Latest / The STA Clinician Podcast / STA185 ‘Thoracolumbar Fascia and Lower Back Pain' with special guest Claire Boucher

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STA185 ‘Thoracolumbar Fascia and Lower Back Pain' with special guest Claire Boucher · 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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Welcome to episode 185 of the Sports Therapy Association podcast.
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My name is Matt Phillips, creator of OneChatLive.com. and
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as always this episode is being recorded live on
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a tuesday at o'clock on the sports therapy association youtube
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channel and also on the sports therapy association
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facebook page and the facebook group so plenty of
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ways to join us if you're honest in the podcast and you do want to join us
0:44
live so you can ask the actual guest questions directly or
0:47
just hang out with other like-minded soft tissue therapists then that's
0:51
what you have to do just eight o'clock head to one of
0:53
those sources so very shortly in this episode thoracolumbar
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fascia and lower back pain my special guest is going to be claire
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oucher lecturer of sports therapy rehabilitation at country
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christ church university and phd researcher
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at university of kent but first as always i
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want to give a massive thank you to last week's guests plural
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uh last week because it's the first tuesday of the
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month we had our regular series ask us anything
1:19
and some of the questions on that included further education
1:22
for myself's therapist sports therapist or physio we had
1:26
rebranding renaming my business which logo how do
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you keep things fresh in your clinics nutrition consultation alongside
1:33
sports massage any recommended courses and also
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a question about hiring an additional therapist is the subcontracting model
1:39
effective what's a fair hourly rate and commission split therapist so all of
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the answers to that were provided very graciously by our sta panel who in this
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episode were made up by daniel peters director of body health gatwick also we
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had in in the studio, Mark Bleasdale.
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Sports massage therapist in Langdala, or apparently in Wales it's pronounced Shandilaw.
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Penny DeMoss, the Soma sports massage therapy. I can't wait for emails about that pronunciation.
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Yeah, Penny DeMoss, the Soma sports massage therapy was also with us on the panel.
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And then last, oh, Sarah Clatworthy was here as well. Sarah Clatworthy, sports therapy.
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And then last but not least, founder of the STA, Gary Benson.
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And so, yes, like I say, if you do want to listen to episode 184,
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and it's available as always on all popular podcast apps and on YouTube and
2:27
of course at the STA website which is thesta.co.uk.
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Also if you are an STA member and you'd like to be part of the STA panel on
2:37
the next first Tuesday of the month, so using my math that will be the first Tuesday of March,
2:42
then you can email me matt at thesta.co.uk and if you fancy being on the panel
2:47
and not an SDA member, then look into becoming an SDA member. Remarkably cheap.
2:53
Particularly effective and welcoming and warm and supportive
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so there you go right then by the way
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if you are joining us via the facebook open group and you'd
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need to give facebook permission for your
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directly and you can share your feelings
3:37
you can just hang out with each other for example in the live lounge at the moment
3:39
we've got glenn murphy hey glenn let's this evening playmates
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back to the 80s glenn murphy thanks glenn
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good to see you here as always ways gary benson
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found at the sda so sorry i'm late to the party gosh everyone's
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painting quite a picture of merriman tonight i hope our
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guest realizes that that it's going to be entertaining as well
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as educating uh cecily hisslop has joined us
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as well hey cecily how you doing good to see you we've got.
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A facebook user now facebook user just to
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point out the reason we can't see your beautiful face and all
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your name is because you just need to click that link which is
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in the show show notes not in the show notes it's in the comments for the
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open the facebook open group or so you
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can see it at the bottom of the screen once i get your comment or maybe you
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want to remain anonymous and haunt our guests the rest of their lives without
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knowing who you are it's fine it's 2024 it's what we do so there we go thanks
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for joining us people live so i think it's about time i've left her for long
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enough down in the lobby as i say tonight it's going to be thoracolumbar fascia, lower back pain.
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So I shall bring up my special guest Claire Boucher.
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Music.
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Hey Claire, how are you? Hey guys. Now I'm a bit unnerved by the party vibe that's going on.
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There's so much to be worried about. We've got a stalker in there.
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You'll never know who they are.
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And yeah, we're expecting balloons and whistles. So there you go.
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But thank you anyway for joining us. I hope you don't run away.
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No, yeah. No, I won't. I mean, I did think I could bring out some party pockets.
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It's my birthday on Thursday, so it kind of fits, you know. Oh,
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seriously? I have a birthday for Thursday.
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Thank you very much. And I hear you've had a busy day today, yeah?
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Yeah. Yeah, seven hours of teaching today, back to back without a break.
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So I am a little bit flat, but the party vibe is obviously waking me up a bit.
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So I apologise if I'm a bit slow.
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Well, that's a wonderful segue into telling us about where you are in the country
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and what you've been teaching. That'd be great.
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Yeah, so I'm down in Canterbury, so southeast of England, basically.
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I am currently working at Canterbury Christchurch University.
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I have also worked at the University of Kent over the past kind of five years.
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I've sort of jump between the two which there's
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a big rivalry between the two universities so it's quite
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comical that I'm that person between them both basically
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so I'll give you my background really I suppose please I well started off with
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I was working as an exercise referral instructor in health and fitness industry
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for about well coming up 10 years really I've been in now a different role and
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I found that I was working a lot with people with lower back pain and we weren't really kind of,
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understanding the kind of what was going on there.
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I mean, there's what, 82% of the population with non-specific back pain,
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and we don't really know what's going on there.
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So that was always a big driver, I suppose, in me and kind of gaining further education.
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I then went back into education, did a sports science degree,
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and then ended up with a PhD kind of in sports therapy. So my.
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Kind of sidestep into there was a bit comical really. I was lying on the sofa
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with back pain, with my legs in the air, scrolling through Twitter and I saw
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this PhD application come up for thoracolumbar fascia and lower back pain.
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And I thought, what the hell is the thoracolumbar fascia? Why have I never heard
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of this in my 10 years of work and education?
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I need to know more. So I reached out to my, well now supervisor and amazing researcher, Dr.
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Kira DeConnick and said, hi, I'm keen, but I know nothing.
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What do you want? Are you interested? Can I apply?
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And then it kind of went from there, really. So I started my PhD and I started
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lecturing, lecturing in sports massage, a lot of kind of muscles,
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gleeful anatomy, various different rehab modules and biomechanics and anything
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they could chuck me at, really.
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And now I'm still doing a bit of everything.
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But today I was teaching exercise referral this morning
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and then introduction to kinesiology and msk
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and after me this afternoon so that's that's the
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whistle stopped all to me really i think you've
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got a lot of people on your side now because it's beautiful the story of not
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how easy it is to get into these things so obviously you've got to do your work
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but how yeah you're lying in pain with your back and you're looking through
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like people just swiping away scrolling scrolling the doom and then suddenly
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wow that looks interesting I can do that.
