Tag Archives: Sports Therapy

Continuing professional development (CPD) – Do you keep it to yourself?

Continuing professional development (CPD) or continuing professional education (CPE) is the means by which people maintain their knowledge and skills related to their professional lives. CPD obligations are common to most professions.

As we all know or at least should be aware of this is an integral part of our education post qualification, as a member of the HPC registrants must;

  • Maintain a continuous, up-to-date and accurate record of their CPD activities
  • Demonstrate that their CPD activities are a mixture of learning activities relevant to current or future practice
  • Seek to ensure that their CPD has contributed to the quality of their practice and service delivery
  • Seek to ensure that their CPD benefits the service user
  • Present a written profile containing  evidence of their CPD upon request

The HPC expects registrants to record activities in a portfolio and enacts an audit programme to ensure registrants are doing this to the required standard. All registrants are required to meet the standards, and the onus is on individuals to decide what CPD activities suit them. Assessors look for a range of activities, and examples of how learning outcomes have been used in practice. No one activity carries a greater weighting than another. If chosen for audit, members are asked to submit a CPD profile comprising a summary of practice history for the last two years, a statement of how the CPD standards have been met and evidence to support that statement.

Or we have this information pertaining to Physiotherapists;

  • CPD is based on quality, accountability and effective practice.
  • Members need  to show they are keeping up to date with new knowledge, techniques and evidence.

It is increasingly important that  members record their learning and how they apply this in their practice. This is necessary to meet regulatory requirements and improve career opportunities. It also makes the case for members’ contribution to service design, delivery and leadership. Members need to undertake CPD that meets their individual needs and be able to  demonstrate the value of their learning activity for doing this, including how  they engage in appraisal schemes and  business planning. Effective CDP involves: reflecting on and recording what you have learnt from your CPD activities; evaluating what effect that learning has had on your practice, patients, colleagues and service; and reviewing learning needs to plan for further activity.

So we have spent 3 years qualifying then post qualification speciality, add on a Masters and possibly a PhD but there is, and rightly, an onus to ensure we are current with our thinking and clinical skills and knowledge.

Having come from a business background courses etc. were always taken during the working day and working week. In essence the Company recognised that this was an important element and invested accordingly. This seems to change in the world of health care, not always, but is certainly common, at this stage it is pertinent to acknowledge that those who run a private clinic may prefer evening/weekend courses as it does not intrude on the working week, were courses are in the evenings and at weekends. Okay, we take this on board, that is the nature of beast and move on and get booking suitable courses. For those in the public sector it may be different but for private practitioners this is a cost to the profit and loss account, our salary, so when we decide on attending a course we are looking at a cost of £40 to £250. However, if we deem it important for our improvement and progression we go ahead and book, rock up learn and implement. Great.

Now, I recently had contact from an old work colleague, 12 months ago. Hi etc. etc. do you have the notes from X course I could use. Thankfully I was on holiday at the time so had a little time to reflect. My initial thought was why not, he was a good work colleague but then I thought I’ve invested £250 without travel etc. so I changed my opinion slightly but was then left with making no decision either way.

If the individual had been someone I had been learning from or had an ongoing working relationship with my stance would have softened, we all know individuals who we can trust to share information with, i.e. a two way arrangement.

As it happens the individual has not been in contact since my return so I am spared the decision, maybe it was the fact that I advised if I were to do it they would need to come to me to collect them!

So, what would you do in this situation, hand your notes over or keep them to yourself?


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The mysterious case of the breast enlargement scar and knee pain

This was brought to my attention, and indeed, received comments galore after it was posted on a social media platform;

‘HAHAHAH! This got me buzzing yesterday in clinic. Female, mid 50s, avid runner comes to see me for bilateral knee pain when running. Quads were mega jacked up! Super tight. Found the quads were weak! Nothing stood out in her history and she’d been following a progressive program with running, so programming and equipment wasn’t the issue. It was her boob job scars! They were causing all the issues!!! Temporary correction relieves her knee pain. Further testing revealed it was the left sided scar screwing things up. So left boob scar gets the treatment!’

