This is a post I’ve been meaning to write for a while. Not that this is anything new or ground-breaking, especially to physical therapists. But this may be new information to those who have never visited a professional regarding an injury or pain condition. Or even to some people who have.
There are many forms of treatment out there, of which several will have been touted as the next amazing form of therapy for helping with reducing pain levels, increasing mobility, lengthening muscle tissues, breaking down ‘scar tissue and adhesions’…yada yada yada.
Whilst some do have positive merits and evidence to support some of the claims, many do not. Whilst many may provide you with temporary pain relief or increased mobility, often the effects are short-lived. Many of these therapies are also very relaxing, so may ease your symptoms by reducing stress levels and increasing your levels of feel good hormones (such as serotonin and dopamine). The problem is that once these effects wear off, you are no closer to recovery from your condition.
Exercise rehabilitation is a totally different kettle of fish. There are wide ranging studies focusing on numerous different muscular, soft tissue and joint conditions which all show that a progressive, gradual loading exercise rehabilitation program has benefits which outweigh those of manual therapy. Research shows that following such a program improves patient outcomes and reduces the risk of a relapse. In addition, whilst following an exercise protocol, far fewer treatments are usually needed, saving the patient money and time. The responsibility is also placed into the hands of the patient, making the process a patient centred and empowering experience, rather than relying on a therapist to ‘fix you’.
From my view point, as a therapist who has training in both manual therapies (such as massage and acupuncture), as well as exercise rehabilitation….I can see why many people, as well as many therapists (myself included in the past) fall into this pattern: Sometimes it’s easier to just get a regular massage to deal with your neck and shoulder tension…Sometimes our lives are so busy, it’s hard to commit to a regular exercise program…Sometimes we just want to lie down and relax and have a treatment which feels nice and eases our pain or tension for a while. And that’s ok. As long as we recognise that soft tissue treatments alone are unlikely to correct the problem.
Most soft tissue injuries are caused either by a large direct trauma (such as rolling the ankle); or a smaller repetitive trauma often termed ‘overuse’ injuries. When we sprain our ankles or break a bone, we don’t tend to get a massage or have any other form of manual therapy. If we are sensible and listen to the advice of our Doctor or Physical Therapist, we perform exercises to regain full motion and build strength and balance to prevent a reoccurence.
So why is it that with ‘overuse’ injuries, those chronic niggling pains which develop for no obvious reason and gradually get worse until we are forced to do something about them, do we decide that a massage is the way forward? I’m not judging…I’ve done the same, still do sometimes.
Instead, we should be working with our therapist to investigate the root cause of the problem, and then to develop a program to correct the contributing factors. Let me give you an example:
A pain in the lateral shoulder which developed gradually over time; hurts most on movements above shoulder height and radiates down into the upper arm, could well be an impingement. This occurs where a structure (usually a tendon, sometimes a bursa) is getting pinched within the shoulder joint as the arm is elevated. No degree of soft tissue therapy is going to solve this as the area of injury is found underneath the bony arch of the shoulder where no therapists fingers could reach! Instead, we investigate why this has happened, common factors include:
Weakness or inhibition of the scapular stabilising muscles allowing an upward rotation of the scapula
Overactivity of the upper trapezius muscle, increasing elevation at the scapula
Shortened length of the Pec Minor, bringing the shoulder into a protracted position
An inability to depress the humeral head, causing increased pressure on the structures which pass above it
Long periods of time spent seated at a desk or computer in a protracted position
Pastimes which involve repetitive overhead motions; or a increase of tension in the chest muscles
Reduced Thoracic spine mobility, into extension especially.
These are not all, but certainly some of the most common factors which may play a part in this kind of condition. So whilst some soft tissue work to the shoulder and chest region may have some limited merit, the main focus of treatment should be to correct the muscular and postural issues identified.
This should be achieved with a graded program. One set of exercises given to you on day one will also not cut it. Any therapist worth their weight will progress your exercises to more challenging variations on a regular basis, once you can achieve the necessary criteria.
In short, the message I’m trying to get to, is that if you are trying to ‘fix’ an injury or pain condition, don’t rely on your therapist alone. They should be providing you with the skills you need to help yourself. If you haven’t been given a treatment plan (either physically or even just a vocal summary of the plan) with a roll to play yourself, then you’re unlikely to find a long-term solution. Take charge of your own recovery, commit to a rehab plan and see the benefits for yourself!