Association of Chartered Physiotherapists in Sports & Exercise Medicine blog series @PhysiosinSport
By Claire Treen @ClaireTreen
The title of Professor Steven’s Blair’s 2009 paper, “Physical inactivity: the biggest public health problem of the 21st Century” couldn’t be clearer. As part of a profession who keep people active, it grabbed my attention, and made me question how we, as physios, can do more to address this problem and grasp the opportunity to positively influence public health.
When I graduated from Physiotherapy over 20 years ago, postural stability, building strength and improving balance were the topics we were familiar with. Our education and graduate posts gave us an understanding of stroke, cardiovascular disease, diabetes, osteoporosis, declining cognition and neurological complications.
What role Sport and Exercise Physiotherapists in health promotion / public health?
The role of Sport and Exercise Physiotherapists (i.e., UK physios in sport) in prevention of these problems was not really on the agenda. That’s not to say we were not given the tool kit to do this. On the contrary! Our Physiotherap degree and professional development, especially directed towards Sport and Exercise Physiotherapists, provides an excellent foundation in biomechanics, exercise physiology and pathology. Physios have an academic and practical understanding of improving physical strength, power and endurance, address barriers to physical activity such as musculoskeletal pain, educate groups and can think imaginatively to maintain and develop cardiovascular fitness, strength, power and endurance in varied scenarios. Such knowledge and skills can be adapted to the general population and those at risk of or living with non-communicable diseases.
Today, Physiotherapy’s proactive role in physical health and wellbeing is gaining prominence.
The most recent Frontline magazine (The magazine of the Chartered Society of Physiotherapy(CSP)) reports that the updated Health Professions Council Code promotes health and wellbeing as one of the standards it expects from the profession. It also features a piece on Lead Allied Health Professional at Public Health England (PHE) Linda Hindle’s address to a recent CSP student representatives development weekend. She identified Physiotherapists as ‘the key’ to Public Health, and stated that the time was ‘absolutely right’ for allied health professionals to become increasingly involved in public health. This reflects a policy shift towards prevention, identified in the NHS England’s Five Year Forward View (1) and PHE’s Evidence to Action priorities for the next 5 years (2).
Both documents highlight the need to develop our ability, as health professionals, to engage and support the public in making healthier choices and mobilise support for broader action to improve the public’s health. PHE’s document outlines its desire to create and protect health, not only treat ill health, applying evidence to achieve what they label a ‘step change’ in the nation’s health. One of their seven stated priorities is tackling obesity, especially in children. Sport and Exercise Physiotherapists play an important role in keeping people of all ages active through addressing pain and injury, which in turn can help maintain a healthy weight. As a profession, we can become more involved by exploring opportunities to work with health workers and academic colleagues to research how we can best promote physical activity and achieve concrete changes in relevant health behaviours.
In November 2015, PHE released a document “The role of allied health professionals in public health – examples of interventions delivered by allied health professionals that improve the publics’ health (3).” It recognised the evidence base for Physiotherapy in addressing and researching musculoskeletal health and pain management for the neck, back and shoulders. The Arthritis Research UK report on musculoskeletal health makes a case for maintaining a healthy weight and increasing physical activity to reduce the risks of osteoarthritis and osteoporosis in later life by offering a range of preventative management methods. It outlines the need for more attention to be given to the risk factors for developing arthritis. Sport and Exercise Physiotherapists are doing this through advice and exercise programmes, and are well placed to promote this to a wider audience. It also noted a strong evidence base for Physiotherapy led group exercise for falls prevention (something we have done at University of Bristol with older clients) in falls prevention and Physiotherapy for primary prevention and management of incontinence in pregnant/peri natal women and older patients.
Whilst some of us working in sport and exercise may feel removed from these therapy areas, many, like myself, treat patients who pregnant, are returning to sport post partum, looking to improve their balance and postural control post sports injury or remain active into their later years. The term, “declining years”, does not apply to our many “silver sporting” patients who, by addressing arthritis and musculoskeletal or pelvic floor complaints, remain on the sporting field or tennis court into their eighties. At University of Bristol, we have promoted physical wellbeing to student groups, often in collaboration other groups such as Student Health, the Student’s Union and Bristol City Council.
It is wise to be cautious when taking on public health related projects, consider professional boundaries and acknowledge when we are beyond our comfort zone. In our clinic, we have found the best way forward has to collaborate with fellow health professionals to provide the most appropriate guidance for students, staff and the public. For example, we have worked closely with nutritionists, dieticians, personal trainers and student health when promoting positive health and wellbeing for students during exam periods.
Sport and Exercise Physiotherapists in Public Health is now being recognised at Post Graduate level. When doing my MSc at Cardiff University, we had a Health Promotion assignment and we were required to identify public health initiatives relating to physical activity in our local area. On a 1:1 patient level and broader level, these tasks, which initially seemed unusual, taught me valuable, directly applicable skills.
The CSP recognises this growing area, providing resources for interested Physiotherapists.
The CSP Public Health and Physiotherapy resource pack helps members gain a fuller understanding of public health and the strong opportunities it presents for physiotherapy. It will also help members maximise on their potential to improve health and wellbeing.
The core document covers:
- An introduction to public health (Chapter One)
- Developing physiotherapy services based on local population needs (Chapter Two)
- Physiotherapy and health improvement (Chapter Three)
- Physiotherapy and health protection (Chapter Four)
- Further Public Health learning and development resources (Chapter Five)
Alongside the Sport and Exercise Medicine iCSP group, the Public Health iCSP group also provides relevant press releases, resources and profession wide discussion. As a recent BJSM blogger noted, “exercise is medicine”, so it’s time to be part of the active prescription.
Claire Treen is @clairetreen
Sport and Exercise Physiotherapist, University of Bristol Sports Medicine Clinic, Stoke Bishop, BS9 2BJ
Please also note the upcoming ACPSEM Anatomy Courses at the bottom of the piece, that would be great too.
There are limited spaces left on ACPSEM clinical anatomy courses this March. For further details:
- Blair, S. 2009. Physical inactivity: the biggest public health problem of the 21st century. British Journal of Sports Medicine 43:1-2.
- NHS: Five year forward view, October 2014. https://www.england.nhs.uk/ourwork/futurenhs/
- Public Health England. From evidence into action: opportunities to protect and improve the nation’s health, October 2014.https://www.gov.uk/government/publications/from-evidence-into-action-opportunities-to-protect-and-improve-the-nations-health
- Public Health England. The role of allied health professionals in public health – examples of interventions delivered by allied health professionals that improve the publics’ health. November 2015. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/483038/Mapping_the_Evidence_of_impact_of_allied_health_professionals_on_public_health.pdf
- Vos, Theo et al. Global, regional, and national incidence, prevalence, and years lived with disability for 301 acute and chronic diseases and injuries in 188 countries, 1990–2013: a systematic analysis for the Global Burden of Disease Study 2013 The Lancet , Volume 386 , Issue 9995 , 743 – 800 43
- Arthritis Research UK. Musculosketal Health- A public Health approach. 2014 www.arthritisresearchuk.org%2F~%2Fmedia%2FFiles%2FPolicy%2520files%2F2014%2Fpublic-healthguide.ashx&ei=D3tIVZCgLs3maKK0gKgL&usg=AFQjCNGPjSSlvN1q7vUvAikATC8tyVYs5g&bvm=bv.92291466,d.d2s