CHEK Therapy
Paul Chek describes himself as working in the fields of “corrective and high-performance exercise kinesiology”. Kinesiology is the study of body movement. He set up the “CHEK” Institute in California; referring not to his name, (really!), but to “Corrective Holistic Exercise Kinesiology”. He recommends “treating the body as a whole system and finding the root cause of a problem” by addressing six areas: -
- Thoughts – suggesting that “the biology of your body is linked to your mind – healthy thinking produces a healthy body.”
- Movement – expressing the belief that “movement is life and life is movement - exercise pumps your organs, removes waste, improves metabolism, and cultivates energy.”
- Nutrition – he promotes organic foods “eaten according to your Primal Pattern Diet Type” suggesting this will “fuel your body for success”
- Breathing – by optimising breathing he attempts to maximize “the most important nutrient – oxygen” suggesting this “removes waste, and energizes your body”. (Now, whilst we have avowedly avoided recommending any particular therapies here we can clearly and unreservedly endorse this element of Chek’s thinking; life without oxygen is miserable, short and often quite desperate. If you want to get the most out of life you must remember to breath, all day actually.)
- Hydration – on the basis of the old adage that “the solution for pollution is dilution” – they suggest “water is an essential cleaning agent for the body”. Drink water.
- Sleep – believing “we get stronger when we rest” they promote 8 hours of sleep each night as being essential for rest & repair.
This is a whole way of life and is not for the faint hearted.
www.chekinstitute.com
Classification:Passive; Active; Prevention/ergonomic
Chiropractic/chiropractor
Invented by Daniel David Palmer a charismatic healer from Iowa USA in 1895 the initial theory was that all kinds of illness could be relieved by spinal manipulation; like its older rival osteopathy, also invented by an engaging American from the mid-West. Palmer’s first patient, Harvey Lillard, had apparently gone deaf when “something popped in his spine” and a few days after some spinal adjustments his hearing returned. Initially surrounded by theories that today sound laughable it is now one of the largest alternative medicine professions. Chiropractics are skilled in musculoskeletal diagnosis and deliver a range of therapies aimed at relieving symptoms and aiding in healing and prevention. Their work very much focuses on spinal disorders. Extensively practiced around the world many chiropractors work in elite sports whilst others are integrated into GP services. In Denmark they study during their first years with standard medical students. Like with all the professions there are good and bad ones but most now address the three pillars of spinal care. chiropractic students in the UK study for four to five years to gain their Integrated Masters in Chiropractic (MChiro) degree. In the United Kingdom, chiropractors are Statutorily Regulated by the General Chiropractic Council (GCC)
www.gcc-uk.org
Classification: Passive; Active; Prevention/ergonomic
Cognitive Behavioural Therapy
A form of psychotherapy, or “talking therapy” it was originally designed to treat depression, but is now used for a many other mental disorders and chronic pain changing unhelpful thinking and behaviour. It focuses on specific problems and assists in developing specific strategies to help address them. This is different from psychoanalysis where therapists look for the unconscious meaning behind the behaviour and then diagnose the patient.
It is used in the treatment of mood, anxiety, personality, eating, addiction, dependence, tic, and psychotic disorders as well as a multitude of chronic pain states including low back and neck pain, fibromyalgia, arthritis, regional pain syndromes in addition to a variety of other chronic conditions such as tinnitus (a constant ringing in the ears) and chronic fatigue syndrome. It attempts to challenge "errors in thinking such as overgeneralizing, magnifying negatives, minimizing positives and catastrophizing with more realistic and effective thoughts, thus decreasing emotional distress and self-defeating behaviour.” In chronic pain the technique is used to help individuals diminish the impact of their condition – the condition remains but its effect on well-being is diminished.
CBT uses a number of different methods: exposure therapy, stress inoculation training, cognitive processing therapy, cognitive therapy, relaxation training, dialectical behaviour therapy, and acceptance and commitment therapy.
