 Poster: A snowHead
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@pam w, and many people have some UK physiotherapy included in their travel insurance if they are injured.
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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As @Oblos has found, NHS is currently so overwhelmed/damaged that it is difficult to get treatment for "minor" injuries in UK. Very advisable to get treatment in resort if possible - they have all the facilities and experience, and it will clearly be covered on travel insurance. Insurers can get picky if you decide after a few weeks that you need private treatment - how do they know the problem was caused by that incident?
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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| pam w wrote: |
| At the risk of sounding rather heartless, @Oblos, if you can afford to go skiing, you can afford to see a physio privately. And possibly should have done right away - good people available in and around ski resorts. You neglected your injury for ages. But having said that heartless stuff, I do hope you now manage to get more mobile. |
Heartless. Yes. Also quite rude as to what you think I can afford. Injury was not neglected at all, but I was not expecting it to last this long or remain so painful with certain, mostly sideways, movements. Interestingly, I had a text from GP today [faster than expected] to say ultrasound shows tendons all attached and evidence of minor sprains and that improvement may take several months (!) [doc's exclamation mark]. If no progress OR gets worse get back in touch. So I will keep doing the exercises and go back to my pilates class. So I have not actually been able to see a doctor and this diagnosis is based solely on an ultrasound by a technician. Nobody has physically checked the injuries or seen how my range of movement is affected. It is worrying that face to face consultations are not taking place. So do I go and spend money on a second private consultation or wait for improvement or worsening first? For how long? At 68 it is worrying as staying mobile and fit is really important. At least I can still walk the dogs.
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@Oblos, a private physio appt will only be about £45. worth it at your age I would say
@Hells Bells, yes I had private physio with my travel insurance - I went three times a week till the money ran out then paid myself twice then once a week supplemented but the gym
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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@Oblos, +1 on physio. NB I had my recent knee MRI and Surgery at Spire Hospital in Southampton. I am using New Hall for physio as much closer to home. Mr Datta was my consultant. Seems good and to focus on you getting back to sport in a lot of his published stuff.
My previous knee surgeon his focus was gutting me walking again, he wasn't enthusiastic about my desire to return to hockey and skiing. Thankfully my physio was far more positive due to how well my progress was and highlighting as long as I keep muscles strong which are having to compensate for my damage reconstructed ACL
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You'll need to Register first of course.
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Have to say do agree with some of the sentiments on here re going private vs NHS.
Majority of all my physio treatments I've paid for, for sure £45 can be a lot out of a tight family budget so I also understand that POV.
Currently whilst I await my Carte Vitale and Mutuelle insurance I pay €20 for a half hour session.
But on reading some of the posts here, and on speaking to a friend yesterday who is now relying on the NHS , I'm glad I'm getting into the French system.
That said my twin daughters were born at 26 weeks and the NHS was superb!
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@Oblos, it was hardly rude to say you'd neglected your injury - your post suggested you carried on skiing and then waited months, increasingly disabled by painful and immobile shoulders, before you tried to see anybody.
I have no idea of your finances, clearly, but ski holidays don't come cheap so you are not poor. Did you have insurance? It's a question of priorities and even at 68 (I'm quite a bit older...) most of us tend to give quite a lot of priority to health over other ways of spending our money.
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@Oblos, a PT is an expert in musculoskeletal rehabilitation and exercise (along with CVR and neuro). They are the best placed clinician to address your issue. if you are able to get your US result and pass it to a private PT I would expect them to be able to get you on your way to health. They would do a whole body assessment of your movement and be able to suggest an appropriate course of therapy/rehab. I would also suggest that seeing a PT is better than going to any other professional as they are trained to treat people across the lifespan. If you go to a sports therapist, they dont have the background education in older age groups or associated conditions (at undergrad level).
The longer an injury is left, the more the tissue is likely to heal in a shorter/crappier way. That reduces range of movement, so the sooner you get seen the better. With exercise you will be able to hopefully get the tissue to heal in a more 'function appropriate' way, rather than all scrunched up scar tissue.
It may seem like cost is an issue but if you have an initial consultation, explaining what you have been doing, you may find you do not need weeks and weeks of therapy. The aim is to get you equipped with exercises which you can do yourself to improve. It is the 'quacky' professions that want you back week after week to justify their existence.
EDIT: This may help your search. https://www.csp.org.uk/public-patient/find-physiotherapist/find-physio
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| Weathercam wrote: |
We also talked about the benefits of the French Health Care system vs the NHS and how once you finally get your Carte Vitale getting nigh on free Physio for as long as you need is not an issue in France, as well as getting new hips/knees etc and the associated Physio.
