Lecturer, Earth Scientist
Job Title: Physiotherapist
Company: Physiolab Melbourne / Absolute MMA St Kilda
Pronouns: She / Her / Hers / Herself
Quiz Results: Regulating, Innovating , Providing a Service, Promoting
I was a mature age student by the time I went to uni, I think I was about 23. So, I was genuinely interested in what I was doing! I felt like I really wanted to be there. I sat in the front row with the other mature age students, we asked all the questions and had an absolute ball. But it was a difficult degree, I found everything hard. Doing biology and chemistry again, after not having looked at them since year 10, was like learning a whole new language. I would have to go and look up pretty much every word from a sentence when I was reading a textbook. I don't think chemistry or physics came easily to me at all, but I was finally able to understand it after having good teachers. We actually did a lot of applied physics in the physiotherapy degree. This was in terms of kinesiology, so learning the mechanics of how the body moves, where the fulcrums and levers are. We need this understanding of how the body moves to help us diagnose and treat patients. That was probably a good 11 or 12 years ago now, I've been a physiotherapist ever since. I've worked at private practices and then built my own business (Physiolab Melbourne), mainly treating combat sports patients.
The other part of my career is being a Brazilian jiu jitsu coach and competitor (a martial art that is very skill-based). I kind of fell into the leadership position here. When I started training, I was the only woman. I was pretty much the highest ranked female for a very long time. I started a women's class just to get more to come into the club so I would have training partners and to encourage a better gender balance. I guess I became a leader because I was just put there, but I do enjoy it. It is a learned skill for me, it didn't come very easily. After that work, I think we now have a great balance at our club (Absolute MMA, St. Kilda). Having women in leadership roles is really important, it encourages other women to not only walk through the door, but also to coach themselves.
I've been an athlete for a very long time. I started jiu jitsu about 11 years ago, but prior to that I represented both Poland and Australia in rhythmic gymnastics and competed in sprint cycling at a high level. I just see being an athlete as a part of me and I absolutely love it. As a Brazilian jiu jitsu athlete, I’m a 3x World Champion (blue, brown and purple belts), silver medalist at No Gi Worlds, I competed at the World Pro Championships and European Championships as a black belt, I’m an ADCC qualifier, Asian Champion, multiple time Pan Pacific and National Champion and Australian Wrestling Champion.
Jiu jitsu, probably like any other sport, is like a form of meditation for me. When I’m rolling, I'm not thinking about physiotherapy or my problems at home. I’m concentrating on one thing, trying not to get submitted. So, it is part of my meditation, but the other part of it is very cerebral. Jiu jitsu is a unique sport in that you do have to study, it’s not like you’re just going for a run. You have to really use your brain to learn new skills every day. It is extremely rewarding in that sense that you're working towards a goal every single time you train.
The first two years of physiotherapy were pretty much aligned with medicine and dentistry. However, apart from the usual anatomy and clinical practice work, we actually did a lot of applied physics. This was in terms of kinesiology, so how the body moves, where the fulcrums are to help us diagnose and treat patients. Once we had the basics, we covered the different parts of physiotherapy. That includes neuro, cardiothoracic, musculoskeletal, hospital and private practice. For example, cardiorespiratory physiotherapy is mainly done in inpatient hospitals. You might be looking at people with pneumonia or people with tuberculosis or post-cardiac surgery. Someone might have a lot of sputum in the lungs, and we look at techniques on how to bring that up again so they can breathe and how to utilize the lungs so they can breathe well. It's a different set of skills and it's quite specialised. In neuro, you get a lot of stroke rehab patients. You have to be aware of which part of the brain controls what function in the body, what the patients can and cannot do and what we can try to retrain. It also might be dealing with spinal injuries and people that were paralysed, thinking about how we can help them function and get back to their lives. Teaching them how to walk again and recognizing the patterns that they need to retrain the brain. It's very interesting, some of it is a lot more emotionally consuming than dealing with, say, a sprained ankle in musculoskeletal physiotherapy.
What does the job of a physio look like?
