The first quarter of 2019 is now in the rear-view mirror and many of us are tied to our desks and hunched over computers or tablet devices and poor posture can lead to a significant amount of physical discomfort including in your neck and shoulders.
We love to see South African therapists putting their content online and sharing their valuable knowledge. We recently met biokineticist Kendra Dykman and she has put together these handy exercises that you can do at your desk:
Don’t forget that you can use our 3D Joint ROM tool to measure neck Range of Motion (ROM)
We are always on the lookout for innovative new techniques and therapists doing interesting things.
Stick Mobility is a training system that improves your mobility, stability, and strength.
The exercises combine joint mobilization, strength training, and deep fascial stretching to increase athletic performance, reduce the risk of injury, and speed recovery after exercise.
In this video the team takes you through a Wall Shoulder Press.
The Wall Shoulder Press, or “The W”, improves your ability to press and pull-down. Takes you through active pressing and pull-down actions, turns on and preps your shoulders for activity, and activates the posterior and anterior tissues of your upper body. This exercise uses two short sticks and is a good way to stretch, strengthen, and mobilize your shoulders.
Don’t forget that you can use our 3D Joint ROM tool to measure shoulder Range of Motion (ROM)
In the four years since the decolonisation debate took centre stage at South African universities, much of the focus has been on what decolonisation might look like in the humanities.
But science subjects, too, need to be taught differently at African universities in the 21st century. This is true of my discipline, sport science. The content of the sports science curriculum needs to change. So does the focus of sports science departments. Increasingly, such departments at public universities rely on private funding to operate. This means they are driven by corporate and donors’ interests, doing less for the public good and not necessarily producing social and political critical thinkers.
Both the curriculum and the structure of sports science departments needs to be overhauled. This is necessary, because nothing in the ideological content of sport science curricula has changed over the past 25 years.
In fact, it can be argued that the sport science curriculum, driven more and more by semi-private institutions at public spaces of higher learning, is more committed to a neo-liberal capitalist project today than what it was 25 years ago.
The field’s history
The history of modern day century sports science, as an academic discipline, dates back to the early 20th century when the medical fraternity and physicians became interested in athletic contests. One such doctor, R. Tait McKenzie, published one of the field’s earliest scholarly texts, Exercise and Education in Medicine.
This book reflected and enforced the cultural hold that the western (Hellenistic) presentation of the human body exerted in the emerging field of sport science. The Greek body – white, muscular, masculine and middle class –dominated as an ideal type. This dominance continues today. What wasn’t discussed was that ancient Greece was a slave-owning society that exploited inequalities based on race, gender and class.
As scholars like Ina Zweiniger-Bargielowska have highlighted, physical culture around the turn of the 20th century existed against the backdrop of competing conceptions of masculinity and a wider debate about the fitness of the British “race”. The scientifically trained sport body, sculpted by the sport scientist, became modern society’s idea of the perfect body.
The untrained body – that is, not trained by a sport scientist – is often presented as the “other” type. These “untrained” bodies are often developed in community sports in local communities without the high costs that accompany sport science interventions. These forms of exercise are looked down on and sports science students are taught that these matter less. Ordinary people in these communities are made to believe that their exercise regimes, and ultimately their physical bodies, are not valid and are unimportant.
There have also been few strides in addressing gender discrimination in sports science. White male bodies are the focus. Students are not taught about alternatives or given space to criticise traditional approaches.
The field of sports science, then, has neglected the development of a thorough, critical analysis of how gender, race and class inequalities play out in sports science and exercise.
But altering what we teach is just one part of the challenge for South African sports scientists.
As higher education has become more commodified, so have public universities’ sports sciences departments.
As sport scientists, we no longer focus primarily on generating and dispensing intellectual knowledge about sport to local communities. Instead, we accumulate knowledge primarily for performance appraisals in accredited publications for distribution in academic circles. This means it’s shared with fewer people.
In this way, sports science’s intellectual property has been captured by what scholar Lesley le Grange refers to as the knowledge economy in the ascendancy of the neo-liberal university.
What does all this mean, in practise?
Simply put, if sport science wants to be relevant to ordinary people, the curriculum needs to be taught and thought about differently. There must be a commitment to a decolonised way of doing things. This means teaching students about different bodies, about different fitness regimes and approaches, drawing from indigenous knowledge systems about what builds a strong body.
We recently came across this great video from physiotherapist David Pope where he looks at “Tennis Elbow”:
In this video, you’ll discover three key research-based tips to help you get your lateral elbow pain patients on track, including:
How to make sure you’ve got an accurate diagnosis, and you’re actually treating lateral elbow tendinopathy rather than another presentation
Treatments you need to avoid like the plague, that will lead to worse outcomes – Specific exercise instructions you can use with your patients – how much and how often should they get stuck into their strengthening exercises?
The release of a final report about the state of competition in South Africa’s private health sector has been delayed again. It was compiled by an inquiry panel made up of medical, legal and economic experts. The panel heard submissions from a range of stakeholders including members of the public, civil society organisations as well as private hospital groups.
The inquiry was set up under the auspices of the country’s competition authority in 2013. It’s remit was to investigate characteristics of the private health sector that may prevent, distort or restrict competition. Its preliminary report, released in July 2018, concluded, among other things that the sector was highly concentrated in the hands of a few major players. The final leg of work was to get inputs from various players on the initial findings before concluding the inquiry. The inquiry has cost tax payers R197 million so far.
Another delay of the report – which should have been released in March 2019 –is therefore bad news. The sooner South African authorities deal with the issues of anti-competitive behaviour in the private sector, the more likely access to quality health care will improve.
South Africa has a two-tiered health care system. The public sector is under-resourced and stretched while the private sector is highly sophisticated and expensive. Even though only 16% of the country’s population uses private health care, it nevertheless gets a large portion of the government’s health expenditure in subsidies.
