Interview with a physio therapist (Primary research)

I decided to do an interview with a physiotherapist as they know a lot about exercise and the problems that can arise if you don't do exercise. I wanted to do a open interview as I do not know anything about the technical side of being a physio so I don't want to create answers that could be wrong. Also I want to get an in-depth answer.

The questions I chose were:

1. How many patients on average have health conditions that are directly linked to them being over-weight?

2. How do you usually handle the awkward scenario where you have to tell a patient that they are over-weight?

3. What kind of injuries have you seen that are caused by patients being over-weight?

4. What are common health concerns that are related to being over-weight?

Link to voice recording:

https://youtu.be/vYrq9KPHaQE

Transcript-

Sophie Husteden: "Hello, this is Sophie husteden and I'm joined by Sean Crinion. And physiotherapist under the NHS interview commenced."

Sophie Husteden: "First question how many patients on average have health conditions that are directly linked to them being overweight?"

Sean Crinion: "That's a difficult one to answer."

Sean Crinion: "I mean, it will usually vary based on where you work about work various different places in the country. And usually, if you're in an area, which is a bit lower socio economic class, you'll tend to find that the ACA vary quite a lot. If you there's also cultural differences as well. So you'll find that certain cultural backgrounds, some of the sort of Asian communities where it's very family knit, you tend to find that with the parents that hit a certain age, the kids do everything for them and they you find that the Have a slightly different outlook to have the modern opinions on things. And I don't know where I'm going with this as in like, I've hit this age, I shouldn't be doing this, I shouldn't be exercising, I shouldn't be using the stairs, I shouldn't be doing that. And so as a result I put on weight and then I can affect it. Generally, if you think of now compared to previously, so about a third of adults in the UK are obese, which has a BMI of over 30. Whereas about two thirds of adults in the UK are overweight, that's over a BMI of 25 then it's obviously going to have a knock on effect. It's just very difficult to see what how much that is."

Sophie Husteden: "Okay."

Sophie Husteden: "Thank you for your answers to that question. The second one is, how do you usually handle the awkward scenario where you have to tell a patient that they are overweight?"

Sean Crinion: "That's one that's never really come natural to me. Comment if you go to a GP surgeries, and often nurses are technically a lot better with that. But they also deal with more cardio directed cardiovascular issues and things where it's imperative that people for the sake of their lives lose weight so that they're often a bit more blunt about it. Myself, it's obviously linked to musculoskeletal conditions. So, it tends to be a case of, if you lost this weight, then it will help to improve your pain. For that, what I'd usually do is, first of all, diagnose the condition, tell them what it is, tell them why it happens and link the pathology and say well, actually, sometimes when you've put on a little bit more weight in a short period of time, this can do this to the body. And then usually I'll say Oh, actually, you know, I've put a bit of weight on recently. It might be Recent years and within the past 10 years, what maybe recently within the past five years, or five months, but that's sometimes a bit of an easier way to go into it. The other way to do it is they've got a on the system that we use for notes, there's a BMI calculator, what you can do is it's got a nice visual to it, where you ask them what their way is, currently, if they ignore the last word, what they hate is, and when you put them both in, you click Enter. And then it's got a little visualisation of a person, and then it It adds the weight to them in green zone, and then orange zone and then red zone. And sometimes that can add that visual shock factor to them to sort of think, Oh, God, is that really what it's like? So that can be quite useful. Otherwise, a lot of times people are bringing up themselves. So we'll come in and say, well, I've got knee pain. I know I'm overweight, I normally lose weight, because they've probably had those conversations with the GP and they're very aware of it themselves, and you don't often get denial, but sometimes you do get a bit of denial about it. I think that the way it isn't really to witness something completely different, and that they just need a scan to tell what the problem is and what they need to do that like to be able more of a challenge for them, you just got to be very careful, tiptoe around it. Otherwise you lose the confidence really."

Sophie Husteden: "Okay, are you ready for the third question? Okay. What kind of injuries have you seen that are caused by patients being overweight?"

