Saturday, 24 February 2018

The Evolution of Biomechanics: A Review


The Evolution of Biomechanics: Stephen Braybrook. Published by DM Press 2016

The subtitle of the book is: Bringing movement theory back to life, and the book goes on to detail the fundamentals of current biomechanics with respect to their origins in the various theories of mechanics and mathematics that underpin mechanics and engineering in general. Throughout the book the author raises questions about the continuing validity of these historical understandings of geometry and maths to human movement.

Perhaps the best way to describe the book is that it seeks to start a conversation about how we understand human movement. It does this by presenting the past and present of biomechanics and in so doing points out the flaws in our current thinking. The author declares his intention  to be:

to evolve the theory of human movement to a level where it accurately reflects reality so the way we understand, describe and experience what is happening in the body is in alignment, allowing us to connect with the physicality of the body rather than the theory of movement being an abstract, mathematical pattern. (216)

Each chapter concludes with a "Pit Stop Summary" and a series of questions for reflection. Of course the questions, while intended to be fairly open and not designed as an examination of whether you have fully understood the theories and argument presented, inevitably reflect the authors position that the fundamental principles upon which much current biomechanical thinking is based is flawed and needs to change. That's okay, because he might just be right and a rethink might be what is needed.

Anyone in sport (I'm an active tennis player and have played rugby and cricket amongst others for many years) knows that the body doesn't move in simple straight lines of movement, that it certainly deforms under impact or pressure and is therefore far from a  traditional "rigid body" when it comes to the mechanics of movement. But do these simple models assist our understanding or hinder it? Is there a better way to think about movement? That's a question the book seeks to unpick and a question that the biomechanics community needs to address.

The principle that deeply affects our traditional approach to understanding human movement is the presumption that we are fundamentally mechanistic. In other words you can treat the body as a machine, or a series of interconnected machines. Link this with other things like the principles behind levers and how they do or do not fit with the mechanism of a joint (a lever can't have a joint in it in the way the arm has the elbow, so is the arm a lever in the traditional sense of the word?), and the rigid body, lever based, mechanistic model for human movement seems to come up quite a long way short of a perfect fit. But then that's the author's point.

The book overall is divided into three main sections:

The Past:

This section deals with the historic basis for biomechanics, it's roots in Euclidean geometry, Descartian mathematics, Newton's theories and a few other notaries of engineering and mathematics history. It is this foundation in history that has shaped the representation of movement in terms of levers, points, straight lines and rigid bodies. You don't need to understand all the intricacies of these various theories and models to get the picture that these models are limited. The question that remains to be answered through the rest of the book is how limited are they and are they doing a disservice to our understanding of how the human body moves.

The Present:

This section deals with current thinking in the field of biomechanics. It covers concepts that are applied to human movement such as degrees of freedom, kinetics and kinematics and continues to address the authors concerns about the fit, or lack of it, that human movement has with traditional maths and geometry.

The final chapter introduces the more recent concept of tensegrity. Is this a move in the right direction, ie away from a mechanical view and towards something new? You might hope so, but apparently nit because it too is based around Cartesian coordinates, Newtonian maths and Euclidian geometry. In other words, it's just a new way of "beating down the same path with outdated ideologies" (p159)

The Future:

The last three chapters make up the final section of the book. This is where we get the author's perspective on a new way to think about human movement. Here we come across ideas like holism, complex and non-linear systems, synergistics, self-organisation and sub-optimisation.

In the final chapter we get to the heart of the search for a new paradigm for understanding human movement. Dispensing with maths, the root of the problem as far as the author is concerned, he looks for a new model. It is his hope:

that by rewriting the theory and rules of human movement that we can gain a deeper scientific understanding of the real nature of movement and provide credibility to a whole host of principles, methods and movement practices. p169

The new paradigm is christened "biokinesis-ontology", and is broken down as:

Biology: the study of living organisms
Kinesis: movement or motion
Ontology: the philosophical study of the nature of reality.

This is not to say we must abandon all physical laws as they are currently applied, but rather to move beyond an understanding of human movement based solely upon those laws.

