3Land- and water-based exercise therapies for musculoskeletal conditions
Section snippets
Exercise
Exercise therapy is a management strategy that is widely used for common musculoskeletal conditions. It encompasses a broad range of specific interventions and approaches, and can include interventions ranging from specific strengthening exercises, balance and flexibility exercises on land and in water, as well as more general physical activity. Exercise can be prescribed and delivered by health professionals such as family doctors and physiotherapists, or it can be conducted by individuals
Clinical presentation
Making a clinical diagnosis is an essential component of deciding on appropriate exercise prescription and determining the likely outcome following exercise. In clinical trials of effectiveness of exercise approaches, case definition is important to describe the study population. Broad classification of conditions is preferred in trials because of the ability to recruit large numbers of participants, which enhances the generalizability of findings and ensures successful completion of the trial.2
Measurement of outcome
There has been an increased awareness of the importance of multi-dimensional assessment of outcome in musculoskeletal conditions. The International Classification of Functioning (ICF)4 and others5 encourage consideration of bio-psychosocial factors; it is less important that a specific exercise can increase range of movement of a knee joint by 10 degrees than that an older adult with knee pain is able to walk downstairs and outside their home as and when they want to.
The management of regional
Prediction of chronicity
Most musculoskeletal conditions are self-limiting.2 Others will wax and wane over months and possibly years before spontaneously settling, and a small proportion will become chronic.2, 8 Psychological distress and a lack of social support have been shown to be important predictors of poor functional outcome in subjects with spinal pain and work-related soft-tissue musculoskeletal injury.9 The role of psychological factors in predicting adherence to exercise therapy and the use of health-care
Evidence for the effectiveness of land- and water-based exercise therapies for musculoskeletal conditions
In recent years there has been an explosion in the number of well-conducted high-quality randomized controlled trials of interventions including exercise therapies, manual therapies and hydrotherapy. The difficulty for the practitioner is obtaining up-to-date and relevant evidence for use in day-to-day practice. Clinical guidelines are emerging as a useful way of summarizing the best available evidence from randomized controlled trials and systematic reviews. Clinical guidelines need to be
Summary
There have been two important summaries of systematic reviews of evidence for exercise therapies.*10, *11 These have shown that there is strong evidence for the effectiveness of therapeutic exercise for patients with osteoarthritis and subacute and chronic low back pain. There were indications that therapeutic exercise was effective for patients with neck pain, whiplash-associated disorders, shoulder pain, and patellofemoral pain. In 2005 Smidt et al10 concluded that there was insufficient
Acknowledgements
Thanks to Hilary Jones for help in preparing the manuscript, and Tracy Reynolds for assistance with obtaining articles. Nadine Foster is funded by a Primary Care Career Scientist Award from the Department of Health and NHS R&D.
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Cited by (18)
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2018, Braddom's Rehabilitation Care: A Clinical HandbookAquatic exercise & balneotherapy in musculoskeletal conditions
2012, Best Practice and Research: Clinical RheumatologyCitation Excerpt :The data also suggested that more targeted and individualised exercise programs might be more beneficial than standardised programs, but no details were provided [21]. The third best-evidence synthesis combined the results of both above mentioned best-evidence synthesis and included recent SRs and RCTs (published after the dates of last search of these best-evidence syntheses until 2007) [18]. None of these best-evidence syntheses provided pooled effect estimates, mainly because the original RCTs did not provide enough information to do so or were to heterogeneous concerning patient population and interventions.
Dysfunction of endogenous pain inhibition during exercise with painful muscles in patients with shoulder myalgia and fibromyalgia
2010, PainCitation Excerpt :Physical exercise is an integral part in the management of patients with chronic musculoskeletal pain [1,12,45].
There's something about passive movement...
2010, Medical HypothesesHydrotherapy after total knee arthroplasty. A follow-up study
2010, Archives of Gerontology and GeriatricsCitation Excerpt :HT was superior to land-based exercise in relieving pain before and after walking during the last follow-up (Silva et al., 2008). There is evidence for the benefit of both land- and water-exercise in OA of the knee, patellofemoral pain, sub-acute and chronic low back pain, mechanical neck disorders and sub-acromial impingement syndrome (Dziedzic and Jordan, 2008). HT improves pain, knee strength, and quality of life in women with fibromyalgia (Busch, 2007).