We know that physical therapy is – in and of itself – good for people. What is perhaps sometimes overlooked, though, is where this care is put to use in a voluntary capacity – doubling the goodness factor.  There are several types of this sort of activity.

Firstly, there’s the voluntary support at sporting events. Hundreds of therapists volunteer at the London Marathon every year, and 1,500 volunteer physical therapists and medics from across the globe volunteered at London 2012 (some of them making many additional sacrifices!). This commitment runs through all levels of sporting event across the world, all year round.

Beyond that, the physical therapy and sports medicine sector often displays a deep commitment to community fundraising. From collecting shoes for charity to donating money to local food banks for each patient who completes a cycle of care to organising charity fundraising sporting events, physical therapists are nothing if not inventive about how they can broaden their support for the communities in which they live and work. Some take it even further – leading some physical therapy institutions to establish volunteering programmes to partner with charities working in local communities facing disadvantage.

While many humanitarian or disaster projects focus on food and basic medical supplies, we all know that lack of physiotherapy or injury recovery support can have a massively debilitating impact on individuals in need. So physical therapists volunteer many thousands of hours a year through recognised programmes to meet this need.

The lack of specialist skills in some areas is outlined here in an article by a Médecins Sans Frontières trainer, but it’s important to note that disaster relief efforts can be extremely complicated, and the same is true for physiotherapy support.

This research paper highlighted many of the issues faced with the delivery of physical rehabilitation services (much of it involving international actors and some of it voluntary) in the aftermath of the Haiti earthquake in 2010. Lack of shared standards, disruption of local markets and lack of capacity for longer-term follow-up were all highlighted as being area where progress is needed, to get the very best out of the efforts made and the skills made available.

Disaster areas are obviously chaotic environments, so you can see how having some sort of shared standards as reference points would be invaluable, and it will be interesting to see how this progresses in the coming years.

However, despite these areas for potential improvement, nobody is questioning the huge impact of voluntary physio services in these troubled areas. As this video report from an MSF physio working in Haiti illustrates, the value of their work is undoubted. This personal account of a volunteering placement in Africa also underlines the huge benefits to be gained by the local population – and the pain at not being able to give more when the need is so great.

So, immense kudos to all physical therapists across the globe who extend their caring responsibilities beyond the workplace. If you’re keen to know more, Voluntary Service Overseas have a specialist physiotherapist recruitment strand, and MSF (who themselves send over 3,000 medical volunteers on international placements each year) also provide a longer list of international volunteering placement agencies.

Do you have experience of volunteering as a physical therapist? At home or abroad? Were you thanked for your work? And what did you take away from the experience? If not, what would encourage you? Please share your thoughts in our short survey which can be found at the following link http://spxj.nl/YGsWf3 and we’ll be publishing the results on this blog.

Related articles

• Volunteering for Commonwealth Games Glasgow 2014
• Free or not for Free?

When does this time end and when does it become a liberty, which seems to only be afforded to the sports massage and soft tissue therapy professions?  Is it because we are seen as the ‘low man on the totem pole’ and therefore we must need the ‘practice’ or is it because we are not seen as a primary service by ‘some’?

In elite sport there is another addition to this quandary, after all we are privileged to work with athletes, surely that’s enough recompense, surely we need no more (just a little sarcasm).  However, this seems to be, unless you are really established, the only way to enter this very exclusive world.

Back in the day when I first was coming onto the scene and even later on, I volunteered my time because I wanted to be the best, so variety of experience was the key.  I wasn’t fussy about who, how long or how difficult.  I wanted every scenario thrown at me so that I would be able to handle anything and not be afraid.  Nothing has changed, I still love a challenge and I am regularly sent ‘difficult’ cases because of that.  I thrive on this stuff and the bonus is, these days I get paid for it.

Would I change what I did?  No, but there definitely comes a time when enough is enough and companies/sports/NGB’s/clubs you name it, need to be clear about what they are looking for out of a practitioner.  If their primary aim is to get something for nothing, unless they are a charity, or you are a student looking for bodies, I would be steering clear.  If however, there is an opportunity to really shine and the possibility of future paid work, grab it with both hands; you just never know where this might lead.  I volunteered to work on the cast of Cats in Birmingham many moons ago when I was fully qualified and established and ended up volunteering with another therapist on that same job to work with Birmingham City.  From here I became employed, then ended up with West Bromwich Albion for four years.  Who knew?

If you are currently volunteering somewhere and have been there for some time, take the plunge, speak to someone in charge and broach the subject of either contracted or employed work.  What’s the worst that can happen, they say no and you have a decision to make.  They may just acknowledge how valuable you are and take you up on your offer.  What have you got to lose?

There are always exceptions and I believe we had one jumping up and down and blowing trumpets in our ears last year.  The London Olympics, why didnt you? I was lucky enough to have been picked once again to be part of the medical team for GB athletics; my third Olympics.  But if I didn’t go as a paid member of staff, I sure as hell would have volunteered.  What an experience, not just the work, not just the sheer fact that it was THE Olympic Games, it was at home …

Many of you will have lost money or ended up paying out a considerable amount to volunteer.  Why was that ok?  Was it because all the professions had to volunteer this time, so for once it was an even playing field? Or was it because it was just simply ‘the Olympics?’ I have a feeling it was the latter … did I say it was at home (sighs). The experience of being in an Olympic Village is incomparable to any other major championships.  If you were there I hope you soaked it up.  You will never forget it. I know I wont.