The downside to the book is that someone needed to proof read it properly. In the first few pages there are too many errors that make reading the book more of a challenge than it needs to be. The problem is that these early mistakes mean that some of the arguments lose their clarity because you end up trying to work out if there is another grammatical or syntactical error or whether the author actually meant what was written. Someone with a better grasp of the principles being discussed and described might well be able to discern and correct minor errors as they go, but if you are unfamiliar with some of the ideas then you might just struggle.

The book wasn't what I was expecting, but then that's not a big problem. I guess I was looking for something that outlined the development of biomechanics rather than raising questions concerning the validity of current theories. It was certainly a challenge to read and stimulating to think about how I think of movement from a soft tissue therapist's point of view.


Wednesday, 14 February 2018

Post-Event Massage Service at The London Marathon

This is the text of the document I wrote proposing a post-event massage service. I've continued to work on it and this text includes a section about costs that arises from a number of conversations I've had with others.

The Idea in Short


The London Virgin Marathon attracts thousands of runners every year. Many run to raise funds for charities. After 26 miles of running it’s great to be able to offer these fund-raising runners the opportunity to have a short sports massage to help ease tired limbs and reduce some or the inevitable post-event soreness that they will experience.
But what do you do if you are either a smaller charity, without the resources, or a charity with only a handful of runners? Our idea is simple: Gather a small team of therapists working with a group of charities to provide a post-event service to their runners.
Rather than work individually we pool our resources and work as a team. Four or five therapist serving up to a hundred runners across maybe six or seven charities. The charities benefit too. Not only can they offer a post-event treatment to their runners, they can work together on meeting their runners after the event and sharing the costs of post-event gifts and refreshments.
If you think this is interesting then read the proposal in full and let’s turn this idea into a reality.
Richard
Introduction

Having supported Against Breast Cancer as a Sports Massage Therapist for the last two years at the London Marathon, and having worked at the event for the last six years, I began to think about other smaller charities and their runners. 
Larger charities, or charities with large numbers of runners, often have access to a large team of therapists who serve their runners. For example, one charity for whom I’ve worked has over 150 runners in the event. We had a team of 8 or 10 therapists and between us we treated around 120 runners. (Not all runners come for treatment.)
So I began to think about smaller charities who may not have the opportunity to provide a service to their runners and this idea was born. This proposal sets out the principles and basic concept of what might be possible.
Given that not all runners come for treatment I would suggest that a single therapist working for a single charity might expect to treat between 50-75% of the participants. That might mean that it is simply not feasible for your charity to seek the services of a therapist.
What if a single therapist is working for a charity and they have 20 runners in the event. Of those 20 runners, only 12 come for treatment. That probably gives the therapist a reasonable number of clients for the day, but it also leaves room for anything up to 8 more possible treatments. From experience, dependant upon how well grouped the runners are as they arrive, it’s possible to treat as many as 25 runners over a four hour period based on a simple 10 minute post-event massage. 
So why not join forces? If 4 or 5 charities with fewer that 25 runners got together we might be able to provide a post-event treatment for more runners.
How it might work
Let’s assume that each therapist could comfortably manage to treat 15 runners over a 4 hour cycle. A typical post-event massage lasts around 10-15 minutes, and there’s a bit of time cleaning the couch etc before the next treatment. Obviously there is likely to be some degree of congestion as a number of runners arrive at the same time. It is also important to factor in breaks for the therapists. Massage can be hard work, and although we’re all trained to look after our hands, it is quite stressful.
So, a team of 4 therapists might reasonably be expected to be able to treat 60 runners. If between 50-70% come for treatment, that would suggest that we could cater for up to 120 registered runners.
If we limited access to the scheme to organisations with 25 or fewer participants, then 5 charities could participate or a greater number if they have fewer registered runners. 
What the charities would need to do
The charities would need to liaise with each other and a designated team leader for the therapists. It would be easiest for there to be one point of contact between the charities group and the therapists on both sides.
Between them, the charities would provide a suitable marquee to house the therapists, provide any refreshments they wished to provide and offer any expenses they wish. Each charity would probably want to provide their own “goody bags” to their runners, but I’d suggest some sort of partnership arrangement so that each runner gets something similar. Each charity would also display its own branding etc around the marquee.
Each charity would organise its own ‘meet & greet’ for its runners, although again this might be something that could be done cooperatively. 
The whole idea is to share the load and provide a service to a greater number of runners.
What the Therapist Group would do
Each therapist would be responsible for bringing their own equipment, food, snacks, water etc to the venue. They would be expected to commit to the day, starting and finishing together.
Each therapists would provide proof of insurance, First Aid Qualification and Sports Massage Qualification. Any student therapists would be required to provide the same details and a minimum level of training would be expected (On the course I did that would be passing the general massage assessment).
The group coordinator would gather all the relevant documentation and provide copies to the charities coordinator. They would also supervise the team on the day and organise any pre-event meetings/training that they felt would be helpful.
The group coordinator would supply consent forms and other administration with respect to treatment.
Other things to think about 
Administration on the day: It is good practise that each runner completes a simple consent form before treatment. If the therapists are busy there may be a need for someone from one of the charities to take responsibility for ensuring that forms are completed and any relevant information passed to the therapist.
This is not an exhaustive analysis, it’s just the germ of an idea that has been taking root over a few years. There are probably a whole host of things that need to be considered in order to make it work. On the other hand I believe that every person who commits themselves to running 26.2 mile to raise money for the benefit of other deserves the opportunity of a little post-event therapy.
Getting a team of therapists together might actually be one of the greater challenges, but we shall have to see! 
A Final Word
Each year I’ve worked at the London Marathon it’s been a challenge getting across the city dragging my couch and equipment. I do it because I believe it’s worth the effort to support all the people who have trained hard and campaigned to raise funds for their chosen charity. Each year I meet first-time, (and last-time!) runners. I hear stories about why they’ve chosen to run.
I’d love to see every charity runner have the option of a post-event massage. They all deserve it. 

