Britains fishermen tend to see pain as just a normal part of their tough job. Matthew Limb hears how physiotherapy is helping improve their health.
Claire Stevenson has a better insight than most into the health needs of fishermen. As a member of a Cornish trawler-owning family, she is steeped in the community’s traditions and has her own physiotherapy clinic by the harbour at Newlyn. She says fishermen, a self-employed, stoic group often living in remote and deprived areas, have long been marginalised with regard to health services. ‘It is the toughest career you could ever choose,’ she says. ‘But there are few reliable statistics on fishermen’s injuries and treatment. ‘They tend to put up with pain and discomfort as part of the job – they are reluctant to take time off work for financial reasons,’ she adds. In 2007, Ms Stevenson was awarded a grant by the Seamen’s Hospital Society for a pilot project to examine fishermen’s musculoskeletal health, provide physiotherapy treatment and assess its impact. Her team of four physios held assessments and up to six treatment sessions for fishermen – funded by the charity – at flexible times to suit their arrivals onshore. ‘Having grown up with fishermen, I know how they work and they know us, which was a big part of getting the project off the ground,’ she says. Forty-six fishermen completed treatment over an 18 month period, representing about 10 per cent of Newlyn’s fishing workforce. More than half of those treated were working alone or in small crews, the vessels ranging from 5m up to 50m with sea time up to eight days in a variety of roles. Ms Stevenson says that while boats have improved over the years, with better winches, haulage systems and decks, some aspects of their working conditions can’t be changed, and the job remains strenuous and high-risk, particularly in rough weather. ‘Every single job they have to do is difficult at sea – such as lifting and carrying equipment, landing fish, gutting and mending nets – they’re sometimes being tossed around in gale force eight winds.’ During the pilot, fishermen presented with a range of problems and injuries, predominantly back, neck and shoulder, plus knee, wrist, ankle and general muscular problems. Over three-quarters of the injuries occurred while working at sea. Shoulder problems were particularly common. Most of these were originated in the neck or were due to overuse and stretch of the mid back and shoulder area. Fishermen were asked about how their problems affected their work, with many saying they found it difficult to bend or carry out different tasks. Ms Stevenson says she discovered that fishermen had very poor balance and stability when on land. While at sea to safeguard against sudden swells, they tended to ‘fix their positions for stability, usually at the end of joint ranges’, which eventually causes pain. ‘There are safety issues when a fisherman is either in pain or suffers poor mobility and balance, not just for themselves but for the crew who work alongside them,’ she says. They were offered education and treatments including mobilisations, soft tissue manipulation, electrotherapy and acupuncture. All were given exercise regimes to get them back to full fitness based on specific injuries as well as general preventive work. An indenpendent evaluation of the pilot has now been written up and highlights a clear need for physio services provided at accessible times, Ms Stevenson says. All the fishermen reported a reduction in pain and improvement in mobility following treatment, according to the report. And not only did fishermen say they had benefited from treatment but they were continuing to comply with advice and to change their mode of practice, quickening their return to work and helping to prevent further injuries or ill health. The evaluation report says 74 per cent changed their behaviour at sea following treatment; half applied new exercises and lifting techniques and half took more care with their posture while at sea. The report says many fishermen may be undergoing unnecessary upper limb surgery. Ms Stevenson says: ‘Fishermen have begun to take control of their own problems and are now appreciating that they don’t have to put up with pain. Those who have gained more mobility where they thought they could not improve feel safer at sea, and with more mobility and less pain are happier to go back to sea.’ According to Nick Addlington, health development manager for the Seamen’s Hospital Society, many of the fishermen were presenting with fairly serious musculoskeletal injuries, usually an acute injury but often a chronic injury beneath it.’ In many cases this could have prevented them from working and earning a living in the longer term. ‘The fact they were changing their behaviour is for me probably the most important finding, because ultimately we don’t want fishermen to be getting injured in the first place,’ he said. The charity is now looking to replicate the scheme at other ports and is in discussions with prospective partners, including the Royal National Mission To Deep Sea Fishermen, which has strong links with the fishing community. ‘I think we’re going to have to roll it out step by step,’ he said. ‘What I’d like to do is get a partnership up and running with a primary care trust.’ Mr Addlington is keen to hear from other physios working with fishermen. ‘It would be great to set up a network of people who could talk to each other, for professional support and also to develop awareness of the area. Perhaps that way we might widen the project to places where there are physios who already have the experience and the skills, and crucially the links.’ Ms Stevenson hopes to interest Seafish, the government body that looks after the training of fishermen, in running prevention training. ‘My dream is that we get funding for a physio to get on board every boat and have a training session with the men, looking at how they can actually change things and make things better for themselves,’ she added.
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