, that's not, that's really not uncommon and often in this kind of subacute phase moving into the longer term phase, the more mobile someone becomes, the more likely they are to fall in that period, especially if someone has a poor insight or a poor awareness into their limitations.
So for some clients, it would appear that their condition actually deteriorates a little bit. Or, especially if they've got limited cognitive function, do you know, if they're struggling to process the information around and they get mobile quite quickly, it can cause all kinds of problems.
Ashwini Kamath: Yeah, yeah, yeah.
Brooke Trotter: Yeah, I can see that.
Colin Green: That you've got the ability, but you've not got the cognitive ability to do with it.
Brooke Trotter: Again, I can see that now, but I didn't know then.
Ashwini Kamath: And I guess, I mean, fatigue also comes into it. You were saying, you know, you walked those ten paces, or you waddle those ten paces.
Brooke Trotter: I suffered so badly from fatigue at first.
I mean, I still do now, fifteen years later, but obviously to a much lesser extent, but yes, fatigue at first was horrific.
Colin Green: And I think the word horrific is, is about right, isn't it? Because it's I think, differentiated between tiredness and fatigue.
Brooke Trotter: Yeah, and add that to the frustration that nobody understands, that you just, particularly, it's more when you get out of hospital, isn't it?
When you're in the hospital, you know, you're surrounded by people that know, and you obviously... You know, your activities there are planned and, you know, you do some fun activity and you have a rest. And then, when you come out of hospital, you just, you know, you've got no structure to you, no structure to your life, so you're just, you're just exhausted all the time.
Colin Green: I think people often have a, people look forward to being discharged from hospital thinking, it'll be brilliant when I'm home, it'll be brilliant when I'm home.
Brooke Trotter: It'll be just like it was.
Colin Green: And when you get home, it… especially if you go back to where you came from, do you know, if you go back to your old place and it's like, it's a slap in the face to say, look what you used to be and look what you can't do now.
But fatigue can be split into two sections. It can be a kind of cognitive or a thinking fatigue, and it can also be a physical fatigue. Could you explain how yours showed itself?
Brooke Trotter: Well, I guess it was right before the, you know, the incident, I was the fittest I've ever been in my life and and in the best shape, which obviously helped me make a good, good recovery.
But I just remember just like, it's, there was a thinking fatigue that really got me. Obviously, my fitness had gone down, my strength had gone down. You still, in your head, you still think you're the same person, don't you? But obviously I was quite, you know, physically strong before it, and I was, you know, physically fit as well.
But all of a sudden this, it was, it was really the, the thinking fatigue, because just to, I don't know, concentrate on something like, even for five minutes, I couldn't follow anything on TV, I couldn't even... Just conversation, just everything, you know, all these things that come into your life, you know, you slowly realize what's happening, like, slowly realise that the different light of a room would… I always, I always equate it to like a battery on a mobile phone, I suppose that was something that was in my life at the time, and it's in everybody's life now, isn't it?
The more things that went on in my life, you know, like for instance, the room was poorly lit, you'd have to, you know, squint to see and that would impact on your battery life. And if you could, if you could, you had to, there was other factors, like there was other external noise that would, you know, and you're having to filter out conversations that would tire you out.
Ashwini Kamath: Yeah, because I don't think you realise just how much is going on.
Brooke Trotter: No, no.
Ashwini Kamath: For you to be able to filter that out.
Brooke Trotter: Yeah, this would come later, realising that, but obviously at first it was all hitting me. I didn't know what to, you know, I didn't know what to avoid and what to look out for. So it was just, I was just getting flat out exhausted and it was just tiredness that, you know, you try and understand, you're trying to explain it to people and you just think that you're really physically fatigued.
But the only thing I've ever could really liken it to was if you've ever been awake for 24 hours for whatever reason, and then just trying to have a conversation, then you would just, it was just like that all the time.
Colin Green: Someone once described it to me. They could feel after a meeting, say after something like this, where they had to concentrate that they felt like they'd been hit by a train.
Brooke Trotter: It's kind of, yeah. Yeah.
Colin Green: It was so severe. And it wasn't a ‘I'm a bit tired’. No. Bang.
Brooke Trotter: And people would say just, you know, go and have a nap. Obviously, the thing with just going for a nap is there was obviously like so much stuff going on in my brain that I just couldn't rest. And I remember that being a thing that I couldn't, I couldn't turn off, couldn't rest.
And when I got to this flat in Scarborough, my first flat. I remember there was a Buddhist meditation group, and I thought, Buddhist meditation, you know, an ability to calm the mind down, and that helped. But yeah, it was just, you know, you were so tired, but then you couldn't really rest neither. So, it was just like a constant thing.
Colin Green: Sometimes the rest can be in other activities, so it could be, rather than trying to sleep. It could be, I'll listen to some music or, you know, I'll listen to an audio book, or I'll go sunbathing if you're in Scarborough.
Brooke Trotter: Yeah, sunny Scarborough, it's always sunny in Scarborough!
Colin Green: But could you compare that with, did you experience any aspects of physical fatigue? Because you'll have known physical fatigue from, you know, exercising in your gym.