A typical programme would consist of face-to-face sessions between patient and therapist, made up of 6-18 sessions of around an hour each with a gap of a 1–3 weeks between sessions. However, this varies. It may be delivered via a live remote computer interface, (CCBT), there are standalone computer based programmes, (some now utilising artificial intelligence), it may be delivered in book format or group sessions and it can be combined with other cognitive therapies such as Mindfulness.
In February 2006 NICE recommended that CCBT be made on the NHS and here is what they say of it: it is most commonly used to treat anxiety and depression, but can be useful for other mental and physical health problems …… CBT cannot remove your problems, but it can help you deal with them…..it is based on the concept that your thoughts, feelings, physical sensations and actions are interconnected, and that negative thoughts and feelings can trap you in a vicious cycle…...CBT aims to help you crack this cycle by breaking down overwhelming problems into smaller parts”
ww.nhs.co.uk
The British Association for Behavioural & Cognitive Psychotherapies (BABCP) keeps a register of all accredited therapists in the UK
www.cbtregisteruk.com/Default.aspx
The British Psychological Society (BPS) likewise has a directory of chartered psychologists but only some will specialise in CBT.
www.bps.org.uk/bpslegacy/dcp
For a good review of its use in chronic pain:
www.apa.org
Classification: Active; Prevention/ergonomic
Complimentary and Alternative Medicine
This term refers to all of the physical therapies and treatments excluding physiotherapy, podiatry/chiropody and all types of therapy excluding Western/modern medicine.
In 2015 the Australian Government's Department of Health published a review of alternative therapies. Whilst those practicing many of the therapies it covers may criticise the report for looking at them through the wrong lens, a Western objective “evidence based” lens, it is a good read.
Regulation and standards are an issue in this field as it is in many. The European Federation for Complimentary and Alternative Medicine EFCAM is instead mainly concerned with “equality of access for citizens to CAM across Europe, and, to gain the right of all appropriately trained providers of CAM to practice”.
However, in the U.K. the Complementary and Natural Healthcare Council (CNHC), a regulator for complementary therapists was set up with government support to protect the public by providing voluntary register of complementary therapists. CNHC's register has been approved as an Accredited Register by theProfessional Standards Authority for Health and Social Care for: Alexander Technique, Acupuncture, Aromatherapy, Bowen Therapy, Craniosacral Therapy, Healing, Hypnotherapy, Massage Therapy, Naturopathy, Nutritional Therapy, Reflexology, Reiki, Shiatsu, Sports Therapy, Yoga Therapy.
www.cnhcregister.org.uk/newsearch/
www.efcam.eu
www.cnhc.org.uk
Classification: Passive; Prevention/ergonomic
Ergonomics
Regulated by the Chartered Institute of Ergonomics and Human Factors, ( CIEHF) the two terms are often used interchangeably, though for some “ergonomics” infers the physical aspects of the environment such as desks and chairs, while ‘human factors’ more relates to the wider way in which activity is undertaken.
It is very much a derived science based on multiple disciplines: anatomy, physiology (a branch of biology that deals with the normal functions of living organisms and their parts), cognitive psychology (concerns mental processes like perception, thinking, learning and memory), organisational psychology (concerns the way people interact), engineering, biomechanics (the study of the mechanical laws relating to the movement and structure of living organisms), kinesiology (the study of the mechanics of body movements) industrial design, and anthropometry (the study of the measurements and proportions of the human body) and statistics. With these tools it seeks designs that complement the strengths and abilities of people whilst minimising the adverse effects of their limitations. As a science it has to accommodate our variable population with its differing ages, sizes, strengths, cognitive abilities, prior experiences, cultural expectations and goals. It aims to match a product, workplace or system design with the people who need to use it. In short, it aims to do things better.
“Good design should go unnoticed giving no cause to be.”
Poor design is noticed; an airport with poor signage, a machine with incomprehensible instructions, poor packaging. The nuclear sector has led the way in understanding, measuring and improving human reliability and in the UK is seen by many as having delivered a gold-standard. In healthcare, improving equipment design and communications between teams of doctors and nurses is seen as a way to reduce harm and maximise gain. Its knowledge can be transferable; the CIEHF website gives a powerful example; “Great Ormond Street Hospital studied Formula 1 pit stops in order to understand methods and efficiencies in teamwork for application in paediatric heart surgery”. The International Ergonomics Association states on its website that proper ergonomic design is necessary to prevent musculoskeletal disorders like repetitive strain injuries and chronic low back pain.
