Consultation with Ben Rowles
Skateboarding Injuries and Physiotherapy: Part One
Photo: Reece Leung.
Ben Rowles – our one-time resident skateboarding physiotherapist – takes a break from his usual Consultation interview format to bring you a two-part beginner’s guide to physiotherapy services.
To start with, I think it's important to note that skateboarding, unlike many other activities, doesn't have the same level of structures around it to support injuries. In football for example, training includes exercises and techniques to prevent injuries from happening, and then if a player does get injured, they are able to begin their rehab straight away. This support is given even at the most amateur football level, whilst in the professional realms, players have a full team of sports doctors and physiotherapists to support them from the moment an injury occurs.
Then there is skateboarding, with all of its freedom and space for creativity. There are no rules on how or when to skate, no obvious need to train in a gym several times a week, and no coach to tell you what to do or how to do it. This lack of structure is often what attracts people to skateboarding in the first place; I can honestly say that it did for me. The freedom of skating works wonders when filming video parts, shooting magazine articles, or just spending time rolling with the crew; it likely helps people to embrace their creative side and show their full potential on four wheels. The area where this freedom may not be as useful is with injury management and lifestyle behavioural change. With these two areas, structure, support and guidance are actually advantageous.
This two-part Skateboarding Injuries and Physiotherapy article aims to give you an insight in to the world of physiotherapy injury rehab, what to expect, and what kinds of things you can start doing for yourself. Beginning with…
How to get a physio assessment for a skate injury.
Here are three of the most common ways to get a physio appointment in the U.K.:
1. NHS referral via a general practitioner (GP).
2. NHS self-referral.
3. Via the private sector.
The most common NHS route is to book a GP appointment where your GP can assess your injury and refer you to a physiotherapist free of charge within the NHS, if appropriate. What is useful about initially seeing a GP is that if the injury needs further investigations, such as an X-Ray or an MRI scan, then they can refer you for this first, and if the injury needs to be reviewed at a consultant level (for example, when considering ankle reconstruction ligament surgery) then the consultant doctor can also refer you to a physio at the appropriate time. However, scans are not required for the majority of minor injuries, and unless you’ve caused some substantial bodily damage, the doctor will likely refer you to a physio. If you are unsure about the severity of your injury then it’s highly recommended to visit your GP first.
As both GP and NHS physio waiting times can be lengthy, then the self-referral route helps you to skip seeing a GP. Please note, you need to be registered with a local GP in order to self-refer, and not every NHS physio service has a self-referral option, so it's necessary to check if this is available to you with your local surgery. If they do offer a self-referral service, they will be able to assist you with the paperwork, and advise on what happens next. As self-referral removes the initial need for you to see your GP, if during the physio assessment the outcome is that you do need a scan or any other type of investigation into your injury, you will likely be referred back to your GP or to another specialist physio in the department in order to request scans.
And then there is the private sector, which is probably the quickest route to getting a physiotherapy assessment. However, as we all know, the private sector is not free. You can simply find and book in to see a private physio in your area, or arrange a virtual physio service for long distanced assessments that can be completed from the comfort of your own home. Some people opt for combining private physio with NHS services in order to get back to skating as quickly as possible.
You can use NHS and private physio search engines in order to find a physiotherapist local to you, or visit benrowles.co.uk/findaphysio
What to expect from a physio appointment.
The nature of how the assessment is set up will depend on the service. NHS and private sector services will vary in what they offer, but there are generally telephone, video call and face-to-face appointments available. The main thing to remember when attending your first assessment is not to worry too much about whether it's in person or not, and here's why:
The most valuable part of a physio assessment is the initial conversation.
Listening to your story, concerns, motivation, expectations, discussing scan results, lifestyle, medical history, what rehab you've tried in the past, and obtaining all of the info about your current symptoms (such as pain) is all that is usually needed to get a clear enough picture of what is going on with your injury, and how best to progress forwards. In physio terms this is called a subjective assessment. For me, the main question I want to answer from a subjective assessment is:
Is this particular injury or set of symptoms appropriate for physiotherapy right now?
If physiotherapy is suitable, then we can move on to the objective assessment, where the physio can now assess - either in person or virtually - how you move, your balance/proprioception, your muscle strength, your flexibility, and - most importantly - what happens to your symptoms whilst doing these exercises. From here, they can provide you with exercises and education specific to you, your injury and your concerns.
