Created for Physiocanhelp.ca by SPC Member Mireille Landry
Evidence-based exercise prescription is a fundamental Physical Therapy skill. Despite this, exercise prescription may be under-employed. So, how do physical therapists raise the standard for exercise prescription in practice? Are we doing all we can to maximize function beyond therapeutic benefit for all of our patients?
The Big Idea
A well designed exercise program will complement the hands-on treatment provided by a physical therapist. But these aren’t just any old run of the mill exercises — they’re hand-picked to help patients move better by strengthening targeted muscles and addressing any muscular imbalances that may exist. We might also suggest they walk more often, further or longer to help with recovery. They are chosen for their ability to significantly reduce the risk of re-injury, improve the speed of recovery and a return to function. In managing chronic disease, we are essential interdisciplinary team members in prescribing exercise for health and recovery. But all too often, in both cases, we stop prescribing exercise prematurely.
In June 2011, the World Confederation for Physical Therapy hosted a panel discussion between five physiotherapists and an exercise physiologist entitled Evidence-based Exercise Prescription: Raising the Standard of Delivery that asked, “Are we, as physiotherapists, fulfilling our potential as experts in exercise prescription?” The transcript of this session is definitely worth a read. We should also be asking ourselves that same question.
My take on things…
Concussion is a HOT topic these days. Cervical pain and dysfunction can be a common associated injury in our concussion population. Furthermore, there can be an overlap in symptoms in neck injury and concussion injury. As such, it is important that we include assessment of the cervical spine into the assessment of our concussion patients. If you are looking for a good read, and some great suggestions on assessment/treatment, may we suggest reading:
Treleaven, J. (2008). Sensorimotor disturbances in neck disorders affecting postural stability, head and eye movement control. Manual Therapy(13), 2-11.
See below for a short summary of the article. We challenge you to incorporate these type of assessments in not only your neck pain patients, but as well as considering the use (when appropriate) in your concussed athletes
It should not come as a surprise that cervical spine pain and dysfunction can lead to disturbances in several areas, including cervical joint position sense, postural stability, and oculomotor control. There is a decent body of evidence to suggest that specific treatments to the cervical spine (DNF training, acupuncture, manual therapy) translate to improvements in cervical proprioceptive awareness, vertigo, and standing balance in individuals with neck pain. Furthermore, training programs focusing on things such as gaze stability, cervical position sense, and eye/head coordination can result in improvements in cervical pain and dysfunction WITHOUT localized treatment to the cervical spine.
What does this mean to us?
Clinical assessment of sensorimotor control disturbances should be worked into the management of our neck-pain patients. To have the best results, a multimodal approach is crucial in the treatment of these individuals. Assessment and management of the following areas should be included:
- Cervical position sense
- Oculomotor assessment (gaze stability, eye follow, saccadic eye movement, eye/head coordination)
- Postural stability
- Vestibular tests
The author suggests that in all areas where disturbances or abnormalities are noted, a home exercise program should be provided and completed 2 to 5 times per day, as long as exacerbation of neck pain or headaches does not occur (although temporary aggravation of dizziness can be acceptable).
“As members of the Sport Division, we have a passion for guiding highly motivated athletes through the rehabilitation process. Outcome measures are needed to provide athletes with the best possible physiotherapy care; but have you heard of electronic outcome measures (eOM)? Let’s say you’ve assessed a 20 year-old basketball player who incurred an ankle sprain. By using eOM, you can track their progress, connect their physician with automated physiotherapy reports, and even compare your ankle outcomes with other physiotherapists in the Canadian Database.
The CPA has partnered with Focus On Therapeutic Outcomes Inc. (FOTO) to be our physiotherapy eOM provider, and by compiling physiotherapy eOM in this growing Database, we can utilize our outcomes to advocate for our profession. Reach out to physiotherapist Kerry Kittson at email@example.com, and click here for more information http://bit.ly/1f3YhVx. Join the free webinar on Feb 24th http://bit.ly/1R9b4Hv as well and receive 2 months free FOTO use! We appreciate your enthusiasm.”
The 2016 WADA Prohibited List came into effect on January 1, 2016
(Ottawa, Ontario – January 4, 2016) – The Canadian Centre for Ethics in Sport (CCES) would like to alert the Canadian sport community that the World Anti-Doping Agency (WADA) 2016 Prohibited List came into effect on January 1, 2016.