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Yeah, and here you are. Brilliant. Very cool.
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So the research, that is the title of today's episode. I'm just going to share
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this for people who have joined us live and put it on the screen.
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It's the second publication you've had so far to this date.
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And it's that it's on the screen now just go to research gate
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in normal places and you will be able to find what's going on but
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yes we're talking about tracheal pain relationship between
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the tracheal fascia and lower back pain how
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long ago was this written wasn't that long ago was it no so
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that was my first or second phd
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study so it's only yeah i've only i've literally only just finished my phd
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i passed my bible two weeks ago so i'm in
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the process of thank you writing writing everything
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up to get more and more things published basically but
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yeah that was kind of the first thing i talked about so the data was collected
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2021 2022 for that one excellent
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and that's gonna we're gonna be talking about that tonight before we
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do just to mention you're also very much involved i love looking
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you up on linkedin actually we've got information about
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you there it's exciting to hear and that you're also
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working part-time i don't know how you find all the
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energy but a lot of times they need triathlon coach yeah
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yeah yeah that's my weekend job so yeah I
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can't really I fell into that as well it seems to be a habit
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with me I was teaching spin class and they
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needed cover for the triathlon class afterwards I was like but
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at the time I couldn't really swim I mean I could swim to survive
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but I couldn't triathlon swim and
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I said I can't do that and they yeah chucked me in
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last minute and I love it I love it I've
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got a little little whatsapp group we've been chatting today there's about 40 of
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us in there about going up to london to watch one of the british olympic
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get swim games and yeah i love it it's my little side hustle.
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With sea swimming and triathlon i can't stop.
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I have enough work yeah i'm getting that pressure i think it's a few episodes
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this podcast you need to look into about taking time off yes how to say no yeah
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yeah doing my spinning class well not teaching and then suddenly the the opportunity
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came up to be a triathlon league coach. Yeah. Wonderful.
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Okay. Right. So a lot of passion and interest there. So we're looking forward
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to listening to this. So let's get straight into it. If it's okay with you.
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A lot of our listeners will be familiar with fascia by now. It's been through
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different waves of popularity.
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It's been credited, maybe over-credited sometimes, and then discredited too
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much. And it's kind of been very rocky.
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I'm interested, first of all, just in theory, it should be the same.
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But can you give us a little definition about fascia and its role in the body
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that we'd like to start with?
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Yeah. So basically, our whole body is covered in fascia.
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And it's an area of connective tissue, really, that encompasses think
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of it like a second another organ really it's underneath our skin
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and it covers all of our muscles our whole body and what
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we used to think of it if we go back to you know 40 plus years ago is that this
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tissue was purely there as like packing material and it meant nothing so you'd
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see lots of research and evidence of surgeons going well we cut through that
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that's not doesn't matter and then we just get to what interesting underneath
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you know the bones the the muscles, the tendons.
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And then we started to kind of go, well, actually, wait a minute,
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there's something here. We won't just have all this much packing material.
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It's got to have a purpose. We've started looking at the kind of the chemical
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makeup of it, the kind of what's going on with the extracellular makeup,
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what's going on in terms of different nerve fibers.
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And we know that the thoracolumbar fascia, which is on the lower back between
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your isthmus dorsi and your glute,
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has more nociceptors than muscle so
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there's more ability to feel pain
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in this than anywhere else kind of in our body so
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how can it not be linked with back pain and that was kind of my main kind of
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burning question so what we've had I suppose in in and around recent years of
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people going this is the this is what's causing everything this is the answer
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and we've not quite managed to quantify that in the research yet.
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I'd argue there's certainly still something at play there, but it's what exactly,
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is it the connective tissue and the dense and the loose layers,
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or is it the extracellular matrix?
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How is it, you know, we don't know chicken or the egg, what's causing what kind
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of thing, but there's something definitely going on there, in my opinion,
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that I think warrants further research from research perspective and further kind of, I suppose,
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trial and error with different practices and manipulations to
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try and improve that clinically because yeah I'm kind
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of on both sides here I want I want to do the research but
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I want to know how to treat the patient because ultimately what's the
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point otherwise if we're just finding all these numbers
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but if they don't help someone it doesn't really matter to me shouldn't say
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that as a researcher no that's a really wonderful beautiful modern interpretation
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of research is because historically has been a little bit kind of academia separated
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from shop floor and that's why it's taken so long for souls to come through.
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13 18 years depending where you look and now people like
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yourself it's very exciting we've had we've had other researchers who
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have turned into clinical or spoken directly to
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the shop floor like dr karen inshore is a good example some of
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those trying to connect the research with the reality
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it's a very kind of modern idea and before it would have been poo.
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Poo say no you're either academic i know you
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know it's kind of like but now there's people like yourself who are like brilliant.
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You're kind of thinking oh this is ridiculous it's the same we need.
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To be together yeah well so now it's very exciting and
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a woman as well which i wasn't going to bring up but you are and that
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is that exciting for you have you noticed that that's because i've
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had a lot of guests who said that one of the problems with
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the research it's traditionally it's been done by men
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on men yeah a lot of differences
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are coming up depending on what you're working on but are you aware that you
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are a woman working research and that's something quite modern and good i
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mean i suppose so in that there's there are less
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women in my universities that i've worked at than men but
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on the flip side of all the BASIA researchers I
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know I think I actually know more female researchers that
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are working with BASIA specifically so perhaps we're
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navigating our way there for some reason I'm not
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really sure but yeah I haven't really thought
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about it to be honest because I just I've got my goals and
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my aspirations with research and training and
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all the rest of it and it doesn't really matter to me that I'm female because
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I'm gonna do it anyway it's probably a very
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healthy answer oh stubborn i didn't say
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that by the way right so let's bring up for again we've
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probably got mixed people um listening and joining us
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live so we're just going to pick up an image here it's if
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you listen to the podcast and want to see the images then you can always hop
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off the podcast and go to youtube and obviously you'll see the recording there
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or you can go to the sta.co.uk and you can you can connect to the recording
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there so i'll bring this up on the full page this is the area we're talking
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about yeah give us an idea about what in particular of the fashion in this area
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does and why it's an area of great interest for you?
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Yeah. So, I mean, what we've got there is kind of, it's a nice image.
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I think it's from Grey's Anatomy. I won't know, which is beautiful imagery.
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So we've got the kind of green oval that's showing you kind of the whole general
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area of the thoracolumbar fascia there.
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So it's connecting, say, all the way up between the glutes and the latissimus dorsi.
