Physiotherapists rarely get a mention, but they improve the lives of millions of people every single year and so many of us would struggle without them. Huge thanks to every single one of you.
RCSI welcomes progress in physiotherapist referral for medical radiological procedures
RCSI University of Medicine and Health Sciences has welcomed the policy decision to permit physiotherapists to refer patients for medical radiological procedures, and the progress made in implementing this important new measure which will make it quicker for patients to access a diagnosis and begin their treatment.
Physiotherapist referral for medical radiological procedures results in fewer health professionals being involved in the patient pathway. At present, physiotherapists with advanced training can refer their patients for radiological investigations, such as X-ray, in several jurisdictions including England, Sweden, Canada and New Zealand.
Physiotherapists in Ireland will soon be invited to undertake advanced training which will allow them to refer their patients for radiological procedures. Initially, clinical specialist physiotherapists working in roles in specific clinical areas in the HSE are being invited to train for the authority to refer. In early 2025, application to the training programmes will then be opened more widely.
Professor Suzanne McDonough, Head of the RCSI School of Physiotherapy, said: “This is an important development which will lead to efficiencies in the patient pathway and reduce barriers to effective treatment for a range of musco-skeletal conditions.
“The evidence from the countries which already permit physiotherapist referral for radiological procedures is positive, with no serious adverse events reported and with many advantages for the patient and the health system,” added Professor McDonough.
An Expert Working Group was established in March 2024 to support the development and implementation of this policy. The group includes representation from Department of Health, Health Service Executive, CORU, UCD and the Irish Society of Chartered Physiotherapists.
Established in 1999, the RCSI School of Physiotherapy aims to educate professionally safe, competent, reflective and analytical physiotherapists.
Muscles in your body are a use-or-lose proposition. You need to use them to keep them strong!
You may not realize it, but we all start losing 1 percent of muscle mass each year after age 30. That’s why your diet in later years should not look the same as it did when you were younger, says endocrinologist Susan Williams, MD.
Skipping breakfast, eating fast food and being inactive in your 20s and early 30s might not hurt your health in the short term. However, poor nutrition and lifestyle habits take their toll over time.
People who embrace good habits early on really get ahead of the game, Dr. Williams says. But it’s never too late to start eating better and taking better care of your body.
Whether you’re 30 or 50, Dr. Williams offers three important tips to get started in eating right when you are thinking about your long-term health.
A roller coaster of weight gain and loss can change your body composition and leave you with more fat mass and less lean muscle mass.
2. Eat three balanced meals a day
You also want to limit your snacks in between. The word “balanced” is especially important because eating a wide variety of foods will help you prevent nutritional deficiencies.
Dr. Williams suggests this simple shopping list:
Lean proteins. Choose chicken, white fish, oily fish like salmon, eggs, tuna fish and red meat (less frequently than other protein).
Whole grains. This includes multigrain breads, and long-cooking rice or oats.
Veggies. Go for fresh or fresh frozen. Choose what’s in season and enjoy a variety to get the vitamins and minerals your body needs.
Fruit. Fresh fruit is best, followed by frozen. Canned fruit can be OK, but choose options in light syrup or water. Check the label and avoid added sugar.
Dairy. Choose milk, yogurts, cheeses and cottage cheese that are low-fat or fat-free.
Steer clear of cookies, cakes, pies, ice creams, juices and rich desserts. If that sounds like no fun, Dr. Williams advises treating these foods as treats. Save them for dining out or special occasions, but don’t make them part of your daily diet.
Eating protein and being physically active are equal partners in the quest for maximum health, Dr. Williams says. Muscles are made of protein, but simply eating protein is not enough to save them.
“Muscles in your body are a use-or-lose proposition,” she says. “You need to use them to keep them strong.”
Can’t carve out time for the gym? Try this daily routine:
After dinner, spend 10 minutes with stretch bands or light weights.
Even a half hour of physical activity can make a world of difference, especially if you make it a habit in your 30s. “Don’t let your weight creep up while your muscle mass creeps down over your 30s and 40s,” Dr. Williams says. The longer you wait, the harder it will be to get started — and the more muscle you will have already lost.
Physiotherapists rarely get a mention, but they improve the lives of millions of people every single year and so many of us would struggle without them. Huge thanks to every single one of you.
If you’re planning to start an exercise program and wondering where to begin, start with your core first, says physical therapist Brittany Smith, DPT. People often think of the core muscles as being the abdominal muscles, but the core includes the muscles in the abdomen, back and hips, all working together as a group.
“The core muscles provide stability for the entire body as it moves,” says Smith. “These muscles are activated when you stand up, turn, bend, reach, twist, stoop and move in most other ways. Everything starts with your core.”
Strong core muscles help you maintain good posture, while weak ones can lead to slouching and slumping. Poor posture can be a cause of aches and pain, especially in the back.
Getting started with your core
To get your core muscles in shape, you need to exercise.
“Our bodies were made to move, so any physical activity is really important,” says Smith.
She recommends these specific core-strengthening exercises below.
The first one engages the deep muscles in the abdomen, called the transverse abdominis. “These muscles help hold us in a better position to stabilize our core, thereby stabilizing our arms and legs,” says Smith.
“The more you work on these muscles, the more it will become second nature to hold these muscles tight when you’re lifting grocery bags, doing yard work or any other kind of physical activity,” says Smith. This will help support your body.
Other muscles that tend to be weak are the gluteus maximus in the buttocks, and the gluteus medius and gluteus minimus on the side of the hip. The bridge and clamshell exercises can help strengthen these muscles.