Ergonomics is an old art. The Ancient Greek Hippocrates in the 5th century BC described how a surgeon's workplace should be designed and his tools laid out in ergonomic terms whilst the early Egyptian dynasties had displayed similar principles in their design of tools and household equipment nearly 3000 years before.
Modern ergonomics is a product of the 20th Century. In 1911 the American Quaker Frederick Winslow Taylor, also a national golf and tennis player, published The Principles of Scientific Management. His contemporary Americans, Frank and Lillian Gilbreth, then developed the "time and motion study", which in eliminating unnecessary steps, improved efficiency; they reduced the number of motions in bricklaying from 18 to 4.5 thereby increasing the laying rate from 120 to 350 bricks per hour. Most famously, on the 1st October 1908 the World saw its first production line role out the Model T Ford.
Meanwhile the Russians, in the throws of revolution, focused on the well-being of the worker. At the First Conference on Scientific Organization of Labour in1921Vladimir Bekhterev and Vladimir Nikolayevich Myasishchev criticised Taylor's proposal to turn man into a dull machine and suggested a new discipline of "ergology" or "ergonology that would place health and well-being at the centre of the massive re-organisation of labour Russia was to oversee. Reality, meet vision!
Ergonomics emerged as a discrete science in the 1940’s as a consequence of the physical and cognitive demands placed on the human operators of the new technologies spawned by World War II. Poor performance was linked to the difficulties the human operators encountered interfacing with their new weapon systems. The “Tayloristic” approach of matching man to machine was thrown into reverse, designing machines that man, with his limits and strengths, could use most effectively. By 1943 and with the appalling losses in the air a lieutenant in the U.S. Army, Alphonse Chapanis, showed that "pilot error" could be hugely reduced with logical and more differentiable cockpit controls. As these technologies expanded into civilian applications disharmony between people and equipment increased and stimulated research into the interactions between people, equipment and their environments. The early focus had been on work environments though increasingly it began to include consumer product design.
Its reach is indeed now wide and vital; driver error is estimated to contribute to over 40% of fatal road traffic accidents so ergonomists work on how road users gather and process information and adjust road layout and signage to improve their decision making.
The term ergonomics was coined at a meeting of physiologists and psychologists at Britain’s Admiralty in 1949 and derives from the Greek roots ἔργον pronounced “ergon” meaning “work” and νόμος pronounced “nomos” meaning “natural law”. Later that year the Ergonomics Research Society (ERS) was formed; it was the World’s first such professional body. In 1977 the ERS became the Ergonomics Society (ES) in recognition of the increasing focus on the practice of ergonomics. It then became a Registered Charity, number 292401, and a Company limited by guarantee, number 1923559, in 1985.
The term “human factors” was coined in the USA and in 2009 the ES was renamed the Institute of Ergonomics and Human Factors (IEHF) to reflect the popular usage of both terms and to emphasise the breadth of the discipline. Finally, in 2014, the discipline’s importance was recognised officially by the award of a Royal Charter that allows it to confer Chartered status on members who fulfil certain criteria and by the end of that year the CIEHF had 294 members.
Meanwhile in 1953 the European Productivity Agency founded in Switzerland, became the International Ergonomics Association in 1961. Until 1976 it was a society of individual members. At that point the IES changed to be the association of federated societies worldwide. In 2011 the IEA became a not-for-profit organisation. It remains based in Zurich.
Comprised of three main subspecialties, physical, cognitive and organisational ergonomics: physical ergonomics is the science of designing user interaction with equipment and workplaces to fit the user; cognitive ergonomics concerns the mental processes, (perception, memory, reasoning), that affect interactions between users and systems; organisational ergonomics concerns the optimisation of system structures, policies, and processes with relevant issues including communication, crew resource management, working times, teamwork structures, and quality management.