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Where I've been particularly interested is the little square.
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And that's not just on that side.
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I have looked on both sides of the spine, which is basically between L1 and
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L2, looking at that kind into this space and we look two centimeters to the
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left and to the right of the spine.
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So we pick this area partly because, I mean, it's the lumbar spine.
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We know we get a lot of specific lower back pain in this area.
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But also, so we can try, and it's because I'm using ultrasound imaging,
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I'm trying to find an area of the thoracolumbar fascia that's relatively.
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Unaffected by the underlying tissue, be that the kind of curvature
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of the body as we go around the trunk or be that as
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we get lower with the glutes coming in or the vertebrae and all the rest
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of it so that's kind of the one of the flattest parts
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for me when measuring which makes it easier for
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me to take the scans if i'm honest but it's also mimicked
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after helene langevin who was what is a really
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really big fascia researcher arguably the pioneer
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here if i'm honest and that's where she started doing her studies and you'll
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see quite a lot of us are like yes that's where we're looking that works and
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it makes some really nice images so yeah you can can really see some nice healthy
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fascia and people with perhaps maladaptive fascia as well at that's.
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Fantastic and i'm interested you mentioned on the paper which
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is freely accessible as a lovely pdf will include the link in the show notes
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but you make a point of reiterating our lower back pain is like the leading
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worldwide cause of years lost to disability i mean you gave a statistic i think
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84 percent of the given population will experience lower back pain which is incredible really yeah.
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Obviously it's probably multifactorial it might be the fact we
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can't see it that might have something to do with it you know you know
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headache just rub it with the back it's kind of like i can't see what's going on but do
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you think maybe the fascia in this area is is something
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which is to do with it do you think that makes a standout yeah i
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do i suppose that's that's my
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opinion in a way because you know there's lots of evidence now and i've recently
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started reasoning about kind of that nociplastic and nociceptive pain kind of
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for back pain coming from the cns basically but i i think i do think it's multifactorial
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i don't think i will ever be able to go yes it's just fascia 100 but i I think it plays a role there.
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I think fascia is adapting and we can see differences with people with pain
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and without pain, whether that's
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a cause of the back pain or caused by maladaptive movement patterns.
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We all know if we're in pain, we hold ourselves differently.
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We're probably more likely to be sitting or lying down. I certainly was.
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We're not doing that regular movement physical activity.
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So I think it's got to play a role. If it's got that many pain receptors, how is it not?
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And we also know that it's connecting everything so when we
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get back pain we very rarely go oh yes it's exactly this
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one point it's more this kind of overarching kind of numbness perhaps tingling
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sensation that covers a lot of ground it's like toothache you generally don't
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feel it in one spot it radiates doesn't it and that makes me think with the
18:15
back anyway that maybe that's back here because it's it's just so all-encompassing kind of pain.
18:20
Wonderful and and we're going
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to get onto what your study ceased to to
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prove or look at and demonstrate but essentially
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some of what you were looking for looking for had been shown before to do with
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the thickness and so if you could like kind of talk to us a little about what
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you thought you were going to find and then we can go into what you actually
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find yeah so i mean again started off with that helene langevin so she had a
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few studies 2009 2011 if you're interested in fascia look her up and go read
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them because she'll blow your mind.
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But she basically found it was a 25% increase in thoracolumbar fascia thickness in those with pain.
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I think it was around a 20% reduction in echogenicity.
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She also looked at shear strain, which is the gliding capabilities of fascia.
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So as we move, they glide.
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I didn't have good enough equipment, unfortunately, to measure that one.
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So I stuck with the two kind of single images.
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But I was sort of hoping, I suppose, and finding and and hoping to find that
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same kind of pattern, that significant difference, that 20 plus percent kind of variety.
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But it hasn't been found by anyone else, not at that significance level.
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We're seeing trends, but we haven't been able to recreate that.
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And, I mean, I didn't either. I found a difference, but it wasn't anywhere near that.
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I think it was about 11% of it. I can't remember the life of me,
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right? You'd think I'd know it by heart by now, but I don't.
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But, yeah, it wasn't significant.
19:45
So there are differences, but why are they not?
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I'd argue that's potentially populations. I looked at sedentary,
19:53
not physically active, you know, and relatively low levels of pain.
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So my participants, I would say, were, and that's for all of my three ultrasound
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studies, I think all three of them were very, what I would describe as kind
20:07
of a typical population with pain.
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So, you know, we've all, all 80-something percent have this low level of pain.
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Perhaps it's going on for a long time with that chronic, perhaps it's recurrent,
20:16
but it's not enough to stop us from functioning. And that, I suppose, is what I was looking at.
20:22
I wonder, and this is my theory, I think perhaps we start seeing those significant
20:26
differences if we look at people with very high levels of PEP.
20:29
It's going to be much harder for me to recruit them because you're in a lot of pain
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you probably don't want to come into my lab so i can scan you and
20:35
do some exercise and movements with you and see any differences and
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yeah i mean that's what i basically that was the
20:41
outcome of my phd that i need to do more to find more with different pain levels
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that just keep going the whole time but yeah i think that's that's these few
20:51
results of anyone who does i've never done recess but everyone we talk to on
20:54
the show seem to think and our conclusion was more studies need to be done It pretty much is.
21:00
I can see a message from Nikki in the chat saying, you know,
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the Langevin study was really pivotal for finding these differences.
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But yeah, couldn't conclude the chicken or the egg. We still don't know. We still don't.
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We don't at all. I did the one of my studies was a six month exercise intervention, which was long.
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I won't lie. So I did have 45 participants. We split into different groups for the control.
21:24
Role and we did two 55 minute
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exercise classes with me instructing twice a
21:29
week every week for six months which was
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a lot keeping these people active we enjoyed it
21:36
we've had great fun actually I made some proper friends with
21:39
these people with all with pain and we did ultrasound at the
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beginning three months in six months at the end and
21:44
then six weeks post and I thought well this surely
21:47
will tell us something you know something significant about
21:50
this because six months of difference and again we
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saw changes and certainly a trend towards a reduction
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thickness and a change in echo but it wasn't
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significant so we still don't know what's causing
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what and I think for that we need studies
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really looking at kind of before that onset of pain we
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need a lot more like that and following them on which takes time and money I
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know Carla Secko has been doing a lot of work looking at a really really early
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I think like pre-birth kind of stages and looking at what is is going on with
22:22
the development of FASIA and perhaps that's something we can then track.
22:26
That's going to be a long time coming because it's not just go and do a quick
22:30
one study or a six month study. It's going to be years and years over time.
22:34
And I think there's certainly interest in it.
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I know my mom, I'm going to keep going on about my supervisor,
22:39
Kira, because she's amazing.