We would really like to hear your thoughts on this?  Would you/Do you? Never? Good experience? Bad experience? Fill in our quick survey at the following link and we’ll publish the results on the blog http://spxj.nl/YGsWf3

I run regular courses, for more information email me: paulaclayton@stt4performance.net or contact me through fb www.bit.ly/stt4performance

Related articles

• Where the Heart Is – Volunteering your Services
• Volunteering for Glasgow 2014

Articles featured in this April’s sportEX medicine journal – the international sports injury and rehabilitation journal

• Chronic Pain in Sport: Treat it better by understanding how it develops by Richmond Stace, MCSP, MSC (incl. CPD/CME quiz in digital versions)
• Platelet-Rich Plasma: A review of actions and applications in sports injuries by Amit Lakkaraju, MD, FRCR
• Groin and Hip Quandaries: The “Bermuda Triangle” of sports medicine by Helen Millson, MPhil, MCSP (incl. CPD/CME quiz in digital versions)
• Emotional Intelligence: The Human Factors Needed for Effective Multidisciplinary Teams by Noe Orozco MBPSS, MSC
• Research review: How does kinesio taping compare to manipulation in the treatment of neck pain? by Joseph Brence PT
• Research review: Is static posture related to pain? Probably not! By Joseph Brence PT
• Journal Watch – the best from this quarter’s research journals

Articles featured in this April’s sportEX dynamics journal – an international sports massage and manual therapy journal

• Facilitated Stretching: an overview by Bob McAtee RMT,CSCS,C-PT
• Medial Tibial Stress Syndrome: a case study of a national tennis player by Ron Alexander, STT (MSK)
• Effective Patient Communication by Lewis Wood, MSc,BSc
• An Alternative Approach to Exercise Prescription: Part 2 by Matthew Palfrey, BSc,CSCS
• Assisted Soft Tissue Manipulation: An introduction to using the ‘spoon’ by Dave Orton, MSc,MCSP,HPC
• Journal Watch: This quarter’s best research from key international manual therapy research journals

These articles are now live online and available in full through a subscription to sportEX medicine, the internationally read sports injury journal and leading manual therapy journal, sportEX dynamics. The articles are all written by practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Despite advances in training methods and equipment, injuries sustained during sport are common. These may be seen either in competitive sport or among amateur athletes. Of these approximately 50% are due to overuse. The common overuse injuries include tendinopathies, ligamentopathies and stress fractures. More acute sports injuries include muscle, ligament and tendon tears as well as fractures (1).

There are strong theoretical arguments and laboratory evidence to show that PRP can significantly improve healing in tissues

Rehabilitation with rest of the area and site-specific interventions are necessary in both acute and chronic injuries. In addition to conservative measures such as rest, elevation, non-steroidal anti-inflammatory drugs (NSAIDs) and physiotherapy, chronic injuries have traditionally also been treated with long-acting steroid injections or even surgery. Both NSAIDs and injectable steroids have potentially deleterious effects if used regularly or in high doses (2,11).

Although there is strong lab evidence and many clinical studies showing the efficacy of PRP, very few Level 1 studies have been performed

In the last 10 years there has been growing interest in the use of platelet-rich plasma (PRP), a substance obtained by centrifuging human blood. It has been trialled in various acute and chronic musculoskeletal injuries. It was initially identified and clinically used in cardiothoracic and maxillofacial surgery in the 1990s. The use has now spread to the fields of plastic surgery and orthopaedics. The applications in musculoskeletal soft tissue injuries are expanding with new research showing a number of applications in both acute and chronic settings. The present article aims to review the pathophysiology of tissue healing and actions of platelets and associated substances in the healing cascade.

The article goes on to review the method of preparation, technique of injection and practical applications of PRP in musculoskeletal injuries with a review of the evidence for each indication. Finally, the article looks at some controversies in its indications in sports. Although this article is primarily directed towards the uses of PRP in sports injuries, it has applications in occupational and age-related musculoskeletal disorders.

The Future of PRP

PRP therapies are an exciting new development in the treatment of musculoskeletal injuries in sport. There are theoretical arguments and laboratory evidence to show that it can significantly improve healing in tissues. Clinically, this has lead to a boom in PRP treatments of various sports injuries with variable but generally good outcomes. Unfortunately, there is little level 1 evidence of its efficacy in the world literature. This has led the IOC, other sports medicine stakeholders and governments to call for better designed studies to look at its efficacy in various sports injuries. With the removal of PRP from the Prohibited Substances list by WADA in 2011, level 1 studies in elite athletes may become more common.

The author: Dr Amit Lakkaraju, musculoskeletal radiologist

Dr Amit Lakkaraju is a musculoskeleltal radiologist with a subspecialist interest in sports radiology. After training in his junior years in orthopaedics, he did his specialist training in radiology at Leeds. Amit went on to do a fellowship year in musculoskeletal radiology at Liverpool where he honed his skills in sports imaging and image guided musculoskeletal intervention. He is currently working as a consultant radiologist at the Goulburn Valley Imaging Group, Shepparton, New South Wales, Australia.

