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Testing, Testing 123

Hello and welcome to the first Revolution Sports Physio blog.

I hope these blogs will entertain, enlighten, empower and inspire you.

I aim to educate, but also be educated. I’m keen to hear about your experiences, your thoughts and opinions. After all, it’s your health that we care about. 

I’m going to begin by attempting to help you navigate the mind-boggling number of therapies now available for pain and injury.

Chiropractors, Osteopaths, Physiotherapists, Sports therapists, Bowen Therapists, Reflexologists, Acupuncturists…to name a few, all claiming to provide that magic treatment that will fix your injury. Sports taping, massage, manipulation, electrotherapy, postural realignment, biomechanical correction, rehabilitation… the list is endless, all with testimonials to their unwavering success.

Despite the dizzying array of treatment on offer however, 7.8 million people in the UK still live with persistent pain (pain lasting longer than 3 months), accounting for 4.6 million GP appointments each year! (reference)

I hear many people voice their frustrations about conflicting advice given by health professionals, and confusion about what to do for the best. I also hear many misconceptions about  how some treatments work.

Firstly, we have to look a bit closer at why we feel pain. The sensation of pain is not an input from the tissues, but an output from the brain.

Stuff hurts because your brain has concluded, for some reason or other, that you are  threatened, in Danger and need protecting.

The amount of pain we feel is dependant on a number of different factors, including context of injury, personal beliefs, and previous experience. It is  not a reflection of the amount of tissue damage.

Now a detailed look at the biology of pain is a little beyond this blog, but if you’re keen to know more, there is loads of information herehere and here.

So, now we know that pain isn’t just about issues in the tissues, what’s the best way to get rid of it?

Sometimes a bit of hands on therapy, massage and the like can help to get you moving again, but you shouldn’t feel completely reliant on these treatments.  Passive treatments do not break down scar tissue, release fascia, loosen or realign a joint. Think about it, if it was possible to change the structure of tissues with your hands in this way, how do we all withstand the stresses and strains of daily life – lifting shopping bags, taking your golf clubs out of the car, the impact of running, without constant and persistent sprains and strains?

Often, we’re just not sure why these treatments work, but it is thought they help reduce the threat perceived by the brain.

The intention of this blog isn’t to focus on manual therapy, but  if you’re interested to learn more, Adam Meakins has written a very thought provoking blog on the topic.

A bit of passive treatment can help calm things down when we’re in pain, but the body has an amazing capacity to heal itself, which is, in part, dependant on active movement. Targeted in the right way, and at the right time, exercise is the most effective tool to promote healing. It increases blood flow, mobilises joints, strengthens, and also reduces the threat perceived by the brain, thus desensitising tissues.

But the real key to reducing threat and facilitating healing is understanding your pain. Knowing when to rest, when and how much to exercise, and most importantly why, puts you in control. A bit like being woken in the middle of the night by an unfamiliar noise. If you know it’s just the cat knocking over a plant, it might be annoying, but far less scary or threatening than the unknown (intruders? ghosts?).

Check out this video here showing how powerful the right information can be.

Of course, it’s not always as straightforward as this. It’s not as easy as flicking the ‘pain off’ switch. The cause of injury can be complex, as are the reasons for treatment succeeding or not.

Not getting enough sleep, poor nutrition, stress, overtraining, being too sedentary can all contribute to injury and pain. Figuring out the relative contribution of these different factors is important and can help treatment choice.

A strengthening programme isn’t the best course of action just after breaking your leg, but it might not be as obvious that a bad back might be more related to high stress levels, poor sleep or just generally being run down. An exercise programme alone may not be effective in this case either.

Having said that, there is sometimes a tendency for therapists to overcomplicate the reasons for injury. A sore toe  after wearing heels all day at a wedding when you never wear heels? I don’t think we have to start doing any complicated biomechanical assessments, foot manipulations or muscle imbalance screening!  In my opinion, this is where the skill in being a good therapist lies. Being able to see the bigger picture, consider all the component parts, yet not looking for ‘injury bogey men’ where they don’t exist.

BUT you may say, is all of this really necessary? If a treatment gets rid of your pain, then does it really matter how or why it works? Do we really need to understand? Why not just pay the money and let the therapist sort things, like getting the car fixed?

Well, while I don’t think an in depth knowledge of neuroscience or the biology of tissue healing is necessary, false beliefs about the effects of treatment can actually have a negative effect in the long term, and lead to unnecessary dependence on a therapist or treatment.

The idea that passive treatments change our body structure can lead to feeling weak, vulnerable and prone to injury, and make the brain vigilant to small, but not necessarily harmful, changes in the tissues.

On the other hand, understanding the body’s ability to heal, the reasons for pain and what to do about it can help us  feel strong and robust.

Think of the body less like a machine that has parts that need ‘fixing’ and more of an ecosystem, where balance in a number of systems needs maintaining (Lehman,2015)

So in conclusion, which is the best therapy to choose? Of course, as a physiotherapist, I am biased, but there are good and bad practitioners in every profession. Like a favourite restaurant it’s really down to individual choice. But be careful. Choose a therapy, that doesn’t just promise to get rid of your pain, but leaves you feeling  empowered and informed. If you feel weak, dependant and confused after treatment look elsewhere.

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