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But I really scan some of the same people she scans.
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So I think she's hoping to kind of see if we can get the research to put those
22:47
together, because some of those have been like 10 years in between.
22:49
Do we have any differences? Have we seen any kind of changes in their pain statuses?
22:54
But it's really hard to kind of knuckle that down and quantify,
22:58
I suppose, that research when, you know, life happens in between.
23:01
So how can we... Spin classes and triathlon coaching. Yeah, it's tricky.
23:06
It's so healthy though. It's so interesting hearing. I don't know.
23:09
I don't want to go on too much about the modern researcher, but it sounds like,
23:12
you know, you're constantly critically kind of thinking, oh,
23:16
but challenging yourself, challenging your expectations and not kind of doing
23:21
kind of study where you're looking for this.
23:23
And therefore hey guess what you're finding this and that seems to
23:26
be a kind of a modern take and a little bit more realistic because
23:30
in the past yeah i mean researchers have been guilty of that
23:32
they've been looking for something and they found it because they were looking for it so
23:35
sounds really healthy which is essentially what clinicians need to
23:38
be doing as well if they if they do a course on i don't
23:41
know this and that and then suddenly the next 100 patients are going to
23:44
have this and that what a surprise they're looking for but that's how
23:47
it's gone with research though if we look at kind of back
23:50
pain in general when we first started being able to to use
23:53
x-rays suddenly all the back pain was to do with the bone to do
23:55
with the spine then we started looking and being able to image the
23:58
muscles and like okay it's all to do with the muscles now we're
24:01
using ultrasound and we're looking at a path here you know we it's kind of I
24:05
think human nature to have that sort of degree and I think we just need to kind
24:09
of remember that whatever we're doing is building on something and I don't think
24:13
I sound a bit preachy there but it kind of is you know it's all I don't think
24:17
we could it's really difficult to find something I think nowadays it's like,
24:20
this is that, you know, it's more likely to be this big picture and how can
24:24
it all interplay, I suppose.
24:28
That's great. And that's so, like I say, that's so similar to what should be
24:31
happening in things, you know, we probably might not find the exact cause of
24:35
your pain, but we're going to address these factors, you know, it could be a factor.
24:38
And hey, if we keep doing a little bit of this, a little bit of this,
24:40
guess what, you're not in pain anymore. Do we know what fixed it exactly?
24:44
No, but we're getting there. But it works. it works you know yeah
24:47
so yeah really interesting um i wanted um
24:50
i was in i think it'd be interesting for listeners again i'm sorry podcast
24:53
listeners you can't see this image but i just want to bring up these images
24:56
which are on the pdf and we will put a pdf in the
24:59
show notes and let's put that on a solo it just kind of shows the participant
25:03
demographics and how did how i'm interested how did you choose what sample size
25:09
to have how did you sort that sort of thing out yeah so we We did some power
25:13
equations to work out kind of the minimum we'd need for each of these studies.
25:18
And we also looked at what's existing elsewhere.
25:21
This study was actually started the day of the lockdown. So I had all my labs booking.
25:27
I had all of my participants lined up and then, nope, we're not allowed to do
25:32
that. We can't get face to face.
25:34
So it was all changed, all cancelled, started again, started again post all
25:38
the lockdowns. I then got a chest infection halfway through,
25:41
so I had to move it around.
25:43
And, yeah, if anyone here is
25:44
thinking of doing a PhD, expect a roller coaster. It really is like that.
25:48
Even without the pandemic, I swear, this is just how it goes.
25:52
But, yeah, and then it was looking for participants.
25:55
So some of the participants with the No Back Pain Group in this were my colleagues at the university.
26:00
For the Low Back Pain Group, I actually recruited from local residence chats.
26:05
So I have the Canterbury Residence Group. there was Whitstable Herne Bay the
26:08
neighbouring town and I put out a nice poster and just like hey I'm interested in back pain.
26:13
Do you want to take part kind of thing and it was actually I
26:17
mean I sent out about 400 emails and I'm not exaggerating in that but I got
26:22
a nice chunk of people back that were really interested really keen and just
26:25
I mean I can't thank them enough like I bought them all chocolate when I finished
26:29
but I'm on a research budget so it wasn't very much chocolate but it was like
26:32
thank you thank you have something so yeah it's
26:37
I like recruiting it's something I think is
26:40
one of one of my favorite things of research which perhaps
26:43
is a bit strange but I like I suppose because I'm working with people with pain
26:46
I want to be able to try and give them something to kind of interesting something
26:50
to learn because so often with well with something that's chronic and going
26:54
on we're just kind of told well you've got to live with it now and it's like
26:57
well actually I think people inherently want want to learn and want to.
27:02
Even if it's still not equivocal we still don't know thank you Anne next time
27:08
I'll let you know but yeah we don't always we don't always have the answer and
27:12
the research isn't always going to give us it in that clear-cut manner but it,
27:16
gives us something to think about something to investigate
27:19
and i think we're inherently nosy aren't we as people we
27:22
want to learn something we want to investigate ourselves and yeah
27:25
it means i get to talk to people about that yeah so that was that was really
27:28
cool i think it's um i don't
27:30
know but i know what how i'm feeling but i think for our listeners as
27:33
well it's encouraging to hear how how research
27:36
truly works as again it takes researchers off
27:39
the pedestal we imagine it's everyday people like
27:42
yourself having to send out emails call people make friends
27:45
say please can i not please you know and then suddenly it's out
27:48
of the world pandemic which kind of puts you know it's i think
27:51
it makes this we definitely need more research done but.
27:54
It makes it more accessible to people thinking maybe i could never
27:57
do research that's for the clever clogs but i'm not saying you're not clever clogs
28:00
but it just it means it is accessible if you've got
28:03
a passion for something and you want to do this then you know
28:06
it's it's hopefully it will encourage people people to do it especially
28:08
clinicians you know especially people who maybe fear academia
28:12
and think i could never do that you can't do it yeah get
28:15
involved like get involved in a research study you
28:18
know obviously i'm down in kent but there are multiple universities
28:21
that run sport therapy courses now but are doing similar
28:24
stuff i think we're the only fascia team down in kent and
28:27
literally the kent fascia team is our new name but
28:30
but people are doing research take part start see what's
28:34
going on and ask how you can get involved there's always usually some
28:37
sort of internships going on in summers you could always
28:39
do a master's you know we have masters by research you could
28:42
go and investigate that yourself and come and join our team you know we'd love
28:46
it we want you know we want to know well certainly i do and so does my supervisor
28:50
well what are you seeing in clinic that we don't know about because we all know
28:55
from working with people you see something over and over again and actually
28:58
you're like why is no one doing anything about this because they they don't know.