Counting the Cost
Since putting this proposal together and sharing it with a number of people it has become clear that we need to put some figures on the cost of providing this service. So here goes!
The first thing to note is that this is not a free service. There will be costs, and rightly so. Therapists are trained professionals and we ought not to assume that they all will give their time for free. There are also costs involved in travelling, transport, admin and supervision. So it seems right to begin to put some numbers on these things.
I’m slowly getting a handle on how it works in other situations, and there’s still a lot to learn, but at a basic level there would be a fee to be part of the service. My suggestion is that each charity pays the same to be part of the service, and at the moment I’m thinking this would be around £50-£100. It’s a bit of a guess, and I’m certainly not trying to make money out of this, but I don’t think that it’s an unreasonable amount. Trying to develop a sliding scale dependent upon how many registered runners each charity has just makes the process a whole lot harder and I’m all for simple solutions. My understanding is that a typical cost to a single charity of £200-£300, dependant upon the size of the team, is typical and means that supervisors are appropriately paid for their work and responsibilities. 
Should the therapists get paid? This is a tricky one. Students can’t be paid (although offering expenses is appropriate), but qualified therapists might expect to be paid. I have always volunteered my time freely, but that’s my choice. A typical fee for a paid event would be around £75 for a four hour day. 
My preference would be that all therapists volunteer their time, but we have to accept that some will choose not to do this. I would certainly set this up as a volunteer service initially, but in the longer term we might have to consider paying therapist in order to avoid people pulling out at the last minute because a paid offer came along. 
There are also admin costs to consider. Managing a team of therapists will require time and effort. I’m not sure how you’d quantify this, but it would need to be taken into consideration. First Aid supplies, water, snacks, all might become part of the overall package.
So, let’s start by assuming that supervisors get paid for their day, and let’s say that they get £250. Let’s also say that there’s a deputy supervisor and they get £150 (future proofing by planning for someone to take over). £400 split between say 5 charities is £80 a charity. That doesn’t sound unreasonable to me, in fact it sounds like very good value!
Let’s take it one step further and assume we now pay our qualified therapists (remember we might have both qualified and student therapists). If we had a team of 4, and 2 were qualified. At £75 a day, that’s £150.
I’ve already suggested that 4 therapists could treat up to 120 registered runners if 50-70% come for treatment. If that’s 5 charities, then the cost per charity to pay the therapists is £30. 
That makes the cost in total per charity around £110.
There's still a lot of work needed to make this happen, but it's far better to get something out there and refine as we go than to try and set up the perfect system with every angle covered. It is, in R&D terms, an iterative process!

