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In praise of shades of grey


INSTAJURY Irish actress Aoibhín Garrihy drew criticism online after she posted this and other pictures from the top of Carrauntoohill, which she climbed with her husband John Burke while seven months pregnant.  Pic: Instagram/aoibhingarrihy


Andrew O"Brien

I think I have mentioned in these pages before that I occasionally and accidentally swear, but only a little bit and only when prompted. The last couple of weeks have seen some unrelated discussions with colleagues and clients on seemingly unrelated topics that have caused me to do so.
It started when I shared a video on social media of Julia ‘Hurricane’ Hawkins, who set a new record of 24.79 seconds for the 60m sprint. I know, most of the top female sprinters run 100m in eleven seconds or so, but they’re not 102, like our Julia.
Anyway, a fellow chartered physiotherapist posted a comment wondering what Julia’s ‘Timed Up and Go’ score might be. The Timed Up and Go is a test used to screen for mobility and falls risk. The participant is required to get up from a normal chair, walk three metres, turn around and sit back down again; anything below 14 seconds is considered acceptable. Six metres in 14 seconds? And here’s a 102 year old running 60 metres in 24 seconds! It made me wonder whether I push my elderly clients hard enough.
Then, only a few days later, a brother-in-law asked me to have a look at his knee. He’d had a niggle in the knee for a few weeks that was stopping him from running more than a few minutes at a time. He’d been to see a sports therapist, whose advice was to stop all lower-limb exercise for at least six weeks. Crikey! You must be far gone kidding? There is no fracture, the leg moves well, but hurts when he tries to run for more than five minutes (something he doesn’t do a huge amount of anyway), so why stop all exercise?
Similarly, a physiotherapist colleague told me a story last week of a young client who had been advised by another therapist to stay out of the gym until she got her new insoles. Apparently you need insoles to do upper body exercise as well these days. Bloody hell!
My frustration in these situations stems from the black and white, yes or no, approach to rehabilitation and training. Surely by now we have learned that there are countless shades of grey between black and white, and an awful lot of maybes between yes and no.
As health professionals, we need to be aware of the effect of our words on clients. Telling someone not to run at all, at age 40, could scare them into thinking they should never run again and rob the world of the next Julia Hawkins. Telling a teenaged girl that she can’t do anything without insoles creates an unnecessary dependence on a form of crutch that isn’t needed in plenty of instances.
One would imagine, with all the piles of research available, that the world had moved on from the days of telling folks to stop exercising for fear of hurting themselves. Sadly not. Indeed I heard this morning that TV personality Aoibhín Garrihy has been criticised for climbing Carrauntoohil while seven months pregnant. Why? Exercise is recommended during pregnancy, and while Carrauntoohil at 1,000m seems like a high mountain, remember that the average elevation for the whole of Bhutan is over 3,000m, and women there still manage to have babies.
We all need to take advantage of the variables more often. For my brother-in-law, why couldn’t he run slower, and for shorter intervals like the Couch to 5k programmes? Why couldn’t the young lady cycle, or swim, or do weights until she got her insoles? Why shouldn’t a fit, healthy woman, whose husband has climbed Mount Everest and was with her at the time, walk up a hill?
Health professionals are, in many ways, teachers or coaches. It’s our job to extend a person’s ability to do the things they wish to do. While it may require breaking a skill down into smaller, more manageable pieces, it rarely involves stopping everything. If you’d like to hear some new words in a strange accent, try to tell me otherwise.

(Disclaimer: the opening sentence may not be entirely (or even partly) true.)

Andrew O’Brien is a chartered physiotherapist and the owner of Wannarun Physiotherapy and Running Clinic at Westport Leisure Park. He can be contacted on 083 1593200 or at www.wannarun.ie.