Have you ever been told to “just get physio”?

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Telling a patient to “just get physio” is as pointless as telling them to “just get surgery.”

Which kind of surgery should the patient get?

Should they see a specific surgeon who is more familiar with managing their kind of case?

Are there any special considerations that need to be in place?

 

As you can see, this same analogy applies to manual therapy (commonly called “physio”).

 

Not all manual therapy is created equal. Some manual therapists will use their elbows to lean on tissue (which I strongly disagree with). Some physiotherapists/osteopaths/chiropractors will not do any hands-on treatment at all, and will only prescribe exercises. And some manual therapists (generally chiropractors and osteopaths) will almost exclusively do what are commonly called “chiropractic adjustments” (technically high-velocity low-amplitude thrusts).

Physio varies as much as surgery, and thoughtful clinical decision-making regarding what kind of soft-tissue injury treatment is carried out must be a feature of any treatment recommendation for any hypermobility-related injury. Active Release Techniques® (ART®) is my favourite protocol for treating soft-tissue injuries due to its precision and targeted approach. Keep reading for why I think ART is particularly beneficial in the treatment of patients with complex, chronic, and “treatment-resistant” injuries.

Active Release Techniques is Precise

If you have never had ART before, you might be surprised by how anatomically specific ART treatment can be. This is because the principle underpinning ART is that individual anatomical structures need to be treated as such, and although this specificity works brilliantly in people with collagen-typical (“normal”) connective tissue, this more precise approach is also incredibly beneficial for patients with more complex chronic injuries involving hypermobile connective tissue. You won’t ever see someone certified in ART just treating your “upper back.” They’ll be focusing on a specific structure, such as the dorsal scapular nerve or the levator scapulae muscle. This specificity is in part what makes ART so much more effective than standard hands-on treatment.

Treating injuries in people who are hypermobile isn’t easy, and a specific, targeted approach can make all the difference when treating injuries in patients who are hypermobile.

Active Release Technique Requires Regular Re-Certification and Examination

The manual therapist who you saw previously might be treating you with techniques that they haven’t been examined on since they graduated from their course years ago. However by seeing an ART Certified Provider, you’re seeing someone who has completed annual courses and regular in-person exams to ensure that their treatment is of a high enough standard that they are allowed to maintain their certification. As I like to say, in the “Wild West” of complementary healthcare, ART provides some degree of quality control. When you see someone who is certified in ART and treating you using ART, there should be at least some degree of consistency in the protocols and techniques they use.

To be clear, I do not work for ART  or have any financial relationship with them at the time of writing this. As an ART Certified Provider, I hold current certifications (ART Full Body Level 1, ART Nerve, and ART Spine Level 2). However, after years of successfully treating injuries in patients which were previously deemed by often multiple other healthcare providers to be untreatable I can say this with confidence:

ART truly is the gold standard in soft-tissue injury treatment, and I personally would never trust a healthcare provider to treat an injury on me if they did not hold a current certification in ART.

I am certainly not saying that ART is the only way to treat injuries (as the saying goes, “There’s more than one way to bake a cake”!). However, by insisting that anyone who treats me holds a current ART Certification I’m ensuring that they hold themselves to a high standard and that they are being examined regularly to ensure that they are maintaining a high standard in their treatment of soft-tissue injuries.

One Word of Caution: Watch Out for Fakes!

Because ART is an expensive and time-consuming certification for healthcare professionals to acquire, a LOT of people will say that they are certified in ART when they actually aren’t ART Certified. In order to check that the certification of the person you’re seeing is current and in good standing, please use the link HERE if you’re in Europe and HERE if you’re elsewhere.

Active Release Technique is Effective

When it comes to efficacy in the world of manual therapy, it’s hard to find high quality research. This is due to a number of factors, including lack of funding (it’s much more lucrative for companies to fund targeted-drug therapies), variation in the methodology of the study (example: it’s hard for another manual therapist to replicate my treatment exactly, just as it would be hard for me to replicate theirs), and heterogeneity in injuries included in the studies (it’s challenging to find 1000 patients with the exact same chronic shoulder injury and clinical history).