Okay, I imagine the majority of people reading this, as I did initially thought ‘well that’s odd’. However, it was not the scar versus bilateral knee pain it was ‘temporary correction and boob scar get’s the treatment’. As you may imagine this attracted numerous comments, the majority incredulous at what has happened in this session. Further explanations were forthcoming;

History and movement testing. Temporary scar work relieves bilateral knee pain. Check the work. Still no problems, fully correct the scar. I was hands off and no flesh was exposed. She did the palpating’.

Now I am thinking, other than the obvious, let’s get back to the knee pain, where is the explanation of what was happening from a biomechanical perspective, (following a progressive program but no information about strength and conditioning program), we have weak quads’ that are very tight, would a graded exercise plan not be more appropriate in this instance as the last time I saw a programme concerning cosmetic surgery the scars are quite minimal and as at the time of writing this can find no evidence to the same.

So how does the individual concerned know thisI invest a lot into geeking up-courses, books, articles, a LOT with hiring top therapists/ practitioners arou d the world via Skype to learn from them. Chiros, physios, massage therapists, TCM, personal trainers, etc. I Skype with then to learn. Some stuff is newly developed and the practitioners are either waiting for supporting research/ its their own developments, ao proprietary stuff that I’ve agreed not to teach.’

So, we have a cure for weak quads that is resolved in one session but no answer telling the world how this works. I can assure you if I had a magical touch I’d be shouting from the roof tops, hitting the lecture circuit all the while becoming a guru to millions.

Now, before I finish, I am aware of Anatomy Trains, research into scar tissue, stretching of fascia etc, the list goes on and on but as a profession can we be taken seriously when we have a secret weapon to cure tight weak quads by rubbing breast enlargement scars?

What am I missing here?! How can a knee be connected to a breast scar? Please help me to understand or is it as I suspect a specific form of woo practice.

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Pre and Post Event Soft Tissue Therapy

I have often wondered why an individual would want to plonk their sweaty bodies on a plinth after completing an event, even more so in the winter when they are generally covered in the dirt of the roads or fields that mixes well with the sweat. Is it because it is ‘part of the experience’, this is what a professional does or is it altruistic in that they can give to charity. Does the therapist look to gain profile whilst giving up their time or do they earn during the day. If it’s the latter then fair enough but if it’s the former how many competitors come back when they have to pay, I’m sure someone can guide me.

I’ve been trying to think this through as it makes little sense to me to stand around in the heat or cold waiting to get a 15 minute, maximum, gentle rub down when you could have had some protein, a stretch, food then be on your way home.

A recent article by Paul Ingram (www.painscience.com), 14 August 2015, titled ‘Massage impairs post exercise muscle blood flow and lactic acid removal’ In this piece he summarises as follows;

‘One of the classic claims of massage therapy is that it “aids muscle recovery from exercise … by increasing muscle blood flow to improve ‘lactic acid’ removal.” But this 2009 evidence shows that just the opposite may be the case, in at least some circumstances. It was a straightforward experiment: the researchers subjected twelve people to intense hand-gripping exercises and then measured their blood acidity with and without basic sports massage. Their measurements showed that massage significantly “impairs lactic acid and hydrogen ion removal from muscle following strenuous exercise by mechanically impeding blood flow.” Yes, you read that right: massage impairs.

That’s quite a surprising result that applies a firm push to the side of a classic sacred cow of massage lore.

Here is the original abstract in full;

Wiltshire EV, Poitras V, Pak M, Hong T, Rayner J, Tschakovsky ME. Massage impairs post exercise muscle blood flow and lactic acid removal. Med Sci Sports Exerc. 2010 Jun;42(6):1062–71. PubMed #19997015.

PURPOSE: This study tested the hypothesis that one of the ways sports massage aids muscle recovery from exercise is by increasing muscle blood flow to improve “lactic acid” removal.