There are many specialisations within these broad categories; in physical ergonomics there is visual ergonomics and within cognitive ergonomics human–computer interaction, and user experience engineering.
Ergonomists employ a great variety of tools and a considerable jargon.
They may use “ethnographic analysis” observing the uses of technology in a practical environment focusing on "real-world" experience and pressures especially relevant to early product design. “Focus Groups” produce qualitative data on opinions about technologies or processes at any stage during development. “Iterative design/prototyping” involves users at several stages of development to correcting and refining a product. Meta-analysis examines a wide body of already existing data to identify trends, form hypotheses and aid design. Two subjects, “subjects-in-tandem”, may work concurrently on the same task while vocalizing observations and by "co-discovery" feed off of each other to generate stronger ideas than they would working alone. Surveys and questionnaires can generate large amounts of data though as any electoral opinion pollster knows, not always accurately. “Task analysis” is a method of analysis which aims to aid in the matching of systems and processes to human capabilities. The “think aloud protocol” is just as it sounds; a researcher gains insights as to the users' analytical process and so identifies design requirements that affect output or user. “User analysis” creates the persona of the user at the outset of a design process focusing on their needs. The "Wizard of Oz" technique involves an operator remotely controlling a device to simulate a computer program obviating the early need to actual build programmes. A “methods analysis” breaks down each task into its component steps to for example see precisely where a “repetitive strain” occurs. Time studies, work sampling and “predetermined time systems” are methods for analysing “time and motion”. The “cognitive walkthrough” imagines a user’s perspective of scenarios to guide design and workflow. The Kansei method is a system for converting consumer feedback into design specification. “High Integration of Technology, Organization and People”, (HITOP), is a step by step manual procedure that exposes the human and organizational aspects of a technology that should lead to a more efficient integration of it into a workplace. Likewise “Top Modeler” helps identify the organisational changes needed when new technologies are introduced and “Computer-integrated Manufacturing Organization, and People System Design”, (CIMOP), does this in the computer sector. “Anthropotechnology” concerns the transfer of technology from one culture to another. The Systems Analysis Tool, (SAT), comparatively evaluates work-system intervention alternatives whereas Macroergonomic Analysis of Structure, (MAS), analyses the structure of work systems according to their compatibility with certain sociotechnical parameters and Macroergonomic Analysis and Design, (MEAD), uses a ten-step process to achieve a similar goal. Virtual Manufacturing and Response Surface Methodology, (VMRSM), uses computerised tools and statistical analysis in workstation design.
When you look at the beautiful and unbeaten ergonomic of a stone-age hand axe you wonder how, without MAS, MEAD, HITOP or SAT, they ever did it? “They” were our early Acheulean forebears in Africa, Homo habilis, 1.76 million years ago! Now, Henry Ford, what in your Model T have you got to say about that?
The point is ergonomics and prevention is important, often very technical and encompasses all aspects of life. If you do not address the prevention and ergonomic end of your condition’s seesaw you will require more treatment at the other end before it tips into remission, more pills, needles and operations. It will take longer and recurrence, the seesaw tipping back into pain and disability, is more likely.
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Where to get OT/ergonomic equipment for spines:
www.spinegroup.co.uk/
www.ergonomics.org.uk
www.hse.gov.uk/pubns/indg90.pdf
www.hsl.gov.uk/health-and-safety-training-courses/ergonomics
Classification: Prevention/ergonomic
Mindfullness
An English word for the Buddist term “sati” it is a form of meditation that promotes a sense of well-being and the perception at least of good health. Popularised by Jon Kabat-Zinn it is used therapeutically to alleviate a variety of mental and physical conditions: depression, stress, anxiety and drug addiction. In addition it is used by many to enhance mental and physical performance and has gained worldwide popularity as a method of controlling emotions and reducing avoidance behaviour. It is used by many in high powered, high performance and demanding occupations.
