While Judges have all the risks of sickness and injury like every other New Zealander, there are additional risks for judges as Malcolm’s first article discussed. In this edition, Malcolm pleads that there’s more we can do to improve performance before prematurely appearing before Mother Nature’s guaranteed end game of pain and joint surgery.
Aristotle said, “If man is to move the world he must first move himself.” Perhaps Aristotle’s comments are superseded by The Lay Public’s, “Do unto others as you would do unto yourself.” The word ‘do’ is significant, and repeated twice in a short sentence can somehow be interpreted as, “Do unto others, but not do to ourselves.” Are judges above Mother Nature’s law?
Hips, knees, and shoulders do not respond kindly to inertia. Be skeptical and hold your arms wide at shoulder level in the crucifixion position for as long as you can only lowering them once you have enough evidence to prove the point! Reproduce this maxim to all your joints and my belief is that the case before you is compelling. We need movement.
Patients never attend a physiotherapy clinic saying something just doesn’t quite work as it should. Rather, pain is the primary driver of people to physiotherapists. If wellness were really an accepted part of medical care in New Zealand, before pain would come prevention.
It intrigued me when working as a locum in Australia that veteran care assessments were made before pain had arisen in a limb or organ. The Australian government has determined veterans are at high risk of joint deterioration, and it’s better to provide several fully funded visits a year to physiotherapy rather than pay thousands once per year for hospitalisation. On economics alone, another comparison as to why the earliest intervention is warranted is this: one joint reconstruction or joint replacement costs NZ$26,000, and rehabilitation is required postoperatively. One treatment under ACC regulated fees is NZ$26. The maths is easy. That’s the cost of 1,000 treatments, when, in reality, perhaps 12 visits a year would be all that is required to keep people moving and avoid the cost of surgery and recovery.
Usually, the first sign of arthritic joints is a loss of movement. The first sign of an arthritic hip is not pain but the loss of movement, especially extension past the midline. There will be many of your colleagues you can pass judgment on as you look at them side-on. If from the side, you see them walking and their hips per footfall do not equally swing backward past the midline then they have a problem. But there is a solution.
Hips
These two simple exercises aren’t difficult, they take little time, and don’t require special equipment or gym gear, yet they can make for better performance of gait and hip mobility that provides immense prevention of more serious injury.
Stand your hip against a table or desk you can’t move. Gently sweep one leg backward without tilting the pelvis. Repeat this three to four times. Repeat with your opposite leg. Don’t twist your torso. Do this each side five times weekly.
Knees
Knees also tend to show loss of performance before pain. Loss of capacity to fully extend and straighten the knee will frequently precede a painful joint. Sitting incapacitates even further. We all know after a court session or long meeting, even with the knees only slightly bent, the relief of getting up to stretch and walk.
Research shows Mother Nature has empowered patients to heal themselves. So for most moderate cases, self-treatment is better than the surgeon’s skill. Knee replacements and knee reconstruction have increased, but the highest and best performance comes from early intervention and full range movement. Indeed, gone are the days of the old Plaster of Paris leg immobilisation after knee surgery. Rather post-surgical immobilisation is now replaced by movement as the most important part of the post-operative exercise prescription.
A few years ago in New Zealand, knee meniscus surgery was an extremely popular operation. Few receive such surgery today. Part of the reason for this is research by a friend and colleague, Professor of Anatomy Harry Brodin of Sweden. Harry showed conclusively that. cartilage is able to regrow. Interestingly, this is called an inner salamander capacity after a salamander that is able to regrow a chopped off limb.
As with hips, there are simple exercises you can do regularly that maintain your range of knee movement.
Caution: only gently commence this exercise.
Sit with your hands behind your back. Have one leg crossed over the other, with the outstretched leg flat. Lean forward. Hold for 10-20 seconds and repeat two or three times. Repeat with your opposite leg.
Shoulders
In my opinion, if every judge in New Zealand became a hanging judge, their shoulders would have the strength and range of movement to more easily carry all burdens placed upon them.
These movements provide instant shoulder tension relief but more importantly increase the stretch and mobility of those predominant muscles and ligaments across your shoulder line.
Feet on the ground, one arm overhead to the front, holding onto an outcrop. Bend knees until comfortable weight is on the shoulders and hold for several seconds. Repeat with your arm to the side in an Air New Zealand ‘here are your closest exits’ position.
I wrote this piece before the challenges of lockdowns and isolation beset us all. I want you to know that people really do care about and honour our judges and the example they set in so many ways, especially at this time by keeping our courts running and continuing to serve at this difficult time. Can I also say that now, more than ever, is a very important time to move and look after yourselves. Kia kaha, keep fit, stay well.