Tag: Injury rehabilitation

Exercises for joint replacement

Biokinetics for joint replacement surgery

by Neil Hopkins Biokineticist, posted in Uncategorized

 

Biokinetics plays an important role pre- and post-surgery.  Your surgeon might refer you to a Biokineticist prior to surgery to improve your physical capacity (which improves surgical outcome and minimises surgical risk) or post-surgery once you have reached a certain level of function / completed your physiotherapy. Therefore a Biokineticist forms part of the medical team that can help guide you through the joint replacement journey.

It is well documented that exercise will yield positive results pre- and post-surgery. From strength and flexibility gains, to maintaining and/or improving cardiovascular fitness.  Below is a very good clip from Dr Mike Evans explaining how to prepare for your surgery, as well as how to recover after it. It is taken from his website Evans Health Lab (http://www.evanshealthlab.com/)

Some take home messages from the clip:

“Minor surgery is surgery that happens to someone else”. This is a humorous anecdote but actually quite appropriate.  Joint replacement surgery is a major life event.  It requires a game plan / strategy. Planning for your surgery, and recovering after it, is an active process rather than a passive one.  The medical team (surgeon / GP / Physiotherapist / Biokineticist) are there to assist and guide you through the process, but the most important thing is that you are involved in the process too. You are a team member. You are at the centre of it.  And as a result you are equally responsible for the outcome. The hard work, and effort that YOU put in will be rewarded.

Dr Mike Evans lists 5 key aspects of joint replacement surgery:
1) Muscle strength and fitness
2) Managing expectations
3) New normal
4) Exercise and lifestyle
5) Attitude

Using Mike’s 5 key aspects in a South African context (Physiotherapy and Biokinetics):

1) Muscle strength and fitness:

As part of your planning for your surgery you can seek the advice from a Biokineticist / Physiotherapist to help in the creation of an exercise routine.  Your exercise routine can be tailor made to suit your needs, and to ensure that you do not experience pain while doing the routine.  It is not necessary to see the Biokineticist on a weekly basis. If you are disciplined enough to exercise on your own you can get a homework programme, which can save you a lot of money.

Your routine can help in building muscle strength, improving flexibility, and increasing exercise tolerance. The gains in strength will help with post-operative walking and recovery.  And even if you cannot train your “injured” / affected side you can train the unaffected side and upper body to make life easier for bed transfers and crutch walking.  The stronger and fitter you are the easier your recovery will be.

2) Managing expectations:

Seeing a Physiotherapist, and eventually a Biokineticist, post surgery can help with managing expectations. The Physiotherapist / Biokineticist can act as a mentor to guide you through the changes, and help you to understand what is appropriate post surgery and what is not.  There are always goals to be attained, but never any fixed timelines as such. Each surgery needs to be managed on a case by case basis, as people respond differently to surgery. Your medical team is there to assist you in reaching your goals, and monitor that you are on the road to recovery.

3) New normal:

There is no point in using your new joint to stay the same. Before surgery you may walk with a limp, experience pain, or be limited in your active daily life. Obviously the new joint will be swollen and uncomfortable post surgery, but the medical team is there to help monitor and assist you back to full function. Seeing your orthopaedic surgeon for regular check ups to assess the scar, joint strength and range, as well as gait (walking pattern) is important.  Your surgeon will arrange these milestones with you pre- or post-surgery.  The goal of the Physiotherapist / Biokineticist will be to assist you with the joint range of motion, strength, general fitness and conditioning, as well as gait retraining.

4) Exercise and lifestyle:

You may be required to make a couple of adjustments to your home environment following your surgery.  They can be as simple as removing loose carpets and clutter so that you avoid trip / slip hazards. For more complex cases it is recommended that you seek the help of an Occupational Therapist to assist with the placement of ramps / rails / hoists etc.

Some joints and joint replacements may come with a set of “rules”. The surgeon may wish you to avoid certain movements or joint ranges (at certain times).  These rules will be communicated to the Physiotherapist / Biokineticist prior to your first consultation.  The Physiotherapist / Biokineticist can then explain how to avoid those movements in day to day activities.

