Latest / The STA Clinician Podcast / Ep.222 'A Therapist’s Guide To Hypermobility’ with special guest Bonnie Southgate

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Ep.222 'A Therapist’s Guide To Hypermobility’ with special guest Bonnie Southgate · The STA Clinician Podcast

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You're listening to the Sports Therapy Association podcast, putting evidence
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back into soft tissue therapy.
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Music.
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And we're live. Hey people, how are you doing? My name's Matt Phillips,
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RadioFrontShotLive.com,
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and this is episode 222, my favourite number,
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of the Sports Therapy Association podcast recorded as
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always live every Tuesday nearly Tuesday
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sometimes Wednesdays but normally on Tuesdays on the
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Sports Therapy Association YouTube channel and Facebook page
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so if you listen to this podcast and you do want to join us
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questions directly for example first to the door this
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evening in the live lounge nicky mansfield says evening peeps
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i'm tuned in an engaging sponge mode on brain for
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bonnie's bombs of bendy wisdom beautiful alliterations
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as always then metaphors fantastic good to
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see you thank you very much if you do join us live if
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you listen to forecast and you want to join us live then it means when
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you ask a question i can bring up the screen and you get to flash your
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logos it's great for networking etc etc however this
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is the last episode of 2024 we'll be
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back of course in 2025 with a brand new season that'll be
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season five isn't that incredible um 222 weeks in a row since covid basically
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amazing and we'll be kicking off in january with a focus on business month with
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four episodes of priceless information with expert guests on the subjects of
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So do make sure you subscribe to the Sports Therapy Association YouTube channel
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Be on Facebook, Instagram, LinkedIn, whatever suits you best.
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So yes, in this final episode of 2024, A Therapist's Guide to Hypermobility,
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my special guest coming up very shortly is Bonnie Southgate,
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a specialist in hypermobility syndrome and MSK advisor to the charity SEDS Connective.
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Bonnie is going to be discussing the do's and don'ts of working with hypermobility along with the clinical.
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Music.
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So, whether you've joined us live or you're listening to the podcast recording,
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kick off your shoes, sit back and enjoy.
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As I bring up special guests for this episode, 222, Bonnie Southgate of Movement
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Anatomy Essentials.co.uk.
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Hey, Bonnie, how are you doing? Hello, I'm very well, thank you.
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Looking wonderfully Christmasy. If people listen to the podcast,
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you can't see this festive delight.
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But you should go to youtube now and check out
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the jumper in the background it's all very christmasy thank you for making it
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for making it feel festive i've i feel totally underdressed now in
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my brandy but anyway how are you doing i am doing very well yeah i'm american
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so you know we like to get over the clock for christmas and long may it last
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but you're not in america now what part of the uk are you in i am in dorset
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i've been here i've been here for 36 years though So my accent's a bit confusing.
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An American in Dorset. That would be a beautiful film.
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I'm just going to say hi to people who are joining us now. Cecily Hislops is
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Evening My Answers. Thank you very much for joining us.
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Cecily and Sir Glenn Murphy, MBE. So it's one to go. Wow, I know, Glenn.
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And I think you've probably been to about 220 of them. So thank you,
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Glenn, for joining us once again.
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So fantastic. Thank you so much, Bonnie, for joining us.
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I'm sorry it's taken me three years and two months to call you back.
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I was busy. What can I say?
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I was busy too you were one of the forerunners to
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the podcast you you were in episode 41 um
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yeah those three years shot by completely i'm not going to ask what you've been
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doing for three years but i think what we would like to do is for people who
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aren't aware of your background we'll jump straight in maybe and ask how and
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why did you end up being a specialist in hypermobility syndrome?
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So my background started as a ballerina. So I originally danced both in America and the UK.
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I danced with the Royal Ballet as a first soloist. And I didn't know I was hypermobile
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because everybody I worked with was.
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And I then, after I left my career, due to a lot of odd injuries and surgeries,
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became a Pilates teacher.
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And for my essay, I didn't know what to do. And my mentor said,
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why didn't you do it on hypermobility?
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And I was like, why? Why would I do it on that?
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Anyway, I started looking at hypermobility and then I started realizing that
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I ticked a lot of boxes for a connective tissue disorder, which is called the
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hypermobile type of Ehlers-Danlos syndrome.
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So I then went and was diagnosed with the condition and,
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And it took me a number of years to work my own body out. I really,
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I had a lot of dislocations.
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I was a dislocating hypermobile and I didn't find people were helping me.
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So I really, I tried to work things out.
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I went on sports therapy training with Mike Grice. Everybody knows the wonderful Mike Grice.
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And actually a lot of the techniques we did were really helpful to me.
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And I just kind of, it went from there. it just spiraled as an interest.
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And I continued trying to work with my clients, learn from myself.
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I then joined something called the EDS Society, and they have an ECHO program,
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which is a worldwide program.
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We're really the top experts in the world on the subject.
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The people who write the criteria for diagnosis are all on there.
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And I've been part of that now since it started.
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So that's quite a number of years. I also started writing a book six years ago.
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So I've done a lot of looking at literature and research, and I've done a lot of clinical practice.
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And over the years, I became quite well known for working with clients.
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So I get a lot of people coming to me from different parts of the UK.
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I also have an interest in dancers. So I recently did an MSc in science because
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I wanted to get into the research side of things.
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And I knew that that would be a plethora of hypermobile
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people for me to work with which did turn
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out to be really interesting like for my thesis we did
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our own research project and it was
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really interesting so that's kind of the story
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the long story so far and once again it's a story we've heard quite a lot particularly
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in cases of these systemic syndromes or diseases is or situations where they
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go undiagnosed or misdiagnosed for so long.
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So it wasn't something where you were told this is the problem,
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it's something you had to discover yourself.
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Has it got better or is it still something where you think people are going
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misdiagnosed or undiagnosed?
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I think it's really poorly diagnosed, but I want to clarify because I think
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one of the problems is hypermobility in itself doesn't really mean that much.
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And my research really pointed this out because when you look at dancers,
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and I used to get a bit cranky because all these top physicians and experts,
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whenever they would give conferences, they would talk about the benefits of
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hypermobility and all these non-symptomatic dancers.
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And I thought to myself, well, I wasn't non-symptomatic. I was wracked with
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issues that I didn't understand related to my condition, but not very many people
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were like me in the dance world. So yeah.
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I recognized that actually there were a lot of hypermobile dancers that didn't have issues at all.
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And I think that one of the things that I would like to do going forward is
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to try and clarify why we have all these non-symptomatic athletes, dancers,
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and then we have other people wracked with symptoms.
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And it may be that there's a connective tissue disorder
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and then there's just people at the high
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end or they're training it in because we
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know that ligaments have creep like tendons
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and you can get cumulative creep so whether they're being it's trained in so
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it's a very different condition completely i think they're they're going forward
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needs to be more clarity between the two because somebody with just sort of laxity in their joints,
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you may not need to treat them very differently.
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But when they get things, comorbidities or co-occurring conditions with it,
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then the body behaves really differently.
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And there's quite a lot of research around that to say that things are different.