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It is not free, people have to pay taxes to pay for all of that.
and around here the doctors are very reluctant to prescribe free this and that for as long as you like.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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| Weathercam wrote: |
 @davidof, aaaaahhh but with reciprocal tax treaties and being a personne retraitée along with a Carte Vitale and a basic Mutuelle insurance it's pretty damn good 
And yes here is probably different to your part of the world, though the OH did recently spend a week on the 8th floor of your local hospital!
| davidof wrote: |
| .....It is not free, people have to pay taxes to pay for all of that.... |
And the NHS is far more lax/beneficial when dealing with étrangers, that's one of the reasons why the NHS is grinding to a halt, they never ever ask how someone might actually have to pay for treatment.
Plus another reason why A&E in the UK is such a shambles as people go there because they're not registered to a GP, who probably would not see them anyway due to Covid.
It's all a horrendous mess.
Ironic as I've just been with another friend whose hubby is now on the 8th floor cardiac unit at CHU Grenoble, us Geezonairres should have our own ward 
So for those that don't know in France very roughly 75% of your healthcare costs are met by the government and the remaining balance is covered by a Mutuelle insurance you take out, which in our case is roughly €100 for both of us pcm.
Apologies for thread drift. |
Just to be clear, it is not paid for by the govt. but by the 30 million French people who pay tax and social security in the country.
And, I'm not sure you are retired, you are not at the UK retirement age unless you are older than I think. So should be paying tax and social security in France to pay for your free treatment.
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You know it makes sense.
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| boarder2020 wrote: |
| NickyJ wrote: |
@boarder2020, A good physio makes a huge difference. The injury normally will heal BUT a lot of the long term issues are created due to muscles compensating for the injury.
Where you don't have full range of motion you get shortened muscles, become weaker etc as a result. The physio exercises target those. I have had far more experience of this than I would like buy it made a massive difference to my long term recovery |
You can't say a good physio makes a huge difference with any kind of certainty. You don't know what would/wouldn't happened if you didn't use a physio. People heal at different rates and there are lots of confounding variables - diet, sleep, age etc. It's also very injury dependent - clearly there are some cases where a physio is much more useful than others.
In terms of weakened and shortened muscles, it's not rocket science - stretch and strengthen through resistance training. From a sporting point of view (excluding impact) most injuries have some kind of underlying cause - usually weakness or imbalance. By far th best approach is to work with a decent strength coach to fix this stuff and decrease risk of injury in the first place.
My PhD is in shoulder rehabilitation. I can tell you following dislocation the vast majority of physios will focus on strengthening rotator cuffs. These exercises do work somewhat, but not because of increased strength of rotator cuffs. If instead they focused on the cause of instability (scapular dyskinesis) there would be much better outcomes. |
I found your contribution of value too. Interested in that last paragraph and what that entails, more in the role of preventative actions to avoid needing to cope with an injury. Is that saying that building strength and fitness into the joint will pay dividends in overall stability and performance? Or am I reading that incorrectly? If that's the case, are there specifically targeted routines or just general strength training.
I know that's not the focus of the thread (avoiding the need to take physio intervention) but certainly of interest.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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Poster: A snowHead
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@ski3, don't think you were addressing me BUT, another route if you can find a good one is Pilates. My instructor is very focused on making sure the movements are correct and that you build strength correctly. It is very easy to "cheat" especially when nursing issues... but also create issues by that cheating, so easier to use muscles build up leaving others week. My instructor is often correcting movements and it turns out at the moment I can't move as far but she stresses even just small movements are fine as long as you are using right muscles it will build with time
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Obviously A snowHead isn't a real person
Obviously A snowHead isn't a real person
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Thankyou @NickyJ, I don't feel I have an injury but more intrigued by boarder2020 comments about specific work (although I believe that referred to rehab) to improve resistance to future injury.
I feel I benefited from instruction some time ago through induction to local municipal gym at which the person took us extensively through stretches, rotation and all sort of apparently simple methods to ultimately reduce risk on following exercise. Since which I've been using these and incorporating more strength focus routinely. We've an outside gym nearby (right out away from surrounding general noisy traffic etc) with parallel bars, overhead bar, along with push/pull upper body machines with bodyweight counterbalance geometry.
Maybe the wrong thread as so far I've not used physio intervention, good strength, less flexibility seems to be where I'm currently established, but wondering what that description entails in boarder 2020 note means. Is there something I could add which would give worthwhile long term benefit?
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Well, the person's real but it's just a made up name, see?
Well, the person's real but it's just a made up name, see?
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Endorsing NickyJ re pilates. Have attended a weekly pilates class for years and think that has definitely helped me to keep core strength and mobility going.
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You need to Login to know who's really who.