Patients may also be required to see an Orthotist to purchase toilet seat raises, crutches, elevated cushions, or other devices that may be needed post surgery.  These may not be necessary but certainly something to consider when budgeting financially for a joint replacement.

In terms of exercise you will progress from in-hospital exercise rehabilitation with the Physiotherapist to out-patient rehabilitation with the Physiotherapist.  Once you have reached certain milestones you will be cleared to exercise with the Biokineticist. It is important to remember that healing can take up to a year.  That is not to say that you have to continue treatment for that long, but certainly you need to keep exercising and keep progressing.  Far too many patients get limited results post surgery because they discontinue too soon. There is the misconception that the hospital exercises and walking will be sufficient. Remember there is a medical team. Your Physiotherapist and Biokineticist are not in competition with each other. They are team-mates and have different roles to play at different stages of your healing.

5) Attitude:

This is essential. Having the right attitude is key. As Dr Mike Evans states: it is a balance of optimism with realism. Your attitude and effort will determine the outcome.

If you are confused and the entire process is overwhelming don’t be afraid to ask for help. The medical team is there to help you.

Is Biokinetics for me?

Ask your Surgeon or Physiotherapist if they feel that you may benefit from seeing an exercise specialist like a Biokineticist.  Otherwise contact your local Biokineticist directly to discuss your case history. If you are not a suitable candidate the Biokineticist will refer you back to your Surgeon / Physiotherapist for more information / treatment.

Now watch the clip and see for yourself: 

(please note Biokinetics is a South African medical profession and is not mentioned directly in the clip)
YouTube – Mike Evans on Hip and Knee Replacement

Acknowledgements:
1) Dr Mike Evans Health Lab – http://www.evanshealthlab.com/ LINK
2) Dr Mike Evans YouTube – https://www.youtube.com/user/DocMikeEvans LINK

Lower back pain rehabilitation

Exercise rehabilitation for lower back pain

by Neil Hopkins Biokineticist, posted in Uncategorized

Lower back pain will affect most adults at least once in their life time. Some individuals are lucky and only experience an acute bout of back pain. Others are less fortunate and progress into a state of chronic lower back pain. The good news is that a number of chronic lower back pain patients can benefit from a carefully structured exercise programme and lifestyle modification.

Exercise can help in reducing lower back pain and associated functional disability. However, when it comes to determining what the “right” kind of exercise is, it may become difficult to determine fact from fiction with so many opinions available online. There is an overwhelming amount of information on exercise rehabilitation for lower back pain and unfortunately a lot of misinformation. Sifting the truth from post-truth can be tricky.

That is why it is important to look deeper than just blogs and social media shares. That is where the Cochrane group comes in. They are the scientists who scrutinise scientists and keep the public up to date on relevant topics.

 

Cochrane reviews on exercise and low back pain



What is a Cochrane review?

Cochrane reviews are systematic reviews of primary research in human health care and health policy. Cochrane reviews are internationally recognized as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of diagnostic tests for some conditions in a specific patient group and setting. Cochrane reviews are published online in the Cochrane Library (LINK).

Who are the Cochrane Back and Neck group?
Cochrane Back and Neck (CBN) [formerly the Cochrane Back Review Group (CBRG)] is one of over 50 international Cochrane review Groups. The CBN coordinates the publication of literature reviews of diagnosis, primary and secondary prevention and treatment of neck and back pain and other spinal disorders, excluding inflammatory diseases and fractures (LINK)

1) Motor control exercise for acute non-specific low back pain. (LINK)

Summary: Motor control exercise (isolating specific muscles such as Transversus Abdominus) showed no benefit over spinal manipulative therapy, other forms of exercise or medical treatment for reducing pain or disability among patients with acute and subacute LBP.