Practiced sitting upright with eyes closed and cross-legged on a cushion or chair, breathing is the initial focus of thought. Starting with short 10 minute sessions a day these are gradually increased as it becomes easier to keep the attention focused on breathing. Eventually awareness of breathing is extended to thoughts, feelings and actions. It is not surprising that scientists have shown alterations in brain function with this meditation.
A two-component model has been proposed: first, by focusing attention on immediate experience awareness of that experience is enhanced; second the adoption of curiosity, openness, and acceptance of one’s emotions reduces their control over you.
The aim is to avoid trying to produce a particular mental state such as relaxation but instead simply to notice states as they arises in the “stream of consciousness”.
In Buddhism Sati is one of the seven factors of enlightenment. Right mindfulness is the seventh element of the noble eightfold path. An antidote to delusion it is considered as a 'power'.
In 1979, Jon Kabat-Zinn founded the Mindfulness-Based Stress Reduction (MBSR) program at the University of Massachusetts to treat the chronically ill. In mindfulness-based cognitive therapy (MBCT) it is combined with traditional cognitive behavioral therapy (CBT).
In the business world interest in Mindfulness arose from the need to succeed. Books abound: Awake at Work (Carroll, 2004) and Resonant Leadership: Renewing Yourself and Connecting with Others Through Mindfulness, Hope, and Compassion; The Mindful Leader (Carroll, 2007) Leading companies provide training programmes: Procter & Gamble, Monsanto and Unilever. Top executives recommend it include the chairman of the Ford Motor Company, Bill Ford, Jr., and CEO at the Monsanto Corporation, Robert Shapiro.
Other uses have seen: Harvard University held a workshop on "Mindfulness in the Law & Alternative Dispute Resolution”; it being taught in prisons to reduce violence and improve self-esteem. Even the British Parliament organised a mindfulness-session for its members in 2014, led by Ruby Wax!!!
Of Mindfulness the NHS says it “can help us enjoy life more and understand ourselves better ….. mindfulness means knowing directly what is going on inside and outside ourselves, moment by moment …… an important part of mindfulness is reconnecting with our bodies and the sensations they experience ….. waking up to the sights, sounds, smells and tastes of the present moment ….. the feel of a banister as we walk upstairs….. another important part of mindfulness is an awareness of our thoughts and feelings as they happen moment to moment……becoming more aware of the present moment can help us enjoy the world around us more and understand ourselves better…… most of us have issues that we find hard to let go and mindfulness can help us deal with them more productively”.
By way of explanation the NHS quotes Professor John Williams of Oxford: "It might be useful to remember that mindfulness isn't about making these thoughts go away, but rather about seeing them as mental events. Imagine standing at a bus station and seeing 'thought buses' coming and going without having to get on them and be taken away. This can be very hard at first, but with gentle persistence it is possible.
Mindfulness is recommended by the National Institute for Health and Care Excellence (NICE) as a way to prevent depression. Chronic pain is a potent source of depression and low mood is often reported by those enduring lasting episodes of either chronic low back pain or neck pain. A large US study showed Mindfulness was effective in relieving chronic low back pain, equally as effective as cognitive behavioural therapy.
Div table grids are great to layout website sections on the page!
www.bemindful.co.uk/
www.nhs.uk/conditions/stress-anxiety-depression/pages/mindfulness.aspx
www.nhs.uk/news/2016/03March/Pages/Mindfulness-may-be-effective-for-treating-low-back-pain.aspx
The Mental Health Foundation has an online mindfulness course at:
www.bemindfulonline.com/
They also have a teacher locator on:
www.bemindful.co.uk/learn-mindfulness/
Classification: Active; Prevention
Naturopathy
Naturopathy or naturopathic medicine uses an array of "natural" modalities such as homeopathy, herbalism, and acupuncture, as well as dietry advice and lifestyle counselling. Holistic and non-invasive it aims to reduce the need for surgery and drugs. Considered by many to be ineffective the term was coined in 1895 by John Scheel and popularized by Benedict Lust, often referred to as the father of U.S. naturopathy. The 1970’s saw its popularity rise.
