Paul Manley Back Pain and RSI Clinic

4 physiotherapy myths busted

There are downsides to just letting myths live on. Spending time and money on treatment that does not work often means that people miss out on the things that would improve their health.

4 myths have been busted by PEDro ( the physiotherapy evidence database which celebrates its 15th anniversary in October 2014). We examined common misconceptions and linked them to robust evidence that disproves these ideas.

• Myth 1: The type of mattress you sleep on prevents back pain
  Almost 80 per cent of people suffer from back pain at some point in their lives. But no high-quality clinical research has been undertaken to answer the question around whether a particular type of mattress will prevent back pain. Any suggestions to the contrary are likely to be marketing tools.

My comment:
Of course it matters what type of mattress you sleep on. I could not sleep on a thin mattress or a lumpy one which slopes off to one side. I don't like tempur or memory foam either. It seems like the study was not very specific.

• Myth 2: Stretching prevents injury and muscle soreness in recreational runners
  Millions of people around the world get their exercise from running. We’re often told we should warm up with stretches before we start, or stretch after we finish. But Testimonials have proved that this makes no difference to muscle soreness or injury prevention.

My comment:
Why then do footballers stretch before matches, are they wrong? I always stretch before and after any exercise. By doing this I prepare the muscles and enable them to adapt to their new functionality and resultant shape. I also have to stretch afterwards otherwise my body will become very stiff soon after and even stiffer the next morning. This is especially so if I haven't exercised for a while or I am doing a new type of exercise.

• Myth 3: You should wear a neck brace if you have a whiplash neck injury
  No, these don’t aid recovery. Whiplash occurs in around 60 per cent of road accidents. We sometimes see celebrities wearing a neck brace after suffering whiplash, but these neck braces do not make any difference to recovery from whiplash.

My comment:
There are times after a neck and shoulder injury like whiplash that it is impossible to hold your head upright due to the pain of muscles in spasm. A neck brace at those times is helpful. However, if people can hold their heads up without too much discomfort, a neck brace can be detrimental. This is because at this point in their recovery the muscles want to move around and begin to be more active. If a neck brace is worn for too long the muscles will become weak and tight and neck mobility will reduce.

• Myth 4: Ultrasound enhances recovery after ankle sprain
  Ankle sprains are the most common sports injury. There are many websites stating that ultrasound may aid ankle sprain recovery, but high quality clinical research has proved this is not true. Ankle sprains get better pretty quickly, regardless of intervention using ultrasound.

My comment:
Ankle sprains can persist due to the displacement of the Talus bone which forms the link between leg and foot. Its ligaments are usually ripped in a typical sprain and often do not repair adequately. Mobilisation of this and other joints allows the foot mechanism to normalize. Ultrasound merely applies heat to the area and stimulates circulation. This is not helpful when the injury is new, cooling is required. After a while the repair process slows down and heat can help with aching and further repair.

Furthermore:

The application and understanding of physiotherapy varies from culture to culture. Its application varies from practitioner to practitioner. In the UK orthodox medicine has succeeded in emasculating that profession by virtue of many factors. The tale I hear the most from new and returning patients is that the physio didn't do much and their advice did not help. Their expectations were not fulfilled. I look at the inevitable exercise sheet with its ticked boxes and see that 50% of the exercises prescribed may be helpful and the other 50% are either plainly wrong or not appropriate at that phase of recovery. Too generalized, not specific to that individuals particular musculo-skeletal problem.

In my workshops I have had many discussions with Physios, Osteos, Chiros, Accupuncturists, body workers, massage therapists and the ilk. I see how starved they are of knowledge, diagnostic abilities and the techniques to 'fix' problems. I am appalled by the way that the physical therapy professions have become more abstracted from the reality of hands-on treatment. One problem is with medical terminology. It is fine for categorizing diseases but lousy for musculo-skeletal problems. Terms like osteo-arthritis, spondylitis and 'slipped disc' are so generally applied as to be meaningless. Other terms like polymyalgia rheumatica and fibromyalgia which strictly translate as 'many muscles aching all the time' and 'tough tight muscle pain' produce a spurious belief by virtue of the simple renaming of the condition that we once knew as 'my shoulder hurts and the muscles are very tense'.

At the root of the problem lies the simple fact that what is possible is not widely known. For me, due to my upbringing, such ways have always been obvious, a natural thing to do, to help people out of pain by using my hands plus a thousand techniques.

Our vocations can suffer greatly from time constraints and profitability. When a practitioner has only 15 minutes to see a patient and must work to some dictated schedule because they are employed by an organization or by their own priorities, they will suffer the frustrations of not being able to spend more time with the patient, especially if the patient is so distressed that they burst into tears in front of them. Can you say sorry, times up? No, we are in a vocation and that means doing our best for everyone possible.

I have been giving one hour and 45 minute treatments for many years. It is by far the most efficient way to help people. That way treatment can be thorough and to the point, exploring every painful crevice and crag, calming them as we go, first finding the painful areas and getting them to relax by using the extraordinary subtleties of pressures that only hands and fingers can exert effectively.

Now, I must express my genuine concern that in the UK, at least, people do not get the quality of care and treatment that their condition requires. This is the case both in the NHS and in the private sectors of musculo-skeletal medicine. There are many new hyper-branded exercise products and pills, as well as machines and devices ranging from Voodoo to just plain bovine produced fertilizer out there. The salespeople (practitioners) often are very sincere for they have been trained to believe that their education secures them a self-appointed cure-all status. Often hampered by paperwork and draconian rules as well meeting their sales targets, they suffer from not being an independent practitioner in private practice. A founding ethic of being in practice is to never sell anything which makes a 'buck' for the practitioner, it was always considered to constitute a conflict of interests.

We need to stick to our roots, hands-on, hard work, knowledge and, above all, compassion.