  • Review question: To evaluate the effectiveness of motor control exercise (MCE) (isolating specific muscles such as Transversus Abdominus) for patients with acutenon-specific low back pain (LBP).
  • Background: LBP is a common disorder that is often associated with pain and disability. One common intervention for patients with LBP is exercise therapy, and MCE is widely used for these patients. However, its effectiveness for patients with acute LBP remains unclear.
  • Search date: Evidence is current to April 2015.
  • Study characteristics: The Cochrane Library included in the review three trials evaluating acute or subacute pain in patients with LBP (n = 197 participants). Most participants were middle-aged and were recruited from primary or tertiary care centres. Duration of treatment programmes ranged from four weeks to six weeks.
  • Key results: MCE showed no benefit over spinal manipulative therapy, other forms of exercise or medical treatment for reducing pain or disability among patients with acute and subacute LBP. Whether MCE can prevent recurrences of LBP remains unclear.
  • Quality of the evidence: Results of this review include evidence of very low to moderate quality. The Cochrane back and neck group downgraded all comparisons for imprecision due to small study sample sizes.
2) Motor control exercise for chronic non-specific low-back pain. (LINK)
 
Summary: Little or no difference is observed between Motor control exercise (isolating specific muscles such as Transversus Abdominus) and other forms of exercise. (Given the minimal evidence that MCE is superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety.)
  • Review question: To evaluate the effectiveness of motor control exercise (MCE)(isolating specific muscles such as Transversus Abdominus) in patients with chronic non-specific low back pain (LBP).
  • Background: Motor control exercise is a popular form of exercise that aims to restore co-ordinated and efficient use of the muscles that control and support the spine. Patients are initially guided by a therapist to practise normal use of the muscles during simple tasks. As the patient’s skill increases the exercises are progressed to more complex and functional tasks involving the muscles of the trunk and limbs.
  • Search date: The evidence is current to April 2015.
  • Study characteristics: In total, 2431 participants were enrolled in 29 trials. The study sample sizes ranged from 20 to 323 participants, and most of them were middle-aged people recruited from primary or tertiary care. The duration of the treatment programmes ranged from 20 days to 12 weeks, and the number of treatment sessions ranged from one to five sessions per week. Sixteen trials compared MCE with other types of exercises, seven trials compared MCE with minimal intervention, five trials compared MCE with manual therapy, three trials compared MCE with a combination of exercise and electrophysical agents, and one trial compared MCE with telerehabilitation based on home exercises.
  • Key results and quality of evidence: MCE probably provides better improvements in pain, function and global impression of recovery than minimal intervention at all follow-up periods. MCE may provide slightly better improvements than exercise and electrophysical agents for pain, disability, global impression of recovery and the physical component of quality of life in the short and intermediate term. There is probably little or no difference between MCE and manual therapy for all outcomes and follow-up periods. Little or no difference is observed between MCE and other forms of exercise. Given the minimal evidence that MCE is superior to other forms of exercise, the choice of exercise for chronic LBP should probably depend on patient or therapist preferences, therapist training, costs and safety.
3) Pilates for low back pain. (LINK)
Summary: The overall quality of the evidence in this review ranged from low to moderate. There is some evidence for the effectiveness of Pilates for low back pain, but there is no conclusive evidence that it is superior to other forms of exercise.
 
  • Review question: To determine the effects of the Pilates method for patients with non-specific acute, subacute or chronic low back pain.
  • Background: Low back pain is an important health problem around the world. One of the most common treatments is exercise and in recent years Pilates has been a common option for treating low back pain.
  • Search date: The Cochrane back and neck group conducted searches up to March 2014. They updated the search in June 2015 but these results have not yet been incorporated.
  • Study characteristics: This review included 10 studies and 510 patients. All studies included a similar population of people with non-specific low back pain. The studies only included participants with chronic low back pain. The duration of the treatment programmes in the included trials ranged from 10 days to 90 days. The duration of follow-up varied from four weeks to six months. None of the included studies measured follow-up beyond six months. The sample sizes ranged from 17 to 87 participants.
  • Key results: The included studies demonstrated that Pilates is probably more effective than minimal intervention in the short and intermediate term for pain and disability outcomes, and more effective than minimal intervention for improvement in function and global impression of recovery in the short term. Pilates is probably not more effective than other exercises for pain and disability in the short and intermediate term. For function, other exercises were more effective than Pilates at intermediate-term follow-up, but not at short-term follow-up. Thus, while there is some evidence for the effectiveness of Pilates for low back pain, there is no conclusive evidence that it is superior to other forms of exercise. Minor or no adverse events were reported for the interventions in this review.
  • Quality of evidence: The overall quality of the evidence in this review ranged from low to moderate.