If the numbers rise then clearly so do the costs. But then the numbers rise with rises charity involvement, so there’s no reason to assume that the costs to any charity will every rise above the £80-£110 amount except for inflation increases.
There's still a lot of work needed to make this happen, but it's far better to get something out there and refine as we go than to try and set up the perfect system with every angle covered. It is, in R&D terms, an iterative process!

Friday, 9 February 2018

Shedul: Appointment Scheduling Software

I tend to do all my scheduling using my iCal calendar. I have one for personal stuff, one for family, one for work and one for admin. It's reasonably efficient and my wife gets to see what's going into my work diary as well as our home and family calendars. It does some weird things, but generally it works okay.

When it comes to handling clients though it does lack the automation that is offered by a propriety piece of software that sends out confirmations and reminders automatically and even allows online bookings. I'm not overly keen on allowing folk to be able to book online without some form of communication first, but that's because of the range of things in which I'm involved. It would be tedious to have to book everything in one diary just to avoid people booking a therapy session when I've already booked a tennis lesson or I"m making a personal visit to see someone. My working hours are quite flexible, so having direct control over bookings is important. I've also had some shall we say "strange" conversations with prospective clients, who in the end I've turned down.

The other thing that is a constant annoyance is the "No-Show". I've had one just the other day. A new client was very keen to arrange an appointment so I made room for therm only to find myself sitting around waiting for them to not arrive.

So when a fellow tennis coach mentioned a system he was trying I thought it might be worth a look. It's called "Shedul" and you can find it here. At the time of writing it's free, and promises to stay that way for those users who sign up now. It offers options for different staff, shifts, opening hours etc.

You can send reminders and confirmations by text and/or email. In short it does more or less everything you'd expect this sort of application to do. I'm currently playing with it a bit before starting to use on clients.

There are some things that make it a little cumbersome and time consuming to use. Some might be resolved as the product develops. The biggest drawback is that it doesn't integrate with my iCal calendars. That means I have to spend time putting appointments into both diary systems and that is tedious and open to error. It would be helpful simply to have my iCal calendars populate shedul, but I can see some challenges with that. For example, if I put a visit to a family for a funeral in my diary I don't really want shedul to pick that up and send them a reminder. All I'd want it to do is block out the time, but then how much time? Also, in the same context, the actual funeral would only need to show up as an event. Obviously the software isn't primarily designed for funeral celebrants, and I understand that. I guess the point is that if you work irregular hours that are very flexible, then time management is always going to be tricky.

On that basis I can see myself using it for therapy clients and maybe for tennis clients. Again there are issues, but that's because I might be trying to make it do something it wasn't designed to do. For instance, if you run a group session and need to cancel it you need to be able to send a group text. Because the software is designed for salons and spas I don't think it can do groups. There might be a way, or a hack that could work. Again it will need a bit of experimentation.

The thing is, the world is an imperfect place. We're never going to get the perfect solution to an imperfect problem. But anything that can do the simpler stuff well and reduce the frustration of having forgetful clients missing appointments can only be a good thing.


Wednesday, 31 January 2018

Smaller Charities at the London Marathon

Last year I posted a short piece about the germ of an idea to provide post-event massage to smaller charities or more precisely, charities with a small number of runners. Having only a handful of runners makes having a therapist on hand unviable. But what if these groups worked together?

I put together an idea of how we might be able to provide a service to more of those dedicated fund raisers who pound the streets for 4 or 5 hours. I tried airing this idea with a few folk but go zero response. It didn't even get shared on a therapist's social media page. Obviously no one thought it was a good plan.

But I still think it's a good idea in principle. So I'm interested to know if anyone also thinks it's a good idea. So here's a link to a pdf of the proposal I put together. maybe one day someone will pick up this thread and all of a sudden we'll have a team. Who knows!

Proposal for Smaller Charities Massage Service at the LVM

Good news. Since posting this I've managed to get some responses and everyone seems to agree that it's a good idea.