METHODS: Twelve subjects performed 2 min of strenuous isometric handgrip exercise (IHG) at 40% maximal voluntary contraction (MVC) to elevate forearm muscle lactic acid. Forearm blood flow (FBF; Doppler and Echo ultrasound of the brachial artery), and deep venous forearm blood lactate and H concentration ([La-], [H]) were measured every minute for 10 min post-IHG under three conditions: Passive (passive rest), Active (rhythmic exercise at 10% MVC), and Massage (effleurage and petrissage). Arterialized [La] and [H] from a superficial heated hand vein was measured at baseline.

RESULTS: Data are mean +/-SE. Veno-arterial [La] difference ([La]v-a) at 30 s post-IHG was the same across conditions (mmol/L; Passive 6.1 +/-0.6, Active 5.7 +/-0.6 mmol/L, Massage 5.5 +/-0.6, NS), while FBF (ml/min) was greater in Passive (766 +/-101) vs. Active 614 +/-62 (P=0.003) and vs. Massage 540 +/-60 (P<0.0001). Total FBF area under the curve (AUC; ml) for 10 min post handgrip was significantly higher in Passive vs. Massage (4203 +/-531 vs. 3178 +/-304, P=0.024) but not vs. Active (3584 +/-284, P=0.217). La- efflux (mmol; FBF x [La]v-a) AUC mirrored FBF AUC (Passive 20.5 +/-2.8 vs. Massage 14.7 +/-1.6, P=0.03 vs. Active 15.4 +/-1.9, P=0.064). H+ efflux (mmol; FBF x [H]v-a) was greater in Passive vs. Massage at 30 s (2.2 +/-0.4 e-5 vs. 1.3 +/-0.2 e-5, P<‘0.001) and 1.5 min ( 1.0 +/-0.2 e-5 vs. 0.6 +/-0.09 e-5, P=0.003) post-IHG.

CONCLUSION: Massage impairs La- and H+ removal from muscle following strenuous exercise by mechanically impeding blood flow.

Whatever you think of the research the effect is brought to home by a recent article by Phil Burt, Lead Physiotherapist at Great Britain Cycling Team and Team Sky. This is what he has to say ‘There is a reasonable amount of evidence that massage immediately before an activity can reduce the amount of power that an athlete can produce. In the “golden hour” between team pursuit heats, unlike many teams, we don’t give the riders a “flushing out” rub down. Compared to their nutrition, cool-down and subsequent warm-up routine, it is way down the order in terms of recovery techniques, of questionable physiological benefits and may even have a negative impact on their performance in the next round.

Also some of the more aggressive soft tissue therapy techniques are quite painful, as they can result in bruising and are fairly draining, are definitely not recommended in the lead up to an event.

The above withstanding he does continue ‘Again, it comes down to personal preference and what works for you. A regular, say monthly, appointment with an experienced soft tissue therapist can be useful as a body MOT and can help identify areas of tightness or concern. Also, do not underestimate the psychological aspect either. If a massage helps you to feel good, increases your motivation to train or you feel that it improves your performance, do it’

So, instead of thinking, this rub is doing me some good the individual should be looking to;

Refuel – Sweet rice and fruit/chicken or turkey tacos/chicken fried rice – The Feed Zone – Dr Allen Lim

Rehydrate – Drink

Repair -Good quality whey Protein

Recover – Power nap

That does not include beer, a study by Yann Le Meur (@YLMsportscience) indicates that within 4 hours, post exercise, you will be as dehydrated as when you finished your event.

This is not a rant about the soft tissue industry, I am part of it, but is an open thought on how an individual may be better off looking at alternative ways of recovery rather than waiting around for upwards of an hour, I’ve seen it, to get a rub when the benefit is negligible. Instead come and see me and my fellow therapists 2 – 3 days after the event so we can give you our undivided attention and specific treatment.

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Piriformis Syndrome

Piriformis Syndrome is the compression of the sciatic nerve by the piriformis muscle.

Conditions affecting the sciatic nerve that refer pain down the posterior thigh are often referred to by the general public as sciatica. This term is not specific, because it may refer to inflammation of the nerve or compression of the nerve in the lumbar spine, in the gluteals or at another distal point along the pathway of the nerve. It may even refer to the symptoms common to piriformis trigger points. 