However, there is a small amount of research regarding ART. And a wealth of anecdotal evidence (and of course, as always, please be sceptical when looking at anything anecdotal).

Here’s one example of a systematic review investigating the effectiveness of ART. Researchers found that “ART® positively impacted patient outcomes and may be a viable treatment option for clinicians treating musculoskeletal conditions” (Barnes 2022).

Anecdotally, I’ll share my experience with my shoulder injury. It comes up occasionally in my podcast Help! I’m Hypermobile as well as my social media, as it was a significant turning point for me in my health.

How ART Treatment Fixed My Shoulder Injury

I started to develop shoulder pain around age 11. I was a butterfly swimmer, and every physio that I saw would comment on how I was so “bendy” and how “all swimmers always have shoulder pain.” My shoulder pain continued to progress, and the physio I was seeing in my teens (who did what was essentially just really bad massage and the occasional exercise prescription) actually made my symptoms worse.

I kept complaining to the physio that my shoulder pain felt like it was inside my shoulder, but nothing came back on medical imaging (I was sent for an x-ray, which was utterly pointless given my symptoms and injury onset). After being blamed for not doing exercises correctly, I gave up and accepted that I would just have to live with constant shoulder pain.

One session of ART changed all that for me. The osteopath treating me treated the long head of my biceps tendon (which, funnily enough, attaches INSIDE the shoulder joint which makes sense given it was where I felt the symptoms), and although it didn’t instantly fix the injury it certainly felt like it did something positive. I noticed significant, meaningful, and lasting improvement after a few sessions.

Over time (I would say it took about 2 years of doing everything “right” in order to get the lasting improvement I have now), ART treatment in combination with a precise and thoughtfully-prescribed hypermobility-specific rehabilitative exercise programme helped me to regain shoulder function, and now as a 32 year old woman I can do anything I want to with my shoulder and I don’t live with constant pain in those joints.

So while I totally get giving up on getting injuries treated (and it’s something which I did, and which was entirely justified given my initial negative experience with that physio), it might be worth trying ART before doing that. It was truly life-changing for me, and I literally couldn’t be doing the work today that I do with patients (which relies on me having functioning shoulders!) without ART treatment for my own injuries.

Active Release Technique is Fast

When I attend conferences on Hypermobile Ehlers-Danlos Syndrome/Hypermobility Spectrum Disorder, one consistent theme always comes up during the physio talk: that it will take months or years to see ANY improvement.

And, based on my clinical experience, that simply isn’t true!

Will it take months or years to get a COMPLETE, 100%, “good-as-new” clinical resolution? Yes, and the reality is that that “good-as-new” outcome sometimes isn’t even possible in everyone with connective tissue disorders.

However, it should NOT take months/years to see any improvement at all. In fact, my policy with my patients is that if we both don’t agree that there has been a clear/meaningful improvement after typically 4 appointments then we will reassess the case and see if a referral to another healthcare professional is needed.

So if you’ve been seeing the same physiotherapist/osteopath/chiropractor for weeks or months and nothing has improved, then it might be time to consider a different approach and get a second opinion.

Conclusion

The musculoskeletal system is deprioritised in our modern healthcare system, and there is nothing “just” about physio. Complex, chronic injuries require precise, effective soft-tissue injury treatment and musculoskeletal injuries need to be treated with the same standard of clinical rigour as any other health issue.

So the next time your healthcare provider recommends that you “just get physio,” ask them to be more precise in their recommendations. And consider working with an Active Release Techniques Certified Provider.

 

Works Cited

Barnes, P. and Rivera, M. (2022) ‘The Effect of Active Release Techniques® on Clinician and Patient-Reported Outcomes: A Systematic Review’, Journal of Sport Rehabilitation, 31(3), pp. 331–336. Available at: https://doi.org/10.1123/jsr.2021-0106