The basic concept is old; Hippocrates, advocated natural cures. The Scot, Thomas Allinson, promoted his "Hygienic Medicine" in the 1880s; a natural diet and exercise, no tobacco and not too much work. The philosophy became less grounded when Lust started to promote it in spiritual and “vitalistic” terms with "absolute reliance upon the cosmic forces of man's nature". He founded the American School of Naturopathy in New York in 1902. After a period of rapid growth, naturopathy went into decline with the advent of penicillin and other modern medicines.
A consultation typically begins with a lengthy patient interview focusing on lifestyle, medical history, emotional tone, and physical features, as well as physical examination. Treatment is traditionally confined to lifestyle changes and alternative remedies such as botanical medicines, vitamins, minerals and homeopathy.
Represented in the U.S.A by the American Naturopathic Association (ANA) naturopathy is not regulated in the United Kingdom.
Classification: Passive; Prevention/ergonomic
Nutritional Therapy
Medical nutrition therapy (MNT) aims to treat medical conditions with specifically tailored diets devised and monitored by a registered dietitian. A classic use of MNT is to reduce the risk of developing complications of conditions such as diabetes, renal failure and high cholesterol. It is little used in spinal disorders though diet and weight reduction is of relevance to some back pain patients.
Classification: Prevention/ergonomic
Occupational Health/Therapist
At its core occupational therapy concerns the occupations of people and their effect on health. Occupations vary so much that OTs work with a wide range of techniques. Indeed their work is not confined to the employed. They will work with whatever “occupies” people: they help people of all ages, abilities, disabilities and with all manner of illnesses and conditions including a substantial amount of back pain and neck pain patients. They cover activities ranging from computing to the activities of daily living: dressing, cooking, and eating.
Physical exercises may be used to improve strength and coordination and mental exercises to improve visual acuity, short term memory, decision making and problem solving. They may use other techniques cognitive behavioural therapy.
Classically they have two roles: work with spinal cord injury and stroke patients on adaptive equipment, including wheelchairs, orthotics, and aids for eating and dressing, they may even design and make special equipment for home or at work; in the work place they will perform work station assessments to prevent problems arising and with individuals whose abilities are either temporarily or permanently impaired.
They will often work within a multidisciplinary team with chronic back pain patients on “self-management strategies” the return to work. They may work in a clinic, the community as part of GP services, the workplace, school or nursing home
In the UK delivery is fragmented and varies depending on the setting and condition. Many employers have OTs. If you are ill then for short-term conditions, such as after an operation, OT is provided by the NHS via the hospital or GP. However, for long-term conditions, such as a permanent physical disability, occupational therapy has to come via a local council. Chronic back pain will probably fall into this latter category as would permanent weakness/paralysis. It is also available privately.
The professional body for OTs in the UK is the British Association of Occupational Therapy which includes the College of Occupational Therapists. Only healthcare professionals registered with the Health and Care Professions Council are allowed to use the title "occupational therapist".
Where to get OT/ergonomic equipment for spines:
www.spinegroup.co.uk/
Patient information leaflet on OT:
www.cot.co.uk/leaflets/leaflets
Information link about OT:
www.nhs.uk/Conditions/occupational-therapy/Pages/techniques-and-equipment.aspx
Health and Care Professions Council on:
www.hpc-uk.org/
Check the registration of your OT:
www.hcpc-uk.org/check/
Information on how to access NHS/Council OT:
www.nhs.uk/Conditions/social-care-and-support-guide/Pages/what-is-social-care.aspx
OT Bodies:
www.cot.co.uk/
www.cohpa.co.uk/
www.som.org.uk/
Physiotherapists specialising in OT:
www.acpohe.org.uk/
Classification: Active Prevention/ergonomic
Osteopathy, Osteopath
This is a type of alternative medicine that emphasizes the physical manipulation of the body's muscle tissue and bones. There is "good" evidence for osteopathy as a treatment for low back pain and "limited evidence” for other conditions. The term osteopathy was coined in 1874 by the physician and surgeon Andrew Taylor Still in Kansas, USA at the time of the American Civil War. It has a long history in the UK; the first school was established in 1917 and it was accorded formal recognition by Parliament in 1993 by the Osteopaths Act. Regulated by the General Osteopathic Council an osteopath must hold a recognized qualification and there are currently more than five thousand osteopaths registered in the UK. Just as in any speciality there are good and bad ones. For a good outcome any specialist needs to address all three pillars of spinal care. (In the USA there is a potential confusion as they have to be differentiated from osteopathic medicine which refers to a medical doctor specialising in orthopaedic/bone medicine cf the USA use of the term physical therapist for physiotherapist.)
