The easy answer isn't always the answer

So a wee while ago I read a blog post by Adam Meakins the Sports Physio about the devolving of self-efficacy. Basically we're becoming a society  of people who cannot take care of themselves and healthcare professionals who complicate the process.

Adam is 100% correct. And I felt I needed to write a post expanding upon this with my view.

We are humans and as humans we want to do things in the easiest way possible. We're always looking for the easy answer, the fastest results and what requires the least amount of effort. In one way this makes us very innovative, but on the opposite side of the coin it makes us very lazy. 

When it comes to sports injuries and rehab it is important that the client is on board with their own rehab. If they don't buy into it or aren't ready to help themselves then the whole process is a mute point. Many sports injuries require us as sports therapists or physios to use the biopsychosocial model, which in short means looking at the biology, psychology and social factors of the client. This means it's not just prescribing exercises to help a client, but the client needs help to reduce their stress and ensure their social circle and lifestyle doesn't impede the process. All this equals a lot of work from the client.

Because we're creatures who want the easy answer, most people will see many different professions before realising that most of them are not actually helping. Most seek those who perform manual therapy, which is the most passive of treatments, and means the least amount of work from the individual. However, passive usually doesn't work. So they see a variety of people and then get to a point where they realise they're tired of "treatments" and want to get better. Until a person is ready to make a change efforts to help using exercise and stress relief techniques are futile.

Reliance on passive treatments makes us, well, passive in our own health. Adam points as professionals we need to make sure we're not part of the problem and reassure our clients and not confuse or frighten them. Sometimes a client doesn't need a steroid shot or surgery or even complicated exercises, often simple is best. Obviously, we need to be aware of any red flags when assessing clients, so in the absence of red flags we can proceed as needed.

I'm sure some of my clients have left thinking "Well, that doesn't seem like much." But, I choose the best exercise for what we're trying to accomplish, not the most complicated and cool looking exercises. This may only be 4-5 exercises, maybe less, but less can be more. If a client sees the rehab as a burden that's going to take too much time, they won't do any of the exercises. Short and simple can be the best remedy. I'm not in the business of performing treatments that aren't necessary or try and make something simple sound complicated just to get more work. My clinic is a  no BS zone!

So, if you've been "treated" by a variety of professions and still aren't any better it might be time to seek the help of a professional who won't complicate the problem. If you are suffering from chronic pain there are physios out there who specialise in using the biopsychosocial model to help you help yourself.

If you have any questions about sports injuries or rehab please email me at sara@prestigesportinjury.co.uk

Is whole body cryotherapy worth the hype?

Short answer, Not really. I’ll explain further.

Cryotherapy is a method of recovery which is done by lowering the skin temperature of the body. Some of the most common modalities are ice packs, ice massages, gels and cooling creams. Recently whole-body cryotherapy (WBC) chambers have been introduced to high level foot ball and rugby teams. But is this new, and costly, method really the best way to enhance recovery through cryotherapy?

I hit the research hard. One of the first studies I found from Hausswirth, el al (2011) claims the benefits of WBC on highly trained runners. One large flaw in this study is that the other modalities involved were far-infrared (not a highly reliable modality) and basically sitting in a chair for ten minutes. These two “sham” modalities would, of course, show that WBC is a reliable way to recover after running.  It’s studies like this that make me angry. They manipulate the data by introducing two modalities they know won’t work to “prove” that WBC is reliable.

Other research I won’t even mention here were studies paid for and sponsored by companies that make WBC chambers. I don’t give research like this the time of day. Many involve manipulated data to sell a product to teams that can afford it.

A more recent study by Viera, et al (2015) studied the effect of WBC on a vertical jump after high intensity training by placing participants in a chamber at the suggested -110 degrees for 3 minutes and a control temperature of 21 degrees for the same time. In this study there was no significant difference between the WBC and control group. Thus, suggesting that some of the “benefits” of WBC are possibly due to the placebo effect. 

One of the better studies from Holmes & Willoughby (2016) looked at previous studies and compared WBC to cold water immersion on recovery and skin temperature. One of the claims of WBC is that the extremely cold temperature is more effective at lowering the skin temperature than other modalities. In this study participants used a WBC chamber at -110 to -120 degrees for 2-4 minutes and cold-water immersion at 8-14 degrees for 5-10 minutes. The results showed that using cold water immersion lowers the skin, muscle and core temperature more effectively than WBC. The study suggests that further high-level studies on WBC be performed to confirm their claims.

