Who dares, wins

With three sporty boys at home, advanced practice physiotherapist Lynsey Cunningham knows the value of outside play. But she never thought it would help her turn a ‘tearing her hair out’ crisis into an award-winning success story.

Cunningham, 40, who works in the paediatric complex needs team at Northern Ireland’s South Eastern Health and Social Care trust won a national Advancing Healthcare Award last month, for project FUNdamentals in Athletics.

The project used athletics as a therapeutic medium for young people recovering from long illnesses that had impaired their motor skill and for some, affected their mental health. A group of four teenagers did a six-week programme of purposeful, outdoor, sporting activity that increased function and was above all, fun.

The physical results were astonishing – one participant who’d been unable to finish a full day at school was back full time five days a week, while another who was too afraid to run because of his muscle weakness went on to be able to sprint 400 metres in just one minute 50 seconds. 

But it was the impact on their sense of wellbeing that swung the project the Chroma award for AHPs working with people who have mental health problems. 

Teenagers with complex needs often experience feelings of inadequacy, inability or just a feeling of being different, stoking an unsurmountable fear about even attending a sports or athletics club, explains Cunningham. ‘That is on top of everything they are already going through with puberty in a social media era that adds extra pressures.’

The 13-year veteran of paediatric physio had started her career in MSK. But when her request to rotate on to outpatients as a band 6 was denied, she ended up in community paediatrics – ‘and the rest is history!’

Reframing rehab 

She admits her traditional mindset – ‘you treat the person, you fix them, they go out the door happy’ came into play when struggling with her teenage clients. ‘Last summer, all their friends were going off to summer camps that they were too afraid to join for fear they’d look stupid and end up on social media.’

It’s a painful reminder of the gap in sports provision for young people recovering from illness, particularly on the eve of Mental Health Awareness Week (9-15 May).

‘I wanted to give them the degree of ownership of their condition and physical abilities that would encourage their reintegration,’ Cunningham continues. 

‘But they just didn’t like the hard work of a formal visit with a therapist in uniform to complete the same really dull half hour of doing squats and leg extensions. I didn’t know what to offer that meant they would enjoy physio.’

This prompted ‘a few tears’, particularly as her caseload of hospital discharges was growing, with more young people presenting with Long Covid and chronic fatigue syndrome.

The confession is a surprise coming from Cunningham, a woman fizzing with positivity who ‘tries to see the light in everything’ – even her weekly relentless, high intensity resistance session with a personal trainer, and more sedate paddle boarding around the local lough. 

The answer was to rip up the rulebook, and FUNdamentals in Athletics was born. This innovative child-centred programme was devised by Cunningham with colleague Clare Gardiner from health development programme SET Outdoors and Special Olympics coach Lee Campbell. The programme focused on movement skills including agility, balance and co-ordination, speed, jumping and landing – all vital for gross motor skill performance – through group games that also built social skills and confidence. 

Activities included running, javelin throwing and jumping into sandpits with drills such as high knees, relays, breathing exercises and the more traditional single leg balance and stretches as part of warm-up and cool-down exercises. Campbell’s background helped her adapt running techniques and make balance activities more challenging for participants. 

Still, these seem quite an ask for young people who viewed their constant pain as a barrier to doing any form of activity. Using gamification to reframe rehab was key, Cunningham argues. ‘They were acquiring skills, reaching that point of fatigue, building muscle and mass but as their brains and bodies are playing a game, releasing endorphins, they were lured in to doing physio without realising it,’ she grins.

Changing mind-sets 

Swapping the clinic setting for an athletics track – with Cunningham and the athletics coach in sports gear, using specialist sports equipment – helped to ‘de-medicalise’ sessions. The group dynamic helped take the pressure off participants, offering unexpected life lessons. ‘They learned it was OK to lose without it adding to their fears over participation. 

‘They just all clicked, and had a laugh, and it was amazing how that camaraderie pushed them to do better every week.’

The teenagers may have started the programme ‘dragging their feet’ but were soon looking forward to sessions that arguably delivered more benefits than a traditional approach. Linking friendship, fun and scoring rewards to exercise paved the way for a life-long desire to be active, says Cunningham. 

You could see them coming along each week with growing excitement and enthusiasm. My manager saw a change in me, too, and it definitely improved my own mental health.

‘I was able to do more than expected and pain wasn’t at the forefront of my mind,’ said one participant. While another added: ‘I feel I have benefitted humongously from this group. I have become more positive and open and I have made new friends.’

With the parents at a distance, healthcare professionals were able to focus more on their patients, too. ‘In a clinic, the parents are always in the room, part of the conversation, but with them standing on the side-lines the children were free to be themselves. It was lovely to watch,’ says Cunningham. As concerned parents often impose limits on young people’s activity, did they find it difficult when she was pushing participants to do more? 

‘The first week or two they definitely hovered round the sides saying, “What? you’re making them run? They don’t run!” There was an expectation that the kids need to be wrapped up in cotton wool because of what they were going through. But we all had a lightbulb moment when we saw that they could be active and have fun even when the pain was still there.’

Going beyond the physical 

On evaluating the project, what surprised Cunningham most was the difference in their patients’ mental health. Using the World Health Organisation Well-Being Index, it showed a rise of up to 32 per cent in wellbeing scores. 

One participant gave an indication of why in his feedback: ‘What I enjoyed most about the outdoor programme was feeling supported.  I didn’t feel alone and I realised that I wasn’t the only person going through these things.’

Cunningham believes this shows how the scope of the physiotherapist role goes beyond the physical. ‘Though we are not counsellors, we do have a counselling role. With many conditions such as chronic fatigue syndrome, there are psychological needs that require support. While in lockdown, families brought everything to us – physical and emotional.’

Her key takeaway from the project was the impact simply changing your approach could have on physiotherapy interventions. ‘Realising I didn’t have to stick to the rule book if they weren’t improving with traditional approaches was a revelation. But now I’d say to anyone in my position, “get outside, go for a walk!”’ 

The judges who gave the project an award were also impressed by the fact that the programme fosters self-management, relieving pressures on an overstretched healthcare systems. ‘If young people develop skills to a level where they can participate in sports that deliver the same or better outcomes than interventions, then it’s better for them, and the NHS,’ says Cunningham.

The trust clearly agrees, as it’s rolling out the programme to all three of its sites this summer.

And the boy who couldn’t see the point of physio? He’s now joined Crossfit. ‘This was the spur to set him on a path where he’s really thriving,’ she adds. ‘And I couldn’t be happier.’