4) Exercises for adolescent idiopathic scoliosis. (LINK)

Summary: No evidence for or against scoliosis specific exercises. The two included studies yielded very low quality evidence that SSEs added to other treatments are more effective than electrical stimulation, traction and posture training for avoiding curve progression, and that SSEs as a standalone treatment yield almost the same results as general physiotherapy.
  • Adolescent idiopathic scoliosis (AIS) is a rare (2% to 3% of the general population) spinal deformity affecting young people aged 10 through the end of the growth period. The deformity may continue into adulthood. AIS is characterised by one or more three-dimensional spinal curves. Disability, cosmetic deformity, pain, activity limitation, quality of life issues, breathing problems and the possibility of the scoliosis remaining with the person into and throughout adulthood are commonly associated with this condition. The cause of AIS is unknown.
  • Treatment for AIS varies according to the degree of severity of the curves. Just the same, exercise is almost always a part of the treatment plan. In milder cases, exercise may be the main treatment, and in more severe cases it may serve as an adjunct. In the UK and the US, physical therapy for scoliosis consists mainly of general strengthening and stretching exercises, along with exercise protocols with which the treating therapist is familiar. There is a corresponding feeling among practitioners in these geographical locations that physical therapy for scoliosis is not effective.
  • Scoliosis specific exercises (SSEs) are individualised exercises aimed at reducing the deformity. SSEs are taught in clinics that specialize in scoliosis. The exercises work by changing the soft tissue that affects the spine. SSEs are also thought to work by altering control of spinal movement. There are no known side effects or risks to using SSEs.
  • The purpose of this review was to evaluate the effectiveness of SSEs in reducing curve progression and postponing or avoiding invasive treatment such as surgery in adolescents with AIS. Two studies involving 154 patients total were included. The review found no evidences for or against SSE. The two included studies yielded very low quality evidence that SSEs added to other treatments are more effective than electrical stimulation, traction and posture training for avoiding curve progression, and that SSEs as a standalone treatment yield almost the same results as general physiotherapy.
  • Possible limitations of this review included the small number of studies that met the inclusion criteria and a high risk of bias, particularly selection bias. More randomised controlled trials are needed in this area, along with a deeper understanding of the types of SSEs useful for the adolescent with AIS.

5) Exercises for prevention of recurrences of low-back pain. (LINK)

Summary: Moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain. However, the results of exercise treatment studies were conflicting. Limitations of this review include the difference in exercises across studies, thus making it difficult to specify the content of such a programme to prevent back pain recurrences.

  • Back pain is a common disorder that has a tendency to recur. The Cochrane back and neck group conducted this review to see if exercises, either as part of treatment or as a post-treatment programme could reduce back pain recurrences. The Cochrane back and neck group searched for studies that included persons with back pain experience, interventions consisting of only exercises and that measured recurrences of back pain.
  • There were nine studies with 1520 participants. There was moderate quality evidence that post-treatment exercises can reduce both the rate and the number of recurrences of back pain. However, the results of exercise treatment studies were conflicting.
  • Adverse (side) effects of exercising were not mentioned in any of the studies. Limitations of this review include the difference in exercises across studies, thus making it difficult to specify the content of such a programme to prevent back pain recurrences.

6) Exercise therapy for treatment of non-specific low back pain. (LINK)

Summary: Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain. For patients with acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.

  • Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in populations visiting a healthcare provider. In adults with subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. For patients with acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.

Conclusion:

1) Motor control exercise for acute low back pain:

  • Are motor control exercises better than spinal manipulative therapy for acute low back pain? No 
  • Are motor control exercises better than other forms of exercise for acute low back pain? No 
  • Are motor control exercises better than other forms of medical treatment for reducing pain or disability? No 


2) Motor control exercise for chronic low back pain:

  • Are motor control exercises better than other forms of exercise for chronic low back pain? No
  • Does the therapist’s training / qualification / background have an effect on exercises for chronic low back pain? Yes 

3) Pilates for low back pain:

  • Is Pilates effective for treating low back pain? Yes 
  • Is Pilates superior to other forms of exercise in treating low back pain? No 

4) Exercises for adolescent idiopathic scoliosis:

  • Are scoliosis specific exercises effective as a stand alone intervention? Limited evidence 
  • Are scoliosis specific exercises effective as an additive to other interventions? Limited evidence 

5) Exercises for prevention of recurrences of low back pain:

  • Are exercises able to prevent recurrences of low back pain? Limited evidence 

6) Exercise therapy for treatment of low back pain:

  • Is exercise therapy effective at decreasing pain and improving function in adults with chronic low back pain? Yes 
  • Is exercise therapy more effective than no treatment or other conservative treatments for acute low back pain? No
Take home message:

Can exercise help with low back pain?