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So it's recognizing what's just lax joints as to something systemic.
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And I think that's like the message that needs to get out there.
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I think that there's, it's, it takes an average of 10 years for diagnosis.
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I think it is getting a little bit better. It's still not great.
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They still don't, a lot of people I know get diagnosis and they get handed a sheet.
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I've had a girl that was told she'd grow out of it. You don't grow out of it.
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So there's a lot of people out there struggling with.
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The EDIA Society has worked super hard to try and inform physicians,
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and there is just ongoing work.
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So it is becoming more recognized.
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It seems to be more prevalent, and they're not sure why and whether it's the
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recognition of it or whether there is something going on.
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Nobody really knows. So every person who does listen to this will have someone
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come to them as sports therapists.
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They will walk through your door so it is good to
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be armed with knowledge really that's great
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so i mean already so the first kind of maybe number
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one in a therapist guide to hypermobility is is
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maybe understand the hypermobility is an umbrella term
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and not that useful by itself and actually part of the problem
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and it doesn't kind of explain enough that
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the different things which could be involved i've just got there's a bit of
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a pen clicking going on can you have you got a pen you have a pen in your hand
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i'm sorry that's fine i started just because i don't want anything to get in
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the way of the great information you're putting out there i'm always getting
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accused of that's nice to tell someone else yeah i'm ready so that's fine,
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so yeah so that's really interesting so to start off then as therapists we need
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to realize that we're going to get people who are hyper mobile and they could
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excel in their sports and maybe not have any particular issues more than the
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person who's not hypermobile.
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And we need to separate that word from something else, which essentially is
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hypermobility, but with what you mentioned as a heritable connective tissue disorder.
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Yeah. So we would just say symptomatic or non-symptomatic.
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And they have the hypermobile type of Ehlers-Danlos.
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Ehlers-Danlos syndrome is
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a group of syndromes. There's 14 different types. One hasn't been named.
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It's a very strict criteria. A lot of people don't actually meet that criteria.
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So in 2017, they had a consortium and they created something called hypermobility
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spectrum disorder, and it's a spectrum.
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And like the sort of, you go from somebody having a hypermobile joint,
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not particularly bothered, going to somebody who may be racked with issues,
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but doesn't quite fit the EDS category.
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And so you can get people who get diagnosed with HSD and you have to treat them.
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There's a lot of controversy. They still don't know whether it's the same thing or not.
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And people just haven't got all the symptoms in the criteria.
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A lot of times it happens sort of over age.
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But I think it's really important when you get people in your clinic and you're
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working with them maybe as a manual therapist or an exercise specialist that
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just because you see someone bendy that you don't give them problems they don't have.
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But also to realize that in my intake or my list when they fill out my forms,
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I'll have things like gastric issues or are you dizzy when you stand up or sit up?
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Things that might relate to comorbidities that they might not themselves know
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relate to the hypermobility.
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Allergies, mast cell issues, neurodivergence.
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So there is a link now they know that I think The statistic was if you were
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diagnosed with, say, ADHD or autism, you are 80% likely to be hypermobile.
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It's different if you're hypermobile. It doesn't mean you're that likely to
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be a neurodivergent. But there's a lot of links they're now finding out.
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Long COVID was linked to hypermobility by Jessica Eccles and specifically morphonoid
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type of characteristics. So you might find people coming in with long COVID.
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You might also look at them for hypermobility. So there's a lot of new research out there.
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On the subject, linking things, because they're working really hard to try and
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sort of work out causation.
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Which is, we were talking a little bit about that off air. It's kind of exciting,
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isn't it? I mean, there's a lot of suffering, obviously. We must never take away that.
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For example, Jessica Janeman, I'm sorry if I mispronounced your last name,
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but Jessica Janeman says, it took me 40 years to get diagnosed.
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Which is pretty extreme.
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Jessica, if you want to share some details of that in the comments,
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if you don't, then that's fine.
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But if you do want to put something in there then that would be very interesting to hear
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about but yeah it's there is an exciting time there
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is some research coming out isn't there and you've been very much involved in
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that you've just completed was in october a master's research in
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dance science so before that opened your eyes to all
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sorts of wonderful information that you can't wait to
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get out oh we should mention as well talking of getting information out well let's
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do it in order let's not get to it i always get so excited when i'm talking
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to somebody i know so much it's got so much to share but for the
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people who love the visuals you can't see this if you listen to podcast but
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I'll put them up on the screen so the website for
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you to check out if you want to see and and understand
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some of the stuff Bonnie's talking about then go to movementanatomieessentials.co.uk that's
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movementanatomieessentials.co.uk and
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that is Bonnie's website there's blogs on there there's
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a few videos and links to YouTube and everything so that's
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a good place to start and also the
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youtube channel which i believe is going
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to be updated a little bit soon but even
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before the update there's still like one and a half thousand subscribers and
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nearly 100 videos all to do with eds and
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rehab if such and then on the website as well there's a little bit of a reminder
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that you've got this book coming out which is where i was going to it this the
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hyper mobile universe tell us a little bit about that if you could this is the
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six years project is it This is the six years project that I was going to have finished so long ago.
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Yeah, because when I, well, throughout my own journey,
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working out my own body, I really didn't feel like people were helping me and
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I had to work out a lot myself.
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And then I became involved in the ECHO program and I decided that I just wanted
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to share something for, it's aimed at sports therapists and physiotherapists
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and exercise professionals.
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It's not an academic book. It's not a medical book because I think at the moment,
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what you get is either books that are about people's own experiences with the
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condition, or they are medical and there is a real gap in the market for something
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that's understandable.
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And each of those planets is a comorbidity attached to hypermobility.
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And the book takes you through what it is to diagnostic criteria.
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I cover Marfan because you have to be way more careful with Marfan.
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We cover vascular EDS and classical, but we then focus mainly on hypermobility
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spectrum disorder and hypermobile type of EDS.
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And I'm trying to cover everything possible.
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I can think of gynecological to just mast cell issues, everything that might
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walk in your door that someone might have.
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And sometimes it's just piecing together these bits that can be really liberating
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for somebody who's struggling.
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Because these days you go to a physician and you're allowed,
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what, seven minutes to talk about one thing.
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And if you have a syndrome, which it is, you're not allowed to talk about the multiple aspects of it.
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And so it doesn't get diagnosed, it gets missed so often.
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And, you know, really, unfortunately, our system then throws you to lots of
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different medical people and nobody really works together. And it's actually
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putting the whole thing together that, you know,
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In my experience of working with people, and I've now worked with people for
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about 20 years, it's often their history.
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When maybe things start going downhill, you look at that aspect because it's
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like parents that have children. If you can tackle sort of what came first,
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a lot of stuff calms down.
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And it's so much. It's so huge, really.
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I wanted to get something out there. And it has taken me six years because research
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and new evidence is appearing all the time quite rapidly.
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And so I look at it and I'm like, oh, no, I have to rewrite that section.
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I have to rewrite that section.
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I have given myself a date for March. It will be out in March. That's it.
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I'll have to write another book after that. You've got proof of that now. You're committed to it.