29:02
How do you link those two off? And that, I think, is a really,
29:06
a big thing is research dissemination, but not just from researchers to clinician,
29:11
but back, clinicians to researchers. Clinicians can give us such.
29:16
Eye-opening experience as to what they're seeing what's working
29:19
for them what treatments are working because otherwise there's too
29:23
much there's too much to cover and give us direction i think
29:26
certainly i do i always want to hear from clinicians and
29:29
what's working or not working for them so we can.
29:31
Kind of quantify that in research yeah very
29:35
encouraging wonderful right so it is going to get a
29:38
little bit geeky now because we're going to show images of ultrasound with
29:41
that which again i'm excited that you're here to comment on that
29:44
because i think it's something else which again we've talked
29:47
so many times about non-physios basically whether
29:51
it's a sports therapist sports massage therapist but having a
29:54
bit of imposter syndrome and i think maybe reading an
29:57
ultrasound is something which strikes the fear into into.
30:00
Any non-alert health professional because it's like oh my god that's a world i
30:03
can't do and if a patient says i could bring in my ultrasound if you
30:06
want all sorts of excuses come up out of sports medicine
30:09
oh that's okay i don't want and so
30:12
i'm excited it's obviously your whole thing about ultrasound let's
30:15
bring up some images of what you found and then
30:18
maybe you can talk us through the significance of the yeah so
30:22
i'll prefix it with i do not have
30:25
a formal qualification in msk ultrasound my
30:28
supervisor does actually a 12-month course
30:32
i think it was southampton don't quote that somewhere somewhere
30:35
with self and basically she trained me in how
30:38
to measure ultrasound so I had like-for-like training and
30:41
how to use this methodical on the fascia so I am I'm not
30:44
an expert I you told me to scan your elbow I could manage it but I couldn't
30:48
guarantee what I'd be looking at but in terms of fascia I kind of I understand
30:52
the methodology behind it and I can well we did a reliability study and I could
30:57
scan as reliably as my supervisor so we know I can do it it's just uh yeah in
31:02
my little area of ultrasound.
31:04
But yeah, so what I did was basically I took ultrasound images of the lower
31:09
back, say between L2 and L3, two centimeters to the left or the right.
31:14
And we did this on people with and without pain. So I'm kind of guessing at that image.
31:18
I know that's one of my analysis software there, but I can tell you that's definitely
31:21
someone with pain from looking at it.
31:23
So what we've got is basically that's a MATLAB script.
31:26
So if you're freaked out by ultrasound, this will make it even worse.
31:29
So basically, we analyze the scans using a piece of software called MATLAB,
31:35
which uses literal code.
31:37
So I think developers, computer people to make this code.
31:40
And I won't lie, my boyfriend helped me with it because he's a web developer.
31:44
So he helped me make the scope work. Oh, yeah, it was very convenient.
31:48
And what that could do was basically what I've done on that image there,
31:52
and that's the kind of section in the middle of a full ultrasound scan at the
31:56
back, is I could kind of sort out the zones that I was interested in, really.
32:01
So I think if you can all see, I'm looking from the top there.
32:04
So the kind of the red line that's going across the top, and between the red
32:08
and the green line is looking at the kind of subcutaneous zone.
32:11
So on some people, this is going to be really, really small. some people
32:14
it's going to be larger depending on where you're holding your
32:17
kind of adipose tissue okay and that's shown by
32:20
kind of the darkest so when an ultrasound is going down and
32:23
bouncing those kind of beams back up to you if it's kind of liquid or fat it's
32:27
going to show as black okay so that's what we're seeing there I then have the
32:31
zones between the green line and the blue line and that that's what I'm interested
32:36
in that's the thoracolumbar fascia here okay so underneath that You can see
32:39
there's an additional kind of white line, kind of pale white.
32:43
That's the kind of covering the muscle. And actually, you can't quite see it
32:46
on there, but underneath there is all the muscle and you can see all the kind
32:49
of the striations there.
32:51
So what I'm looking at in that kind of between the green and the blue is the
32:55
kind of, oh, I've got a funny sound. Can you hear me OK?
32:58
I can hear you fine. Yeah, cool. It's the kind of the lines,
33:01
which are the dense connected tissue and the loose connected tissue kind of lining up.
33:05
They look very neat and tidy at this angle because of where I'm slicing through with the scanner.
33:09
But in reality, they're more honeycombed up.
33:12
And looking at the darkness between those lines at the extracellular matrix,
33:16
so the kind of the fluid that's between these layers, which allow them to glide.
33:20
And actually you can kind of see something I found
33:23
in that image so we haven't managed to quantify
33:26
this but it's something I mean I certainly want to look
33:28
into and if you're at home zoom in pause the screen
33:31
and zoom in later you can see there's kind of two little pockets
33:34
of kind of really dark areas inside that fascia
33:37
can you see what I mean where it's kind of a bit bigger it's
33:40
kind of they're kind of this kind of shape in there slightly
33:43
up in the blue yeah so I have a
33:46
of theory on this and it's very much theory but basically
33:49
what we were seeing in people with pain is they
33:52
had more of these kind of pockets of this fluid and what
33:56
I think that is is evidence that we've got reduction in shear strength so reduction
34:00
in that movement between the layers and I'm going to do it with my hands because
34:04
otherwise I can't explain it so if we imagine the kind of dense connective tissue
34:07
layers are like logs and they're in a gel kind of water so they're moving around
34:12
happily, the fluid's moving, everything's good.
34:15
If we then get kind of adhesions or it's just getting stuck or whatever,
34:19
and I imagine it's got a sticking between the two, you kind of get this kind of ballooning behind.
34:24
Does that make sense? So that's what I think is happening. And I didn't measure
34:28
shear strain, so I don't know if that's true, but I think we'll see these pockets
34:32
when we've got that sticking because it's going to pull on the other side.
34:36
And that kind of makes sense to me. So that's what I think is happening.
34:40
And certainly what I'd like to go on and study would be
34:42
to get away to measure that shear strain look at it have
34:45
we got those pockets are they moving are they not
34:48
because we certainly saw them in people with pain and
34:51
we saw less of them after a while so running theory needs some work we need
34:56
some samples taken out of there i think katarina fede does a few samples and
34:59
that down in italy but why because you can see it right you can see that there's
35:04
something there and what why is it like that maybe it's just random maybe maybe
35:08
there is something going on.
35:10
So that's kind of, yeah, that's kind of me. And yeah, my MATLAB script,
35:13
basically I put in those layers and it gives me some computational kind of numbers
35:17
which work out the depth.
35:18
So how deep it is from the skin, how thick it is effectively,
35:22
and then those brightness.