This article “Platelet-Rich Plasma (PRP): A review of actions and applications in sports injuries” is now live online and available in full through a subscription to leading international physical therapy journal, sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Upon a patient’s initial visit to a Physical Therapist, a static postural assessment is routinely performed.   Many therapists assess for “abnormalities” such as a forward head, rounded shoulders, decreased or increased spinal kyphotic/lordotic curves, abnormal pelvic positioning, etc.  They often associate any abnormal findings to their patient’s condition and attempt to treat by altering the found positional faults.  But in doing this, is there existing evidence that associates abnormalities found in static postures with pain?  In this article, I want to challenge this widely-accepted association by presenting a review of the current understanding of pain in addition to research which has assessed the relationship between posture and pain.

Quick Review of our Knowledge of Pain

In a post that I wrote for SportEX last year, I discussed the topic of pain.  I stated that one of the most essential things we must understand about pain is that nociception (which is input from nociceptors—unmylenated, danger receptors) is not necessary or sufficient for the experience of pain.  Pain is always an output from the brain based upon many different variables, and simply the brain’s suspicion that a tissue has the potential for damage, will cause it to react. The brain’s reaction can be based off a conglomerate of information including but not limited to: sensory input from the body, previous experiences of injury, social and/or environmental influences, expectations of consequences of the threat, beliefs/logic, etc.  Mechanical tissue deformation, which may occur with prolonged static posturing, may result in nociception, but according to the current models of pain, it will not always result in pain.  Other variables are likely necessary.

The first association made between posture and pain was likely based upon an older, Cartesian model of pain.  Pain was originally thought to be a bottom-up response, in which excessive stress on a tissue causes this negative sensation. This concept first originated in 1664 by Rene Descartes.  In the Treatise of Man Descartes theorized that pain was carried from nerve fibers to the brain and was the result of physical and mechanical deformation.   This theory (with slight modifications) was followed for centuries until the current models of pain, the Gate Control Theory and the Neuromatrix, were developed by Dr. Ronald Melzack.   Melzack proposed that pain was an output of the brain and is caused by much more than simply tissue damage.  His model challenged the belief that posture and pain are simply associated.  Its much more complex.

What does the research show?

A 2010 systematic review assessing the relationship between awkward occupational postures and low back pain found that there is strong evidence to support there is no relationship between the two.  This article included the review of eight high-quality studies that assessed individuals who worked in professions that forced  them to assume prolonged, static postures.  These professions included scaffolding, nursing, retail sales, podiatry, firefighting, etc.  It would be expected that individuals with these professions would have higher incidences of low back pain but statistically , they did not.

A 2007 article published in Manual Therapy assessed the relationship between sustained static posturing and postural neck pain.  Similar to the systematic review, the authors found that neck pain was not associated with the individuals habitual postures or kinesthetic sensibility.   The study came to this conclusion after assessing the habitual sitting posture, perception of good posture and postural repositioning error in symptomatic and asymptomatic individuals.

Another article published in 2000, challenged the concept of lumbopelvic imbalances and pain.  Many Physical Therapists believe that excessive lumbar lordosis is due to weak abdominal muscles in combination with shortened lumbar extensor and hip flexors muscles, which in turn leads to pain. This positional fault leads to an anterior pelvic tilt which should be addressed through abdominal stabilization (often utilizing  the infamous posterior pelvic tilt).   The article assessed 30 men and women who had chronic low back pain (CLBP).  It assessed the location of pelvic inclination and magnitude of lordosis and found that in individuals with CLBP, there was no more standing lumbar lordosis or pelvic inclination than their counterparts with healthy backs.  In patients with CLBP, the magnitude of the lumbar lordosis and pelvic inclination in standing was not associated with the force production of the abdominal muscles. The authors go as far as concluding,

“Abdominal muscle strengthening exercises are routinely recommended by physical therapists to correct faulty standing posture in patients with CLBP. These recommendations are often based on assessment of standing posture. We urge physical therapists to avoid prescribing therapeutic exercise programs of muscle strengthening of abdominal muscles in patients with CLBP based solely on assessment of relaxed standing posture.”

So what does this mean?

I would argue that we spend too much time focusing on holding static postures and less time on movement.  It appears that there is little evidence to support the notion that poor posture leads to pain.  I recommend to my patients to find positions of comfort.  When those positions get uncomfortable, move and find another position of comfort.  We were built to move.

The author: Joe Brence, physical therapist

Joseph Brence is a doctor of physical therapy from Pennsylvania, USA. He is currently a director of two facilities in Pittsburgh and takes a manual approach to patient care. He is also a contributor to www.physiotherapyinfo.com and www. theptproject.com and is currently working on multiple research projects which he will present to the sportEX community as they are published. To read Joseph’s monthly contributions, click the following link http://eepurl.com/bRGmj