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I know. I am committed. i have my my illustrator
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and and formatter and
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she's sort of keying finishing it and we have
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discussed that if it takes us every weekend until
18:36
march that's it amazing and as good
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did you say off air i think you said there's gonna be two volumes such
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as the size of this universe or well because the book is
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too big yeah yeah yeah yeah understandable
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no very exciting i mean it is a
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topic that i don't know it's the bubbles we move in and everything
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but i do get the sensation from the feedback we guess and
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the people we talked to the podcast and therapy expo that
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it's on people's radars now which is great you know
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people are talking about it along with kind of
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because it's not just women but it is something which obviously affects a lot
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of women and that's in people's minds now both in male and female therapists
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of having to treat the person in front of you and sometimes whether they're
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male or female can make a big difference on what you are kind of thinking about
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and putting onto the table and stuff so it seems to be out there but Now,
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just because something's out
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there doesn't mean that all the information we see is going to be great.
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In fact, it might open the door to letters of misinformation.
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But I reckon your book slash two books, yeah, it's going to be a fantastic guide for therapists.
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Jessica's come back here. So,
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Jessica, thanks for sharing. I think this is really cool to hear from you.
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Obviously, everyone's individual story is going to be different,
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which is one of the things which we've already mentioned. And we'll probably
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go on to talk about connective tissue disorders.
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It's very individual based. But Jessica Jernman, who said it took me 40 years
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to get diagnosed, she says, I was diagnosed by a geneticist last year with hypermobile
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ADS after battling for a diagnosis for a daughter who dislocates subluxates.
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Everything we'll chat about dislocation and subluxation later on.
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Jessica continues, we're a good example in some sense because I present very differently.
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I don't dislocate, but I have a leaky heart. My retinas are both detached,
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which we will talk about as well.
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And the link with all the different organs, sadly, in the body,
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which can be affected by this.
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But there are many, many, many other symptoms that seem unrelated but really aren't.
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Which obviously is, yeah, part of it. And Jessica terminates her sharing with,
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I'm so excited for Bonnie's book. I'm sure.
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Of course, I'm thinking how useful it will be for therapists who want to help people.
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But it must be a hugely well-received book for people who are suffering from
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it as well, who have finally got somebody who is making sense of the disorder
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they've had for so long without receiving much help.
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Does that excite you as well, having the actual person with it reading it?
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It does. And it will be profound, I think, when people go to see that therapist. I have so many people.
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And after the first session, there's a lot of tears because they actually have
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somebody not only who understands them, but believes them.
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And they've struggled and struggled and struggled with so many different areas.
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And if you can just sit there and help them make sense of it and just have discussions.
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And I think for tonight, what I definitely do want to cover as it's for therapists
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and sports therapists is certain things that I know I've had clients come to
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me where they've seen other therapists and things have gone wrong.
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And I think it's really key just to note a few things in some of the common comorbidities.
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So there is something called a triad, but a lot of them, a lot of people with,
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say, EDS or HSD will have what they call mass cell triad.
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Activation. And this is like, it's down to a set of cells that are meant to
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be your first offenders in the body.
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And to be diagnosed with it, you have to have issues in two areas.
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So it would be like eczema, skin issues with respiratory issues or gut issues.
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So you would have more than one issue in the body. And that would be a telltale sign.
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And the problem with the mast cells is that what they do is they help our body
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to heal and they help our body to fight things.
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So they interact with thousands of different enzymes and different things,
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but they open, they work with elastin and so they can open tissue up and make
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it more lax and they also interact with heparin.
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So you can get a lot of easy bruising and you can also get a lot of allergic reactions.
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What I think is really important for therapists to know that like if you get
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somebody, say if you have on your intake form that you put allergies on there,
22:57
you really need to look at the different systems, gastric issues.
23:02
Respiratory issues, asthma, skin, eczema.
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If they ever tick two of those boxes, then be a little bit more careful with
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them because they may, number one, have reactions to all kinds of things.
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And it could be, it could change hour an hour day to day. It can be really random.
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And also just know that the bruising, you might feel like you're doing nothing.
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They also can get a lot more small fiber neuropathy is shown in biopsies.
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And that will be, if you think about healing, whenever you heal,
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you get more blood vessels and you get more nerve endings.
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So if you've got tissue that's being sort of damaged or the mast cells are overreacting
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and you've got a lot of histamines and inflammation, then they're going to be more sensitive.
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So approach them more conservatively and then just feedback,
23:58
feedback and working with that client.
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And also really don't just rub out everything that feels tight,
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especially the upper trapezius.
24:07
A lot of these people have what is known as POTS or
24:11
dysautonomia and the reason they're tight
24:14
up there is a lack of blood flow because when they
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stand up the blood doesn't make it back up to the brain or
24:20
that area and they all want rubbing out and it's like the worst thing you can
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do a lot of times their shoulders are hanging off you'll see the the upper traps
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are lengthened and the last thing you want to do is that I tend to wake them
24:33
up from underneath and then approach it as a bringing blood flow to the area,
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not as a, I need to rub this out because,
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well, we know we don't do that anyway, but it's,
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I have a lot of people and then they become unstable in their cervical spines.
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So it's just, those are like really key watch out points.
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That's really, that's so important, isn't it? It's so important because we are,
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maybe as humans or the way we're educated, we tend to see everybody the same.
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If someone says, oh, I feel really tight up here. We just can't wait to get
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our hands on them and massage them and do all these wonderful things.
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And this is a classic example is if you do your homework and you do your subjective properly,
25:16
before going into that kind of objective and
25:19
the actual service you're going to give them you'd realize hold
25:22
on and then i should not be doing that it's equivalent of maybe
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other things that come to mind is we had uh with the way hip dysplasia or something
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where and therapists have got this urge to stretch the hip flex always and often
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that's the last thing that you need to be doing is trying to stretch the hip
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flex it's just going to lead to more subluxations or something and give them
25:39
more pain so it's such a responsibility isn't it we were talking off air.
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How massage therapists in particular hands-on therapists are so important in health care,
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because people suffering from these systemic diseases especially or disorders
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especially if they're going undiagnosed and they're frustrated they're going
26:00
to go a lot forward but a lot of them are going to go for massage on that for
26:03
an hour to get away that trust with you to lie down and just kind of just think
26:07
okay i can deal with life just the next hour just by relaxing.
26:11
So on top of giving them that, you can also ask the right questions and side
26:16
post them to the right people.
26:17
It's huge responsibility, isn't it? It is. And I do think we are a huge part
26:23
of actually what could be a great part of treatment.
26:27
Like you said, they come in and they want that time. A lot of the issues will
26:32
cause a sympathetic nervous system to go into overdrive And actually anything
26:37
that can calm that system down and calm everything down.
26:41
Even if it's just talking, anything that makes that body feel a little bit safer
26:48
or a little bit more comfortable can be just a huge thing.
26:51
And I don't think there's a problem in seeing someone repeatedly for that when
26:57
you have got a condition like this.
26:59
And, you know, it's like having a warm bath or lighting a candle,
27:03
whatever it is that makes that nervous system calm down.
