PAIN AND POOR PERFORMANCE? EXERCISE AND GUIDED ACTIVITY ARE THE GREAT OPTIONS - IF THEY WORK!

Exercise is a vital part of treatment for many conditions seen in physiotherapy practices.  However, despite performing the "correct" exercises, lessening pain and improving movement and performance may not be achieved. Failure to recognize and address contributing factors, underlying problems, or improper exercise may worsen a condition. To maximize the chance of achieving the best possible outcome after an injury or maximize the effectiveness of a strength and conditioning program, a detailed and comprehensive examination from an appropriately qualified and experienced clinician is a sensible option. Mark has developed a new approach to identifying and eliminating underlying problems so that conventional exercise programs and rehabilitation can be effective and appropriate. Mark teaches this method to clinicians all over the world.

WHAT TO EXPECT AT THE INITIAL APPOINTMENT

Principles of evidence-based practice and incorporation of the best available evidence with clinical expertise and patient preference.

Identification of causative and contributing factors

For anything other than simple presentations, the first part of an initial consultation aims at identifying causative factors, including: 

•    Poor sleeping positions, the suitability of a bed, appropriateness of chairs and office equipment

•    Habitual stressful sustained positions and work duties or habits

•    Altered or abnormal breathing patterns

•    Psychosocial stressors

•    Adherence to improper advice 

•    Poor exercise habits or inappropriate exercise

•    Relevant health, dietary issues, and medical conditions

•    Abnormal pain system behavior (e.g., central or peripheral sensitization). 

•    Predisposing genetic factors

Comprehensive physical examination

The examination allows patients to experience in real-time how various problems and injuries may result in loss of movement range, quality and power. Mark has taught this examination approach to thousands of clinicians worldwide. The consistent feedback from course participants and patients alike is that the process is simple, effective, and "makes sense".  Video examples and further details are HERE. 

Treatment plan

If the presenting problem is amenable to intervention, a treatment plan is formulated and discussed with the patient. If not, a referral may be made to another health professional for appropriate investigation or treatment.  

Treatment

Depending on circumstances, treatment may commence during the initial consultation or follow-up visit. The examination may occupy the entire initial appointment if the presentation is complex and long-standing. Strategies to eliminate or control significant causative factors are given at the initial consultation so that improvement resulting from treatment is not undone by aggravating activities, exercises, postures, or habits. 

FOLLOW-UP APPOINTMENTS AND TREATMENT OPTIONS

Mark is an expert post-graduate qualified musculoskeletal physiotherapist and offers a wide range of treatment options. The information provided below is specific to Marks' approach.

Treatment may include techniques to optimize static and dynamic postures, breathing and movement patterns. Mark's specific posture drills facilitate appropriate reflexive contraction or relaxation of so-called "core" muscles, eliminating excessive bracing caused by pain avoidance or inappropriate postural instruction. Modified postures, breathing patterns, and movements to maximize efficiency and reduce injury risk can be incorporated into running, cycling, swimming, surfing, horse riding, and rowing.

Mark utilizes a wide variety of "hands-on" techniques. That said, he prefers to use mobilisation with movement (MWM) techniques developed by Brian Mulligan and is one of only 50 clinicians accredited to teach this method worldwide. MWM is unique in that it combines active movement and manual therapy.

MWM techniques involve applying forces to the body so that painful movements or activities (even if present for a long time) are rendered pain-free in real-time.  A patient can perform MWM techniques as an exercise. MWM provides a method of instantaneously controlling and eliminating fearful responses, bracing patterns, and other maladaptive compensatory movement strategies that may render activity and exercise painful and ineffective. MWM has been developed for all body regions and has the most substantial evidence base of any manual therapy method (https://bmulligan.com/references-list/). Research has demonstrated that MWM is particularly effective for tennis elbow, knee pain, ankle pain, neck-related headaches, and neck-related dizziness.

Exercise becomes the essential treatment element when underlying problems causing pain or hindering performance have been lessened or eliminated. Patients are provided with the knowledge to exercise safely and effectively. Mark's "no-fail" exercise system is designed to correct maladaptive movements. By subtly altering position or loading, exercises are made more challenging. Patients record Mark performing and describing each exercise (using their mobile phone) to ensure correct performance. Much better than a generic printout or stick figures!   

While undergoing rehabilitation, it is often possible to carry on with gym training, golf, bowls, surfing, horse riding, bike riding, and running. 

Mark frequently collaborates with like-minded health professionals and exercise instructors.

Suppose you cannot commit to a collaborative effort that may include a sensible exercise regime and reasonable, logical modifications to work or leisure activities. In that case, this approach is probably not for you!