Taking ‘Before Photos’ to improve rehab exercise compliance – Lessons from the fitness and weight-loss industries.

Have you noticed that the primary sales tool in any weight loss or fitness programme is a before and after photograph?

There is always an eye catching and impressive before-after photo.

The before photo generally shows the unsmiling face (not here though! – see below) and the classic large belly.

The after photo shows a bright smiley face with either an exposed torso or the person standing in a pair of their old ill fitting trousers!

There are many different exercise programmes and diets but generally the key reason the programmes fail is because people give up.

Thinking about this, I wonder: is the act of standing in front of the camera – embarrassed and ashamed – and getting a photo taken a key factor in cementing someone’s commitment to stick to an exercise/diet plan? 

In the goal-setting/ life coaching business, announcing your goals as a public statement of intent is quoted by leading experts as one of the cornerstones of reaching goals and achieving success. Is that what the before photo does?

So, alongside the weigh in, should anyone looking to get healthier and lose weight/ exercise get a set of before shots to paste around their house?  If we want to have the ‘after-shot physique’, perhaps the starting point on that journey is actually taking some before-shots!

What lessons can clinicians take?

With easy access digital photography at our fingertips, could clinicians make more routine use of before shots to show starting posture and weight and thus help patients comply to a given exercise/rehab/posture corrections programme?

‘This is how you look now, here is the goal and this is how we want you to look’  As one saying goes ‘if you can see it, you can believe it’ and another says ‘if you can believe it you can achieve it’.

If you have an opinion, you can use the comment box below.

PS – In the photo I use above, the before shot actually shows the guy smiling … hmmm. I wonder, in taking the photo is that he knows what he is committing himself to do and he is smiling because he is excited by that prospect?  I think that he has faith in the programme and by taking the photo he is committing himself to the end goal.

Often improvements in health are subtle and are revealed by the change in someone’s face. Patients can forget what they were like when they started, so this may really help them appreciate what you have done for them.

PPS This thought occurred to me as I wrote an earlier post about using Wall Calendars to help boost exercise compliance for spinal rehabilitation.  I applied the idea from the Insanity Exercise Programme http://www.beachbody.com/product/fitness_programs/insanity.do?e=5b

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machine [contact-form-7 404 "Not Found"]

Exercise Compliance for Back Pain: Lessons from Selling Fitness Programmes on the Shopping Channel

The other morning, one of my daughters was watching the TV shopping channel where ‘Shaun T’ was selling the 60 day workout programme – INSANITY.

I had actually heard of Insanity because my gym instructor had lost 2 stone doing the programme and also, he had the classic “after shot” physique!  So I watched some of it and it got me thinking about back pain.

One of the bonuses Insanity gives is a 60 day wall chart calendar where people tick off their exercise days.

Why would Insanity offer that?

Sure, it’s a free bonus but they could give any kind of bonus.  The reason they choose the Wall Calendar is to help customers with self-discipline and thus help customers comply with the programme.

Such an approach is more likely to lead to a happy customer and therefore company is happy because they don’t have to honour the money back guarantee from people giving up!

You may have read my piece about using exercise diaries to plan when patients will do their exercises.  This is a way to help patients be more disciplined in planning and doing their exercises so they get the benefits (i.e. diaries help with compliance).

Why not go a stage further and get some A3 clinic-branded posters printed with a 60 day exercise planner?

Give one to each patient to put on their wall; they then tick off the days as they do their exercise.

For 2-5p, a (branded) wall calendar is something else to hold patients accountable to themselves.

It contributes to an overall professional patient approach and since you are giving it to your patient like a piece of homework, they may feel honour-bound to use it (and it just so happens to be good for them!).

Put it this way, which of these adjuncts is more likely to have a positive effect on exercise compliance?

1/ Use an exercise diary with a wall calender tracker        2/ Use nothing

You can choose to use nothing pending a clinical trial to categorically prove diaries and a wall calendar will help patients comply with their exercise programme, or you could just go for it!!!

By the way – If you want to transform your body this summer, you can see the Insanity workout programme here, over 600k Facebook likes can’t be far wrong! Not sure if my joints could take it but it does seem the Insanity programme achieves its goals http://www.beachbody.com/product/fitness_programs/insanity.do?e=5b

Author: Stephen Small
Director, Steadfast Clinics Ltd
www.SteadfastClinics.co.uk 

Steadfast Clinics is the international distributor of IDD Therapy spinal decompression, SDS SPINA, Accu SPINA devices, Thermedic FAR infrared therapy systems and HydroMassage machines.