27:07
We really have such a good...
27:10
Position to be helpful to people like this.
27:14
And also you can signpost and you can put things together for them.
27:19
You can advocate for them for their GPs if they're not being listened to particularly well.
27:26
There's so many things that we can be useful for.
27:29
Also, and I know I mentioned this to you earlier, there was a bit of new research
27:33
done by a woman named Tina Wang and And the Stecos, who, I think it was Antonio
27:39
Stecco, they did some fascial research.
27:42
And I think he originally did research looking at pain.
27:46
And he found that people that had pain had slightly thickened fascia.
27:51
But she found that the fascia in the hypermobile type of EDS was thicker than
27:58
people who had pain and that it didn't glide.
28:00
So there was a thickening. It was a deep fascia, which is actually only just
28:04
under the skin. It's not that deep.
28:06
But actually some techniques just to glide the top, to glide those tissues that
28:13
bring in fluid, it's moving fluid around, can be really beneficial in terms of bringing relief.
28:20
It's not going to be permanent, but it can bring a good deal of relief.
28:25
So always thinking in terms of that sort of light movement.
28:30
Maybe rolling of the skin type of
28:34
thing can be really rather than thinking muscles thinking
28:37
more on that level of working
28:41
with these clients can be really beneficial very exciting
28:44
that's very exciting time i think for hansel therapists
28:48
and massage therapists as long as you've ever
28:51
done this is the thing isn't it i mean again we
28:54
talked about you can get by you don't have to
28:57
be it might not be your thing to look at the research and be in academia but
29:00
you need to be aware of it you need to have that kind of foundation
29:03
of this is where we are at the moment i'm going to still use all these other
29:06
things and that but because otherwise you could do people harm
29:10
essentially and we'll come to some of that later you've already
29:13
mentioned like with the trapezias and stuff and in that situation but
29:15
there's other things you do especially when it comes to exercise prescription great stuff
29:19
i'm so excited in fact i want to say now because you're you're you're
29:22
already dropping such clinical bombs here and delight
29:26
that you have got a course coming out next year oh
29:28
it'll coincide with the book won't it hopefully in march you're at
29:31
that's that's the idea yes the
29:34
sd school and the course is going to
29:37
be on the 22nd and 23rd of march
29:40
fantastic and that's going to be in exeter then
29:43
yes i believe so the details
29:47
haven't been completed but yes it should
29:50
be on her her website i believe it is i
29:53
believe it is if you're interested i am probably
29:56
only teaching that course next year.
29:59
Just to let i i i yeah.
30:02
I have a lot going on so okay get
30:06
that out people there you go you've been warned i'm just yeah i am warning because.
30:10
I'm i'm thinking phd i don't know probably doing a little bit of research with
30:16
an snc coach looking at load and things like that and i time is limited when you're also practicing.
30:24
I'm glad i'm a real man managed to call you a therapy expert
30:27
then and force you to sign the dotted line because that would be that'd
30:30
be amazing i actually did i don't know i can
30:33
see in my mind now amazing and right we've got you
30:35
are really generating a lot of chat here apologies for i'm not getting
30:38
to chat straight away people but i understand that there's
30:41
a lot of things that people want to say in here let me move
30:44
to let's have nikki mansfield first of all
30:47
nikki mansfield says as a bendy with a capital b as
30:50
a bendy with a scary amount of autonomic comorbidities i
30:53
see too many bendy clients cut loose by docs who think that
30:55
diagnosis is the end rather than the start of their journey
30:58
to wellness yes but communication
31:01
is so important as well with anybody in pain but especially
31:04
somebody with a systemic disorder like this or something
31:07
i imagine that's something which you'll touch on as well in the courses and
31:10
the communication with people and yeah very much so I mean I I did run a support
31:16
group in Bournemouth for many years and I am the advisor to a charity so we
31:21
do advocate and there is things that you can do to help,
31:27
advocate for your clients with their physicians, but it has to be done in an
31:31
appropriate way with the physician. Yeah, definitely.
31:36
Tomato and basil soup. Lovely name. Fantastic. Is that the name of your therapy
31:39
clinic as well? I'd love that. I'd definitely go there.
31:42
I'm seeing Bonnie for you or so. Open my eyes to what was going on after treating
31:46
a fibromyalgia diagnosis was doing nothing.
31:49
Her experience and knowledge gave me a good starting point to better understand,
31:54
and not quite yet manage what's happening. I cannot wait for the book, Bonnie.
31:57
This is Sarah from Tomato and Basil Soup.
32:00
I need to know if that's the name of the clinic. What a great place for,
32:03
unless you're allergic to either of those.
32:06
But anyway, yeah, thanks for sharing that, Sarah. Amazing stuff.
32:10
Nikki Mansfield's come back with Robert Schleip, currently involved in research
32:14
about the abundance of mast cells in superficial fascia. It's not just deep fascia involved.
32:18
Indeed, and also talking of fascia, I can't say fascia without saying Dr.
32:22
Claire Boucher, who spoke with the therapy expert. She's actually on the Fascia
32:26
Research Council along with Tina Wang.
32:28
She was mentioning as well how exciting it is for people working in the research
32:33
about fascia and how they're realising that's thicker.
32:37
People in certain pain that could have implications and the
32:40
idea is that we can do more now maybe with hands-on work
32:43
than we once sought when we were all kind of quoted charity
32:46
papers and saying oh you can't change fascia didn't
32:49
you know it takes 1200 newtons or
32:52
something we've moved on since that i'm pleased to
32:54
say and it's we're kind of going into a nice exciting stage now with
32:57
a bit more of an open mind so exciting stuff
33:00
right i've got so much on my sheet here i want to.
33:03
Talk about with you so okay let's let's really back
33:06
a little bit to the clinician because one of the
33:08
things i'm interested in is you've already mentioned
33:11
the other systemic symptoms which we need to
33:14
be aware of but i think it's also
33:17
interesting to be aware that a lot of the people we
33:20
see who are suffering from
33:22
hypermobility don't even know they're suffering and they don't even know it's a
33:25
thing i think we talked to them three years ago about asking
33:28
if they've got any party tricks and kind of like a series of questions
33:31
which they might think is totally innocent it's just the way they are when
33:35
really if we ask the right questions then we can
33:38
start opening up and asking about some of these comorbidities and
33:41
things so what should we be looking out for
33:44
because there's different tests in there for hypermobility i think some of them
33:46
are more worthwhile some of them are less but a patient comes in
33:49
and they've ticked a box oh they've said oh yeah i'm very i'm hypermobile
33:52
where should we go with that in our line of questioning so
33:56
so on my intake form i will
33:59
have i will have questions like did you ever do party tricks when you're younger
34:03
yeah a little bit of sort of and also historical did anyone has anybody in your
34:10
family being diagnosed with it but i asked the question of the allergies hernias
34:15
prolapses They're on the diagnostic criteria.
34:20
Mass cell also allergies. Gut gastric issues is a big one because a lot of the
34:26
people struggling will have either sort of chronic inflammatory bowel stuff going on or gut stuff,
34:34
or they'll have really slow motility. So.
