Rules of movement

A single wrong turn, sharp pain and we are definitely taken out of our familiar daily routine. How are our thin muscles, ligament complex, nerves and vertebrae interconnected? What strings are affected or even broken when we suddenly feel the sharp pain? The average person has no idea. But there are unique specialists who know how to bring us back to normal life: they will press somewhere, switch on some machine… And, after a series of almost magical acts, we finally feel the long awaited relief.

Simon Heinis, head of the physical therapy department at the Merian Iselin Clinic, can be called a “tamer of pain”: in his arsenal he boasts experience of treating a variety of professional athletes, for whom pain is almost normal. He was entrusted with the health of the Swiss fencing team members.

– Would you agree with the statement that modern physiotherapy plays a bigger role in the overall course of treatment than it did 5 or 10 years ago?

– Yes, many things have changed over the past couple of years in this area – there are innovations in technical means of treatment, and specialists now get a higher education and come to work with a much more extensive knowledge base versus earlier years. Today, we use physical therapy not only after surgery or during treatment, but also in preparation for surgery. The interaction between different areas of medicine has become closer.

– Your patients are mostly athletes?

– Our clinic provides a complete set of services for various groups ofpatients: professional athletes, outdoor activities fans and ordinary people that want to stay fit. For instance, one senior lady has set a goal – to be able to work in her garden without pain and extra effort. There are young patients too from the ages of 12 to 19.

– Your experience can be called unique – you work a lot with professional fencing athletes. What specific issues do they have?

– Fencing is a very active sport, despite being contactless. Often they have serious muscle sprains, even asymmetric ones, because one part of their body is always under more strain than the other. Of course, there are more issues with shoulder joints and lower back.

Athletes are very sensitive to all changes in their bodies, and as soon as they feel something is wrong they come to us. We apply manual treatment techniques, massages, and adjust their athletic load. Physical therapy helps them to heal quickly and get great results again.

– How long does it take an athlete to go back to professional sport after the surgery?

– It depends on the trauma. We cannot speed up the regeneration time or the time required for the wound to heal. In this case the human body sets its own pace. But in the case of professional athletes, we can take a certain risk and begin serious training a bit earlier, since they are already in a good physical shape. With ordinary people we have to be more careful.

– What diagnosis is the most common among your patients?

– Of course, the majority of our patients are those recovering from surgery as a result of trauma. Not all of them are professional athletes, they are often ordinary people that have completely ruined their joints over the course of their life – to the extent that we can only replace them with artificial joints. They all want to go back to their normal life – travel, ski, etc.

– Let’s imagine you have a new patient – a man of 40-50 years of age, healthy but with bad genetics. What can you offer him?

– We have a training center, Physio Plus (Trainings- center PhysioPlus) with a physical therapist always overseeing the training process. The disease often begins to develop unnoticed, when nothing worries the patient – well, sometimes the joint aches, but then it passes… A specialist can detect the problem at an early stage and develop a set of preventive measures.

There are patients who come several times a year, learn their exercises under expert supervision, and then exercise at home.

– Do you recall any cases in your practice when physical therapy measures helped to avoid surgery?

– Yes, we are often able to rid the patient of spinal disc herniation without surgery. I believe that in any case you have to try first to cure without surgical methods, but often it is surgery that is needed, after all. But the earlier the patient starts to deal with his problem, the more chances there are that it can be cured with power exercise and training of the musculoskeletal system. The most important thing is to stabilize and support the core stability.

– At what age would you recommend beginning the physical therapy programs?

– The earlier, the better. The borderline age is 40. By the age of forty most are heavily involved in their work and their family business, and have almost no time left for themselves. And this is when the first issues arise and the problems of first-world civilisation start to pile up, the main one being a lack of movement. People spend 8-10 hours in the office, then drive home in their car and spend the rest of the day relaxing on the sofa.

We try to find a suitable physical activity for each patient and calculate the right load. The training can be combined with such physical therapy methods as massage and always remembering to eat healthily.

– If your youngest patients are 12, it is obvious that it’s not easy to work with them – it is more difficult than with grownups. What are the specifics of such work?

– The specificity with them is that their adolescent body is still growing and it means we can’t automatically apply the same measures to them that were developed for adults. Depending on age, the exercise load can be adjusted every year, increasing gradually. The growing body changes very fast, and you have to know a lot in order to correctly influence this process – for instance, to calculate the pause between school classes and sports training.