Brooke Trotter: I guess it was like just a mixture of both.
Colin Green: It's hard to, it's hard to differentiate sometimes, isn't it?
Brooke Trotter: Yeah. And I mean, like I said, it's only, you know, with the benefit of hindsight and the benefit of accruing different, you know, knowledge about my condition.
But at the time, I just didn't have a clue. So it just used to hit me, full-on, like a train.
Colin Green: I think that would be really useful for people listening to this who, who have got fatigue, because they kind of can look and hear your lived experience of, you know, what does it feel like? Oh, I feel... I feel like that, and it's, it's horrible.
Brooke Trotter: It is, yeah.
Colin Green: But it can change as well.
Colin Green: Obviously, you know, it does change over time. You don't notice it changing though. Well, with me anyway, in my experience, it changes that slow that you don't really, you don't think you're any better.
What tends to, what tended to happen was like, if I'd not seen somebody for like a couple of months or something, they would always remark about how much better I was, but then in your head you're just thinking, they're only just saying that to make them feel better.
Yeah, you don't notice it yourself.
Colin Green: Someone gave a really good analogy one time. They said it's like a train journey from Manchester to London. You get on the train in Manchester and it's pitch black. You get off the train at Euston and it's a beautiful sunny day. But you don't realise on that journey when the light started to go up.
Brooke Trotter: Yeah.
Ashwini Kamath: Yeah. Yeah.
Colin Green: But you can spot parts that probably when you're in Stoke, it was miserable. But as you got to Northampton, you know, you could see the sun coming up and by the time you get into London… So it's that kind of journey sometimes, isn't it? There's not one Eureka moment where you're like, ta da!
Brooke Trotter: And it's better now. It's, I mean, it's, yes, obviously now it's immeasurably better than what it used to be, but it's, it was, yeah, it was pretty grim at the start. I think what helped was… exercise helped. I was always, I was dead keen on exercise from the start. But you can, that, you know, that has its dangers as well, because you can, I used to overdo it, always overdo it and I used to just tire myself outmore.
You'd read these things about people exercising in the morning and I worked out that exercising in the morning was kind of the worst thing for me because that would kind of ruined my day because I’d never really recovered from it.
Colin Green: Right, quite often our work with clients is making exercise consistent, reliable, not over demanding, that it's something you want to go back to because we've all done the thing, haven't we? We eat too many mince pies at Christmas and then January we're going to go for it.
Brooke Trotter: Full on mentally, yeah.
Colin Green: You join the gym. And then by mid January, the gym's empty.
Ashwini Kamath: All manageable changes rather than big changes.
Brooke Trotter: Yeah.
Colin Green: We had a client very recently and we said, Right, what are we going to do? He said, I'm going to go to the gym five days a week.
Alarm bells immediately start ringing because the one week that he doesn't go five times.
Brooke Trotter: And it's ruined.
Colin Green: The weel after he’d probably not go at all.
Brooke Trotter: Yeah. I found that to do well, if you could, if you do something step counters, that's really good. If you're going for a certain amount of steps in a day, that's really good because it's something that you can, you know, you can keep your eye on can;t you. But I found that like doing something every other day is good because you've got a recovery day.
Colin Green: And from a training point of view rest days are just as useful…
Ashwini Kamath: Yeah.
Brooke Trotter: Yeah
Colin Green: …as exercise days.
Brooke Trotter: Yeah,
Colin Green: So I think to get that pattern in and as a physiotherapist, if we can kind of say, you do need those rest and fatigue diaries can be really helpful.
Brooke Trotter: Yeah,
Colin Green: So we can plot "Right? What have you done, what's your fatigue been?" So you could put it on a battery level or you could do it on a like traffic light system and see, you know, where your fatigue's going and we can look at it. In fact, we did this with a a client who was an ex-professional golfer and his fatigue was terrible and he said to me not so long ago, he said, Colin, can you believe how bad his fatigue was? He would do one thing. He might do 10 balls at the driving range and then he'd sleep for two days. But now he'll go all over the place. He'll play golf all over the place. And he's fine. He said, I can't believe how fatigued I was in the past and over five years where I am now.
Brooke Trotter: That's, that's a good point actually, because to sleep for two days, it really is that bad and people don't really get it.
Colin Green: And there doesn't look often to be anything wrong.
Brooke Trotter: No.
Colin Green: So, especially if someone's going back into employment, if they're going back into education or back into family life, the family can be ‘Well, are you doing all right? You're walking, you're moving, you're doing a bit of exercise. Off we go. We'll go on a holiday’.
Brooke Trotter: Yeah.
Colin Green: Going on the holiday might be... Sound good, but it might be the most stressful.
Ashwini Kamath: Yeah. And very cognitively demanding as well as.
Brooke Trotter: And the stuff that goes on in your head as well.
What are they thinking about me? Are they on to me? What do they think? You know, do they think I'm weak?
Colin Green: So fatigue is a really crucial thing.
Ashwini Kamath: Yeah.
Colin Green: That's a useful diversion, I think!