Usually people come to you because they’ve got pain. If it’s acute, it can be a signal that something is happening in the body. Acute pain is your brain telling you that there is danger. For example, you sprain an ankle because you twisted it, there was some inherent weakness in it, or your scar tissue was weak. Due to the injury, inflammatory cells are sent to the tissue to help with healing. The inflammatory cells signal pain receptors or nociceptors that then send a signal to the brain. That tells you that there is danger and that you shouldn't move or continue to walk on it. Whereas chronic pain doesn't necessarily mean that there is imminent danger. Some people might have had chronic back pain for 40 years, it doesn't necessarily mean that there is anything structurally wrong with the back. It might be that the pain receptors are picking up a sort of white noise. The brain then interprets that as pain.
Part of a physio’s job then is to assess whether it's acute or chronic pain. Because in the case of chronic pain, we don't want to offload. We want to slowly reload and teach the brain that it's okay to put the tissues under stress. We assess with both subjective and physical assessments. A subjective assessment is looking at the history of the patient. Chronic pain is something that's been there for at least three months, you use your interview skills there. You'll pretty much always do a physical assessment as well. If it's the shoulder, you might have a look at how the shoulder moves, its range. You'll ask the patient, what movements are they restricted in doing, what movements can they do? We might ask them to tape it or do some exercise and then we try the assessment again and see if that helps. There's a range of different techniques.
We also look at loading the body in the correct way. That's where applied physics comes in. We utilise our knowledge of leavers, pulleys and fulcrums to teach proper lifting techniques. For example, holding something close to your body when lifting puts less force on the spine. We look closely at this for injury prevention and occupational health and safety. There's a big fad, I think in physiotherapy, of going ‘I'm sitting slouched and therefore I have pain’ and it's not necessarily true. It’s more important to look at loading on tissue, whether it's not enough or too much. When we talk about rehab, we focus on loading tissue to make it adaptable, which is part of recovery. A lot of injuries result from overloading or underloading or doing something too quickly or not quickly enough. We try to rectify that with rest and appropriate loading so that the tissue can adapt and get stronger. That's the way I see physiotherapy.
Recovering movement after an injury
The majority of the evidence supports using movement as therapy, loading the tissue and doing active type recovery. Some people think of physiotherapy as hands-on massage. There is a time and a place for it (to decrease pain and make the patient feel more comfortable) but it’s not a long-term solution. The modalities that are passive treatments, such as laser, ultrasound, hands-on massage and mobilizing are not very effective long term. I see the job of a physio in guiding people on when they're allowed to load the tissue. Some GPs (with less experience in musculoskeletal) might advise their patient to just rest for six weeks. We know that muscle tears take an average of six weeks to heal, but it's not a good idea to do nothing. We can help the patient heal but also get stronger and load the tissues appropriately so that they can return to whatever they want to do in their life.
Treating elite athletes
Elite athletes must be a little bit crazy, you have to overtrain a little bit and really put your body on the line. To me, this is not a healthy thing. If we're looking at the best advice for heart and joint health, it's something like 30 minutes of moderate exercise five times a week. This is nowhere near enough for an elite athlete. So, we are putting our bodies under a lot of stress. But if a physiotherapist was treating someone getting ready for the Olympics and told them to reduce their load and train five times a week for only 20 minutes-that’s not going to work. We know that won’t work. So, it’s about saying, you can still train, but how can we do it safely? What body parts can we save so that you don't get more injured? How can you still be active and move without aggravating your injury?
In these athletes, there is definitely more wear and tear on their joints that are being put under pressure for years and years. The impact of this, however, depends completely on the individual. There are people that are really flexible, and they might have less load on the lower back because their hamstrings are more flexible. But they might have other issues because they're more flexible. A stiff person might have less subluxations (partial dislocation) of a shoulder. But they might have more load put on their lower back as they get into really compromising positions in jiu jitsu. There are trade-offs for everything and it's very individual.
Working on the combat sports board
I spent 3 years sitting on the combat sports board, I’ve just finished up my term because I’m currently on maternity leave. The role of the board is to oversee the safety of contestants in boxing, Muay Thai and MMA and make sure the legislation is being followed. We approve matchups, professional fighters, their trainers, and promoters. We ensure that there is no corruption in promotions and that everything is fair. We also oversee the judges and referees, making sure that they are properly trained. Looking after the safety of contestants also involves educating athletes, we try to make sure that everyone is educated about concussions and weight cuts to make sure that there are no unfortunate mistakes. We conduct weigh-ins before the events, we’re at the promotions, making sure that everyone's safe and that everything runs according to the law. We’re also the voice for combat sports. Due to the nature of the sport, some people don't agree with it and there tends to be less support in general from the public. So, we're advocates for the fighters as well. If there are any disputes or issues that people might have, they can come to us for help and we try to resolve it in any way possible.