At the same time, private health costs continue to balloon and fewer people can afford it.
The inquiry’s preliminary recommendations offered a clear agenda for how the private sector can become an integral part of the current national health system. There must be no more delays: if South Africa is to reach its lofty goal of universal health coverage, the report must be released and those recommendations adopted.
Key findings and recommendations
The inquiry examined three aspects of the private sector.
Medical schemes through which people pay for private health services and the administrators who run them.
Private facilities, such as hospitals and clinics.
Medical doctors and specialists in the private sector.
Medical schemes provide multiple plan options for cover without providing adequate information to understand what they cover, how the plans compare and what value the patients receive. As a result, consumers aren’t able to compare what schemes offer or choose plan options on the basis of value for money.
There is a lack of transparency on the pricing of health care goods and services, standardised reporting of health outcomes and implementation of evidence-based guidelines and treatment protocols.
Medical practitioners and specialists are concentrated in the private sector. As a consequence, there is time to over-service and inefficient use of expertise and time.
In light of these and other findings, the inquiry made a number of recommendations to remedy the situation.
These included putting measures in place to enable the Council for Medical Schemes, which regulates medical aids, to exercise more effective oversight.
In addition, to ensure that people who belong to medical aids get more comprehensive cover, the inquiry proposed that all medical schemes also offer a standalone standardised obligatory basic benefit option. The basic option would include a standard basket of goods and services and be comparable among schemes. This option would include cover for the prescribed minimum benefits, make provision for the treatment of these prescribed minimum benefits outside of hospital settings and add primary and preventive care.
And the inquiry recommended tighter regulation of the sector through the establishment of a dedicated health care regulatory authority. This would govern the number and distribution of doctors and hospitals to meet current and future needs. And it would ensure the development of clinical protocols as well as shape the structure of payment systems.
The inquiry also recommended that a centralised national licensing framework be introduced. This would accredit all health facilities including clinics, hospitals and GPs’ rooms. Another recommendation was to establish a price-setting mechanism.
The recommendations are innovative and would go a long way toward making health care in the country more equitable. But South Africans will have to keep waiting to see if they actually bear fruit.
The latest development is that, due to a lack of funds, all the inquiry’s work has been suspended until the end of the financial year in March after which a new date for the release of the final report will be published in the Government Gazette.
It’s important that the inquiry is allowed to complete its task sooner rather than later. This is because its findings could have a bearing on a piece of legislation currently making its way through parliament – the Medical Schemes Amendment Bill. The bill proposes changes to medical scheme governance and benefit options. Reports suggested that the department of health wanted to wait for the outcome of the inquiry before finalising the bill.
The inquiry could also affect the National Health Insurance Bill which is meant to herald in universal health care. But the bill is mired in controversy. The most recent version was recently rejected by the country’s cabinet which instructed the national department of health department to review what’s been proposed.
Until the final report is released, South Africans must contend with a fragmented, poorly regulated and expensive health care delivery system.
People with shoulder pain who expect physiotherapy to help them are likely to have a better recovery than those who expect only minimal or no improvement, according to our latest study. We also found that people are likely to have a better recovery if they are confident they will be able to continue doing things that are important to them, such as socialising, hobbies and work.
Shoulder pain affects people of all ages and can become persistent. Injury and overuse are common causes of shoulder pain, but sometimes the cause is unclear. It can disturb sleep, interfere with work, leisure and everyday activities like washing and dressing. Exercise, prescribed by physiotherapists, is an effective treatment for shoulder pain, but not everyone benefits from physiotherapy.
Researchers from the University of East Anglia and the University of Hertfordshire in the south-east of England, together with local physiotherapists, wanted to find out more about the characteristics of people who benefit from physiotherapy compared with those who continue to experience persistent pain and disability.
Knowing the outcome is important for people with shoulder pain as it helps them decide whether or not to pursue a course of physiotherapy.
Our study, published in the British Journal of Sports Medicine, included 1,030 people attending physiotherapy for musculoskeletal shoulder pain in 11 NHS trusts across the east of England. We collected information on 71 patient characteristics, such as age, lifestyle and medical history, and clinical examination findings before and during the patients’ first physiotherapy appointment.
A total of 811 people provided information on their shoulder pain and function six months later.
What surprised us was that patients who had said they expected to “completely recover” as a result of physiotherapy did even better than patients who expected to “much improve”.
The most important predictor of outcome was the person’s pain and disability at the first appointment. Higher levels of pain and disability were associated with higher levels six months later. And lower baseline levels were associated lower levels six months later. But this relationship often changed for people who had high “pain self-efficacy”, that is, confidence in the ability to carry on doing most things, despite having shoulder pain.
Another surprise finding was that people with high baseline pain and disability, but with high levels of pain self-efficacy did as well as, and sometimes better than, people with low baseline pain and disability and low pain self-efficacy.
First study of its kind
This is the first study to investigate patient expectations of the outcome of physiotherapy for shoulder pain. Earlier research shows that high patient expectation of recovery predicts a better outcome following physiotherapy for back pain and neck pain, and a better outcome following orthopaedic surgery.
On a similar note, this is the first study to show that higher pain self-efficacy predicts a better outcome in non-surgically managed shoulder pain. Previous research has shown that self-efficacy predicts a better outcome for a range of other health conditions. Also, people with higher self-efficacy are more likely to do the home-exercise programme suggested by their physiotherapist.
If you have shoulder pain, there are several ways to increase your pain self-efficacy. Work with your physiotherapist to understand and manage your symptoms. Practice your exercises together and ask your physiotherapist for feedback, including how to adjust your exercises to make them harder or easier. Finally, make sure you discuss what you want with your physiotherapy and the activities that are important to you.