Adam is right!!! A guest blog by Tom Goom

My mate Tom Goom aka ‘The Running Physio‘ is a machine! Not only is he a top physio, a devoted dad and husband, and a decent runner, he is also a social media super hero who has been working his little ankle height running socks off. He has teamed up with David Pope from Clinical Edge to produce a series of free videos on achilles tendinopathy so go check those out here! Tom is also a pretty smart bloke and he has finally realised that I am right, but I will let him explain more…

I’ve been friends with Adam for about 5 years and he’s certainly someone I enjoy sinking the odd beer with from time to time, but few people know though that our friendship was born out of months of relentless debating and arguing on Twitter! Despite our disagreements however we always kept a measure of humour about how we discussed things, even if they got a little heated, unlike a few of his other debates with some others.

However, there are lots of things we have agreed on too, such as we both champion the importance of education and exercise as core treatment strategies. They’re central to both of our models of care and while mine is furnished with lots of other options…

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Adam’s is a bit more stripped down to key approaches….

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And recent research in patellofemoral pain (PFP) suggests Adam may be is right (gulp!). @JFEsculier, @BlaiseDubois and colleagues have just published a great study comparing three treatment options for runners with PFP (Esculier et al. 2017). All three groups received education and advice about training modification, one group had this alone, one had this plus an exercise programme and one group had it with the addition of gait re-training. So who did best?! Surely it was the group with the exercises added in? If not, it must have been the gait re-training?!

Well nope, all three groups got very similar outcomes. The addition of exercises or gait re-training did not lead to greater improvement in pain or function.

Now the aim of this blog is more than pointing out that Adam was right for once as always, it’s more about highlighting just how effective education and activity modification can be. If we can help someone find their activity ‘sweet-spot’ or ‘G-spot‘ as we discussed in detail here, that is neither too little and leads to de-conditioning, or too much and leads to flare-up in symptoms, then we can help them progress towards their goals.

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Studies like this should makes us ask ourselves tough questions. Do I over-treat? Does my focus on ‘adjuncts’ like massage or taping distract from a simple and effective key approach? Maybe even, how necessary are all these exercises I’m giving out?! It’s also fair to say though that we should question the study too and be aware of its limitations.

We’ve discussed this research in more detail in this blog here which includes a video review of the study and a great response from the authors.

While multimodal treatment is recommended for PFP (Barton et al. 2015) there is a downside of a very ‘comprehensive approach’ in that it can give the patient an awful lot to do. It can be intrusive in theirs lives and add to the headache an injury provides. As both me and Adam have said recently here and here, we need to find the balance between being effective without being too intrusive. Hopefully we can find that by working closely with the patient to identify what their priorities are to work towards their goals.

And as for mine and Adam’s relationship, well after a fiery start we’ve entered the ‘comfortable’ phase as I’ve become accustomed to his grumpy ways and he seems to be happy as long as I pretend he’s right from time to time all the time.

Thanks for reading

Tom

4 thoughts on “Adam is right!!! A guest blog by Tom Goom

  1. Great blog post as usual.I haven’t read the specific article, but I was wondering, could you take a subset of those sunners with partiular “problems” such as valgus or hip drop or poor posture in running and compare those with an education/loading program v. a “comprehensive” program? Would it still end up wih no significant clinical difference between cohorts? I sometimes wonder if in reseach when looking at means and statistical comparisons, how much we miss the individuals. For eample didn’t you once right a blog post about how not all patients in trials of diet and exercise loose weight. On average they do, but some gain weight and some become emmaciated. Some peolpe may just respond to PF taping and G med strengthening for whatever reason, where the avarage result shows no improvement. The trick is picking those that do and those that won’t… Hmmm but how :)? But totally it’s mostly about load management……

    Ashley

  2. “All three groups had the same outcome”
    Doesn’t that suggest the possibility that it’s all regression to the mean and none of the treatments have much effect?

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