Occupational violence prevention
Pro Com approached my husband Lachie, who is also a physiotherapist, to write a course for Ambulance Victoria. They wanted to prevent physical injuries in their field, where there are a massive number of injuries and health claims. Specifically, a lot of these injuries are from lifting and moving patients with some, unfortunately, from being assaulted. Lachie designed a course to help them with lifting techniques and teaching them when to move someone and when to not. I helped deliver the course to all of their Ambos in Victoria. That was very successful, we did a lot of practical lessons on how to lean over a patient, how to carry a patient to minimize the load on your back. Some of those pracs also addressed psychological elements, teaching them to not just rush in to help the patient.
As a result, they had something like a 40% reduction in physical injuries in a year. So that was very, very successful. Being a smaller female that does a high level martial art, I also helped them train security guards at crown casino, pilots, airline hostesses. I taught them how to hold their bodies and how to restrain someone safely in any emergency situation. We also worked with doctors and hospital staff, teaching some really simple self-defence techniques to deal with abusive patients. We taught them how to get out of a situation, how to get out of a choke, how to get up safely and ask for help. That was really interesting work to be a part of.
Right now, I have a newborn, so most of my time goes to him. But generally I compete and coach in Brazilian jiu-jitsu (BJJ), I have been for the last 11 years or so. I've been an athlete for a very long time. I represented both Poland and Australia in rhythmic gymnastics and competed in sprint cycling at a high level prior to jiu jitsu. I just see it as a part of me and I absolutely love it. I think what I like is just being good at whatever I'm doing, whether that’s athletics or work. When I first started physiotherapy, I just wanted to be the best physiotherapist I could be. The emphasis and time I give to each change. There are times in the past 10 or 11 years where I lost a little bit of passion for physio, but my jiu jitsu got better. It’s also a constant weigh up of where and how I could make money. That’s also an important part of the career. When I was younger, I probably didn't care as much. But the older you get, the more you want to be able to pay bills and make some good money.
Taking a more scientific approach to a traditional sport
Teaching is a skill in itself. Traditionally, especially in Brazilian jiu jitsu, there's no pathway to become a coach that refines your teaching skills. You get promoted to a high enough belt and your coach says that you’re now ready to take a class. There is no recognized body that says you should do this course or follow this curriculum (unless your school or teacher specifically gives you one). In those terms, it means that the sport is really behind because we've got these adults that probably took up the sport as kids. They know how to do a lot of things naturally, but they don't know why or how they do them. That’s how it's traditionally taught, but it is changing.
I take a lot of my inspiration from my husband Lachie. He is the head coach at Absolute MMA St. Kilda. We're always trying to find better ways to teach people. Sometimes it might be starting from the beginning of a sequence. For example, if you’re teaching someone how to do a choke from the back: we might teach them to get past the legs, get to the back and then put on the choke. For others, we might teach them from the end. Just get the choke, and then figure out how to get there. If you’re new, a lot of this can be really confusing. You don't know why you're on the ground, on your back. You don't know if it's a good situation for you to be in. We're trying to help people see the big picture.
We do a lot of study with our students, we try to get people to analyse video footage from competitions. Study the footage and think about why that competitor might've done this particular move. Then we try it ourselves. We encourage a lot of question-asking in class and after class. Self-learning is a really, really big thing. We're trying to get our students to rely on themselves rather than relying on the one coach to teach you something. There isn't a coach in the world that can meet everyone's styles and that is everybody's cup of tea. We’re trying to get people to be a bit more self-accountable in their learning. And there is research to support that: you learn a lot better when it's self-directed.
We also teach in blocks. We focus on sequences that we want people to do over 10 weeks. You train for 10 weeks, which helps you build an overall game plan that hopefully brings everything together for some people. And then after that 10-week block, we do revision. Long-term memory doesn't get consolidated by itself. So, there are a lot of different things we're researching and trying, we're always trying to improve.