Notable modifications include:
- Insulin-mimetics were added to category S4. Hormone and Metabolic Modulators, to include all insulin-receptor agonists.
- Meldonium (mildronate) was added to category S4. “because of evidence of its use by athletes with the intention of enhancing performance.”
- It was clarified that the ophthalmic use of carbonic anhydrase inhibitors (S5. Diuretics and Masking Agents) is permitted.
- It was clarified that clonidine (S6. Stimulants) is permitted.
- The International Motorcycling Federation (FIM) was removed from the list of sports prohibiting alcohol (P1. Alcohol) as a doping agent, and FIM “will address the use of alcohol using their own regulations.”
For the complete summary of modifications to the 2016 Prohibited List, along with other details, visit www.wada-ama.org/en/resources/science-medicine/prohibited-list.
Athletes can verify the prohibited status of their medication(s) using the following CCES resources which were updated on January 1, 2016 to reflect the new Prohibited List.
Two important areas for physiotherapists working with sport are Taping and Protective Equipment. SPC is proud to announce that we have two courses to meet your learning needs!!
SPC Taping for Sport & Performance
In the clinic or at a sporting event, taping is an essential rehabilitation technique that can effectively help a client return to work, play or daily living activities. Learn how to prevent and care for common injuries with the proper use of taping and wrapping techniques. Content focuses on the most common injury areas of ankle, wrist and thumb taping with simple elbow or knee blocking also covered. Direct instructional support and hands on practice are key elements of this course. Participants also gain access to our online learning system with both pre and post course information to enhance learning retention
SPC Protective Equipment – Analysis & Application in Sport
Protective equipment is an essential component of safe participation in all levels of sport and activity. Learning focuses on assessment of design features and analysis of sport-specific considerations. Through hands on application, participants develop confidence and skill in the selection, fit, and maintenance of sport protective equipment.
Click here for upcoming courses in your area: COURSE SCHEDULE
This week the news broke that Ontario will be introducing Canada’s first concussion legislation. The bill is being dubbed Rowan’s Law after Rowan Stringer a 17 year old girl who died after suffering a concussion playing rugby.
The national post released a four part series featuring SPC Ontario Executive, Siobhan Karam.
Read it here: http://news.nationalpost.com/sports/head-shots-how-one-family-dealt-with-a-very-mild-concussion-that-felt-anything-but-mild-for-their-young-son
The Globe and Mail details the introduction of the bill. Read it here: http://www.theglobeandmail.com/news/national/ontario-introduces-concussion-bill-named-for-teen-who-died-after-rugby-injury/article27481192/
Physiotherapists play an important role in the conversation as one of the assessment and treatment providers. SPC is currently assembling a committee to ensure our SPC members have the most up to date practice, research and treatment information. We are currently seeking members to be part of our concussion panel.
Download Information & Expression of Interest
Concussion Committee Terms of Reference
Sports Physiotherapy Canada Grant
Sport Physiotherapy Canada was established in 1972. This grant will provide funding for research that facilitates the advancement of the role of physiotherapy in sport and exercise under the tenets of health promotion and injury prevention and rehabilitation. Preference will be given to applicants who are pursuing clinically applied research. Successful applicants must be members in good standing of Sport Physiotherapy Canada of the Canadian Physiotherapy Association. One grant of $5,000 will be awarded. The successful applicant will be asked to do a webinar and AGM presentation to share their project.
ACCESS FULL INFORMATION ON THE PFC Grant Page
The Deadline for all Applications is January 31st, 2016.
For further information:
Grants Program Manager
(613) 564-5454 ext. 280
SPC would like to congratulate the 2015 Sport Physiotherapy Canada PFC Grant award winner: Joanne Parsons from the University of Manitoba. The winning project is looking at the effect of FIFA 11+ Injury Prevention Program on Performance & Movement Control in Young Female Athletes.
About the SPC PFC Grant
This grant will provide funding for research that facilitates the advancement of the role of physiotherapy in sport and exercise under the tenets of health promotion and injury prevention and rehabilitation. Preference will be given to applicants who are pursuing clinically applied research. Successful applicants must be members in good standing of Sport Physiotherapy Canada of the Canadian Physiotherapy Association. One grant of $5,000 was awarded in 2015.
Stay tuned to the PFC website and SPC website for information on when the 2016 application process opens.