Sean Crinion: "Similarly to the first question that one's a difficult one answer because we tend to find that with most conditions, healthy people who aren't overweight will also get them. But there are certain ones where you do get a high proportion of people that are overweight. So in terms of this is injuries, isn't it that we're talking about with injuries? I mean, the common ones back pain. In terms of back pain, most of us will get back pain at some point in our lives. We look at in terms of workers of 80% of workers. I think this issue of back pain around the country at some point, that's the biggest single cause of disability in time spent off work, or obesity does increase the chances of that. So it does tend to find that although there are people that have back pain who are overweight, if you're susceptible a back pain, and if you have back pain, we're just doesn't help. And that can be probably the biggest one or the most frequent problem. We'll see injury wise knee issues. So the knee tends to be the joint that's most badly affected due to the biomechanics of the body. So people who have very overweight knees take the brunt of the force. It's not a case of if the follow on tell 10 kilogrammes in the course with 10 kilogrammes more. In terms of the way that the knee works, it means that if you put on 10 kilogrammes, and he's actually coping with 50 to 60 kilogrammes more gone through it. So it is a massive difference and people don't appreciate that. The other side of it is overload and over use, so the tendons and soft tissues in the body. They've got a certain level that they're able to tolerate and that needs to be changed gradually over time by building up exercise. But if you're overweight, they just don't get a chance to recover. And particularly in the lower limb, you tend to find that the tendons and tissues can aggregate and break down over time. So people end up with a lot of tendon injuries as well as joint injuries. Okay."

Sophie Husteden: "And Question number four, at what are the common health conditions that are? What are common health concerns related to being overweight?"

Sean Crinion: "Suppose a lot of it will be in the media at the minute of the common ones that you would hear from diabetes would be out there as type two diabetes would be one of the most common ones and potentially one of the most detrimental ones. Alongside that which tend to go hand in hand, you'll often see that people with type two diabetes that come in with the same problems of hypercholesterolemia, high cholesterol, hypertension, high blood pressure and then no And around that you've got other cardiac issues and other cardiovascular issues that come in with that. And then later down the line, you might be thinking of things like stroke. In the clinics that I work in, it's musculoskeletal. So you don't see too many of the strokes around that time. But then working on stroke unit in the past, you do get a lot of people that are overweight, but it tends to be obviously the older population from that. But you are finding these days that diabetes is setting in a lot younger people. So, you find out people in even late 20s, early 30s, again, tend to link back to areas where there's a lower socio economic class, you often find that people in the early to mid 30s have a borderline diabetes. And it's a it's quite difficult for the body to reach that point that early on. So, but if there are other factors as well like alcohol intake and smoking and other things that can contribute to it's not just the way but yeah, so that those are common ones and obviously, the musculoskeletal conditions which I've touched on before. So early development of arthritis in the knees and the hips, back appeared tendon problems, all sorts of things. There tend to be the more common ones. But yeah, the To be honest, there's quite a lot that can affect and you could put links to various different conditions about the effect of obesity. It's just it's gonna be difficult to study those sorts of things to actually defensively see this causes that."

Sophie Husteden: "Okay. And the last question is, what are some common health concerns that are related to being inactive?"

Sean Crinion: "So, I mean, an activity is a big thing these days with Office based work. A lot of us spending time on computers, we have a lot more inactive than we are than we were in the past. In terms of linking it back first to the musculoskeletal problems to deal with the physical body. The you do get a lot of overuse, repetitive strain type of injuries, but tend to be because of under useful to see if your tissues can cope with a certain amount of stress, but you don't exercise very often. That level of stress is very Also, it can be something a lot of people that are very inactive you tend to find that there suddenly do an activity like move house and the body just can't cope with it because the on a daily basis, the tissues just don't get proper through any stress. So simple musculoskeletal conditions can be quite a common cause diabetes, cardiovascular problems, the same sort of things. If you're inactive, I mean your blood pressure needs to self regulate and as it increases and decreases your exercise, it's beneficial but when you're on under active than the same problems can develop. Another thing that's quite common in discussion these days mental health issues, anxiety, depression, as well knowing that exercise, increases, releases, endorphins increases self serotonin regulation, all these things that are positive for the body. You do find that with anxiety and depression increasing in some cases, exercise can actually be significant and most psychologists and mental health work as well. recommend exercises that is the big form of treatment rather than medication. There's lots of other things again, it links back to can you definitively prove that something causes something else but obesity or inactivity can be a risk factor in things like cancers and other rare diseases. But it's difficult to see when in the long run essentially, if we're, if we're inactive, we'll put ourselves in a lot more risk of a lot of these conditions, which most studies tend to show."

Sophie Husteden: "Is that everything?"

Sean Crinion: "I believe so."

Sophie Husteden: "Thank you for the interview."