www.osteopathy.org
www.bso.ac.uk
Classification:Passive; Active; Prevention/ergonomic
Physical Therapist
In the UK and most of the World this is a collective term for physiotherapists, osteopaths, chiropractors, McTimoney Chiropractors, Cranio-sacral therapists etc. In the USA it is the name given to physiotherapists and has to be distinguished from consultant doctors specialising in “Physical Medicine” a field others term musculoskeletal medicine.
These physical therapists, (physiotherapists, osteopaths and chiropractors), can be differentiated from medics as instead of using medicines they utilise some physical manipulation of the patient to effect relief. Just as medicine has developed over the years so too have these specialties. It matters less which is seen than that the overall treatment plan addresses all three pillars of spinal care.
Classification:Passive; Active; Prevention/ergonomic
Physiotherapy
The most established and common of the physical therapies this aims to make people better by improving their mobility, strength and function. They may work independently or in conjunction with medics. It goes back a long way. Physicians like Hippocrates and later Galen are believed to have been the first practitioners of physical therapy, advocating massage, manual therapy and techniques like hydrotherapy as long ago as 460 BC. However, physiotherapy as a profession dates back to Per Henrik Ling who founded the Royal Central Institute of Gymnastics (RCIG) in 1813. Sweden was the first country to give official registration to physiotherapists and in 1894 four nurses in the UK formed the Chartered Society of Physiotherapy, still their regulatory body, a full 20 years ahead of the USA.
A physiotherapist, like an osteopath or chiropractor, will take a history, examine the patient, reach a diagnosis, develop a care plan including information/education, symptom relief, rehabilitation and prevention.
The aim is to restore movement and function when someone is affected by injury, illness or disability through movement and exercise, manual therapy, education and advice. They work with all ages and will specialise in one of many fields. Spinal physiotherapists will overwhelmingly restrict their activities to that field though spinal disorders make up such a large percentage of musculoskeletal medicine that all will have significant experience of it.
This is what the CSP says of themselves – “Physiotherapy is a science-based profession and takes a ‘whole person’ approach to health and wellbeing, which includes the patient’s general lifestyle. At the core is the patient’s involvement in their own care, through education, awareness, empowerment and participation in their treatment.”
Some of the main approaches used by physiotherapists include:- education and advice, movement, tailored exercise and physical activity advice, manual therapy – where they use their hands to help relieve pain and stiffness
www.csp.org.uk
Classification: Passive; Active; Prevention/ergonomic
Pilates
A physical fitness system developed Joseph Pilates in the mid1900’s and now practiced worldwide. Pilates called his method "Contrology" emphasising the need for precision and control. He developed his system of exercises believing that mental and physical health were interrelated. The concept of "corrective exercise" and "medical gymnastics" was very much alive in the early 20th Century.
Along with many Germans he was interned in Britain during World War I on the Isle of Man where taught his fellow internees exercises and began developing a variety of equipment from the bunk beds. The most popular apparatus today is the Reformer though there is now a full complement of equipment:- Cadillac, Wunda Chair, High "Electric" Chair, Spine Corrector, Ladder Barrel and Pedi-Pole. There is range of difficulty from beginner to advanced and the intensity can be increased over time as the body conditions and adapts to the exercise.
