BE INFORMED: An Elite Sport Perspective to Physical and Manual Therapies, it doesn't have to be
Protocol in elite sport is different to National Health protocols. When an athlete comes to the clinic with pain or injury, the clinic deciphers whether they first require Physiotherapy or Sports Doctor.
Physiotherapy: Assessed, and depending on assessment, they are treated and often referred to Sports Massage/Soft Tissue Therapy for further rehabilitation. NSAIDs are rarely advised if treatment is given as reduced pain symptoms can hinder assessment and potentially cause more harm. If there is no improvement, referral is made to the Sports Doctor who often refers to Radiology. This protocol is swift and efficient, which reduces athlete anxiety and promotes quicker recovery.
Sports Doctor: Assessed, and depending on assessment, refers to Radiology, or Physiotherapy, with occasional Sports Massage/Soft Tissue Therapy referrals, noting athletes seeing the Sports Doctor usually have a more specific issue that requires in depth assessment. Again protocol is swift and efficient.
National Health Protocol: An appointment with the GP often leads to the NSAIDs, to which if no success, referral is made to Physiotherapy. Referrals can take a long time depending on the catchment area, to which symptoms can worsen leaving the patient feeling helpless and hopeless by the time of their appointment. Physiotherapy assesses, noting some catchment areas promote no physical touch which can weaken quality of assessment. Depending on assessment, the usual advice tends to be a few appointments to Physiotherapy, with a Sports Doctor referral often made if no success is made during the course of Physiotherapy. By which point, the patient's situation is consistently worsening, impacting mental and physical health which can augment inflammation symptoms. Noting the chronic use of NSAIDs, usually increasing in strength due to increasing symptoms, can damage the liver causing further issues.
Once the patient has seen the Sports Doctor, they are referred to Radiology, a Doctor specialising in another area of medicine more applicable to the patient's situation, or further Physiotherapy this time being with more direction from the Doctor. Very rarely is Sports Massage/Soft Tissue Therapy considered, and rather surgery is the more accepted path if pain persists.
How and why Sports Massage/Soft Tissue Therapy could help
The main reason why this form of therapy is not considered at National Health level is due to inconsistencies in therapists understanding and awareness, something which is not a problem in elite sport due to the high standard of requirements.
- Sports Massage/Soft Tissue Therapy has been found to increase T-lymphocytes, thus boosting the immune system (Major et al., 2015, also research conducted by the BBC: https://www.bbc.co.uk/programmes/b04j9gny).
- The Young's Modulus is stress vs strain, showing that they increase together and when results are placed on a graph, they produce a linear curve. When considered in conjunction with Anatomy Trains (James Earles and Tom Myers), pain and injury begin to make sense. The more a person has dysfunctional and imbalanced biomechanics and posture, including breathing patterns, the more stress vs strain increases, which can cause the tissues to align to the strain. This can then cause increased collagen deposition, reducing elastin capacity, therefore increasing tension and reducing flexibility, influencing pain symptoms and risk of injury. Sports Massage/Soft Tissue Therapy therefore can address these imbalances and dysfunction, influencing healthy alignment and healthy tissue composition.
But why the inconsistencies?
Due to various levels of training available, and the wide variety of physical and manual therapies now available, it is difficult to regulate. A lack of regulation means the understanding and awareness held by the therapist can differ greatly from therapist to therapist.
Important general advice: If you have an injury, seek a therapy specific to the issue - Overall assessment can be given by a Physiotherapist who can then refer further to aid rehabilitation, with the occasional return appointment to ensure improvement. Chiropractic and Osteopathy can help skeletal issues such as impingement, and Sports Massage/Soft Tissue Therapy can help a plethora of problems from shin splints to tension headaches, and is an excellent complimentary treatment for mental and physical medical conditions.
Noting to NOT buy into ANY course of treatments as recovery is ALWAYS subjective.
Research before you book - look at experience both education and since qualifying noting level of qualification can help determine level of understanding and awareness, and thus quality of treatment. A low level Sports Massage/Soft Tissue Therapist can be helpful for maintenance and recovery such as DOMS, but not advised for specific problems.
You DO NOT have to live with pain, there is no excuse from the patient personally or the therapist professionally.
Understanding and awareness of Hypermobility and it's various scales differs across the medical field, which can hinder a patient's treatment. If you are double jointed, extra flexible, or even able to hyperextend your knees and elbows for example, it's worth getting an assessment from a Hypermobility specialist. If you are diagnosed with Hypermobility, or a condition of Hypermobility, this can vastly help treatment perspective, meaning more efficient and higher quality treatment.
Types of treatment to look out for: when and why
- Physiotherapy: Pain or injury. You can seek a Physiotherapist who specialises in a specific area to get a more in depth assessment and treatment.
- Osteopathy and Chiropractor: Both can address skeletal issues and joint tension. There are various types of treatment perspectives taken, so research beforehand including testimonials and experience since qualification.
- Sports Massage/Soft Tissue Therapy: Differs greatly to that of Swedish Massage for example, as the treatment is specific to you, with an increased level of knowledge, understanding and awareness. I have heard many a client tale of bad therapy, the latest one being poorly applied acupuncture which worsened symptoms, yet after one treatment with myself, she left pain free and confident to continue training.
To show how understanding and awareness can help, there is a story from AIMAG 2017: An athlete arrived at the clinic with ankle pain, to which Physiotherapy, Sports Massage, Sports Doctor, nor Radiology could solve. However, upon watching his overall performance, I noticed imbalance and was able to identify the cause being in the TMJ (Jaw joint). Upon treating this joint intra-orally, the pain was gone. I advised the athlete to see his dentist on returning home for further assessment of jaw alignment, and thus, help the athlete solve his pain long-term. An insight as to how and why can be found in other blogs at www.movewellnottingham.com/blogs, or book an appointment with Kim today to see how she can help you.
Just because you have a pain somewhere, it doesn't always mean the cause of pain is there also. It is vital you have a subjective assessment each treatment, even with Sports Massage/Soft Tissue Therapy, and level of assessment can be identified by level of qualification. I personally do not trust any therapist who does not display the qualification, or place of qualification - it is important for the client to make an informed decision in the booking process.
- Acupuncture: Level and place of qualification is VITAL. A 1-day course in acupuncture alone, with no real qualification in anatomy and physiology, can increase risk of worsening symptoms. Acupuncture can be very helpful when applied properly, there is a plethora of supporting research for its benefits, and also how it works, so research before you book.
- Podiatry/Chiropody: All things feet from corns to insoles/supports. Leg length assessments are not always carried out in practice, so ensure one is performed.
- Myofascial Release: A less invasive treatment useful for patients with fibromyalgia for example, as pressure applied is no greater than 5mg!!!! Can help treat a wide range of health issues including pain, brain fog, neuralgia, tension, and symptoms of anxiety.
- Cranio-Sacral Therapy: Extremely beneficial to people suffering from spinal deviations, vertigo, TMJ neuralgia, headaches, pain, and symptoms of stress and anxiety.
The Integrative Approach
Elite sport uses an integrative approach, with each professional recognising their skill set, and when another's may be more appropriate. One type of therapy is not always the answer, and therapists can discuss a plan in accordance with your monetary situation, meaning recovery does not have to stress the bank account. Therefore, ensure the therapist has a wide network to refer patients if required.
So pain and injury does not have to be debilitating or frustrating, you've just not found the right therapist!
Like this article? Then please share it to raise awareness of the importance of high quality manual and physical therapy, so we can raise the standard overall. The answers to pain and injury are there, it's just finding the good therapists (can be like a needle in a haystack) to give you those answers.
Any questions? Please feel free to contact me.