15% of patients seen each day by GPs have back pain: more needs to be done!

Stephen Small with BMI team at GP event in Coventry

Stephen Small with BMI team at GP event in Coventry

Two weeks ago I got some interesting feedback from GPs during an IDD Therapy CPD event about the actual incidence of back pain in their daily surgeries.

Whilst 99% of back pain presentations I have heard begin with the usual “back pain is the second most common reason for GP visits” etc, etc, I was interested to know how that translated into a percentage of their daily appointments.

I was quite surprised.

The general consensus amongst the group of GPs was that back pain represented approximately 15% of their daily case load,  i.e. about one in seven patients.

Given the hundreds of different conditions people might come to a GP with, I had expected the percentage to be lower.

GPs are up against it here because patients with chronic back pain clog up the system.  GPs really have limited options and often the patient is dissatisfied.  Help please!

Given the pressure on budgets within the NHS and the costs to society as a whole, surely it makes sense to make back pain resolution and prevention a top priority?

This is particularly important when we consider that societal lifestyles are appalling for disc health and spinal function and in addition, we are all living longer!

As far as the IDD Therapy programme was concerned, there was universal interest from the GPs:  some were extremely positive whilst one said “Listen, if we have a chance to help some patients, then there’s very little to lose and everything to gain.”

Exactly.

Author: Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

Hamstring Injury Treatment – Doing more with new Thermedic FAR Infrared Therapy

Having had my share of hamstring injuries, I know that the biggest pain is not the physical pain, but the pain of not being able to play your sport.

The risk of injury recurrence with any injury is very strong because for the competitive sports man or woman the desire to play can lead to an overwhelming temptation to play again too soon.

This is particularly the case with hamstring injuries and is especially aggravating because good hamstrings are so essential for running (fast!).  Incomplete healing, scar tissue, inflexibility and muscle imbalance with the quads mean that recurrent hamstring problems are a common (and expensive) problem.

So, can clinicians do more to help their patients with hamstring injury treatment?

Following the acute injury phase, it goes without saying that good blood flow to the injured site is essential to carry oxygen, nutrients and repair cells for efficient healing.  Stretching during the re-modelling phase of healing is essential to ensure that new collagen fibres are laid down neatly. 

Evidence shows that applying heat increases the extensibility of hamstrings1 and improves myofascial relaxation2 , thus applying heat before stretching muscles is beneficial.  Heat causes vasodilation: a widening of the blood vessels which in turn leads to more blood going through the injured area.

The problem to date has been in finding a comfortable and effective heat application for the hamstrings to help with healing and to help with the return to sport.

pw150_2%20close%20upThe new Thermedic Thigh is the ideal treatment tool for hamstring injuries.  It includes a cold pack to limit bleeding in the injured site whilst the support provides compression during the acute phase.

But the main benefit for athletes is a unique carbon-fabric FAR infrared heat element which delivers resonant energy into the tissues.

Mains powered, Thermedic has three temperatures and has been show to increase blood flow in tissues and joints; by 204% in the knee and 49% in the abdomen3.  The exact amount of increased blood flow in the hamstring hasn’t been measured but we might reasonably assume that the amount be somewhere in between.

At the same time FAR infrared has been shown to increase fibroblast proliferation and collagen regeneration, which are key components of healing4 .

Thigh ThighAnother significant benefit of Thermedic FAR infrared over standard heat products is that skin temperatures do not reach burning levels.  Thus, it is possible to apply FAR infrared for longer periods meaning that there is a sustained increased flow of blood through the injured site.

So, rather than 5-10 minutes of superficial warmth, with Thermedic it is possible to increase the blood flow for longer periods for a greater therapeutic effect.  This may have interesting implications for angiogenesis in the injured tissues but that question is for a phd student somewhere!

The key thing is to try the Thermedic Thigh on your hamstring and feel the difference compared to ANY other heat application.  When you feel this difference yourself, you can appreciate why Thermedic is becoming so popular for hamstring injury rehabilitation and many other painful conditions and injuries.