References

• Merskey H, Bogduk N. Classification of Chronic Pain. 2nd ed. Seattle: IASP; 1994.
• Melzack R, Katz J. The Gate Control Theory: Reaching for the Brain. In: Craig KD, Hadjistavropoulos T. Pain: psychological perspectives. Mahwah, N.J: Lawrence Erlbaum Associates, Publishers; 2004.
• Iannetti GD, Mouraux A. From the neuromatrix to the pain matrix (and back). Exp Brain Res 2010; 205; 1-12.
• Moseley GL. A pain neuromatrix approach to patients with chronic pain. Manual Therapy 2003;8:130-140.
• Roffey DM, Wai EK, Bishop P. Causal assessment of awkward occupational postures and low back pain: results of a systematic review. The Spine Journal 2010: 10; 89-99.
• Edmondston SJ, Chan HY, Ngai GC, et al. Postural neck pain: An investigation of habitual sitting posture, perception of ‘good’ posture, and cervicothoracic kinaesthesia. Manual Therapy 2007: 12; 363-371.
•  Youdas JW,  Garrett TR,  Egan KS, et al. Lumbar Lordosis and Pelvic Inclination in Adults With Chronic Low Back Pain. Physical Therapy2000: 80; 261-275.

This article “Is static posture related to pain? Probably not.” is now live online and available in full through a subscription to leading international physical therapy journal ,sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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This article has been adapted from a handbook, Groin & Hips: the latest international evidence, 2012, written by the author of this article, primarily for premier league football medical personnel, but also for those involved in other elite sports, in response to the controversy and lack of consensus among clinicians working in this area. On reviewing the literature, it became clear that the best answer to these problems is prevention/pre-habilitation. An in-depth knowledge of the basic and functional anatomy of this area is critical and this encompasses the entire kinetic chain above and below the groin. In particular, the adductor muscles are mostly neglected and are invaluable in the prevention strategy. Thus the most pertinent point is that many of the groin/hip pathologies can be averted by thorough and specific pre- habilitation. That is … treat the cause, not the symptom!

There are 82 differential diagnoses relating to the groin + another 41 related to the hip

The literature review that was undertaken for the handbook, Groin & Hips: the latest international evidence (1) was based on 240 studies and confirmed that the groin, an anatomical region where diagnosis and symptoms are often confusing, and may also represent a Bermuda Triangle for clinicians to disappear into in vortices of suppositions and assumptions. The Fédération Internationale de Football Association (FIFA) sports physiotherapist, Dr Mario Bizzini (2) called groin pain “The Bermuda Triangle” of sports medicine, and with good reason. There is little international consensus on diagnosis, pathophysiology, investigation or management. The diagnosis is multifactorial and there are 82 differential diagnoses relating to the groin, plus another 41 related to the hip. It is not simple. Also, in elite sports, it is often very difficult for a doctor to diagnose accurately and thus be able to send the player to the relevant specialist who deals only with his specific area. One of the key points is to understand the entire anatomy and likely generator of pain (3). The importance of the two joints in the pelvis should be emphasised – the hip joint and the pubic symphysis (PS). If one bases one’s diagnosis on this anatomy and, in particular, the functional anatomy, the whole diagnostic reasoning becomes easier.

The author: Helen Millson, physiotherapist

Helen has worked for IRPS Ltd for Elite Sports since 2006. As medical director, her expertise has been taken to all premier league (PL) football clubs to collate and interpret medical information for Insurers. This has included advising lawyers during complicated high financial claims. She organised a bespoke database specifically for PL and therefore has an excellent overview of all injuries/illnesses sustained by PL footballers. She has comprehensive knowledge of PL football medical conditions and has been acclaimed by the industry as a top-class expert. The medical advice to Insurers includes England cricket, international rugby, professional golf, international cyclists, UAE footballers, and other professional sportspeople at the pinnacle of their careers. As sport physiotherapist for Elite National Sport she worked in pre-habilitation, treatment, rehabilitation, and return-to-play criteria. Her professionalism, expert advice and outstanding interpersonal skills have been sought and appreciated by all medical and management teams at elite sports level, with insurers and their medical teams. She has a unique ability to confer and collaborate with other high-level experts in her field. She is the evidence based clinician for the company and the medical legal advisor within and outside the company, Previously Helen gained high acclaim in her field as physiotherapist for national rugby, hockey, cricket and surf lifesaving in South Africa. She also provided physiotherapy cover for two All Africa games, for football (Maccabi Games) and two Commonwealth Games (1992 to 2006).

This article “Groin and Hip Quandaries: The “Bermuda Triangle” of Sports Medicine” is now live online and available in full through a subscription to leading international physical therapy journal, sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Chronic pain in sport is a problem. It is a problem for professionals and amateurs alike although the stakes are different. The professional athlete will consider the consequences of persisting pain and injury in terms of his or her career and income. The amateur sports person will not be concerned about income but will certainly be frustrated and disappointed. Both will struggle if they cannot resume their chosen sport within their expected time span. The professional is supported by a medical team who will ensure that every test and investigation is performed to reveal the nature of the pain whereas the amateur must often fund his or her own treatment. Both must develop an effective therapeutic relationship with the therapists and medical staff based upon trust to move forwards.

The injury moment: nothing happens in isolation

Around every injury is a circumstance that led to the injurious event, a point in time that I call the ‘injury moment’. They include the stage of the game, the fitness of the player, the environment, previous experiences of pain, and prior successful and failed attempts to deal with injury. Nothing happens in isolation. The great Muslim philosopher Ibn Khaldun talked about the importance of placing an event in context when referring to history. We can learn from this and apply the same thinking to understanding an individual’s injury experience. The player is a complex, moving and thinking instrument playing a tune that seeks to follow the rhythm of the game. Dependent upon what he is thinking, doing, planning, and anticipating within the game, the injury moment will unfold.