34:39
Gastric issues is a really big
34:41
one. And I think that I shouldn't say this because I don't really know.
34:46
They're going to come out with new criteria probably in 2025.
34:50
But I think some of these things will be added into the criteria of diagnosis
34:55
because it's so obvious that there is a connection.
35:02
A lot of the slow motility because maybe because the sympathetic nervous system
35:08
is in overdrive, which shuts it down,
35:10
but also that the sort of contractions aren't as great or as quick.
35:18
And so they can get a lot of things like food sitting in the gut that then ferments
35:23
and they can get things like SIBO.
35:25
So you ask these questions and a lot of times they'll go to the GP or they'll
35:31
get reflux. A lot of them will have reflux.
35:34
So they go to the GP and they're given, And of course, well,
35:37
a lot of imaprazole, which then sort of inhibits absorption, which isn't great.
35:44
I've seen people on drugs for years and years.
35:47
And, you know, you sit there and you start to look at these things.
35:52
And I usually, if I see a list of symptoms, then I just sort of casually am
35:58
like, well, let's look at your little finger.
35:59
So there's the Bayton criteria, which is the diagnostic criteria that the physicians use.
36:06
It's not great. It only looks at, you know, fingers and bending over and elbows
36:14
and knees. It doesn't include hips.
36:17
It doesn't include shoulders. There are...
36:21
Validated criteria for shoulders
36:24
for lower limb and upper limb but they take too
36:27
long so nobody uses them but it's interesting
36:30
because i think the baits and criteria they might not know it's but i think
36:33
and correct me wrong people in the live lounge if you're listening and i think
36:37
quite a lot of therapists are probably once the patient says hypermobile they're
36:40
doing the finger bending test they're maybe getting them to touch the floor
36:44
without flexing their knees and also skin Is that still relevant?
36:49
Is the skin one something you should do?
36:51
The skin has actually been a funny one because I know a lot of people who went
36:57
to rheumatology and they went, well, your skin isn't stretchy enough.
37:00
Now, Professor Rodney Graham is really the person who put it on the map.
37:05
And he first started looking at scleroderma.
37:08
When he was looking at different patients and stretching their skin,
37:11
he noticed a difference in the stretchiness of the skin.
37:16
Hypermobile type of Ehlers-Danlos syndrome doesn't have the classical type of super stretchy skin.
37:22
That's a specific genetic alteration that affects the skin.
37:27
What he says, though, is that when you go to stretch the skin with somebody
37:33
with, say, Ehlers-Danlos syndrome, it stretches around the hand.
37:37
You can see how it's stretching from different parts of the hand.
37:43
So the stretch sort of comes from everywhere, where in a normal person,
37:48
if they stretch it up, it's just like it's a line where it stretches up.
37:52
It doesn't start to pull from other parts of the hand. And that's what he explained
37:57
you would be looking for in hypermobile type of Ehlers-Danlos syndrome.
38:01
So it's not this crazy, stretchy skin thing.
38:06
That they're looking for. It's how it stretches, really.
38:09
That's good. But you also get, I think they recognize that there's going to
38:13
be many, many, many, many more types of EDS probably that they find genetically.
38:19
And when I look at my clients, you get two very different types.
38:22
You get people that have like, their skin literally is like putting your finger
38:27
in dough. It feels really different.
38:30
Or mine, which is super thin, and you can just see all of the vasculature.
38:36
And there seem to be like a couple of different types that I see come to me with diagnosis.
38:43
And they all have the hypermobile Ehlers-Danlos type of diagnosis,
38:46
but I'm sure that as time goes on, they're going to start separating more.
38:52
So the skin, you can still get an indication with the skin.
38:55
If it doesn't stretch from around the hand or it doesn't seem stretchier,
39:01
then it probably isn't an issue.
39:04
Okay. So the message is do these tests, which I think a lot of you are doing,
39:08
but the biggest message is don't think of high availability.
39:11
It's just about getting a positive on those things. The questions then have
39:14
to be asked about the other systemic things like you've mentioned with the gastric issues and so on.
39:21
Excellent. And I think obviously joints. The joints are the obvious one for
39:27
therapists in our position.
39:29
Sometimes they don't know they've got a subluxed joint. I have plenty of them
39:33
that come in with their shoulders subluxed and they don't even know they are.
39:37
They just know they're in a lot of pain.
39:39
And you start sort of dealing with them and then all of a sudden it's like,
39:45
boom, I can actually lift my arm without pain with correct movement and positioning.
39:53
So it's all in the book. All in the book. It should be as well.
39:57
Everything. I was expecting everything to be in this book. It's got to be.
40:00
That's why it's taking six years.
40:03
One of the questions that came
40:05
up, actually, you mentioned joints and obviously the range of movement.
40:08
One of the questions that came up and wasn't quite solved, and maybe that's
40:11
because it depends on the individual and individual.
40:14
Kind of movements they need in their sport everyday life because i
40:18
think it was in tim stevenson who of dynamic shoulders
40:21
he had a great presentation therapy expert he was he's had
40:25
subluxations and i think two dislocations to his shoulder
40:27
he was a rugby player and he was
40:31
talking about basically his stance was quite with
40:34
regards to when he's working with elite athletes who are going
40:37
to get impacted rugby players who are whatever happens
40:40
their arm's going to be put into that extra range of
40:43
movement he was saying if you are doing strength training which
40:46
ticks the boxes depending how it's done it needs to
40:48
be graded but strength training is key in a lot of these situations he
40:52
said you need to strengthen that extra range
40:55
and he was not a supporter of going just into neutral
40:58
because if you're going to neutral and you know that
41:01
person is going to be going into that extra range in
41:04
their activity particularly in the case of sports people
41:07
then they've got to be prepared for it otherwise it's always going to be a danger area and
41:10
there's a little bit of murmuring and shuffling in
41:13
the audience because they were like oh no you don't want to you don't want to train them
41:16
to actually be into nutrient and to learn to stop it you should not go
41:18
any further so does it depend is that the answer or what are your views on that
41:23
no i'm a i'm 100 on board with him and when i was dislocating and i used to
41:31
work with a physiotherapist when i first did the pilates she was the only one
41:34
who let me go into range If you don't train the range,
41:37
they're not going to get support outside where you train them. It's not going to...
41:43
The hypermobility, when you train somebody, so if I train my legs and I have
41:50
done lots of training, you don't lose the hypermobility and the laxity.
41:56
Like, you can pretend it's not there, but it's always there.
41:59
They're always going to be at risk of going into that extra range.
42:04
What is key, so say with the shoulders and what he was doing,
42:08
what I would be saying is that.
42:11
When they start to take that arm back there is that they're integrating the
42:15
scapula with it because it's the, it's the stocket.
42:18
So, and this is where with the hypermobiles, they're really good at not having
42:23
their movements connected.
42:25
So I often work from the bones rather than focusing too much on the musculature.
42:31
If you get the bones moving cohesively together, the muscles fall into place.
42:36
So if I take my arm out here and my scapula moves into retraction, I'm not at risk.
