Physiotherapy UK 2018: Exercise specificity is vital

Prescribed exercise must be specific to the individual patient and designed to produce a defined outcome, physiotherapy experts told the event

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Exercise for neck pain should not simply be dictated by the clinician’s preference, said Deborah Falla

‘Rather than having patients with different presentations and different pain mechanisms being given the same exercise approach, we need to be more specific,’ said Deborah Falla.

Professor Falla, chair in rehabilitation science and physiotherapy at the University of Birmingham, spoke about the key principles underlying effective prescription for neck pain.

She said neck pain was one of the most common musculoskeletal conditions and advised: ‘Get patients into the right exercise that matches the mechanisms driving their painful disorder.

‘And in doing so, hopefully, you give them reduced pain, improvement in function, better quality of life and ultimately reduce the recurrence of neck pain.’

She told delegates that the type of exercise for people with neck pain should not simply be dictated by clinicians’ preference. Instead, decisions had to be based on knowledge and skills, informed by a comprehensive assessment plus ‘good old fashioned’ clinical reasoning.

Physiotherapists need to consider what mechanisms they should be intervening with, rather than simply what approach they should choose, said Professor Falla, adding: ‘In other words, we need to understand for our patients what are the key drivers, because ultimately exercise is going to be different depending on the mechanisms.’

For some patients, that may be movement-driven, where there are clearly changes in neuromuscular control, poor quality of movement. But for others, there could be a large psychosocial aspect, pathology, or it could be biologically driven.

If physiotherapists understood the different components, by performing a comprehensive, multi-system assessment to tease out the physical, psychosocial and biological factors, then they would be in a better position to understand which components of exercise were going to be relevant for the patient.

‘It may be that a motor control approach is relevant, it may also be that strengthening is necessary for that patient, or the general change to their attitude to exercise is important,’ she said.

‘Thinking about the immediate analgesic effects of exercise, for instance, and ultimately developing more individualised strategies and packages of exercises which are more ideally matched to the patient’s presentation.’

Summing up after his talk about spinal exercise prescription in elite sport, Simon Spencer said the ‘critical element’ was that exercise must always be defined by intention and outcome.

Head physio with the English Institute of Sport, and a physio with the England football team, Mr Spencer told the audience: ‘Next time you go away and prescribe exercise to your patients, there is no problem if you create exercises that potentially touch two different outcomes, as long as you are clear on the outcomes you are trying to chase, and the prescription and the nature of the exercise matches that prescription.’

 

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by Gill Hitchcock

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