To order a Thermedic Thigh visit www.Thermedic.co.uk

Author Stephen Small
Director Steadfast Clinics Ltd
www.SteadfastClinics.co.uk

1 D. Funk, A. M. Swank, D. Treolo, K. J. Adams.  Efficacy of Moist Heat Pack Application Over Static Stretching on Hamstring Flexibility.  Journal of Strength and Conditioning Research, 2001, 15(1), 123–126

2 T. Muraoka, K. Omuro, T. Wakahara, T. Fukunaga, T. Fukunaga, K. Kanosue, Passive mechanical properties of the human muscle-tendon complex at different temperatures.  Journal of BiomechanicsVolume 39, Supplement 1 , Pages S197-S198, 2006

3 B.Y. Liau, A. Yang, T.K. Leung, M.C Ou, C.K. Ho and Y.S. Lin.  Inhibiting Effects of FAR-Infrared Ray-Emitting Belts on Primary Dysmenorrhea.  International Journal of Photoenergy, Volume 2012, Article ID 238468

4 Toyokawa H, Matsui Y, Uhara J, Tsuchiya H, Teshima S, Nakanishi H, Kwon AH, Azuma Y, Nagaoka T, Ogawa T, Kamiyama Y. Promotive effects of far-infrared ray on full-thickness skin wound healing in rats.   Exp Biol Med (Maywood). 2003 Jun;228(6):724-9.

Google search results for Physiotherapist vs Osteopath vs Chiropractor in the battle for the hearts and minds of back pain sufferers.

What does Google tell us about back pain and the different professions?

Google back painWhen people are in pain, they go online.  Working with Google Adwords, I decided to look at the search volume and see whether the search patterns revealed anything interesting about what people are looking for.

I began by taking the three main professions which treat musculoskeletal conditions: physiotherapists, osteopaths and chiropractors and then I looked at the search volume for specific conditions.

Google displays results in two columns, the first, for the world and the second, local to where you are – in this case the UK.  Here are the results:

Keyword

Global

UK

physiotherapist

1,500,000

368,000

physiotherapy clinic

60,500

18,100

chiropractor

2,740,000

165,000

chiropractic clinic

74,000

14,800

osteopath

1,220,000

135,000

osteopathy clinic

9,900

4,400

back pain

2,740,000

368,000

low back pain

673,000

90,500

herniated disc

368,000

27,100

slipped disc

165,000

22,200

sciatica

1,000,000

135,000

neck pain

550,000

74,000

shoulder pain

550,000

90,500

shoulder injury

74,000

9,900

knee pain

673,000

90,500

knee injury

246,000

33,100

sports injury

135,000

40,500
arthritis

4,090,000

450,000

Of course there are thousands of keyword permutations but these are the broad searches.

When people look for a clinician they do so because they have a condition.  Each profession has specialities but back pain is the number one reason that people visit a clinic.

Based on conversations with clinicians over the years, I would put forward the following general percentages as back pain-related patient visits for each profession globally:

Physiotherapy: 40-50%
Osteopathy: 60-70%
Chiropractic: 70-80%

The profession-related search reveals three interesting things for me. 

1/ When people need help, they are looking broadly for a profession.  The type of treatment is a commodity ie I just need a physiotherapist, chiropractor or osteopath.

2/ People are looking for information about back pain and they are looking for private treatment in very large numbers (you don’t need to search if you just go to your GP to get treatment/ referral)

3/ Clinics need to plant the name of their clinic in the minds of future patients so that when they do get pain, they won’t search generically, they will search for their clinic!

There are up to 10 times as many physiotherapists in the UK as osteopaths and chiropractors, but large numbers of patients are looking for osteopaths and chiropractors over physiotherapists.

If we take it that a search for a clinician is in essence a search for treatment for a condition, then applying some percentages we can see more dramatically that osteopaths and chiropractors are getting a disproportionate amount of search traffic for back pain for the number of clinicians in those professions compared to physiotherapists.

Keyword

UK Search

            % of Patients with Back Pain  

physiotherapist

368,000

50%

184,000

  

chiropractor

165,000

70%

115,500

  

osteopath

135,000

60%

81,000

196,500

This is search for broad terms only and the numbers may not be entirely accurate but they do give a ball park figure.  Combining the chiropractic and osteopaths (although I know the two professions are very different!) their combined search number of 196,500 is greater than the search for physiotherapist, 184,000.

What can we infer from this?

Quite a number of things but two things for me.

1/ The numbers show that in broad search terms for the professions, osteopathy and chiropractic are winning the day in the hearts and minds of back pain sufferers.

2/ With an ageing population, clinics can do worse than be the best for back pain … and arthritis.

Stephen Small
Director Steadfast Clinics

Steadfast Clinics is a dynamic medical company which helps clinicians do more for back pain sufferers and helps to grow clinics with the IDD Therapy spinal decompression programme.

For details request an information pack using the form below or visit www.SteadfastClinics.co.uk to read clinician testimonials and more.

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