42:43
If I do that and I've now internally rotated my shoulder and I haven't moved
42:51
my scapula, I'm at much bigger risk.
42:54
But I would be training the strength
42:57
as long as I know they're moving correctly in
43:01
full range of movement because and you
43:04
might take it there but you you start to
43:07
teach for me I start to teach movement
43:10
and then I take the movement into strength
43:14
and that's how I ended up really becoming stable
43:17
because I dislocated both shoulders all the time as well
43:20
and I never had surgery but I would wake up
43:23
in the morning and my right arm was like down to the ground and out
43:27
of the socket and I like put it back in
43:29
and this one yeah both shoulders
43:32
were a mess and I did find
43:35
I have found it will be in the book patterns patterns
43:40
with these really unstable shoulders and I highly recommend lovely Jo Gibson
43:46
the real she's yeah she said I went to one of her courses and I had a chat with
43:53
her and her exercises are fantastic.
43:57
And I've kind of, from those exercises, started to work out patterns that I've
44:02
seen in my clients with the unstable shoulders.
44:05
But I'm fully on board with him in terms of taking things to range.
44:11
It's just knowing that one bone, it's never one bone moving independently.
44:16
There's always a series of bones moving. You know, if the ribs can't move and
44:22
the scapula can't move, like you have to integrate all of it,
44:26
really, to get really good, safe,
44:30
to work safely with them.
44:33
Hopefully, I'm going to do some research with S&C. That would be exciting. Yeah.
44:38
Yeah, he was very much, I mean, this is what he's, he, basically,
44:42
he was a similar story after the, not being able to play rugby and he was a very high level.
44:48
His rehab was rubbish it just wasn't helping at all and then he discovered eventually calisthenics,
44:54
which a lot of people are like that's just designed for you know
44:57
super strong people but but he was always talking
45:00
a lot about the rings which he's very much into functional movement
45:03
physical literacy and that sort of stuff and people like surely you're
45:06
not to put somebody who's hypermobile on rings because and he's oh
45:09
i think that sounds great yeah as it's even
45:12
though you can progress you can regress it easily if
45:15
it's just down on the ground you're just getting them to hold it there gently and
45:18
they're safe you know it's no different than you know anything
45:21
they're going to do in their real life but it involves everything that proprioception
45:25
and it was yeah it was very interesting how tied it i think i
45:28
think you know when you start to work like i do with this the range of clients
45:33
i have people that have been in bed for two years like you're not gonna put
45:37
them on rings but if they're like he was athletic and they've had these multiple
45:43
discations and you're probably pretty safe doing all that.
45:47
But, you know, you're going to see a range. We'll see a whole range of people. And we all are smart.
45:54
And we're going to know where you've got to start. And it's about listening
45:58
to the client. It's always just about listening to that client.
46:01
I think that's where the smartness comes from, isn't it? You know,
46:04
which I'm sure will be in the book. We're smart as long as we listen to the client.
46:08
It's 100% about that. I always say to my clients, everything you tell me.
46:15
Because they get gaslit a lot.
46:18
And I say, you're absolutely right with everything you tell me.
46:22
If i listen they're always
46:25
right right i've got
46:27
a big question here that i wanted to ask you if actually it was emailed to me from
46:31
a massage therapist who realizes that as they need
46:35
to do some strength and conditioning courses which is where people like joe gibson
46:38
and then tim stevenson and the other great strength and conditioning coaches
46:41
we know can help but they were asked me
46:44
if you are doing strength training with these clients okay
46:48
and it's within your scope of practice and you've got certification and stuff what
46:51
is the likelihood that they are going to have a
46:54
subluxation or a dislocation even and what should you do if it happens because
46:59
she's read that the last thing you want to do is go to A&E because they'll just
47:03
try and pull on it and that could make it even worse what what how likely is
47:07
it to happen and what should they do if it does well they it shouldn't ever happen it's,
47:12
It won't happen on my watch, I can tell you. That's great. Like… Or what would
47:16
you do? What have you done wrong if it does happen?
47:19
Not listen, I guess, to the client, not progress. No, then you don't know your
47:22
anatomy well enough. Okay.
47:25
Like you… And this is… It is a big thing.
47:29
I think you do have to become more detailed.
47:32
And I, with my own experience with my body and my clients.
47:39
When i first did my pilates training and
47:42
we had to do another essay because that was for the equipment training
47:45
i went to the physio you taught us anatomy and
47:48
i said well where's the book that tells me when i move this bone how the next
47:52
bone moves and how the next bone moves and how the next bone moves and how the
47:54
next bone moves and she just laughed at me and she said i think you should just
47:57
take a joint but she missed the whole concept that in actual fact we do move
48:02
we're capable of tons of different movements,
48:05
but we, there is, that's why we've got ligaments.
48:09
You get to the end of a range and then something else has to move.
48:14
And like, I, I went on a really fantastic course, anatomy and motion,
48:20
and it was really detailed movements of the bones.
48:25
And I started about getting too detailed or too specific. It's just understanding
48:37
that things move and they move together.
48:40
And I sort of use that with my hypermobile clients because they are the people
48:45
that can take a joint and let it spin, where it doesn't then move naturally
48:50
into the other joints, which with the average person, it just happens anyway.
48:55
But with the hypermobile clients, They can do some pretty weird things.
49:00
And sometimes it's just going, let's look at the joint and see how it works
49:05
with the rest of the body, not just independently and in an isolated manner.
49:10
And if you do that, it's not so risky than loading up.
49:17
In my in my sort of clinical practice
49:20
that's what i found so when you mentioned earlier
49:23
that you kind of woke up and your knuckles were dragging along the
49:26
floor is that because you whilst you're asleep you've
49:29
moved and you have kind of taken it into a very weird situation
49:33
and you just roll on it and they pop out
49:36
yeah so it can happen that easily when someone's asleep but as
49:39
long as oh it's very common pretty common but
49:42
when you're doing i think her fear comes from if she's doing strength and
49:45
conditioning with them if you can come out while you're asleep and she's
49:48
putting weight in the hand so the thing
49:50
is if if they're coming out when they're asleep
49:53
you have to start with you don't start with strength and
49:56
conditioning you start with basic movement the joe gibson stuff is really good
50:02
as a starting point using therabands using stuff for pro-perception yeah i i
50:08
had one woman who came to me and she had really severe problems with dislocating shoulders.
50:14
And I spent, oh, I don't know how many sessions trying to get her to understand
50:20
that her arm is a long bone. And if her elbow goes up, it needs to drop back
50:24
at the other end, doesn't pop forward.
50:27
And so it was like, you have a little boy on the seesaw. And when this one comes
50:31
up, that one goes back to just like keep it in the joint.
50:34
And we literally started with hands under her shoulders, getting her to understand
50:39
the correct movement pattern.
50:41
Then we got her upright against a wall when you lift your arm.
50:45
That's the movement pattern. And then from there, we loaded it.
50:48
And then she went on a cross training, cross hiking, and you go from there.
50:56
And then there are certain things, it's easier to load them on their backs because
51:01
a lot of times I had somebody with a grade three severely dislocating shoulder.