My personal opinion is that WBC is very expensive and some of the membership rates are well over £100 a month. Most people would not use the WBC more than once or twice a week, making it a very expensive means of recovery. Plus, it means coming home from your run or workout, getting in the car, driving to a centre, going in a chamber for 3 whole minutes then driving back home. A lot of effort when you can simply fill your tub with cool water once you get home and sit and chill in it. Studies are not conclusive of its claims, and with that kind of cost, you may be better off buying a gym membership or hiring a personal trainer.

However,  saying that, its definitely worth trying. I will admit though getting a snapshot of yourself in the mittens, slippers and headband in a chamber is pretty cool, but unless it works for you, it’s just a lot of money for cold air.

If you have any questions about sports therapy, sports injuries and cryotherapy please feel free to email me sara@prestigesportinjury.co.uk

Who do I see, a graduate Sports Therapist or a Sports Massage Therapist?

Often as a graduate sports therapist I get mistaken for being a Sports Massage Therapist. It’s a tad frustrating as having completed a three-year BSc it’s safe to say I’ve had a significant more amount of educational and in-clinic training than a Sports Massage Therapist/Soft Tissue Therapist.

So, what’s the difference?

Sports Massage Therapist/Soft Tissue Therapist:

A Sports Massage/Soft Tissue Therapists will have the scientific knowledge of and manual therapy skills to address specific of soft tissue injuries, their function, and the result of manual therapy on injured and uninjured tissues. They will have experience in anatomy, principles of health & fitness, principles of soft tissue dysfunction, sports massage treatment

Sports Massage is a Level 3 course focusing on injury prevention and performance enhancement through manipulation of the muscles, ligaments and fascia (debatable – will blog about next year).

Most high-quality Sports massage courses will be ITEC/BTEC/VTEC Level. Many Sport Massage/Soft Tissue Therapists are registered with the Sports Massage Association of as part of the Complimentary and Natural Healthcare Council. However, there are other bodies they can be members of, and there is no statutory requirement.

It is also important for the therapist to have attended a course approved by a professional body above, as there are many "fast track" courses out there which are not always providing quality courses.

Here is a brief summary of ITEC/BTEC/VTEC Levels:

3: Sports Massage Therapist - qualified to work on non-injured tissue.
4: Sports Massage Therapist - qualified to work on injured tissue
5: Sports Therapist/Massage Therapist - qualified to work on injured tissue, recognise sports injuries and prescribe rehabilitation exercises
6: Sports Therapist (can be diploma or graduate) - qualified to do all the above and diagnose soft tissue injuries using clinical reasoning.

Graduate Sports Therapist:

First, the title of sports therapist is not a protected title, so you’ll find most of us who are graduates us the term “graduate sports therapist” or put our degree qualifications on all our paperwork.

I’m not going to get into the nitty gritty of who is better a  diploma or a graduate sports therapist as it depends on the practitioner not the qualification.

Diploma level 5 sports therapists often do courses on the weekend with coursework and exams during the course process and graduates spend 3 years developing the required skills while being assessed throughout.

A graduate Sports Therapist will have an undergraduate diploma and would have completed a course verified by one of the sports therapist professional bodies: Sports Therapy Association, Society of Sports Therapists or the Sports Therapist Organisation. There is no statutory requirement for regulation, but it’s best to find someone who is registered with one of these professional bodies to ensure they are practising at the correct level and attending CPD courses.

Graduate Sport Therapists focus on the assessment, diagnosis and rehabilitation of soft tissue injuries. While courses may vary, a graduate Sport Therapist will have courses in anatomy, ethics, biomechanics & gait assessment, fitness testing, injury prevention, sports massage, clinical assessment and decision making, advanced manual therapy, sports nutrition and first aid/sports trauma skills.

Both professions are helpful for people who participate in sport and need to have appropriate insurance for their profession. Both can provide sports massage for recovery, but only Level 6/Graduate Sport Therapists can assess and diagnose injuries using clinical reasoning, and Level 5's can recognise sports injuries and prescribe appropriate rehabilitation exercises. This becomes very important if you have an injury as Level 3 Sports Massage/Soft Tissue Therapists should not be working with injured tissue, diagnosing injuries or prescribing exercises.

Sadly, many CPD providers are teaching techniques which are beyond the remit of lower level qualifications. This can cause problems for the therapist as they will likely not be insured for those techniques, and therefore, should not be using them in their practice or advertising them on their website.

It is important to know the qualifications of your therapist, if you're not sure just ask them. They are not always noted on their website and some therapists may be advertising abilities beyond their qualification level. If you're looking for a non-injury related sports massage a Level 3 will be suitable, however if you are having pain or are injured you should book in with a Graduate/Level 6 Sports Therapist for an assessment and rehab program. 

If you have any questions about sports massage and sports therapy, please do not hesitate to email me: sara@prestigesportinjury.co.uk