It depends on the nature and duration of the back pain as well as the type of exercise.

  • Chronic non-specific low back pain can benefit from exercise rehabilitation.
  • Acute low back pain and specific (neurogeneic, discogenic, spondylilosthesis, etc.) conditions may respond better to other modalities initially.

What type of exercise will help with chronic low back pain?

  • There is no consensus on one definitive exercise intervention. Therefore it is wise to steer clear of dogmatic approaches and practitioners that give guarantees on their particular modality. The data above indicates that Pilates and core stability (motor control exercise), which have been heralded as a cure for back pain, are not superior to general exercise.  Movement is good, but using the right kind of exercise at the right time is important. Patients need to find a practitioner that can assess their needs and give them an exercise intervention that is tailor made to their needs, not to dogmatic beliefs.

Is Biokinetics for me?

Ask your Orthopaedic Surgeon (back specialist), GP or Physiotherapist if they feel that you may benefit from seeing an exercise specialist like a Biokineticist. Otherwise contact your local Biokineticist directly to discuss your case history. If you are not a suitable candidate the Biokineticist will refer you back to your Specialist / Physiotherapist for more information / treatment.

Published Cochrane review articles on exercise for low back pain:

Pending Cochrane review articles on exercise for low back pain:
Acknowledgements:

1) Cochrane library. (LINK)
2) Cochrane library: Back and Neck. (LINK)

Biokinetics for sporting injuries: Children

by Neil Hopkins Biokineticist, posted in Uncategorized

Children and sporting injuries

Injuries in sport:
It is important to note that all sports carry a risk of injury. The severity and frequency of injury varies depending on the sport, position played, amount of preparation building up to competition, level of competition, and the age of the “athlete”.

There are many predisposing factors for injuries in sport. Three major factors which affect the prevalence of injury in younger athletes are: lifestyle, seriousness/level of competition, and amount of preparation.

1) Effect of lifestyle and posture:
Lifestyles and economics have changed the way we raise our children. Kids are more sedentary then previous generations due to pressures at school, increasing technology (gaming consoles) and lack of access to safe play space. In the past children would cycle, run, swim, climb trees, and be outdoors. All of which helped with muscular development, co-ordination and posture. Now children are taking part in exercise and developing over use injuries, that are normally seen in adults. Young children are developing injuries like lower back pain and rotator cuff impingement, due to abnormal biomechanics (movement patterns) and muscle development.

2) Seriousness of sport:
Children don’t play anymore. There are fewer and fewer non-outcome based activities (like climbing trees). There is an increasing agenda of goal driven outcomes. Play to win. School sport, especially at younger age levels, should be about learning (skill driven) not about winning. It should be about learning motor skills in a fun and enjoyable way. Not about crushing the opposition and scoring goals.

Parental pressure and early specialization also have a large role in the incidence of injury. Childrens’ tiny bodies are getting overloaded by increased training demands and an increase in pressure from parents and schools. Kids are becoming sporting “specialists” at far too young an age. Swimming is a case in point where potential swimming “stars” are required to swim longer distances, more frequently (every day twice a day). The problem with this is that there is a direct relationship between rotator cuff impingement and the number of hours/distance swum. Combine this fact with the poor posture sedentary children have and the risk of injury drastically increases.

Parental pressure on the side of the field, and at home, also has an impact on the young athlete. Sport takes on a whole new dimension if a parent tries to take control of the child’s sporting “career”, and it is no longer fun. More and more parents have begun shouting at children, coaches and sporting officials. Parents should let the professionals deal with the child’s sport and conditioning. Children are very impressionable and will push themselves harder and further to win parental approval. Some children will even hide the fact that they are injured to avoid upsetting a parent. Parents shouldn’t try to live their sporting dreams through their children’s lives.