35:22
So I can look at how bright are the white lines compared to darkness and kind
35:27
of, is that different? People with pain and no pain.
35:30
I think I answered that. I may have got excited. No, that's wonderful.
35:34
It's really easy to understand you, I promise. It's great.
35:38
And I'm hoping, again, if you listen to the podcast, then go along to YouTube.
35:43
We're approximately at 39 minutes in or something, and you'll see the image come up.
35:47
And, yeah, you can pause it, zoom in, and have a little look yourself.
35:51
But, yeah, no, fascinating.
35:52
I was interested in the results you found.
35:56
There was a there was something which you said was different or
35:59
in contrast to other studies where you mentioned echogenicity yeah
36:04
i know i say thracolumbar different than you you
36:07
said beautifully but i i probably won't i think i learned it in spain where
36:10
it's kind of thracolumbar it might not be you it might no no it's me it's me
36:15
i'm sure it has been all my life but but yeah so i'm reading out from here you
36:19
said the echogenicity of the thracolumbar fascia in in those who the LVP was
36:24
significantly lower when compared to control,
36:26
is in contrast to other studies where the ecogenicity was higher.
36:30
What's the significance of that and why do you think that was the case?
36:32
I would argue potentially that that pain level, and that's my running theory,
36:37
is perhaps people with higher pain levels have a difference in ecogenicity and
36:41
perhaps on the low-level pains, perhaps that's slower to change.
36:45
Because the ecogenicity would generally look at how dense those connective tissue layers are.
36:50
If we look at an ultrasound, the sound things coming back kind of
36:52
brightish white are the most dense and hardest to
36:55
get through so kind of think about the kind of the fascia and
36:58
the connection because you're covering bone you see the kind of the outline
37:01
that's the brightest you're going to see so potentially if it is an adaptation
37:06
to fascia and kind of the injury comes first the fascia change comes second
37:11
then perhaps that takes a bit longer perhaps that takes higher pain levels that
37:15
those change but but I don't know.
37:19
I don't know. It's the honest answer. I don't know. That's my theory.
37:23
You're hearing inside my brain now.
37:25
This is great. We're going deep into it, Claire. We're about to break.
37:29
So echogenicity sounds like a complicated word, but essentially we're just talking
37:32
about the ability of the tissue to reflect, which is how kind of sound waves work. The brightness.
37:37
Okay, fantastic. And by the difference in visual, you can then kind of contrast
37:43
between different types of tissue.
37:44
You and in your case you can see whether fascia has increased or decreased
37:47
in people would accept the idea of it yeah yeah pretty
37:50
much and i mean i haven't i haven't
37:52
got an image of this there but obviously i did over over 200 scans you know
37:58
over the kind of time of my phd and and some people obviously you've seen the
38:02
kind of poster i've got there i've used the nice ones haven't i because you're
38:05
not going to show the ones that are difficult to read that's not that's not
38:09
what what we'd do as researchers or clinicians,
38:11
but some of the scans we looked at, and this wasn't just me,
38:15
Kira found the same, and my external examiner and Professor Natalie Godreau
38:19
in Canada, who also does some brilliant work here.
38:22
Were they always that easy to scan? Or did you find some that were an absolute nightmare?
38:26
And you're like, yeah, some of them honestly look like cotton wool.
38:29
They look like candy floss.
38:31
And you're looking at this going, what am I looking at? You know, where are these layers?
38:36
They're so messed up, for lack of a better word.
38:40
And why? Why are they like this? You know, why is that connective tissue just
38:44
not showing those nice lines?
38:46
And if we look at someone without pain, we generally see, you know, it's thinner,
38:49
but they look far more regimented, far more kind of tightly
38:52
packed and they look really neat they look beautiful you can
38:55
literally go oh lovely and then on the
38:58
flip side of that you've got the cotton wool and you go well well i'm not surprised you
39:01
have pain because what is happening you know that's not
39:03
what we want to see we want to see these nice lines but
39:06
i don't have i'd show you if i had one in front of me and go look no cotton
39:10
wool but i don't unfortunately nikki mansell's come up the question here you
39:15
mean pockets of interstitial fluid kind of getting damned by tissue sticking
39:19
i wonder if the possible Pressure buildup there might cause a nociceptive response
39:22
where it pushes out on the fascia. Yeah, another theory.
39:25
So I think there's something got to be happening there, isn't it?
39:28
We know certainly evidence is showing that reduction in shear strain is definitely
39:32
seen in people with pain and also animal studies.
39:35
There was a big, big animal study by Bishop in 2018, don't quote that.
39:41
And they basically immobilized a leg on a pig and they also,
39:46
it's more multiple, and they injured one side of the fascia.
39:48
And noticed the massive, massive changes in shear strain kind of on the opposite
39:52
sides of where I was kind of trying to manage all of this.
39:55
So there's certainly lots of evidence to say that shear strain reduces in pain.
40:00
But what is causing that, whether it's the connective tissue,
40:03
whether it's the fluid, we don't know.
40:04
And I think, yeah, sticking and causing that kind of a dam is kind of a good idea of how to work that.
40:10
Yeah, I wouldn't be surprised if that does cause more pain because it's,
40:14
I mean, if anything, if something's getting stuck, we know if we've had someone
40:18
come in with a muscle injury, if they've got kind of stickiness,
40:21
let's say, around the IT band, it hurts, doesn't it?
40:23
So we need to manipulate, we need to massage, we need to get them moving to
40:27
move that and it alleviates that pain most of the time.
40:30
So I think, yeah, but I can't back that up with quantified evidence, unfortunately. Yeah.
40:38
That's a great segue. great you've just given me the perfect segway
40:41
to my next question so okay so the the your
40:44
research has congratulations for being second paper
40:47
which has shown this i think because you said before there was only one it's a
40:49
great note too yeah you just said
40:53
oh so you know something's stuck and we need to be able to move it
40:55
and get it moving and stuff like that so what is the significance of
40:58
this do you think for clinicians yeah so
41:02
yeah so the answer is i
41:05
tried to do a big six month study to say yes this type of
41:07
exercise cures it and i found nothing significant so
41:11
i don't have a clear answer for you but
41:14
i did see a trend okay so i found with all that exercise
41:17
and basically what i did in that was there are
41:20
some studies coming out with kind of specific manual therapies and stretching
41:23
but i looked at the exercise kind of angle and that returning to
41:27
movement and that kind of rehabilitation approach in that respect
41:30
and we did say those hour classes had a mixture
41:32
of kind of typical gentle aerobic of course
41:35
i'm with a population with pain and then that kind of alternate
41:38
movement so if you think about one arm going one the leg going the other trying
41:41
to move that fascia in as many directions as possible and then some kind of
41:45
core strengthening work okay so i went with that because it's the most typically
41:49
used people with pack pain you know it's the most safe it's the most effective
41:54
if you look at kind of reducing pain levels so So that was the argument behind it.