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My Pilates classes certainly helped with balance and core strength, but sadly they've been a victim of the pandemic as the group classes are no longer running. I've been unable to find a good replacement at a convenient time. Zoom is just not the same as there's no-one to correct your position or suggest slight changes to the intensity. She does private sessions on the reformer etc now, but I can't afford a weekly class.
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Anyway, snowHeads is much more fun if you do.
Anyway, snowHeads is much more fun if you do.
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My Pilates teacher restricts her Zoom class numbers to what she can see really clearly on her screen, so as (inter alia) to be able to tweak exercises for individual needs. It works well, but she is an exceptionally good teacher, the best I've had in getting on for 30 years of doing Pilates. I do three classes a week, one online and two in person, and can honestly say they are my physical and mental lifeline.
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You'll need to Register first of course.
You'll need to Register first of course.
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@Hurtle, and you kindly shared her details, but the timetable didn't quite work for me. I am now on a waiting list at another studio, but in my current condition, it might be a few weeks before I can commene anything.
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| Weathercam wrote: |
... And the NHS is far more lax/beneficial when dealing with étrangers, that's one of the reasons why the NHS is grinding to a halt, they never ever ask how someone might actually have to pay for treatment.
...
Apologies for thread drift. |
What data do you have to support that?
I've seen the claim made in the daily mail, but the last time I looked at SUS/ HES data it was untrue. Evidence, please.
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Yes, I think that's one of those "NHS myths". What I believe is NOT mythical is that France spends quite a bit more on health than England. Germany spends even more.
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You'll get to see more forums and be part of the best ski club on the net.
You'll get to see more forums and be part of the best ski club on the net.
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| philwig wrote: |
| Weathercam wrote: |
... And the NHS is far more lax/beneficial when dealing with étrangers, that's one of the reasons why the NHS is grinding to a halt, they never ever ask how someone might actually have to pay for treatment.
...
Apologies for thread drift. |
What data do you have to support that?
I've seen the claim made in the daily mail, but the last time I looked at SUS/ HES data it was untrue. Evidence, please. |
Well, as an optometrist providing NHS eye tests we have to offer them free of charge to anybody who qualifies irrespective if they are British or foreign. They would qualify if they are over 60 or under sixteen, have a family history of glaucoma (no way of checking so we have to take their word for it), are diabetic etc. So, anybody in one of those groups here on holiday from Tenerife or Timbuktu is entitled to free eye test paid for by the British taxpayer.
I believe that this applies all across primary health services i.e. GP and A & E, too and is not restricted in any way. Secondary care (hospitals) there are charges but whether they are actually applied is another thing.
From the horses mouth: https://myhealth.london.nhs.uk/help/advice-overseas-visitors-london
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@Snow Monkey, thankyou for that !
@philwig, if you go to A&E in the UK you are not asked for any supporting evidence as to where you reside, or God forbid any NI number etc etc
There have been numerous documentaries about the Tourist / NHS shambles.
Whereas in France at least you are asked for a lot of identity/insurance / E/GHic / Carte Vitale etc even if there's no actual follow up.
Maybe I should change the thread subject 
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snowHeads are a friendly bunch.
snowHeads are a friendly bunch.
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| ski3 wrote: |
| boarder2020 wrote: |
| NickyJ wrote: |
@boarder2020, A good physio makes a huge difference. The injury normally will heal BUT a lot of the long term issues are created due to muscles compensating for the injury.
Where you don't have full range of motion you get shortened muscles, become weaker etc as a result. The physio exercises target those. I have had far more experience of this than I would like buy it made a massive difference to my long term recovery |
You can't say a good physio makes a huge difference with any kind of certainty. You don't know what would/wouldn't happened if you didn't use a physio. People heal at different rates and there are lots of confounding variables - diet, sleep, age etc. It's also very injury dependent - clearly there are some cases where a physio is much more useful than others.
In terms of weakened and shortened muscles, it's not rocket science - stretch and strengthen through resistance training. From a sporting point of view (excluding impact) most injuries have some kind of underlying cause - usually weakness or imbalance. By far th best approach is to work with a decent strength coach to fix this stuff and decrease risk of injury in the first place.
My PhD is in shoulder rehabilitation. I can tell you following dislocation the vast majority of physios will focus on strengthening rotator cuffs. These exercises do work somewhat, but not because of increased strength of rotator cuffs. If instead they focused on the cause of instability (scapular dyskinesis) there would be much better outcomes. |
I found your contribution of value too. Interested in that last paragraph and what that entails, more in the role of preventative actions to avoid needing to cope with an injury. Is that saying that building strength and fitness into the joint will pay dividends in overall stability and performance? Or am I reading that incorrectly? If that's the case, are there specifically targeted routines or just general strength training.
