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