– Today’s children start to engage in sport activities very early, starting tennis at the age of 5, fencing at 8… Do you also offer then training under the supervision of a physical therapist?

– Certainly – at this age children need the best specialists that can supervise them. And everything matters with them, the quantity as well as quality of exercise. Sometimes, a child is successful in sports but at the age of 18 he starts to experience trauma after trauma. This is the result of an incorrect training program.

With the little ones, we have to make sure that training varies and it does not become routine; we have to monitor its quantity. We have to make sure that the exercises are done correctly and try different ones. We cannot make small adults out of children. The best result is achieved when the child engages in the activity together with parents, trainers and physical therapists or doctors who supervise the load intensity.

– What is the ideal sport for those over the age of40?

– You can choose any type of sport activity – medical science doesn’t prohibit any. But you have to understand which muscles you can put strain on and which you should go easy on. This is why I cannot name one activity that would suit everybody. For patients with back problems swimming would be a very good choice at the start of the therapy course, but for those with arm and shoulder joint problems it would not be the best choice. It is also important to make sure you enjoy the chosen sport, otherwise it is better to choose something else.

There should be variety: for example, one day you should go jogging and the next day opt for a bike ride. But if the overall process is chaotic, it will not yield any results. You can’t just say to a person, “Go for a bike ride”, you have to develop a program for him, because if he has excess weight, problems with overload may arise. This is why supervision and control over training are so important. Physical therapist can also provide the correct motivation for a patient.

– It is said that the optimal load for a person is to walk 10 000 steps in one day. Is it true?

– It would be great because not everyone is fit enough for very active sport activities. And in a routine day, 10 000 steps would be a good workout. Generally, you should strive to “take” every next step. Don’t drive a car when you only need to walk 500 m. It is good to do a small set of exercises in the morning. Those that were disciplined about this rule will, at the age of 80-85, feel much better than their lazier peers. You can always tell if someone is a big car lover and if someone rides his bike a lot.

– Many experts advise engaging in the popular Scandinavian walking workout, claiming that it is easier and safer. Do you agree with this?

– Of course, it is easier to just walk with support poles. But training is something else entirely and you had better tell your instructor about it, because you will have to learn to use the poles correctly and to understand the limits of your exercise load… It is for this reason that you shouldn’t choose group training at the beginning, since there will always be someone for whom the load will be too much, and someone who handles it effortlessly. It is enough to take 4-5 lessons with a specialist and then you can do the walking on your own. You can start with 20 minutes and gradually increase the training time to one hour.

– You have a wide selection of physical therapy treatments, several dozen. What treatments do you consider to be the most efficient from this list?

– For me, considering my 20-year work experience, the most interesting ones are manual therapy and manual joint mobilization techniques, as well as working with the fascia, which include parts of the muscle bundles and ligaments. There are lots of options: for example, we use a model of fascial disorders – FDM (Fascial distorsion model), a progressive and highly effective form of treatment of the fascial system. Manual techniques can be very painful, but the result can be felt immediately. They help patients with chronic back pain, joint pains. This method isn’t very well known around the world.

– Does physical therapy help with arthrosis and arthritis?

– Yes, sure. If a person experiences some random discomfort, the issue can be solved with manual techniques and exercise aimed at stabilizing joints. But in the case of strong pain we have to apply technical means, for instance, electrical therapy, cryotherapy or high-temperature therapy. We can help the patient at any stage of his illness. But we cannot renew the cartilage.

– Which illnesses benefit the most from physical therapy?

– Certainly, back-related illnesses. Nowadays, such problems are very common, due to a number of reasons: excess weight, lack of physical activities, traumas. About 80 percent of people have experienced back pain at least once in their life. We have extensive experience dealing with such problems, we do a lot ofbiomechanical analysis, and we view the individual as a whole system, trying to involve all of his structures in the healing process.

Simon Heims is a specialist in the area of sport physical therapy, manual and fascial distortion therapy. He has led the physical therapy department of Merian Iselin Clinic since 2000. From 2003 until 2010 was a physiotherapist with the Swiss bobsleigh team and was a part of medical service of the national team during the Vancouver Olympic Games. Was the chief physical therapist of Swiss Fencing Federation since 2004. Since 2008, he has been the chief physical therapist of the Swiss International Circus Art Festival called Young Stage. He is a member of the Board of Directors and Co-founder of Swiss working group on rehabilitationtraining (SART). He has been actively teaching since 1996.