The “meaning” of pain has a significant influence on the route of management

This article discusses the science of pain in relation to the sports injury and how it can evolve into a persisting problem. No injury happens in isolation, and the early responses and management have an influence upon the journey – hence the need for effective pain control, diagnosis and a plan. Understanding that a persisting problem is underpinned by an ongoing protective and vigilant state allows for wise action in terms of treatment.

About the author

Richmond Stace MCSP, MSc (Pain), BSc (Hons), is a chartered physiotherapist who specialises in the treatment of persisting pain and injury. In addition to being a qualified physiotherapist, Richmond has a Masters degree in Pain Science from Kings College London. The Specialist Pain Physio clinics in London were set up by Richmond in 2008 to deliver comprehensive neuroscience-based programmes for ongoing pain. Outside of the clinic Richmond writes and talks about pain with the aim of advancing the general understanding of pain.

This article “Chronic Pain in Sport” is now live online and available in full through a subscription to leading international physical therapy journal, sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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>> More sports injury articles

April’s issue of sportEX medicine features an overview of the following studies with sportEX “take home” messages.

1. ACUPUNCTURE FOR ACUTE LOW BACK PAIN: A SYSTEMATIC REVIEW. Lee JH, Choi TY, et al. The Clinical Journal of Pain 2013;29(2):172– 185
2. KINESIO TAPING DOES NOT ALTER NEUROMUSCULAR PERFORMANCE OF FEMORAL QUADRICEPS OR LOWER LIMB FUNCTION IN HEALTHY SUBJECTS: RANDOMIZED, BLIND, CONTROLLED, CLINICAL TRIAL. Lins CA, Neto FL, et al. Manual Therapy 2013;18(1):41–45
3. GRAPE CONSUMPTION’S EFFECTS ON FITNESS, MUSCLE INJURY, MOOD, AND PERCEIVED HEALTH. O’Connor PJ, Caravalho AL, et al. International Journal of Sport Nutrition and Exercise Metabolism 2013;23(1):57–64
4. RESVERATROL DECREASES NOISE-INDUCED CYCLOOXYGENASE-2 EXPRESSION IN THE RAT COCHLEA. Seidman MD, Tang W et al. Otolaryngology–Head and Neck Surgery 2013; doi: 10.1177/0194599813475777
5. EFFECT OF AEROBIC DANCE ON CARDIORESPIRATORY FITNESS IN PREGNANT WOMEN: A RANDOMISED CONTROLLED TRIAL. Halvorsen S, Haakstad LAH, et al. Physiotherapy 2013;99(1):42–48
6. PERFECTIONISM AND BURNOUT IN JUNIOR SOCCER PLAYERS: A TEST OF THE 2 X 2 MODEL OF DISPOSITIONAL PERFECTIONISM. Hill AP. Journal of Sport & Exercise Psychology 2013;35(1):18–29
7. RISK FACTORS FOR LOWER EXTREMITY MUSCLE INJURY IN PROFESSIONAL SOCCER. THE UEFA INJURY STUDY. Hägglund M, Waldén M. The American Journal of Sports Medicine 2013;41(2):327–335
8. THE EFFECTS OF A CONGESTED FIXTURE PERIOD ON PHYSICAL PERFORMANCE, TECHNICAL ACTIVITY AND INJURY RATE DURING MATCHES IN A PROFESSIONAL SOCCER TEAM. Dellal A, Lago- Peñas C. British Journal of Sports Medicine 2013; doi:10.1136/ bjsports-2012-091290
9. CHANGES IN HUMERAL TORSION AND SHOULDER ROTATION RANGE OF MOTION IN HIGH SCHOOL BASEBALL PLAYERS OVER A 1-YEAR PERIOD. Oyama S, Hibberd EE, Myers JB. Clinical Biomechanics 2013; doi:10.1016/j.clinbiomech.2013.01.014

These research reviews are now live online and available in full through a subscription to leading international physical therapy journal, sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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This article is the second in a series that presents the rationale for an alternative approach to exercise prescription in the fields of physiotherapy, sports rehabilitation and general fitness training. The aim of this article is to further expand upon the concept of human movement patterns, describing example exercises in both the squat and push patterns. These are presented in an instructional fashion with example progressions, regressions and common coaching points. Subsequent articles will examine the other movement patterns of lunge, pull, bend/hinge, twist/rotate and gait and further develop the theory of exercise prescription based on these concepts.

As a general rule of thumb, exercises increase in challenge as the number of planes of motion that they move through also increases

In part one of this series I presented the seven basic human movement patterns. In examining the squat and push movement patterns we will be using a common base-level exercise. The base-level exercise is typically one which offers significant value to a broad cross section of the population. You may find that the base-level exercises that you select for certain individuals may differ from those presented here. For example, an elite-level athlete could use the back squat as the base-level exercise for the squat pattern whereas a sedentary individual may use the body-weight squat. In a practical sense, one can use the information presented here to prescribe an exercise programme. The base-level exercise variations can also be used to maintain progress after the initial prescription. The base-level exercises will also have progressions. These variants are used to make the programme suitable for the individual and encourage progression throughout the life of the programme. They have been listed in the probable order of progression, ie. the exercises become more challenging as you go through the variations.