3) Preparation for sport:
Preparation for sport can be a double edge sword as too little may result in an acute (sudden) injury and too much may result in a chronic (overuse) injury. It is a fine balance which is easy to get wrong. Our provincial and national teams will have an entire coaching team to ensure the proper conditioning of the athletes. At lower levels this responsibility falls entirely on the coach. Most coaches will condition their athletes the way they were conditioned, with a no pain no gain approach. The problem is that science and conditioning has evolved. Proper planning is required especially with the change in modern lifestyle. Sedentary children need different conditioning to children of yesteryear who were out roughing it in the garden. Children are not mini-adults. They cannot do the same strength and conditioning as adults. They need special consideration and individualized conditioning. A conditioning coach or biokineticist needs to be consulted to avoid over-training and to prevent injury.

Recommendations:
• Correct conditioning is essential for sedentary children
• Do postural exercises and “prehab”
• Seek medical attention when your child is injured (don’t rely on the coach
to make a diagnosis)
• Don’t specialize too early (most of the top athletes today played a variety
of sports when they were younger)
• Let kids play and have fun (avoid the “wrong” kind of parental pressure.
Encourage sport and physical activity. Not a win at all costs attitude.)

What to do following an injury:
• Follow the PRICE recommendation (P – position, R – rest, I – ice, C –
compression, E – elevation).
• Seek medical advice (Doctor/Sports Physician, Physiotherapist, Biokineticst).
• Treat appropriately
• Do extensive rehabilitation to prevent future injury.
• Do “pre-habilitation” to avoid any other injuries.

Rugby Injuries:
Rugby is a physically demanding full contact sport, which carries a high risk of injury. There is an injury continuum ranging from minor soft tissue injuries to severe fractures. The most common injuries from lower level rugby games are the soft tissue injuries. Where there is blunt force trauma to a muscle or joint (most often the knee). These are relatively simple to recover from, and if not too serious can be treated conservatively. However, if the pain persists then you should seek medical advice from a Doctor or Physiotherapist. More severe injuries like fractures or concussions need to be treated by a medical professional as soon as they occur. These injuries are extremely serious and should not be taken lightly. With adequate preparation and conditioning the risk of injury can be significantly lowered. Basic strengthening exercises (using body eight) should be included over and above normal rugby practice. A Biokineticist should be consulted as to which exercises are the most appropriate for your child.

Soccer:
Soccer carries a lower risk than rugby as there is less contact. However it is still possible to sustain a concussion in soccer, so the sport should not be taken lightly. Medical professionals still need to be on hand to treat the more severe injuries. As in rugby the majority of injuries are soft tissue injuries. However, rather than blunt force trauma these injuries are in the form of muscle strains. The most common being the hamstrings or groin. Ankle injuries are also very common in soccer. The severity of the ankle injury will determine the treatment protocol and the best course of action is not to limp around but rather seek medical attention.

Swimming:
Swimmers can occasionally suffer from back pain, but the most common injuries are to the shoulder. Swimmers will often have poor postures due to abnormal muscular development and tightness. This predisposes them to abnormal biomechanics (or movement patterns), which in turn leads to over use injuries. Rotator cuff impingement syndrome can be caused from abnormal biomechanics and repetitive strain from hours and hours of swimming. A Biokineticist should be consulted for a shoulder assessment and pre-habilitation programme to prevent overloading the shoulder.

Running and Jumping injuries:
In recent years there has been a higher incidence of over use injuries in children across all sports. More and more research is indicating that activities performed in younger developmental years can shape and form the skeleton. This is not always a good thing as it can affect biomechanics later on in life. Adolescent bones are weaker than adult bones, and are often weaker than the tendons that pull on them. This results in over-use traction injuries, where the bone is forced to grow outwards at the site of tendon attachment. This causes bony deformities and in many cases pain. The most common locations for traction injuries are the heel where the Achilles tendon attaches (Sever’s Disease), or just below the knee where the Patella tendon attaches (Osgood-Schlatter’s Disease). These injuries are chronic injuries, in that they develop over time. However, painful acute symptoms usually present after a sudden increase in activity, such as the start of athletics season. The course of treatment is to rest (avoid the aggravating activity such as running or jumping) and do corrective exercises prescribed by a Biokineticist.