The six "principles of Pilates" are: concentration, control, centre, flow, precision, and breathing. "The Pilates Method teaches you to be in control of your body and not be at its mercy." The “centre” refers to the abdominal muscles and those of the lower and upper back, hips, buttocks, and inner thighs. Known as the "powerhouse" all movement in Pilates begin there and flow outward to the limbs. The aim is for an elegant economy of movement that with precision flows out from a strong core. Pilates saw considerable value in increasing the intake of oxygen which he saw as cleansing and pointed out that forced exhalation is the key to full inhalation, obviously. “Squeeze out the lungs as you would wring a wet towel dry.” In order to keep the lower abdominals close to the spine the breathing is directed deep into the back and sides of the rib cage. When exhaling the deep abdominal and pelvic floor muscles are fully engaged. Breathing has to be coordinated with movement; breathing instructions are given with every exercise.
Though recent reviews have seen little evidence it promotes health, (2015 Australian Government's Department of Health review of alternative therapies), it is now widely practiced and for the treatment of lower back pain, there is evidence that Pilates may provide greater benefits than other types of exercise. Certainly there is strong evidence that exercise helps back pain. Clearly acute and extreme back pain prevents exercise. However, chronic low back pain is less common in those that exercise and core muscle weakness is a feature of those with chronic low back pain and those who have repeated acute episodes of low back pain – so called “acute relapsing low back pain” where sufferers get bad episodes lasting days or months, usually brought on by trivial triggers such a bending over or getting out of a car, and which are interspersed by long periods of little or no pain during which they can do strong exercise without a problem. In addition sufferers get relief from the exercise element of any rehabilitation programme. The key publication in this regard was in 1987 when Professor Claus Manniche of Denmark published his results of an active exercise programme in back pain patients in the leading medical journal The Lancet. When compared to the then standard recommendation of rest the exercise group completely outstripped those prescribed rest. It was a revolutionary idea which received much initial criticism – back pain was attributed to “wear and tear” and so logically rest would promote healing and exercise would only generate further damage. Manniche had proved the reverse was true and as acceptance of this truth grew the world and his wife took up exercise witnessing a global explosion of Pilates and all manner of other exercise methods. It was Manniche’s group that 25 years later discovered an association between certain forms of chronic low back pain and bacterial colonisation of discs so adventing antibiotic therapy.
Pilates is unregulated though the Pilates Method Alliance provides an international organization to connect teachers, studios, and facilities, promote quality training and so the legacy of Pilates and his exercise method.
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www.pilatesmethodalliance.org
www.pilates.co.uk
Classification: Active Prevention/ergonomic
Podiatry
Podiatry concerns the diagnosis, and medical and surgical treatment of disorders of the foot, ankle and lower extremity. The term podiatry has become the commonest name for the speciality; the older title of chiropody. The qualification, training and scope of the practice vary among countries. In the USA they are trained in a specific podiatric “medical” school where the curriculum includes anatomy, physiology, general medicine, biochemistry, neurology, pathology, genetics, embryology, microbiology, histology, pharmacology, rehabilitation, sports medicine, research, ethics and general orthopaedic surgery as well as foot and ankle surgery. Like medical doctors they rotate through major areas of medicine during a “residency programme”
The practice has long roots; the ancient Egyptian Ankmahor tomb, dating from 2400 BC, has relief sculpture depicting attendants working on the hands and feet of others. Corns and calluses were described by Hippocrates who invented skin scrapers. Until the early 1990’s they worked separately from organised medicine but were well recognised for their skills; the Kings of France, Napoleon and President Abraham Lincoln all had one.
The first society of chiropodists was established in New York in 1895 and one year later the British established a society at the London Foot Hospital where a training school was established in 1919.
Podiatrists will take a medical history and complete a physical examination. Their treatments include: minor foot surgery, the administration of local anaesthetic, prescribe limited medications, treat sports-related injuries, prescribe and fit orthotics, order or to some degree perform physical therapy, take and interpret X-rays, ultrasound, MRI's and other imaging studies. They often form part of a community health team in general practice. In the UK they can supply some prescription only medicines, perform injections and non-invasive surgery e.g. performing partial or total nail resection and removal, with chemical destruction of the tissues. This is similar in Australasia.
www.nhs.uk/Livewell/foothealt
www.scpod.org
www.iocp.org.uk
www.bcha-uk.org
Classification: Passive; Prevention/ergonomic