The author: Matthew Palfrey, sports scientist and strength and conditioning coach

Matthew Palfrey BSc holds a degree in Sport Science and Biomechanics and has been a health and fitness industry professional for 15 years. Currently a practising strength and conditioning coach and the health and wellbeing advisor for BMI Healthcare. He enjoys working with a range of individuals and teams and working to bridge the gap between rehabilitation and the fitness industry. He is also the cofounder of Fitedia, a specialist online store for health, medical and fitness professionals (http://fitedia.com/).

This article “An Alternative Approach to Exercise Prescription: Part 2” is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are all written by leading massage practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Are you really listening? Do you take the time to hear and understand your patient’s story? Often a therapist will fill in the gaps with what they think was said, rather than what was actually said. This is described as partial listening. Commonly, without realising it, therapists practise preferential listening, where their listening is unintentionally influenced by their emotions, interests, experiences or personal background. Effective communication is an essential part of exchanging information, understanding your patient, yet still allowing a natural spontaneous conversation. It is a key foundation to building a successful patient–therapist relationship, thus enabling you to become a more effective practitioner by providing bespoke treatment for that individual. Even though the task of communication is simple, advanced communication skills still need to be learnt. Advanced communication combines a set of skills including effective listening, skilled thinking, non-verbal cues and having the ability to manage conflict and resolve any differences. By creating an open environment for empathy, decision- making and problem solving, a practitioner will quickly get to the root of their patient’s presenting symptoms, identifying the nature of their condition and are more likely to meet their treatment expectations.

Improving your communication skills will immediately improve your practice

The goal of this article is to challenge you to think about how you communicate with your patients on a daily basis. There is increasing emphasis for therapists to provide evidence-based treatments, but applying these techniques will make little impact unless you communicate effectively. Advanced communication is a skill that can be learnt and we discuss here the key components for achieving a spontaneous and useful exchange of information. Improving your communication will not only allow you to understand your patients better but will build trust and respect, resulting in a successful medical encounter.

The author: Lewis Wood, physiotherapist, osteopath and clinical specialist in MSK therapy and sports injuries

Lewis Wood is a clinical specialist in musculoskeletal therapy and sports injuries. He is a physiotherapist (BSc Hons, HPC, MCSP), osteopath (MSc Hons, GOC, BOA), medical acupuncturist (MAACP, CGIMS), clinical pilates instructor and sports massage therapist (MSMA). Lewis worked as a physiotherapist at Athens 2004 and London 2012 Olympic games and is the founder of the Body Align Clinic, a multidisciplinary private practice based in Lewes, East Sussex.

This article “Effective Patient Communication” is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are all written by leading massage practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Functional fascial taping (FFT) is a treatment approach that uses sports tape to apply tension to the skin, fascia and muscles in order to pull damaged structures back into alignment. The author of this article has pioneered and developed this technique, which has been used to treat a wide range of conditions such as plantar fasciitis, carpal tunnel syndrome, back, neck and shoulder pain, muscle tears and repetitive strain injury. This article demonstrates the use of FFT on a tennis player suffering from medial tibial stress syndrome. The digital versions of the article feature two videos which are central to the case study.

The author: Ron Alexander, soft tissue therapist

Ron Alexander is the director/founder of the Functional Fascial Taping Institute Melbourne, Australia. FFT was refined over eight years’ service as the principal soft tissue therapist (musculoskeletal) for The Australian Ballet. During this time he was awarded the Lady Southey Scholarship for Excellence from the Australian Ballet Foundation. More recently he was a co-investigator of Randomised Double Blind Placebo Controlled Trial of FFT for Non-Specific Low Back Pain (PhD thesis), Deakin University, Melbourne, Australia. Ron has an interest in chronic pathologies, continues to research the effects and mechanisms for change in the body from FFT. For more information see the author’s website  and facebook page 

This article “Medial Tibial Stress Syndrome: a case study in a national tennis player” is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are all written by leading massage practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Most manual therapists and fitness professionals agree that stretching is an important part of training for sport. Beyond sport, stretching is useful for maintaining general flexibility for daily activities and as preventive maintenance to counteract the effects of repetitive motion activities. This article published in the April issue of sportEX dynamics describes the different types of stretching that can be performed, with an emphasis on facilitated stretching.

For many years, manual therapy practitioners, health and fitness professionals, coaches, and athletes have been using the stretching protocols of proprioceptive neuromuscular facilitation (PNF) to effectively improve flexibility, with an eye to enhancing overall sports performance. Athletes using facilitated stretching techniques often achieve dramatic gains in flexibility in a short period of time. As with any flexibility training, however, long-term gains are only possible with consistent practice. This article offers a brief look at a variety of stretching techniques and a more in-depth explanation of facilitated stretching, a technique based on the theories and principles of PNF.