How do I choose my Biokineticist?

by Neil Hopkins Biokineticist, posted in Uncategorized

Choosing a Biokineticist:

  • Between professions:
    Choosing the right professional for the right job can be difficult. Especially when there are so many professionals and services available to choose from. To the layman it is not always clear as to what the scope of each profession is. There is often confusion between Physiotherapy and Biokinetics, or Biokinetics and personal training. The short answer is that a Biokineticist is a medical professional that uses exercise as a treatment. They are more qualified than your average trainer, and do not do soft tissue work like a Physiotherapist. All three sell exercise. But Physiotherapists and Biokineticists are more qualified, and medically trained to do so. So please be careful when selecting a personal trainer for injury rehab.
  • Within Biokinetics:
    Knowing how to pick the right Biokineticist has an impact on your success outcome. Having the best social media platform or the best SEO does not necessarily equate to skill or ability. So be prepared to search wider than just online. Every year there are at least 70 students graduating from various Biokinetics programmes around the country. A number of these students will drop out of the industry following their internship year. But many continue on to work alongside other more established Biokineticists.

Here are some pointers to assist with your decision making process:

Simple choices:

  • Gender: This is a personal preference and is often the easiest choice to make. You either have a particular preference or you don’t.
  • Location: Choose a Biokineticist that is in a location that suits your life. If you have a Biokineticist that is too far away / or in a location that is not user friendly (parking, etc.) it can be a barrier to your training. Biokinetics rehabilitation is an active process, you need to be involved in your recovery. Therefore you need to make the journey as easy as possible.
  • Time: A Biokinetics consultation is a medical appointment. Unfortunately it is often considered as a “training session”. As a result most people are unwilling to take time off work. They prefer an appointment before / after work, or on a weekend. Choose a Biokineticist that is able to arrange a mutually agreeable time. Otherwise come up with a strategy that will allow you to have a mid-day consultation.

Harder choices:

  • Experience: This is a difficult decision as older does not necessarily equal wiser.  With more time in the industry a Biokineticist has more time to make acquaintances and to build a referral network. However, do not get lulled into a false sense of security as older practitioners could be dogmatic and out of date. On the other hand younger Biokineticists may not have experience with your particular condition, leaving you as a guinea pig.
  • Duration: Initial consultations take between 30-60min. For complex cases it is essential to have a longer and more thorough assessment. Shorter consultations can be arranged for ankles, elbows, and wrists. Follow up sessions can be between 30-60min. Be careful of sessions that are too short and too rushed. Choose a Biokineticist that dedicates enough time to help you with your recovery.  One that is invested in the process and not just interested in your session as a pay cheque.
  • Frequency: Frequency depends on your condition. Some conditions require a weekly session for the first 6-8 weeks. Then should scale down to less frequent sessions. Be careful of being roped into 3x per week sessions, or once a week sessions with no timeline. You are welcome to see a Biokineticist on a regular / lifetime basis if you are financially able to, but it is not essential. Your Biokineticist should be your exercise mentor. They should help to guide you through your rehabilitation process and then become “obsolete” once you have recovered. A successful Biokineticist is one that trains you so well that you are able to survive and thrive without them at the end of the treatment process.  There is no fixed timeline for rehabilitation, but try to get a ball park figure before you begin so that you are not strung along for a never ending rehabilitation journey.
  • Structure: Your initial consultation will be one-on-one with the Biokineticist. Hopefully your follow up sessions will be as well. One-on-one sessions involve more direct supervision and professional guidance. However, some practices prefer to have group rehabilitation sessions or a greater patient to practitioner ratio. This is done for financial gain rather than evidence based medicine / best practise. Some medical professionals (including Biokineticists) will have 3-4 patients booked for one time slot. The practitioner then roams between the patients as they are doing their exercises. There is no problem with this kind of training, but do not expect customised training. If you want bespoke-Biokinetics then you need one-on-one sessions.
  • Price: Price has unfortunately become a big factor in how patients choose their Biokineticist. Prices for initial consultations range from R250 to R800, depending on: province, practice location, level of experience / confidence. Follow up consultations range from R250 to R600. It is not wise to shop around based on price. Rather follow the steps below to find out more information so that you can make an educated decision.