51:06
She was a little dancer and she'd been,
51:10
in-house to Stanmore, which is a clinic for hypermobility, and hadn't had any progress.
51:17
And what I found was you could get her to move when she was sitting and you
51:21
could get her to move and load it when she was lying down.
51:24
And the minute she stood up, it all went haywire.
51:28
And what I did find was when she stood up, she hyperextended her knees massively,
51:34
her pelvis tipped forward over her hips, and her lats just grabbed and then
51:38
her scapula stopped moving.
51:40
So we had to get her to actually adjust things so that actually we could get
51:46
movement because the body's looking for stability. They're not like anybody else.
51:51
The muscles will go into spasm and
51:54
behave a bit weirdly because they're protectively trying to hold things.
51:58
So I think the best thing you can do if you're going to try and strengthen somebody
52:03
is not to over-focus on one joint and to make sure you work the entire body.
52:09
That would be my big takeaway. Start low, see how they respond, and then go from there.
52:18
When I go strength and conditioning, I don't do an upper half day and a lower
52:24
leg half day. I tend to do a whole body day.
52:27
I would rather do less and do it that way because it seems to be more integrated and work better.
52:35
So like addressing the whole, the whole body. That'd be interesting as well.
52:40
I don't know if you've planned to put this into the book and I'm sorry if this
52:42
pushes you forward to April, but will you be including where you've come from
52:47
in terms of ability, your strength and conditioning routine to where you are
52:50
now to show like, to give people an idea?
52:55
That's book two. That's volume two. Volume two doesn't come out in March.
52:59
Oh, really? I didn't say that initially. Okay.
53:01
It's two volumes and volume one is very much. And I did this specifically because
53:06
it was going to be like a thousand page book.
53:08
And then I'm like, no, because nobody's going to read the front half of it.
53:13
They're going to go straight to the exercises and to the rehab.
53:16
And so I actually went, no, I need these people to understand the comorbidities
53:21
and all about the condition before I let them actually see then how to deal with it.
53:26
Because it's really important that people do take that in, in working with them.
53:32
That's a good idea. Yeah, great.
53:34
But what do you what are you lifting what are you bench pressing bonnie
53:37
and what i don't think no i don't i don't
53:41
i don't do it i tend to work more on cable based machines or i do i do a bit
53:49
of lifting i haven't done a lot an awful lot though through my msc it must be
53:54
said although i did although i did do the snc module on my course.
54:01
But with cable stuff. I don't know. You know what? I'm not really good. I don't note it down.
54:06
For me, it's more about taking myself to fatigue than worrying about the weight.
54:12
It's knowing that I've reached my fatigue level.
54:16
I have a really fun friend who I work with, and she's on here tonight,
54:20
Maria. This is a shout-out for Maria.
54:22
She's also the illustrator of the book and the format. Oh, wow.
54:25
Maria definitely needs to be here.
54:27
She's doing her level four S&C. and we go
54:30
to the gym together and she sits there and she monitors
54:33
me a little bit like that shoulder is doing something
54:36
really funky that looks not great
54:39
as i i know enough like if i'm doing a bicep curl and i try and turn my arm
54:45
that way if it won't rotate i know my shoulder's not in the socket correctly
54:49
it affects everything wow so like there is an awareness i feel really safe I'm
54:55
so happy to lift weights,
54:58
but only because I know how my body functions.
55:02
And I think if you're working with somebody and you're worried about working
55:07
with them, conversation, conversation.
55:09
If something doesn't feel right to them, it probably isn't. That would be my advice.
55:15
So if they're not super comfortable, then either back off the weight or check
55:22
out the motion and it's not about rubbing it out.
55:27
It will be coming from somewhere else. Probably.
55:30
Look at, look at the chain. Great advice.
55:34
And I just realized now what Maria was saying, which says it will be done.
55:39
That's great. It's applying to Mark. The only decisions are going to be done by Mark.
55:43
It will be done. It's brilliant.
55:45
Oh, look at the time's going now. I've already been there. I just wanted,
55:48
I've got a note here just to mention, I think you mentioned it before,
55:51
with vascular EDS and Marfan syndrome, then that does bring in other criteria,
55:55
doesn't it, with terms of how much you're exerting yourself rather.
56:01
Can you tell us a little bit about that? If you are working with somebody with
56:03
either of those, what do you have to keep an eye on?
56:05
Oh, well, yeah, weight and how much you load them.
56:09
There is a table. You can go like on the Marfan Society or the organizations
56:15
there, and there is recommended sort of exercises, different levels that is acceptable.
56:23
You wouldn't stick weights on somebody with Marfans.
56:27
You don't want to increase. They say it should never create pressure like the
56:33
valve, solve, and maneuver.
56:34
So anything that makes them hold their breath and creates pressure can just blow stuff.
56:39
I would also say if you have a hypermobile Ehlers-Danlos patient who has had
56:45
vascular issues, then be careful with them as well.
56:49
You do want to look at the weight. So you would be asking about like how easily
56:54
they bruise or if they've had bleeds in the past or the heart.
57:00
So some of them can have heart issues.
57:04
And you just, that could be, if you've established that they're maybe have a
57:08
connective tissue disorder, then these questions are important to ask.
57:12
Because it just varies. They vary so significantly from person to person. Amazing.
57:18
And would that go forward as well? Well, what about if we haven't really talked
57:21
much about exercise, but if you're doing a massage and hands-on treatment in
57:25
terms of pressure and degree of pressure, does that have to be taken into account
57:29
as well, especially if you're pushing down on joints and things? Yeah.
57:33
Well, what I have found is METs, muscle energy release techniques,
57:38
are amazing for anybody with hypermobility because you've got contraction at the same time.
57:47
It's like a reset for the brain. It's proprioceptive.
57:50
I think I usually start with that before I do anything else to see if I can
57:55
make the change. I wouldn't do that with a neck.
57:58
Like if there's cervical, if you suspect cervical instability and they will always feel tight.
58:06
You have to be super careful. One thing I do, and I'm going to put this out there as well,
58:10
is when I first get somebody and they either have a diagnosis or you suspect
58:15
they might have more than just hypermobility, I will put my hand on top of their
58:21
head and I'll have them push up.
58:23
So I give them a bit of axial lengthening and I'll do a bit of muscle testing.
58:27
If they test weak and that helps increase the strength instantly,
58:34
then I don't touch their necks because there may be a bit of instability in there.
58:40
And the first thing they get is then axial lengthening exercises with like a TheraBand.
58:46
The other one is to push their chin down without clenching their teeth because
58:50
we don't want to use the master.
58:52
So you're either getting the neck flexors working or say the multifidus in the
58:57
back, if that changes their strength and it's quite amazing how it can really alter things,
59:05
then I know that they've got a degree of instability in the cervical spine and
59:11
that has to be addressed first.
59:13
And then I'll do other strength exercises from there.
59:17
So that would be like a top tip to take away. And I do that with all of them.
59:23
Because they won't build, this is the thing, they won't build strength anywhere
59:28
else if they're not plugged in at the big microchip at the top.
