With a client/patient initially injured, a usual first step can be the diagnostic and initial treatment pathway of the physiotherapist to offer particular skills in the treatment of a new injury. The treatment pathway can be broad, where the initial treatment can consist of manual therapy and soft tissue treatment / specific range of motion tasks / specific activation / restoration of function / etc.
When an individual has regained a certain base level of function, the client is often referred to the EP to further enhance the functional capability. This may incorporate several processes, where programming for specific flexibility / load-volume capacity / specific postural awareness / etc, and is basically an extension of the initial work completed by the physiotherapist.
Often it is not a black and white handover from one professional to another where the client may still have use for both professionals at once, where with increased functional movement demands, soft tissue management may also be aided by the physiotherapist along the way.
An Area That The EP Can Be Helpful In The Management of MSK Patients
With musculoskeletal injury, the EP can identify the specific areas of concern for the client to improve. A common functional error that may be identified is with internal and external rotational strength and range of motion with the shoulder. To give a sporting example, most throwing sports athletes are very dominant in internal rotation strength when compared to external rotation strength in the throwing arm. With the external rotators acting with a breaking force on the deceleration phase on the throw, there is a high load of strength force required to consistently slow the arm down after a ball or implement has been released.
If the internal rotation range is short and the external (eccentric) strength is low, there is a higher chance that shoulder fatigue may occur, and eventual injury may be the result. If these factors are identified in a client (screened-tested), they can be trained with progressive volume and loading applications, where the appropriate function can be restored over time. Further to this, the EP can assist in the process of providing ongoing programming for the client to complete, providing independence skills and methods for management, which the client can be taught to complete on their own.
An EP may provide specific preparation and recovery applications, where drills and tasks can be tailored to the client’s individual needs. Where specific injury mechanics can differ between clients, an individual approach is required to be applied.
Benefits of the EP
The EP is the specialist providing exercise prescription and long-term planning for the client/patient. Exercise prescription may be incorporated for a number of purposes such as enhancing specific strength (isolated/functional), enhancing load capability of a movement pattern (volume capability of a pattern ie: specific work postures, sporting positions or a number of repetitions required at a certain load), specific range of motion of a joint / muscle / neural complex, or multiple areas of a specific range of motion through a larger pattern. An alternate common area of prescription is positional awareness and movement skills (or motor skill), where many individuals require an increased awareness of the correct position to complete a task.