41:58
And we saw a proper trend towards a reduction in that thickness.
42:03
So what I need to do is do, I think, probably a longer study.
42:07
I think fascia takes a very, very long time to change.
42:11
There's been sort of some hypothesis around this.
42:14
If you look at Robert Sleip, he was, I think, one of the first to say,
42:17
we're looking at six months plus, you know, maybe 24 months for these changes.
42:21
If we look at connective tissue in other types, so tendon,
42:24
if we look at ligament, and if we look at just how that fast
42:28
that turning over we are looking at over six months
42:31
so i think whatever we're doing i think
42:34
i think exercise will be able to adapt faster i
42:37
think manual therapy will be able to adapt
42:40
faster but i think it's going to take a long
42:43
time i don't think it's going to be oh we'll bring you in for four sessions
42:46
then we'll fix it i think it's going to be a case of us working with these kind
42:50
of treatment plans and stuff these clients can do do at home because I don't
42:54
want to have someone keep coming back to me every single week for the rest of
42:57
their life potentially I want them to be able to take something back and learn
43:00
from it and do it themselves,
43:03
But I think we've got somewhere to go to kind of find out what exactly is the answer.
43:09
I think I'm very confident that we will find this target fascia which helps back pain.
43:16
But yeah, we've got a lot to do there to actually quantify that.
43:21
And I'm sure some of the listeners here would probably actually agree that,
43:26
you know, well, they've done X treatment and it worked or perhaps it's back
43:29
pain, perhaps there's other injuries.
43:30
But there might not be that nice stamp of a pupil with the nice guidelines or
43:35
World Health Organization that says definitely do this.
43:38
Yeah. But I think, yeah, we've just got to keep trial and error.
43:42
We've got to keep doing it. We've got to keep researching and bringing out these
43:45
big studies, because as often with research, I'm not sure how many researchers you have on.
43:50
It's often an acute study. Someone comes in and does one session with a personal
43:54
trainer or whatever that is, or it's four weeks.
43:56
Whereas actually we're looking at chronic health we need to kind of
43:59
look at longer duration studies and see how it's
44:02
going to work in the long term and maybe if i scan all
44:05
my participants again 12 months later and see if see if they
44:08
kept up the uh the routine they have got youtube videos of
44:11
what to do so maybe i'll see that to get some
44:13
more ethics in yes sounds like a good idea
44:16
do you think either is there any
44:19
particular exercise or manual therapy which affects
44:22
the fashion more which we which we can do
44:25
that on purpose than other tissues in
44:28
the body or is it just a case of any movement will affect the fascia and the
44:32
muscle at the same time because you can't separate it so what yeah it is all
44:36
connected and i think that that term connected is kind of what i would say is
44:41
your take home here so we know that the fascia is covering the whole body so the most.
44:46
Movement and manipulations and massage we can do that target multiple kind of
44:51
body sites following you look at body slings, you know, following it or the
44:54
whole posterior chain, I think that will be far more likely to target fascia.
44:58
If we look at doing rehab exercises and even myofascial release and everything,
45:03
which is going, your body's going one way, we're going the other.
45:05
Keeping those direction changes, I think would certainly have more of an impact here.
45:10
And that's been discussed in a few different books, but again, not fully quantified.
45:15
But you know, that is where I think the research is going.
45:18
That is what I would expect to see coming out is that multi-directional kind of treatments.
45:24
And I think most of us are doing that anyway. You know, we don't just.
45:27
Treat a muscle in the same way all the time do we we try and bring
45:30
in the movement whether it's active whether it's passive and trying
45:34
to put it all together so i think naturally we're
45:37
gravitating that way and i think the evidence is gonna it
45:39
will back that up it's just a case of when what
45:43
do you think of the idea that kind of
45:46
maps of fascia and and and following that
45:49
and doing movements which follow those maps is that something which
45:52
you're into as well or do you think it's a little bit pinpointing it
45:55
too much or telling them too much potentially too much
45:58
and i have and i might not get friends for this
46:01
but i've seen a lot of the whole kind of people coming out with
46:04
specific fascia training you know you have to do this you have to do that and
46:08
you'll work on fascia and i think that that's jumping a bit i don't think we're
46:13
there yet to tell you exactly what training method exactly what manual therapy
46:18
treatment you know i don't think we're there i think I think we've got hints
46:22
of what we think it will be,
46:24
but ultimately they're all people like me going, I think it's this.
46:27
I might be wrong. People have been wrong over the years. I mean,
46:30
they thought fascia was packing material, which we know it definitely isn't
46:33
now, but we're constantly learning and building upon who's been there before
46:38
us and who's kind of built something else.
46:40
So every single research paper that comes out from FASIA is hitching us more and more and more.
46:46
We've got more journals taking notice. I know the Journal of Bodywork and Movement
46:50
Therapy are creating a FASIA special issue right now.
46:54
So we've got a whole issue coming out to do with FASIA.
46:56
You guys are talking to me about FASIA, which, I mean, it's my first podcast.
47:00
So you're risking it and I'm risking it here. But, you know,
47:03
we're talking about it, aren't we?
47:04
And I think, you know, there's the conferences. I'm one of the board of directors
47:09
for the FASIA Research Society, which, again, I got into because I need to know more.
47:13
And, you know, there's more and more and more building, I think,
47:16
globally, probably more so than nationally.
47:19
I think there's not many of us FASIA researchers in the UK, but we're trying.
47:24
We're trying to build and we're trying to learn and understand as much as possible
47:28
so that we can really kind of understand this and give everyone who's working
47:33
in these populations a nice guide.
47:35
That's what we want. I want to find something where I can go,
47:37
this works, pass this on and get this working in clinics.
47:41
Because otherwise, yeah, it's pointless. It's absolutely pointless if I don't
47:45
pass that down and we don't find what works because, yeah.
47:49
Brilliant love you it's great you know it sounds like we're lucky to
47:51
have you on the board and and it's got
47:54
a great question here i'll read out if that's okay with you and cochrane says very interesting
47:57
work there have you looked at the work by mcclellan mstr effects
48:01
on fascia scars and correlations to such things for example as back pain
48:04
from c-section wouldn't it have been great also scans of
48:07
your square box yeah so i've seen a little
48:10
very little but yeah certainly well we've got
48:13
to do some sort of collaboration don't we i mean kira and i and
48:16
now she's got a master's student tracy meller as well so there's kind
48:19
of three of us over here with these huge number of
48:22
scans now so we've we've got these scans we need to do
48:25
something with it and yeah make it a bit bigger and make it a bit
48:27
more accessible and there's talks let's put it that way we're talking we're
48:32
trying we're trying to kind of collaborate and get more out there because we're
48:37
only small everyone's there's such a nuanced and kind of new area we all need
48:41
to jump together and and share this research and get it out there and that it's happening.
