Guest blogs are like buses. You don’t see one for ages then three turn up at once. So after two awesome recent guest blogs I now give you a third by the blogmeister and running physio legend himself Sir Tom of the Goom. Tom has done a couple of guest blogs for us in the past and has now done another good ‘un in response to Damo’s recent ‘Just Run’ blog. So without further ado its over to the Goominater…
How can we be effective without being intrusive?
Damian’s excellent blog on running really got me thinking… how can we be effective without being intrusive? Let me highlight the dilemma…
A runner presents with proximal hamstring tendinopathy and we think of all the options available to them. They could reduce sitting and aggravating movements, use isometrics to reduce pain, modify their training programme, alter their running gait, challenge their beliefs around pain, use a graded return to provocative movements, complete a 3 month heavy slow resistance training programme, address all relevant kinetic chain deficits, manage their stress, drink green tea and leave their desk job to become a monk.
My point is we could bombard them with treatment options all of which we can justify through clinical reasoning (apart from the bit about becoming a monk). But how intrusive would all this be in their life? The pain is already an unwelcome intrusion, do we really want to give them a huge ‘to do’ list that intrudes even more?
Damian’s approach certainly seems less intrusive and embraces the idea of using running to develop the resilience needed for the sport,
“Having this physical and psychological flexibility should be recognised, nurtured and then celebrated when assessing and rehabilitating runners. Further it should be the only real strategy in the prevention and resolution of running related pain.”
The question is though, is this enough?
It may not be intrusive and require much effort or change from a patient but is it effective? For some runners it may well be, all they may need is a gradual return to the sport they love but sadly, for many, this in isolation may not be an effective approach.
What I’ll take from Damian’s blog though is that we should try to keep our treatments as non-intrusive as possible while remaining effective. Consider the PITA factor (Pain In The Arse) of what we recommend. A patient I saw many years ago helped me come up with this after this response to my ‘comprehensive, evidence-based exercise programme’…
“Yeah the knee pain is a bit of a nuisance, it is a pain in the arse but not as much as doing all those exercises you’ve given me!”
One way that can help is to think of providing our patients with a toolbox of options to manage their pain. Like a toolbox it can be big and cumbersome to carry everything with you all the time so it’s best to select the tools as and when you need them. We can highlight what the best tools are to get the job done, i.e. What are the priorities you need to work on?
The legend that is Mr Meakins’ Physio Treatment Pyramid serves as a great indication of what’s most important, we just need to highlight what patient specific info is key for advice and education, general movement, resistance exercise and beyond.
Closing thoughts: As much as 70% of patients may not do the exercises as suggested and we see similar low adherence to taking medication and other treatment advice. Is this partly because these approaches are perceived as too intrusive into a person’s life? On a personal level have a think how you would fit the advice, lifestyle change or exercise into your world. It isn’t easy! If we’re aware of this it can help us strive to be effective without having unrealistic expectations of the patient and requesting change they’re not able to make.