Exercise Therapy and Stretching

Chronic musculoskeletal pain (CMP) refers to ongoing pain felt in the bones, joints and tissues of the body that persists longer than 3 months. For these conditions, it is widely accepted that secondary pathologies or the consequences of persistent pain, including fear of movement, pain catastrophizing, anxiety and nervous system sensitization appear to be the main contributors to pain and disability.

While exercise is a primary treatment modality for CMP, the intent is often to improve physical function with less attention to secondary pathologies. Exercise interventions for CMP which address secondary pathologies align with contemporary pain rehabilitation practices and have greater potential to improve patient outcomes above exercise alone.

Biopsychosocial treatment which acknowledges and addresses the biological, psychological and social contributions to pain and disability is currently seen as the most efficacious approach to chronic pain. This clinical update discusses key aspects of a biopsychosocial approach concerning exercise prescription for CMP and considers both patient needs and clinician competencies.

Background: While static stretch (SS), proprioceptive neuromuscular facilitation (PNF) and oscillatory physiological mobilization techniques are documented to have positive effects on a range of motion, there are no reports on the effect of dynamic oscillatory stretching (DOS), a technique that combines these three techniques, on hamstring extensibility.

Purpose: To determine whether DOS improves hamstring extensibility and stretch tolerance to a greater degree than SS in asymptomatic young participants.

Methods: Sixty participants (47 females, 13 males, mean age 22 ± 1 years, height 166 ± 6 centimeters, body mass 67.6 ± 9.7 kg) completed a passive straight leg (SLR) to establish hamstring extensibility and stretch tolerance as perceived by participants using a visual analogue scale (VAS). Participants were randomly assigned to one of two treatment groups (SS or DOS) or a placebo control (20 per group). Tests were repeated immediately following and one hour after each intervention.

Results:  Immediately post-intervention, there was a significant improvement in the hamstring extensibility as measured by the SLR in both the SS and DOS groups, with the DOS group exhibiting a significantly greater increase than the SS group.  One hour post-intervention, hamstring extensibility in the DOS group remained elevated, while the SS group no longer differed from the control group. Furthermore, the stretch tolerance remained significantly elevated for the SS group, but there was no difference between the control and DOS groups.

Conclusion: DOS was more effective than SS at achieving an immediate increase in hamstring extensibility, and DOS demonstrated an increased stretch tolerance one-hour post-intervention.

Static Stretch (SS) does not appear to reduce injury risk and any effect on earlier return to sport is of marginal clinical significance.  In contrast, a graduated strength training programme appears to significantly reduce injury risk and significantly reduce the time to return to sport after injury.

Therefore, the only area in which SS might seem to offer a specific advantage is in the area of increasing flexibility.  However, there remains a lack of evidence that gains are superior to those of a strength training programme. Even if strength training is eventually confirmed as being inferior to SS at increasing flexibility, the fact that strength training improves performance, pain, disability, injury and return to sport rates mean strength training must be a mainstay of athletic development and training, in contrast to SS.

Therapeutic exercise for low back pain has traditionally focused on programmes for enhancing cardiovascular fitness, as well as trunk muscle strength and endurance. More recently, exercises which address changing motor control strategies in back pain patients, have been recommended. 

This course describes the rationale for the proprioceptive antigravity training model, for the prevention and treatment of low back pain.

We all know that exercise is good for us. There’s scientific evidence that shows that people who exercise are generally healthier, fitter, live longer and are less likely to develop a number of disabling medical conditions. As therapists, we often use exercise to reduce patients’ acute and chronic back, neck, shoulder and knee symptoms.

But what if your patients can’t exercise, function or correct their posture effectively because pain inhibits their movement? How often do your patients just want to give up on their rehabilitation because of this? And how frustrating is it for you not to be able to use your skills as a physiotherapist to the fullest extent possible?

This article describes an innovative, practical, quick and easy approach that will give you effective tools to enable your patients to function and/or exercise without pain as well as increase your confidence to utilise exercise as part of patient management.

It’s called Exercise and Function without Pain (EFWP) and it’s making a huge impact on physical rehabilitation across South Africa.

Loss of range of movement (ROM) is a common outcome following injuries. The problem is that traditional stretching methods are often ineffective in improving ROM, let alone reducing pain and disability in various conditions -particularly where multi structure impairment is present.

SO, WHAT CAN YOU DO?

Kinesiologist Aaron Mattes has developed a solution to deal with the problem.

It’s called DOS and it’s a lot more than a stretching method.

This course will show you how to use DOS and its three evidence-based pain relieving modalities. DOS will increase your patients’ tolerance to pain while stretching and so improve their ROM.

The aim of this course authored by Prof Paul Hodges is to present current understanding of the interaction between movement and pain; as a cause or effect of pain, and in terms of the role of movement (physical activity and exercise) in recovery of pain and restoration of function.

The purpose of this course is to introduce alternative treatment approach for piriformis syndrome using a hip muscle strengthening programme with movement re-education. Interventions for piriformis syndrome typically consist of stretching, dry needling and/or soft tissue massage to the piriformis muscle. However, this case study highlights an alternative view of the pathomechanics of piriformis syndrome and proposes an effective different treatment approach.

The purpose of this course is to introduce alternative treatment approach for piriformis syndrome using a hip muscle strengthening programme with movement re-education. Interventions for piriformis syndrome typically consist of stretching, dry needling and/or soft tissue massage to the piriformis muscle. However, this case study highlights an alternative view of the pathomechanics of piriformis syndrome and proposes an effective different treatment approach.

Does physical activity have an impact on the quality of life of the elderly?

What if the individual only takes up physical activity later in life?

Previous studies have examined the effects of mid-life physical activity on healthy ageing, but not the effects of taking up activity later in life. This on-line course examines the association between physical activity and healthy ageing over 8 years of follow-up for a group of individuals aged at around 63 years at the start of the study.