Really pleased to announce that Tom will be joining the Ed Pratt Sports Therapy team. He will be working on Saturday mornings at the Northallerton Clinic. Tom has been working in another clinic in York and was invaluable last year at Northallerton Rugby Club, covering our home games, which has given him an invaluable experience in a wide variety of both acute and more chronic injuries.
After initially graduating from the Sport & Exercise Therapy in 2017, Tom went on to complete a masters degree in Sports & Exercise Medicine, graduating in 2018. For his MSc research project at Leeds Beckett University, Tom investigated the effects of barefoot running on muscle performance and risk of running-related injuries in habitually shod runners. The findings of the study have formed the basis for PhD research at the university.
Tom will be available for bookings from Saturday 7th September between 08:00-13:00. So whether its for a pre-match massage, taping session, an injury assessment or preventative exercise programme, get booked in with Tom as soon as possible!
Last week Amelia and I had a great catch-up and CPD session at our sports injury clinic in Bedale. We try to do this once a month, and work on various aspects of Sports Therapy, from the business side to joint assessment review (our last session was the wrist and hand). This session focussed on objective measures, in particular the use of a simple crane scale, clips and furniture lifting straps in measuring leg strength. This is as simple and effective way of obtaining a measure of the difference in strength between the right and left sides.
We devised set-ups for measuring knee extension and a seated calf raise, please excuse the faces we’re pulling, but the effort was real!
This was a simple and inexpensive way of getting a measure of the force generated during the movement and applied to the lifting straps. The benefits of this set-up lie in the objective measurement of injuries such as anterior crucial ligament reconstructions and Achilles’ tendon injuries. My thanks to Eric Meira (@erikMeira) for the idea and we’re looking forward to utilising it more during future sessions.
Exercise prescription versus manual therapy, or do they work hand in hand? The aim of a sports therapist, or indeed any practitioner, is to rehabilitate an injury and help maintain and improve performance. This is done through the use of manual therapy and exercise prescription, but there is no hard and fast rule on how much manual therapy should be done versus exercise prescription. This article will explore current literature and aim to give insight into the basis for clinical decision making when it comes to methods of treatment.
Manual therapy includes massage, joint mobilization and joint manipulation; it aims to reduce pain and increase mobility of joints. Exercise prescription can be used in a reactive or proactive way, it will aim to improve the flexibility, stability, strength, endurance and power.
Chronic low back pain (CLBP) was prevalent in the research, one study by Aure et al. (2003) suggests that 60% to 80% of the western population will experience low back pain at some stage. The study had 49 participants, one group received manual therapy with the addition of 11 exercises for the spine, abdomen, lower limbs, spinal segments and the pelvic girdle. Another group performed general exercise therapy for 45 minutes; the programmes were individually designed. Results, with a one-year follow up, showed that there were significant improvements in both groups but the manual therapy group showed better results. A contrasting study by Geisser et al. (2003) found that CLBP was improved following manual therapy alongside a specific exercise program but it did not improve perceived function, stating that other psychological factors need to be addressed. Both studies were randomised control trials which are seen as the gold standard for research. However, neither study effectively blinded participants or therapists which is likely to influence the results.
Moving away from CLBP, a study by Hoeksma et al. (2004) looked at the use of manual therapy versus exercise therapy in osteoarthritis of the hip. The graph below (Figure 1) details the effect of manual therapy versus exercise therapy, it shows that manual therapy had better results on range of joint motion from flexion to extension. This result is unsurprising as the manual therapy group included manipulation and ‘vigorous stretching’ while the exercise therapy group included exercises to improve muscle function and joint motion. Diercks et al. (2004) found the opposite in a contrasting study looking at manual therapy for frozen shoulder versus exercise therapy.
Figure 1 – Results on range of motion from flexion to extension (Hoeksma et al, 2004)
The manual therapy group (physical therapy) received passive stretching and manual mobilisation and the exercise therapy group (supervised neglect) received exercises within pain limitations. Results (Figure 2) showed that the exercise therapy group had better outcomes up to 24 months after injury. This is depicted by the graph below, which shows the difference in treatment over a 24 month period; the exercise therapy group was more successful in this case.
Figure 2 – Results of both groups (Deircks et al, 2004)
Hoving et al. (2002) conducted an alternative study, investigating the use of manual therapy, exercise therapy and care by the GP for neck pain. Neck pain is common in the general population and this study found that the success rates after 7 weeks for manual therapy, exercise therapy and care by the GP were 68.3%, 50.8% and 35.9% respectively. Although it would appear that manual therapy was the most successful, patients were allowed to continue exercises at home throughout the trial and continue taking medication which makes it difficult to control the outcome measures in isolation. Figure 3 shows that manual therapy was most successful. However, the outcome measures (perceived recovery, severity of physical dysfunction score, average pain intensity score and neck disability index score) are subjective measures relying on the patients to report how they feel. This is an unreliable way to measure due to a potential lack of understanding, dishonesty or outside influence from the patient,
Figure 3 – Manual therapy, neck pain and GP care (Hoving et al, 2002)
In conclusion, from a brief look at the literature it is clear that manual therapy and exercise prescription work in varying degrees depending on the injury. There is no one course of treatment that is best overall and the choice depends on the stage and severity of the injury. It is also important to note, when using a patient-led approach to therapy, manual therapy may be more appropriate for one person but another may prefer exercises. It is not necessarily a question of manual therapy vs exercise prescription, but instead using a patient-led approach and selecting the most appropriate course of treatment.
My experience with a Pilates Reformer at The Pilates Studio, Yarm.
So when Helen Smith owner of Yarm Pilates studio first described the Pilates Reformer to me, the mental image it conjured up was not exactly enticing and thoughts of medieval torture kept popping into my head:
Medieval rack has definite similarities!
Helen, however, assured me that it was great for loads of different exercises and so we arranged a time for me to have a go. What I found surprised me, other than the similarities in size and shape, it was nothing like a medieval rack!
Under Helens guidance, we started to go through just a few of the many exercises you can do on the reformer, working the legs, trunk muscles and arms. The Reformer adds adaptable resistance to the movements (by adding / removing springs), which change the feel of many of the common Pilates exercises. I found that there were definite similarities to some gymnastics strength training exercises, such as weighted mobility drills.
Using the Reformer was an interesting experience and hopefully, we’ll get a few more sessions in to really get to grips with it. It won’t be for everyone (nothing ever is), for those who have tried Pilates, I would definitely recommend it as a way of adding a bit of a twist. Helen is a great teacher who focuses on and promotes movement rather than holding a bracing, which is great to see. I did end up in some rather strange and unflattering positions though!
Pilates Reformer rollbacks.
The Pilates Studio, Yarm is located on Yarm High Street and offers several friendly Pilates classes with great instructors to suit all levels, as well as 1-1 Reformer sessions. My clinic is at the studio on a Thursday afternoon / evening and appointments can be made via the Book Online button.
It was great to have Scott Lincoln in the other day to go through some of the finer points of the shot put (well no points, it is round after all). My student Amelia and I even got a couple of practice throws in!
It’s really important to find these opportunities for students and help them to gain an understanding of some of the less well known sports.
As Sports Therapists it’s really important to gain an insight into the strength and power required in the sport. By understanding the sports of the athletes we treat, we are more able to assess and treat them effectively. Shot put is tough and requires a great deal of timing and skill (perhaps not so evident in the videos) and is a drive of power from the ground up, finishing at the finger-tips.
There’s a British Champion in these videos and pictures, but I’ll leave it to you to decide which one of us that is…