The sciatic nerve supplies sensory and motor function to the skin and muscles of the posterior thigh, most of the leg and foot. It is composed of nerve roots L4 to S2/S3, with sources differing to the later (Omer, Spinner 1980, Dawson et al 1990). The sciatic nerve is comprised of two peripheral nerves, common peroneal and tibial which travel as one to the knee.

The piriformis muscle interts on the anterior surface of the sacrum (S1 to S4) and runs horizontal to attach at the medial superior aspect of the greater trochanter of the femur. Deep to gluteus maximus, the pirirformis and upper lateral rotators spread out from the greater trochanter like a fan. The broader portion of the muscle emerges from the foramen and the muscle narrows at the greater trochanter.

Function of the Piriformis;

  • Restrain rapid/vigorous internal rotation of the hop, such as occurs with running or in the stance phase of walking.
  • Externally rotate the femur when the hip is extended or in neutral.
  • Horizontally abduct the thigh when the hip is flexed to 90 degrees.
  • Internally rotate the femur when the hip is fully flexed.


  • Anomalies in the course of the nerve.
  • Direct/indirect trauma.
  • Inflammation.
  • Overuse.
  • Postural and positional.


  • Usually unilateral – Pain from a variety of sources results in pain/paresthesia in posterior thigh to calf and foot, numbness.
  • Pudendal nerve compression causes perineal and inguinal pain.
  • Compression of the gluteal nerve causes buttock pain.
  • Active trigger points can result in low back pain, buttocks, hip and posterior thigh.
  • Pain can decrease with external rotation of the hip.
  • Weakness in performing abduction, flexion and internal rotatlon of affected hip.
  • SIJ dysfunction may be present due to shortening and tension in piriformis.


  • Pace abduction is positive.
  • Piriformis length is positive – short piriformis on affected side.
  • SIJ motion palpation – may reveal restricted movement.

Differentiating sources of radiating glue pain;

  • Lumbar spine stenosis results in progressive pain, usually bilateral in the calf and foot.
  • Facet Joint irritation positive Kemp’s test.
  • Inflammatory arthrides, ankylosing spondylitis, x-ray.
  • Compression of nerve at lumbar spine from a herniated disc.
  • Which location is common for compression – lumbar or piriformis. Symptoms – numbness and tingling to lateral foot and small toe – S1, or to dorsum of the foot – L5, or to medial calf – L4.




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Remedial massage definition

Remedial massage is the systematic assessment and treatment of the muscles, tendons, ligaments and connective tissues of the body to assist in rehabilitation, pain and injury management.

It’s performed to create favourable conditions for the body to return to normal health after injury and is defined by the premise that the treatment can reasonably reverse certain physical effects a patient may be presenting.

If a patient has suffered a moderate injury resulting in structural pain and/or loss of function, then remediation is required to reduce or eliminate pain and restore that function. Remedial massage is designed to balance muscle/soft tissue length, tension, tone which will in turn promote the return to normal joint/capsular/bone position; increase the flow of blood and lymph, particularly in the injured areas, thus removing blockages, damaged cells, scar tissue and adhesions resulting from injury.

A remedial therapist must have knowledge of anatomy, physiology and pathophysiology to determine where to treat patients. Their services must be based on best practice principles and before any remedial massage treatment begins, a thorough patient consultation and assessment is to be performed to ascertain the patient’s current health status.

If the patient is suitable for remedial massage and relying on the patient’s feedback to identify the areas that require attention, the therapist can then apply the relevant and appropriate treatment. Note: The assessment must include the development of a specific treatment plan as to the best course of treatment for the patient’s condition/injury. This treatment plan forms the basis of the clinical notes. It’s a requirement that all comprehensive clinical notes are taken for each consultation/treatment and that the patient’s records are duly maintained.

These notes must be consistent with accredited professional and are to be maintained in English. It’s important for the remedial therapist to understand that a patient’s needs are unique, and therefore particular remedial massage techniques need to be selected with clinical expertise and applied in a way that suits that patient.

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