Now before I get a multitude of complaints from my Physiotherapist friends I feel I should mention I’m including Sports Therapy in the spot light here too. It just wouldn’t have made for as punchy a headline. I don’t care about the discipline you work in, we’re just asking the question does it work? My opinion is no! But I feel I need to justify where that comes from.
What Is Exercise Based Physiotherapy?
Exercise based Physiotherapy, Sports Therapy or any other discipline for that matter is the practice of trying improve injuries through performing a series of appropriate exercise. It is very popular in the NHS. I’m sure many of you reading this, probably still frustrated with the same injury you’ve had for a long time, can relate to this experience. You turn up for your Physiotherapy appointment. You have a 5-10 minute assessment of your injury and then your given a sheet of exercises and told to do them to fix yourself.
What’s Wrong With That Approach?
Before I start I’d just like to sympathise with my NHS Physio friends. They are, after all, just like me lovely people who just want to help their patients. But of course they are massively under resourced and unable to give appropriate amounts of time to each patient.
This leads to the non personal experience described above. If I saw 15 people a day I think I’d have to do the same! After 12 years in the game I can honestly say I’ve not seen the same injury twice. Very similar yes. But for effective treatment you need to treat the individual not the condition. Regardless of your discipline. A simple sheet of standardised exercises hardly makes someone feel looked after and cared for.
It is also a very convenient hands off approach to avoid litigation. Again, NHS Phsyios, you have my sympathy. In an era where the wrong people will sue you for looking at them in the wrong way the NHS is keen to avoid any human contact and so therefore cannot be blamed it anything goes wrong.
Which is not to say things can’t go wrong anyway – I’ve seen countless people who have meticulously done all their exercises as instructed only to make the pain worse.
Let’s talk physiology. In order to get proper muscle adaptations we need about 6 weeks. We’ll get some improvement just by waking up the nerves but 6 weeks is the accepted amount of time to increase muscle strength. 6 weeks! What about people pain now! What does that do for them. They could merrily do there exercises for 6 weeks whilst in pain and if the exercises they were given are not the right ones still be in as much pain 6 weeks later! We need to know why this person is in pain today.
Why Do I Think It Doesn’t Work?
Bitter experience! That’s what. Whilst I do have quite a few controversial opinions I try not to form them without first giving things a good chance. After 12 years I’ve given lots of exercises a chance. Firstly, there’s lots of evidence to suggest people don’t do their exercises! One article suggested that was in the region of 75%. So that’s three quarters of your punters not getting fixed right there. Here’s an article about adherence to exercises in Physiotherapy.
Of the ones that do the exercises how many do them frequently enough to get the appropriate muscular adaptations? Now the best bit. The people who are really good and lucky in that the exercises have cleared their symptoms. What does human nature dictate. That we stop doing the exercises! And then the problem just comes back.
And this brings me nicely onto the real reason it doesn’t work. It doesn’t change anything. Well maybe a bit, but not much. All it can change is the muscles your are exercising. Not the movement patterns of the person and certainly not the beliefs, fears and concerns of the person in question. What goes on the brain is such a massive part of the any pain experience as we discuss in our 50 Shades Of Pain article.
What Are The Alternatives?
There are countless alternative options from the world of Physiotherapy, Sports Massage, Chiropractic, Osteopathy and even, if you like to hug trees, reflexology, Reiki, Bowen technique etc. I’ll stick to what I know and talk you through some of the alternative options that I know best.
Sports Massage – looks to change the tone and function of the muscle. Not necessarily of the region where the pain is coming from, though it can be if appropriate, but more likely the areas that will affect the painful region i.e. look for a long term fix
Joint Mobilisation – encouraging the joints to move more freely in their natural planes. When the joints move freely muscles do not have to compensate and so start working more effectively and efficiently. Taking pressure off the all important painful area.
Muscle Activation – using special regions on the body that have profound affects on other muscles around the body. Like secret little switches you can use to switch muscles back on to their full strength in a matter of moments. Not having to wait 6 weeks to see if we’ve had any impact on the pain! I accept that sounds a bit too good to be true but this can be tested scientifically to see if it is having the desired affect on the not only the muscle in question, but that pain you have been feeling.
Identifying Postural Mistakes – we all have our favourite positions we get into. Chances are they are contributing to the pain that we find ourselves in.
What Works Best?
Here we come to the crux of the blog. After 12 years in the job no one method is the magical panacea. We get amazing results with our Muscle Activation treatments – but sometimes we need to add something else in. Sometimes we need to do some Sports Massage of an area that refuses to release off. Sometimes we even give an exercise or stretch to help – see we are flexible really!
Each therapist from any discipline be it Physiotherapy, Sports Therapy, Osteopath, Chiropractic or anything a little more fluffy will have their own thoughts. But the key is to be adaptable a not to rely on just one aspect of what is a massive subject matter. The human body!
Does Exercise Based Physiotherapy Still Have A Role In Modern Treatment?
Having completely slated it for this blog I absolutely believe it still has a role in modern physiotherapy. It’s just my plea to therapists and patients to not rely solely upon it. There is some fantastic research on how training certain muscles helps certain conditions. But be flexible. Challenge the norms. Why does this muscle affect this symptom? How can I go about getting this to work without having to spend 6 weeks strengthening it? What other regions elsewhere in the body might be causing the muscles to be weak and should I train or stretch this instead?
When selecting the therapist you want to work with look for one who is adaptable. You don’t want a one trick pony. You need someone who is going to look at all aspects of your injury to give you the most appropriate and effective treatment for your condition. We’d love that to be us. If you’d like to understand how our multifaceted approach can help you with you injury then please call or mail info@BrightonSportsTherapy.co.uk and we’ll be more than happy to explain how we can help.