Where to look:

  • Referrals: First place is to ask any of your existing medical professionals if they know of a Biokineticist. Or if they refer to a particular Biokineticist that they trust.
  • Word of mouth: Ask your friends / family / work colleagues if they can recommend a good Biokineticist.
  • Discovery Vitality Network: (LINK) This is the most comprehensive list of Biokineticists in South Africa as it lists all of the Biokineticists registered to perform Discovery Vitality tests. The limitation is that some Biokineticists are not registered.
  • The Biokinetics Association of South Africa BASA: (LINK) This is a list of Biokineticists that are registered with the Biokinetics Association of South Africa. It is not compulsory for Biokineticists to be a member of BASA therefore the list is limited.
  • Medpages: (LINK) Medpages is a directory of medical professionals that are Registered with the HPCSA (LINK) or AHPCSA (LINK). It is an open registry, but practitioners have to voluntarily supply their details. The more prominent listings are paid for.
  • SA medical specialists: (LINK) SA medical specialists is a directory of medical professionals that are Registered with the HPCSA or AHPCSA. It is an open registry, but practitioners have to voluntarily supply their details. To be listed requires an annual licence fee.
  • Virgin Active: Most Virgin Active clubs (excluding Virgin Red clubs) have an onsite Biokineticist. Ask the General Manager or Fitness Manager at your local Virgin Active for more information.
Places to be weary of:
  • Scope: Biokineticists are trained medical professionals that are registered with the HPCSA to assess individual needs, and then prescribe rehabilitative exercise. The scope of Biokinetics, at this point in time, is limited to exercise and exercise prescription. It does not involve “physical modalities” (massage, joint manipulation, hands on myofascial release techniques, dry needling, acupuncture, Bodywork, craniosacral therapy, etc.) or non-registered modalities (Reiki, Touch for health – Kinesiology, BSR, TRE, selling products / supplements, etc.). Please be careful when consulting with practitioners that stray outside of the boundaries of their registered profession. There is a time and place for those modailites, but not within the realm of Biokinetics. If you cannot code for the treatment on a medical statement then it is not prescribed or accepted as part of the scope of Biokinetics. If you have claimed for these non-registered services then it is considered to be medical aid fraud and the practitioner should be reported.
  • Paid for listings: Paid for listings on search engines (Google Adwords, etc) or social media (Facebook) are not allowed. The medical / ethical stance is that practitioners should refrain from self promotion. The reason being is that practitioners who are more financially able to advertise are not necessarily the best practitioners in terms of treatment. Paid for web presence and success are not mutually exclusive or directly correlated.
  • Special offers: Specials, discounts and guarantees should be warning signs rather than an indicator of success / ability to treat. Biokineticists are medical professionals and should not use cheap marketing techniques to canvas clients.
  • Ego: Drawing attention to personal attributes, sporting achievements, non-registered academic qualifications, and areas of specialization are frowned upon. These factors have no relevance when it comes to level of skill, or ability to treat a patient.
  • Non-registered Biokineticists: A practicing Biokineticist is required by law to be registered with the HPCSA. If your Biokineticist is not registered then you should find out why. The HPCSA registration is for your safety as a patient.
  • Non-practising  Biokineticists: Some Biokineticists opt not to practise as Biokineticists (even if they are registered with the HPCSA). They choose to work as personal trainers / exercise scientists / conditioning coaches.  They have made this choice voluntarily and therefore should not be doing Biokinetics rehabilitation.
Summary:
Word of mouth is the best source of information on how to find a good Biokineticist. However, if you are not in a position to get word of mouth feedback then hopefully this post will help guide you to make an informed decision about who to see. Future posts will deal with when you should see a Biokineticist.

Acknowledgements / links:

  1. Discovery Vitality Network: (LINK)
  2. The Biokinetics Association of South Africa BASA: (LINK)
  3. Medpages: (LINK)
  4. SA medical specialists: (LINK)
  5. Image: © 2016 HigherEdGames (LINK)