48:47
Marvelous. Okay, thanks for the question, Anne. Great question.
48:50
Right, well, look, it's already 8.52.
48:52
If people want further information on this, obviously they can have a look at
48:56
your studies, but is there any particular sources which you would recommend
48:59
or website that they go to?
49:01
So check out the FASIA Research Society. Definitely, you know,
49:04
they're always talking about FASIA.
49:06
They run webinars and all sorts. You can obviously join as a member,
49:09
but you can also pay to view them them separately and i'm not on
49:12
commission i'm a volunteer i promise so but there are things like
49:15
that that's happening yeah on google
49:18
scholar get looking at what journals exist following those
49:22
new articles follow me on linkedin and twitter and i will share everything obsessively
49:27
that i find out and we'll kind of go from there really but it's i think talking
49:32
about it you know there's there's been evidence evidence is the wrong word there's
49:36
been researchers now starting to talk about that that need for that collaboration
49:39
and talking with the clinicians.
49:41
So we're really, I think at the kind of beginning of that at the moment,
49:45
which perhaps is a bit far behind, but we want to collaborate.
49:49
We want to talk. We want to get that discussion going on between clinicians
49:54
and researchers. So I think that.
49:56
Keep your eyes peeled really i suppose is the
49:59
outcome from that wonderful so we'll
50:02
make sure again these links obviously go into show notes but fascia research
50:05
society is that a dot com i think it's dot
50:08
all is it a dot all there we go make sure that
50:11
goes in there and also you mentioned on twitter your
50:14
clarem voucher is that right yeah pretty sure it's
50:17
a c-l-a-i-r-e-m-b-o-u-c-h-e-r and
50:21
then you mentioned instagram as well yeah i mean yeah
50:24
i didn't say the instagram you can look at my instagram no i said linkedin
50:27
oh linkedin sorry my instagram is mostly me
50:30
doing fun activities i mean you can watch it but
50:33
it's not not gonna be as informative no
50:37
might be loads of spinning picks and and yeah yeah
50:40
there's a lot of open water stuff on there and suddenly a kayak comes and
50:43
you're like what's she talking about okay so linkedin
50:47
then yeah i mean i've got so much information linkedin that'd be great and yeah
50:50
people to go to that yeah i've been told i'm a bit obsessive with my linkedin
50:54
i'm constantly posting stuff but everyone's like my god she's on it and i'm
50:57
like but it is you know how people say with instagram it's the kind of the highlights
51:01
reel linkedin is my highlights reel of research so but it's not been as nice
51:05
and clear-cut as that there has been drama.
51:09
And fantastic we're looking up now on linkedin and nicky mansfield says cb i'm
51:15
presuming that's Cleo Batch.
51:15
Yes, CB is my new favourite researcher. Oh, thank you.
51:19
A genuine passion for the subject and for clinical applicants.
51:21
Akin to Schleip's, there we go,
51:24
Who's part of Fresh Research? Yeah, our founding director. There you go, founding director.
51:30
So that's great. So you work with him directly then?
51:33
So I have had the pleasure. I haven't worked with him on academic work or research
51:37
work, but yeah, he's on the board with me.
51:39
I spoke to him last night, in fact. There you go. Wow. There you go.
51:43
Excellent. We'll see if he's free to show. That'd be nice to get him on at some
51:45
point. But Alan, brilliant.
51:48
I'll tell you what, he probably wouldn't do a better job than you because you
51:51
managed to break this down the same way as many people try
51:54
to break down fashion with their elbow it's been wonderful you've made
51:57
it very clear and um and really infectious as well your passion shines
52:00
through so i really thank you for that thank you um i'm
52:03
especially if you've had a very busy day um so
52:06
i appreciate you coming along thank you very much no i really appreciate
52:09
it and i i don't think i said anything stupid so first
52:12
podcast nothing not even slightly slightly
52:16
right great so thank you everybody who
52:19
joined us in the live lounge obviously i'm sure that was
52:22
interesting entertaining for you if you listen to podcasts
52:25
and thank you very much for listening do please if you did enjoy this
52:28
then please leave a rating and review on your
52:31
app particularly on apple because it just helps it
52:34
get found easier on google it's as simple as that and
52:37
the good word of our amazing guests like claire boucher will
52:40
appear high end results and that's the way to disseminate this information okay.
52:43
It's not a money thing it's just more people who rate it the
52:46
more it gets out it's like true advice or something when we've talked to
52:49
top so please take two minutes to do that we will
52:53
be back next week oh yes right important stuff coming
52:56
up so if you listen to the podcast or you're listening to the live lounge next
52:59
tuesday at eight o'clock we're going to start a three-part series called something
53:04
like how to set up a massage therapy business and we're going to do three parts
53:08
first one's going to be at your home so including people are thinking or already
53:11
doing it and coming in a room garage or building a purpose wheelchair we're
53:15
also going to have part two which will be episode 187 a week later which is
53:18
in a rented room so we're going to.
53:20
The gym or something or talk about that and part
53:22
three will be in events now when i say we we're going to have a panel again
53:25
so we're looking for volunteers from the sda who would like to be part of
53:28
that panel share their experiences share their wisdom and help
53:31
members and non-members learn so if you're interested
53:34
in being part of that panel and even if you're scared but
53:37
kind of interested then talk to me i'm friendly i won't
53:40
shout at you or anything just email me matt at the sda.co.uk and
53:43
i'll help build up your confidence it's essentially just talking about what
53:46
you do on the camera here the same as claire has
53:49
been okay it's not has it been scary claire it
53:52
was before i started but at the party vibe you guys
53:55
fixed it exactly so yeah i'll read
53:58
you well so there you go you will be scared before you start that you soon ease
54:01
into it so yeah if you're interested in being part of that panel just to help us
54:04
share um your experience because members love annual
54:07
members tissue therapists love hearing about each other's
54:10
work and it's a great way of learning as well so yeah matt's at the
54:12
stf.uk and right that's it
54:15
thanks everyone who joined on this live like i said to our special guest this episode claire
54:19
boucher everything we're going to share notes for links and have a follow claire
54:22
and if you are interested in joining us live then tuesday eight o'clock either
54:28
on youtube or facebook sports therapy association page or group and in the meantime
54:34
thank you very much and take care of each other.
54:38
Music.