I know that's not the focus of the thread (avoiding the need to take physio intervention) but certainly of interest. |
I would say the key to shoulder stability is having the scapula (shoulder blade) move "correctly". When it doesn't move "correctly" (technical term dyskinesis) you end up with a dis-alignment between the humeral head (ball) and the glenoid fossa (socket). If the ball and socket is not aligned you can imagine how the joint becomes less stable.
Explaining and fixing the dyskinesis is not so simple. It may be due to an imbalance in muscle strengths, inflexibility, or just faulty movement patterns. (A common example in athletes is tight pectoral muscles and weak back muscles because people do a disproportionate amount of chest to back exercises and spend too much time sitting at a keyboard with terrible posture - which pulls everything forward).
Traditionally the rotator cuffs were thought to be of more importance. This came from seeing that tearing rotator cuff a lead to decreased stability. I like to compare them to more of a seatbelt - there to stop the shoulder from dislocation rather than provide stability. In fact with people with shoulder instability you often find the rotator cuffs are much more active than in a stable shoulder as they are having to overcompensate for the instability. So assuming the rotator cuff isn't torn, instability is much more likely to be caused by scapular dyskinesis than weakness of a rotator cuff.
It's hard to give specific advice for shoulder stability, as it depends somewhat on the individual and their issues. Very generally most people could benefit with pectoral stretching and strengthening the muscles of the upper back - reverse fly's and above the head band pull aparts are both great.
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And love to help out and answer questions and of course, read each other's snow reports.
And love to help out and answer questions and of course, read each other's snow reports.
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@boarder2020, so if i understand what your are saying correctly? I need to make sure I am drawing my shoulder blades down more on my back? In which case you are agree with my physio. She set me exercises to work on that and I have to keep consciously working on that. My pilates instructor also agrees. As I said above.... a hood physio makes a big difference. I have never said they are the only way.
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@NickyJ, I'm saying your shoulder blade needs to move correctly in relation to your torso and upper arm. What you need to "fix" depends on how it moves right now, so varies from person to person. As I said poor posture from sitting at a keyboard and right pectorals is pretty common and the goal would be to pull the shoulder blades "back".
Pilates is good from a neuro-muscular control point. For purely strengthening the muscles I'd go with a normal strength and conditioning program over the kind of Pilates classes that tend to be done in UK (although I realise there is quite a range). Reverse fly's, pull-ups, over head band pull aparts, heavy rows etc.
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You know it makes sense.
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Thanks @boarder2020, and emphasising that I'm not compromised seeking recovery, but more to consider avoiding potential injury through good planning.
At the outside gym I use there's a machine for upper body (framed and with cantilevered seat that gives proportional loading based on body weight) that has three iterations of arm position for pull exercises (another for push with similar variations) which encompasses reverse fly type movement. It seems beneficial to me (installed 2009, used these regularly since) and not only for me but appears accessible for a wide range of adult at different fitness levels.
Also, I'm using over head bar for pull up, parallel bar for dips at straight body weight obviously. I certainly see these as pro active and hence not used any physio intervention, this hopefully being the reason behind that.
Hopefully others can recover more athletic use of their function through good advice though. Certainly through using that equipment I see other very regular users, some only once and speaking to people can see a very different outlook to personal fitness (as mentioned in thread about participation in recovery) guess it depends upon how serious people are about looking after their own abilities to take part in physical activity longer term.
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Otherwise you'll just go on seeing the one name:
Otherwise you'll just go on seeing the one name:
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@ski3,
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I'm not compromised seeking recovery, but more to consider avoiding potential injury through good planning.
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I suspect many injuries could have been avoided by a decent "prehabilitation" program. In fact it often surprises me that we don't see even more ski injuries from people who do very little exercise all year then expect to go and spend multiple hours for 6 days in a row physically exerting themselves. Avoiding injury in the first place should be the goal, unfortunately it's a hard sell to people.
As much as some may (wrongly!) get the impression I don't like physios I'd actually say that for most people looking to reduce their likelihood of injury a physio is a good first point of call. You want a functional assessment that identifies weaknesses, imbalances, and areas of instability or inflexibility. If you don't know what problems you have it's hard to proactively fix them!
In terms of general prehab exercises most people could do with more abduction and adduction exercises and glute activation exercises. Increasing quadriceps strength is also a huge thing (this is a great predictor of healthy aging).
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Poster: A snowHead
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Ultrasound followed by a text from gp to say tendons all intact/evidence of strain but let doc know if it gets worse or stays the same so I’m back on the mountain. (Chatel) Just have to let someone else lift the chair lift safety bar (ouch). Keeping things moving.
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FAQ