The author: Robert McAtee, remedial massage therapist and strength and conditioning coach

Robert E. McAtee (RMT, CSCS, C-PT) maintains an active, international sports therapy practice at Pro-Active Massage Therapy in Colorado Springs, Colorado, USA. He is the co-author of Facilitated Stretching, a how-to book about PNF stretching, used by fitness professionals worldwide. Since its release in 1994, the book has sold over 100,000 copies and been translated into Spanish, Italian, Portuguese, Korean, Chinese, and Japanese. Bob regularly presents workshops on facilitated stretching, sports therapy, and rehabilitative exercise nationally and internationally. His seminars consistently draw rave reviews for their depth of information, hands-on learning, and for Bob’s teaching style.

This article “Facilitated Stretching: an overview” is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are all written by leading massage practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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‘Get the spoon out’ or ‘use the butter knife’, are a couple of new phrases popping up in the clinic these days. We have been using the i-assist, a tool for applying instrument-assisted soft tissue manipulation/massage (IASTM). IASTM comes in many forms now. It originated from a more chiropractic background but, because of its medical and holistic nature, it is now increasingly used by osteopaths, physiotherapists, sports rehabilitators and sports injury specialists.

This article provides a good working knowledge and understanding of a new adjunct on the market which is growing in popularity. It has been widely used at the recent Olympics in London 2012 and throughout sports clubs alike. This gives a great facet to your treatment that really helps, and hopefully gives you a better feel for tissue change.

The author: David Orton, physiotherapist

Dave is currently the physiotherapist for the senior 1st team at the Leicester Tigers Rugby Club. He has previously worked with Watford Football Club, Saracens Rugby Club, consulted for a Red Bull racing driver, and has worked with many other elite athletes.

This article “Assisted Soft Tissue Manipulation: An introduction to using the ‘spoon’” is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are written by leading massage practitioners from around the world. The publication is available in print, online and on the Apple, Android and Kindle Fire platforms.

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April’s issue of sportEX dynamics features an overview of the following studies with sportEX “take home” messages.

• LEISURE TIME PHYSICAL ACTIVITY OF MODERATE TO VIGOROUS INTENSITY AND MORTALITY: A LARGE POOLED COHORT ANALYSIS. Moore SC, Patel AV, et al. PLOS Medicine 2012;9(11):e1001335
• ATHLETES’ OPINIONS OF FOOD PROVISION AT THE 2010 DELHI COMMONWEALTH GAMES: THE INFLUENCE OF CULTURE AND SPORT. Burkhart S, Pelly SE. International Journal of Sport Nutrition and Exercise Metabolism 2013;23(1):11–23
• EFFECT OF REDUCING TOTAL FAT INTAKE ON BODY WEIGHT: SYSTEMATIC REVIEW AN AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS AND COHORT STUDIES. Hooper L, Abdelhamid A, et al. BMJ 2012;345:e7666
• BILATERAL MYOFASCIAL TRIGGER POINTS AND PRESSURE PAIN THRESHOLDS IN THE SHOULDER MUSCLES IN PATIENTS WITH UNILATERAL SHOULDER IMPINGEMENT SYNDROME: A BLINDED, CONTROLLED STUDY. Alburquerque-Sendín F, Camargo PR. The Clinical Journal of Pain 2013; doi: 10.1097/ AJP.0b013e3182652d65
• THE 21ST CENTURY HAZARDS OF SMOKING AND BENEFITS OF STOPPING: A PROSPECTIVE STUDY OF ONE MILLION WOMEN IN THE UK. Pirie K, Peto R et al. The Lancet, 2013;381(9861):133–141
• WALKING, RUNNING, AND RESTING UNDER TIME, DISTANCE, AND AVERAGE SPEED CONSTRAINTS: OPTIMALITY OF WALK–RUN– REST MIXTURES. Long LL, Srinivasan MJR. Journal of the Royal Society Interface 2013;10(81):20120980
• SCAPULAR POSITIONING ASSESSMENT: IS SIDE-TO-SIDE COMPARISON CLINICALLY ACCEPTABLE? Morais NV, Pascoal AG. Manual Therapy 2013;18(1):46–53
• HUMOR USE IN POWER-DIFFERENTIATED INTERACTIONS. Dunbar N, Banas J, et al. Humor. 2012;25(4):469–489

This journal watch is now live online and available in full through a subscription to leading manual therapy journal, sportEX dynamics. The articles are all written by leading massage practitioners from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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During recent decades, private and national sport organisations have been fostering the creation of multidisciplinary teams in order to give support to their athletes so that they can achieve their objectives with high levels of efficiency. These multidisciplinary teams of specialists, also called high performing teams (HPTs), invariably include masseurs and/or physiotherapists who provide their services in coordination mainly with sport coaches and strength and conditioning (S&C) coaches, but occasionally also with sport scientists, nutritionists and sport psychologists. A clear example of a highly efficient multidisciplinary sport team is British Cycling (BC). We have seen the remarkable success that they have had in the last ten years by winning dozens of medals in the Beijing and London Olympic and Paralympic games, several world championships and the last Tour de France (2012). Every member of that team works toward a common goal (ie. the highest possible performance). But what exactly makes and affects these HPTs?