Based on the assessment, if physio is not appropriate, then the most common reason for this is because the injuries or symptoms need further investigating via scans or blood tests, which need to be arranged by a doctor or specialist. Depending on the service, the physio should be able to refer you to the correct person, or tell you how to go about referring yourself. There are some objective assessment techniques that can be used to help determine if an injury needs further investigation, so if you have an NHS phone assessment for example, and there are still uncertainties surrounding your injury at the end of the session, then they may book you a face-to-face appointment to enable clarification.
While physiotherapists differ in styles and specialities, their assessments are usually conducted in a very similar way, regardless of whether the appointment has been obtained through the NHS or via a private practice, and it's very common for physios to work across both sectors. There are many time constraints in the NHS so it's normal for sessions to feel fairly quick, whilst private sessions often have the luxury of a little more time.
Pre-injury Sam Beckett ollies the Driving Range hip, Belfast. Photo: Leo Sharp.
How to get the most out of physiotherapy.
We can think of injury rehab like filming a new video part; the process will have ups and downs, it will push you both physically and mentally, you sometimes have to make plans, you have to be adaptable, you have to put in the hard work, and underpinning it all is your own personal motivation for persevering despite any setbacks.
Often, what helps with filming a part is knowing what you're trying to achieve, and how to go about doing it with the help from others - usually filmers, sponsors, and a good crew to support you. Physio rehab is no different. To get the best out of your physio sessions, it can be helpful to ask yourself these questions:
1. What do I want to achieve?
2. What and who do I need to help me to achieve this?
3. What will motivate me to achieve this?
For example: 1. could be that you want to get back to skating following an ankle injury, and that you'd like to shoot a final photo for your upcoming mag interview. 2. could be that you need some injury rehab knowledge, in which case a physio or doctor could help, and that you need some support and encouragement from friends, family, a magazine and sponsors. And 3. could be that you have been working on this interview for a while and you'd like to finish it to coincide with your new part dropping.
However, it's really important to remember that everyone is different, and people’s personal goals and motivation will differ. In comparison to the above, I've spoken to skaters whose goals are to return to skating following an injury, but their motivation for doing so is because skateboarding helps with their mental health, and when they can't skate due to a physical injury, they feel the psychological impact.
The more insight you are bringing to your physio session, the more the physio will be able to help you, and ultimately the more you should be able to get out of it.
Keep it simple.
On a final note, I want to emphasise the importance of keeping things simple, and to take as much pressure off yourself as possible during the rehab process. Here a few tips to help with this:
1. If you're worrying about not being able to skate when you're relying on sponsors for product or financial income, remember that injuries are a part of skateboarding, and any good sponsor will understand that. If you're taking positive steps forward to get back on your board, then your sponsors should support and encourage you.
2. It's still common for some physios to over-prescribe exercises. So, if a physio gives you a list of 10 to 20 exercises and says to do each of them three times per day, then you can freely ask them to condense it to two or three extremely beneficial exercises that you will be able to progress with, and make harder throughout your rehab. This should save you time in your daily life and make your rehab a bit more targeted towards your injury.
3. Physio exercises are often prescribed regularly at the start - such as every day, or every other day - but this is often just to enable you to get back on your feet quickly. It's helpful to remember that this level of regularity is usually only applicable in the short term. Once you have achieved your goals (such as feeling confident on your board again) it will be helpful to carry on some exercises to prevent a future injury, but they won't have to be done on a daily basis. It may be that, once recovered, you only do the exercises twice weekly to keep yourself in check, for example.
4. Have a discussion with your physio about your expectations, and how to set yourself achievable goals. Minor injuries generally take less time to recover from, whilst more severe injuries understandably take longer. It can be frustrating not being able to skate for a while following injury, but often what makes this worse is putting pressure on ourselves to get back to skating quickly, and worrying that we could be doing more to achieve this. Your physio will be able to help you manage your own expectations.
5. Like skateboarding, expensive equipment is not needed with injury rehab. Most required equipment can generally be found in your own home, and if not then any additional equipment should be fairly cheap to buy. If anyone tries to tell you that you need to buy a £300 massage gun in order to get better, I'd say to them that I'd rather spend that money on going to Barcelona!
Stay tuned for Skateboarding Injuries and Physiotherapy: Part Two, where I will discuss the importance of progressing exercises, and how to manage symptoms like pain when returning to skating, among other topics.