Exercise Prescription vs Manual Therapy

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.

Exe vs Man Th Blog1Manual 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.Ex vs Man Th Blog 2 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.

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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.

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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,

 

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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.

Amelia.

Welcome to our new Sports Therapist, Amelia Gill!

I’m really pleased to announce that Amelia Gill is joining Ed Pratt Sports Therapy! I’m really excited to be working with Amelia, she brings with her a great work ethic and patient centred focus. Amelia spent some time working in the clinics as a student and for me it was a no brainer, when she applied after she had qualified. Amelia graduated with a masters degree in Sports Therapy in 2017, which she completed whilst finishing her time in the military.

Amelia Gill Headshot

Amelia Gill, MSc, MSST

Amelia served 6 years, with 4 as a physical training instructor, she therefore brings with her a wealth of knowledge and experience in exercise prescription. Take a look at her full bio on the about page.

Amelia will be starting officially in September and working out of the Bedale clinic two afternoons a week. Before the official start she will be covering a couple of days for me whilst I am on annual leave – Friday 10th August at Northallerton and Wednesday 15th August at Bedale. The slots are available via the online booking portal.

Sports Therapist Required!

Job Vacancy: Graduate Sports Therapist / Physiotherapist

Organisation: Ed Pratt Sports Therapy

Salary: To be negotiated.

Location: Northallerton, Bedale, Yarm areas.

Position: Part-time, associate Sports Therapist

Closing Date: Friday 13 October 2017

Job Description:

An exciting opportunity has arisen for a graduate Sports Therapist / Physiotherapist, working alongside an experienced sports therapist in both the clinical and pitch side environment. The therapist will be required to help in the development of three busy clinics and therefore must be flexible and available for evening and weekend work. The successful candidate will also be required to provide match day cover for a local rugby team and as such, a pitch side first aid qualification is essential and a sports trauma qualification desirable.

Candidates must be able to demonstrate excellent interpersonal skills, patient communication, moving & handling skills, strong exercise prescription and manual therapy skills and a patient centred approach to rehabilitation.

Ed Pratt Sports Therapy is a well established sports therapy business in the local area with an excellent reputation. The successful candidate will initially be working part-time, but opportunities are a available for further hours based on performance and feedback. In-house CPD takes place on a regular basis.

How to apply: email CV & cover letter (demonstrating why you are suitable for the post) to ed@edprattsportstherapy.com.

The Reformer or the Rack?

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:

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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!

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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.

Guess Which One’s The British Champion!

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.

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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…

 

Goodbye and Hello

Mugshot JosieFirst the sad news. Unfortunately, we say goodbye this week to our sports therapist Josie Grieve who has been a great part of the team for the past year. Josie is relocating and we would like to wish her all the very best for the future. She will be missed.

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Next the good news! Lucy is back from her snowboarding holiday – injury free too – and will be back working in the Bedale clinic this Thursday. It was great to get some excellent feedback regarding Lucy over the last week and she has made a great start to working as part of the team. With marathon season just around the corner, now would be a great time to get booked in and get those niggles seen to.

Appointments with Lucy are available at a discounted rate of JUST £20 until the end of January 2017. Get in quick and get your session booked.

5 Tips to Running Your 1st 10k

The Northallerton 10k is just over two weeks away and for many it will be there first 10k. To help you prepare for the event I asked Josie to write 5 tips to preventing running injuries. The event is already full, but there will be limited entries on the day. We will be there on the day providing taping, massage and advice pre and post race, near the start/finish on the high street in Northallerton.

Training for a 10K? – Tips to prevent injury. 

Are you preparing to run your first 10K but not sure about how to do so safely? Well you have come to the right place. Below is 5 of the most common mistakes and misconceptions people make when training for a running event:

1 – Failing to warm up and cool down

It is so easy to forget or neglect to warm up and cool down before going out for a run. Warming up is vital to help prepare your body for the stress it is going to be put under when running. I would recommend a gentle jog then completing the lunge matrix, calf raises and leg swings, to get your muscles prepared. Not only will you find the warm up will help prepare your body for the training session it will also allow you to get in the right mind set for the run ahead. Cooling down after the run will allow you to gradually reduce your heart rate back to normal and stretch out you muscles.

Lunge matrix – (Credit: Coach Jay Johnson).

2 – Incorrect footwear

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A lot of you (including myself) may have a trusty pair of trainers which you have worn to death but just can’t seem to part with them. When our trainers start to wear out they lose the shape and support which we need to prevent injury when running.

When it comes to choosing some new trainers I understand there are many different types and deciding which ones are best for you can be tricky. Personally my best advice is to go to a running shop and get a good pair of trainers to suit you, go for comfort first, then work from there. Trust me you will thank me later.

3 – Increasing milage too rapidly

So you’ve finally decided to enter your first 10k race, but now it’s getting closer to the event your 3 and 5k training sessions just aren’t going to cut it anymore. A lot of you panic (I myself have fallen victim to this) and jump straight into 10k training. Though doing this you are putting a lot of stress on the body

In the sporting world there is a basic rule stating you shoulder increase your training session or weekly mileage by 10% only. Personally I think this is a good rule to follow making sure you gave yourself adequate recovery time in-between each training session.

4 – Ignoring any little niggles or twinges

The majority of us will have little niggles and twinges from time to time especially when starting out running and it’s important to understand that REST is not always the answer. Although for a lot of injuries this will help in the first instance; when you get back out running the injury will more than likely re-occur and get progressively worse. This is because there is usually a reason for the injury occurring in the first place; whether it be bad running technique, a muscle imbalance of even an incorrect training program. This is why it is important to get any niggles of twinges checked out as soon as you feel them occur in order to prevent them from advancing into a more serious injury.

5 – Neglecting strength training 

So you’re doing everything by the book; wearing the correct footwear, warming up and cooling down before each session, increasing your running distance and speed slowly and giving your body enough time to recover in-between, yet your still getting little niggles and twinges. Why? Well it’s rather simple, you need to incorporate some strength training into your program. This is because if your muscles are weak more often than not they can’t take the demands we put on our bodies when running.  Don’t panic, strength training doesn’t always have to mean lifting heavy weights, in fact using your own body weight is one of the best forms strength training you can do. Exercises such as calve raises, Nordic curls and bridges are excellent to incorporate into your training. As an added bonus you will also find that strength training not only helps with injury prevention it can also contribute to your overall running performance.

So to conclude: Make sure you warm up and cool down after a running session, get yourself a pair of good running trainers, increase your mileage at a steady pace giving your body enough time to recover, get any niggles of twinges checked out, incorporate some form of strength training into your program and most importantly ENJOY YOURSELF.

Thanks Josie Grieve.
Sports Therapist

Mugshot Josie

Josie Grieve (MSST)


Josie works out of the Yarm clinic every Tuesday. To book an appointment you can easily book online here.