Sporting success – it’s down to the right people surrounding the most talented athletes

With regard to the elements that influence HPTs, Castka et al. (1) identified two sets of factors which seemed crucial for the successful implementation of HPTs; system factors and human factors (HFs); in turn HFs include: knowledge and skills, needs of the individual and group culture. Pertaining to these HFs, Brian Cookson, BC president, argues that their success, “it’s down to the right people surrounding the most talented athletes who pay that attention to detail in every aspect of their performance and development” (2). Therefore, given the central aspect that HFs have in HPTs, it is appropriate to ask: what human factors and behaviours do team members in HPTs have and show while providing their services to elite athletes?

The author: Noe Orozco, MBPsS and MSc in Psychology of Sport and Exercise.

Noe is from Loughborough University, has provided sport psychological advice for a number of years to national sport bodies, university and local sport clubs, as well as individual athletes in a wide range of sports whether in the heat of the competition or in the consultation room across Europe and North America.

This article “Emotional Intelligence: The Human Factors Needed for Effective Multidisciplinary Teams” is now live online and available in full through a subscription to leading international physical therapy journal, sportEX medicine. The articles are written by leading physical therapists and sports medicine specialists from around the world. The publication is available in print and online as well as on the Apple, Android and Kindle Fire platforms.

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Neck pain is a common and costly diagnosis to the United States (US) and European healthcare systems.  It has been predicted that the 1-year prevalence of an onset ranges between 16.7  to 75.1% of US population.  Many seek medical attention for treatment and Physical Therapy is often ordered as one of the first approaches in it’s management.    An article published in the August edition of the Journal of Orthopaedic and Sports Physical Therapy (JOSPT) compared the effectiveness of two clinical interventions, which Physical Therapists use to treat mechanical neck pain, kinesiotaping and manipulation.  You may be surprised with the results.

The authors of this study performed a randomized-controlled trial.  Eighty subjects with complaints of mechanical, idiopathic neck pain were randomly assigned into one of two interventional groups.  The first group had kinesiotape applied to their posterior neck.   The second group received two thrust manipulations directed at the mid-cervical spine and cervicothoracic junction.

 Kinesiotape:

This was done by placing one piece of tape extending vertically from the dorsal region of T1-2  to C1-2.  A second piece was placed perpendicular, over the midcervical region (C3-6).  The subjects were instructed to leave this on for 1 week.

Manipulation:

 The mid-cervical manipulation was performed with the patient supine and resting their neck in the therapists hands.  The therapist put a finger over the zygapophyseal joint of C3 and gently  induced ipsilateral cervical sideflexion and contralateral rotation until slight tension was perceived.  The therapist then applied a high-velocity, low amplitude thrust upward and medially in the direction of the subjects contralateral eye. 

  The cervicalthoracic junction manipulation was applied bilaterallu.  The subject was prone with their head and neck rotated to one side (in this case, let’s say left).  The therapist stood on the left side, and placed their right thumb against the right side of the spinous process of T1.  The therapist’s left hand supported the subject’s head.  The head and neck were then gently flexed laterally to the right, until slight tension was perceived.  A high-velocity low amplitude thrust was then applied toward the patient’s left side. 

Out of the eighty subjects, five reported adverse events from the applied interventions.  Three patients in the manipulation group experienced a minor increase in neck pain or fatigue after the manipulations and two patients reported cutaneous irritation related to the tape.  These symptoms resolved within 24 hours.

The results of this study demonstrated that kinesiotape and cervical manipulation had similar short-term effects in reducing pain and disability (measured on a Numeric Pain Rating Scale and Neck Disability Index (NDI)). The mean NDI reduction was near 6 points and pain was 2.7 points.   Improved ROM also occurred, for both groups, in all planes expect rotation.

My Impression:

I am not surprised by the results of this study.  Both interventions undoubtedly have cutaneous effects on the skin.  The kinesiotape “pulls” it and the manipulation “stretches” it.  We are learning from a neurophysiological perspective  that the skin  plays a vital role in communicating with the brain, which is responsible for producing the perception of pain.  By changing the brain’s perception of that region of the body, it may become less defensive and produce less pain.

I also suspect a placebo effect and expectation for recovery played a role in the results.  If one believes something will work, it will likely work.  In this case, the participants were consenting to have one of two interventions, which have demonstrated some effectiveness in reducing pain and disability. There was no chance of being a control or receiving a sham intervention (which was likely explained during an informed consent).  If you are told you will receive an intervention which has been shown to be effective, then you will likely think it’s effective.

Overall, I believe the study has questionable clinical significance.  It looked at and compared the short-term effects of two interventions performed in isolation.  Most physical therapists do not perform a single intervention, once a week.  A control group was also not included, which would have been beneficial in assessing for placebo effects.   I believe this study is a start, but further research needs to be conducted to compare these interventions when used in conjunction with a more typical plan of care.

The author: Joe Brence, physical therapist

Joseph Brence is a doctor of physical therapy from Pennsylvania, USA. He is currently a director of two facilities in Pittsburgh and takes a manual approach to patient care. He is also a contributor to www.physiotherapyinfo.com and www. theptproject.com and is currently working on multiple research projects which he will present to the sportEX community as they are published. To read Joseph’s monthly contributions, click the following link http://eepurl.com/bRGmj

Saavedra-Hernandez M, Castro-Sanchez AM, Arroyo-Morales M, et al. Short-term effects of kinesio taping versus cervical thrust manipulation in patients with mechanical neck pain: a randomized clinical trial. JOSPT 2012; 42: 724-730.

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