Smith emphasizes that getting the proper position of these exercises correct is more important than the number of repetitions you do. “It’s better to take your time, maybe do fewer reps, but with better quality,” she says. For that reason, it can be helpful to have the guidance of a physical therapist to get started.
Move on from the core
Core exercises are the starting point of overall fitness because you need to hold those muscles engaged while you strengthen other muscles, such as the biceps in the arms or the quadriceps in the legs.
Smith suggests setting short-term goals (for about a month) and then more long-term goals. Once you have achieved short-term goals, such as getting around more easily, add other types of weight-training or resistance exercises to build muscle elsewhere.
With any exercise you do, always listen to your body, warns Smith. If you have pain other than muscle burn, take it easy. Reduce the number of repetitions, the weight or the duration of the exercises. Then build up gradually. “You don’t have to be in pain to make gains,” she says.
Beginner exercises for core strength
For each of the following, work up to one to two sets of 10 to 15 repetitions once a day.
Abdominal bracing
Lie on your back with your knees bent and feet flat on the floor. Contract your abdominal muscles, and press the arch of your back down toward the floor, pulling your belly button toward your spine. Hold for 5 to 10 seconds. Make sure your lower back stays flat on the floor. Relax and repeat.
Bridge
Lie on your back with your knees bent and feet flat on the floor with your arms at your sides. Squeeze your abdominal and buttocks muscles, push your heels into the floor and slowly lift your buttocks and hips off the floor. Keep your back straight. Hold for 5 to 10 seconds.
Clamshell
Lie on your side with knees bent in line with your hips and back, draw up the top knee while keeping contact of your feet together as shown. Don’t let your pelvis roll back during the lifting movement. Hold for 5 seconds.
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Chronic Back Pain? You May Find Relief With Behavioral Medicine
Understanding the brain’s relationship to pain
No pain, no gain? Not true for people suffering from chronic back pain. Instead, it’s the opposite: Back pain is one of the main causes of missed work (and missed paychecks).
But could the key to coping with chronic back pain be in your mind? “We actually know that pain is not just a sensory, or physical, experience,” says psychologist Sara Davin, PsyD, MPH. “It is also an emotional experience.”
Dr. Davin explains how you can harness your pain management super-powers by understanding the very real connection between pain and your thoughts.
The 411 on the mind-back pain connection
To understand how it all works, think of pain’s purpose. Pain is your brain’s way of alerting you that something is wrong, whether it’s a stubbed toe or a slipped disk.
How your brain processes an injury, then shares that information, has a direct connection to the level of pain you feel. You’re aware of pain because your brain tells you it’s there. (Psst — your brain also controls your thoughts and emotions.)
“Pain is processed in the brain and the central nervous system. Both have areas connected to the sensory experience, but both also have areas connected to the emotional experience,” Dr. Davin explains. “The sensory and emotional go together to create the output of one’s experience of pain. So to comprehensively treat chronic back pain, we have to look at both sides.”
And while traditional treatments like medications and physical therapy can take the edge off, they often ignore the elephant in the room: your thoughts.
“Managing back pain with behavioral medicine strategies might even prevent the pain from becoming chronic,” Dr. Davin states.
What is cognitive behavioral therapy for pain?
CBT for pain is talk therapy’s more specialized cousin. It’s a behavioral medicine strategy that teaches people how to:
Make the connection between how they think about their pain and the way they interpret it.
Understand how pain impacts their emotions.
Choose coping skills to help with how they function and behave.
Still not sold? Dr. Davin gives this example: Someone who feels that their pain is unbearable may cope by lying in bed and isolating themselves from activities they value. “This cycle can go on and on,” she explains. “The person becomes more helpless and then, from a physical standpoint, becomes weaker. Naturally, they now have even more pain.”
With CBT, that helpless feeling (and associated pain) is kicked to the curb because pain psychologists teach people how to:
Pace activities so they don’t overdo it.
Practice relaxation and meditation to decrease pain and stress.
Soothe their central nervous system, which increases the feeling of pain when under stress.
The proof is in the pudding. Dr. Davin runs an interdisciplinary program that uses physical therapy and CBT to treat chronic back pain. Patients participate in this program for 4 to 10 weeks, depending upon their progress.
“Folks in the program were better when compared to physical therapy alone,” she reports. “We have consistently seen significant improvements across all quality of life measures, including how much pain interferes with someone’s life, levels of fatigue, anxiety and depression, plus improvements in pain-related disability.”
Interestingly, one of the metrics that improves the most in the program is how satisfied participants are in their social roles. “In our program we teach people how to start having fun again and connected with others,” Dr. Davin notes. “I suspect this is why we see people wanting to be more socially active after the program.”
3 ways to put this new knowledge into action
Here’s how you can incorporate behavioral medicine strategies into your back pain management:
Find a good pain management doctor. “You want a doctor who helps you rehabilitate and regain quality of life, but who also thinks about pain beyond its physical components,” Dr. Davin says. “Patients often struggle with the behavioral piece and think it means that their pain isn’t real. But your pain is real — you just need someone to help you manage it better using behavioral medicine skills and strategies. Pain psychologists are trained to do this.”
Get your research on. Dr. Davin suggests powering up your e-reader and searching for books that outline the basic strategies for cognitive behavioral therapy for pain. Your doctor may also recommend an online course or resources that offer science-based education about how to overcome chronic pain.
Don’t neglect physical therapy. Dr. Davin emphasizes that physical therapy is essential to maximizing back pain relief. “A physical therapist who’s trained in pain and neuroscience education can explain why behavioral medicine treatments work, plus help you use them,” she says.