59:31
And also things like gastric issues, if they can't absorb their nutrition,
59:36
you're going to really struggle to get them to build muscle.
59:40
So there are certain things that I really make sure are okay before I try loading them too much.
59:47
Some of my hypermobiles love load, more the better.
59:51
Some really can't tolerate it those
59:54
tend to be the people with pots more they seem
59:58
to be less happy to load too
1:00:01
much but that's just an observation not
1:00:04
research-based lots of research needs to
1:00:07
be done still excellent loads in
1:00:10
there loads of people hopefully got your notepads firing away
1:00:13
and steam coming from them and we've reached the time nikki you okay for one
1:00:17
more question bonnie yeah yeah i've got a question and nikki i saw this question
1:00:20
and i think it's a great question uh nikki says have you come across chronic
1:00:23
urinary retention like gastroparesis for the bladder as a symptom of mcas mast
1:00:28
cell activation syndrome or of hypermobility in general.
1:00:32
So you can definitely get bladder issues it can it could be from mast cell it
1:00:38
could also be from pots it could be from pretty much anything that causes the
1:00:43
nervous system to go into sympathetic overdrive.
1:00:46
So you tend to get like a holding in the pelvic floor area,
1:00:51
with all of that. So yes, definitely.
1:00:55
Also, they don't get the messaging from the stretching of the bladder.
1:00:59
So you end up with the bladder being super full and they still haven't got,
1:01:05
because they don't get the sort of signaling from the nerve endings because
1:01:09
it's all too stretchy. So you definitely get that.
1:01:14
You also have this degree of neurodivergence where actually
1:01:17
the sensory perception can often
1:01:20
be altered because of that so you are
1:01:24
dealing with a whole spectrum of things that can cause
1:01:27
that it's all in the book it will be that right look it's 905 thank you so much
1:01:35
for your time if people want to well we mentioned already you're going to be
1:01:39
Anna Maria's the SC school in Exmouth I always get Exmouth and Exeter confused
1:01:43
it's Exmouth it's One nearer the coast, yeah.
1:01:45
In Exmouth, March the 20... 22nd and 23rd. It'll be a two-day course.
1:01:51
Wonderful. That's great. If people... I'm sure that people will...
1:01:55
Hopefully people are going and signing up now because I'm sure there'll be a
1:01:58
big demand for that because I think it's one of the only ones you're going to do in 2025.
1:02:02
You've got the book coming out as well, which should be around in March.
1:02:05
And we'll be sure to let people know when that is available.
1:02:09
It can be pre-ordered or whatever the situation is.
1:02:11
And if other people want to follow you, we've mentioned the website already,
1:02:15
moving to nationalessentials.uk.
1:02:17
We've mentioned the YouTube channel, Heads Rehab or H-E-D-S Rehab.
1:02:22
And then you're also on Facebook.
1:02:24
I am. I'm not very good at social media. I have to be honest.
1:02:27
But what I am really happy to say to everybody on this podcast is that if you
1:02:32
are struggling with client or you have questions, because I do a lot of charitable
1:02:36
work, I am super happy to have a Zoom meeting,
1:02:40
because I would just rather help.
1:02:43
Than let somebody just run there well it's
1:02:47
true i'm sort of getting old and nearing retirement
1:02:50
but i do a lot of online stuff for
1:02:53
for different charities and if you
1:02:56
have a question you can
1:02:59
go like on the sports therapy and put
1:03:02
it in there and or try and even message me
1:03:05
i'm really happy to help what's the best way to message you
1:03:08
going to the website is there a i do have two facebook
1:03:11
pages actually I have one called HEDS rehab
1:03:15
and I have one called exercise hypermobility exercise and education you can
1:03:21
join either of those and you can message me through those okay I will hopefully
1:03:28
now my MSC is out of the way I'll get better and get back on social media and
1:03:32
get everything going again,
1:03:34
We'll make sure we give links to those Facebook pages and also the website and
1:03:38
everything on there. And even Instagram, maybe. Who knows?
1:03:43
I've got to get better at it. We don't have to. It depends. We'll get someone
1:03:48
to look after you for you. Lots of people would love to do that.
1:03:51
Amazing. Right. Thank you so much. I think Jessica has summed it up here.
1:03:54
Jessica Janiman says, thank you so much. I'm going to listen to this over and over again.
1:04:01
That's great. Okay. Well, that's it, people.
1:04:04
We will be back in 2025 we're finished
1:04:07
now for this year because the way the day's full and the tuesday's full i
1:04:10
think it's like christmas day and new year's eve or something on a
1:04:12
tuesday so we're back in 2025 the brand new season
1:04:15
like i say kicking off in january with a focus on business month four
1:04:19
amazing episodes guests all sorted out already talking on coaching
1:04:22
skills communication client attention use of social media and much
1:04:25
more so if you are listening to this or you've done
1:04:28
us the pleasure of joining us live do make sure you are subscribed for
1:04:31
free to the sports therapy association youtube channel and
1:04:34
make sure you're following us on social media whether it's facebook instagram linkedin
1:04:38
or whatever suits you best but as far as tonight goes and this year goes just
1:04:42
once again thank you so much bonnie southgate what a lovely way to finish the
1:04:45
year with yourself i really appreciate your time bonnie thank you well thank
1:04:48
you and thank you for all the podcasts like your work is amazing and these podcasts
1:04:53
are so enjoyable and informative like i have always.
1:04:57
Thought you were amazing amazing that's so nice thank you very much that's very kind,
1:05:03
and thanks everyone who joined us live if you do listen to the podcast we
1:05:06
don't get to hang out together so maybe next year one of your new year's resolutions
1:05:09
will be i'm going to do something in real time maybe that's
1:05:12
a form of mindfulness you could be working on to actually do something
1:05:15
in real time instead of clicking on record and play that
1:05:18
might be healthy for you and hang out with other people and ask questions generally we
1:05:21
know that you learn more and you engage more if you are mixing
1:05:24
with other people not everyone especially if it's behind your
1:05:27
own keyboard so it might be something for you to think about but if you are listening to
1:05:30
the podcast and do us a good favor of leaving a rating and a review if
1:05:33
you've enjoyed it and that really helps us just go higher and
1:05:36
google search results and if somebody puts in hyper mobility then
1:05:39
bam bonnie southgate episode 222 will be at the top if
1:05:42
you leave a review so that's something which you need to do before christmas and
1:05:45
if you do decide to join us live and fantastic we'll
1:05:48
get together and we'll chat in 2025 but until then
1:05:52
i guess i can't believe i'm saying this again it's come
1:05:54
so quickly have a lovely time over the festive holidays
1:05:57
everybody we're there again yeah god but anyway yeah enjoy yourselves whatever
1:06:01
you're doing over christmas especially if you're having to work i'll be fine
1:06:04
a few moments just to have a smile and share maybe a little chink of glasses
1:06:08
with somebody somewhere if you are working thank you for working especially
1:06:10
everybody who's working healthcare and as always take care of each other and
1:06:14
we'll see you very soon thank you very much bye-bye.
1:06:17
Music.