**Two things physiotherapists and patients should know**

1. Do not employ passive physical agents for chronic pain conditions. Instead, encourage participation in an active treatment program:

There is limited evidence for use of passive physical agents to obtain clinically important outcomes for musculoskeletal conditions.

A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life.

While there is some evidence of short-term pain relief for certain physical agents, there is emerging evidence that passive physical agents can harm patients.

Communicating to patients that passive, instead of active, management strategies are advisable exacerbates fears and anxiety that many patients have about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery.

Evidence suggests that passive treatments are only useful if used to facilitate participation in active treatment.

2. Don’t prescribe under-dosed strength training programs for older adults. Instead, match the frequency, intensity and duration of exercise to the individual’s abilities and goals:

Improved strength in older adults is associated with improved health, quality of life and functional capacity, and with a reduced risk of falls. 
Older adults are often prescribed low dose exercise and physical activity that are physiologically inadequate to increase gains in muscle strength.

Failure to establish accurate baseline levels of strength limits the adequacy of the strength training dosage and progression, and thus limits the benefits of the training.

A carefully developed and individualized strength training program may have significant health benefits for older adults.

REFERENCES:

1.
Chatzitheodorou D, Kabitsis C, Malliou P, Mougios V. A pilot study of the effects of high-intensity aerobic exercise versus passive interventions on pain, disability, psychological strain, and serum cortisol concentrations in people with chronic low back pain. Phys Ther. 2007;87(3):304–12.

Hooten WM, Timming R, Belgrade M, Gaul J, Goertz M, Haake B, Myers C, Noonan MP, Owens J, Saeger L, Schweim K, Shteyman G, Walker N. Assessment and management of chronic pain. Bloomington (MN): Institute for Clinical Systems Improvement (ICSI); 2013 Nov. 105 p.

Hurwitz, EL, Carragee, EJ, van der Velde G. Treatment of neck pain: noninvasive interventions. Eur Spine J. 2008;17:123–52.

Jewell DV, Riddle DL, Thacker LR. Interventions associated with an increased or decreased likelihood of pain reduction and improved function in patients with adhesive capsulitis: a retrospective cohort study. Phys Ther. 2009;89(5):419–29.

Ulus Y, Tander B, Akyol Y. Therapeutic ultrasound versus sham ultrasound for the management of patients with knee osteoarthritis: a randomized double-blind controlled clinical study. Int J Rheum Dis. 2012;15(2):197–206.

Philadelphia Panel evidence-based clinical practice guidelines on selected rehabilitation interventions: overview and methodology. Phys Ther. 2001;81(10):1629–40.

2.

Silva NL, Oliveira RB, Fleck SJ, Leon AC, Farinatti P. Influence of strength training variables on strength gains in adults over 55 years old: A meta-analysis of dose-response rela tionships. J Sci Med Sport. 2014;17(3):337–44.

Raymond MJ, Bramley-Tzerefos RE, Jeffs KJ, Winter A, Holland AE. Systematic review of high-intensity progressive resistance strength training of the lower limb compared with other intensities of strength training in older adults. Arch Phys Med Rehabil. 2013;94(8):1458–72.

Valenzuela T. Efficacy of progressive resistance training interventions in ol der adults in nursing homes: a systematic review. J Am Med Dir Assoc. 2012;13(5):418–28.

Mayer F, Scharhag-Rosenberger F, Carlsohn A, Cassel M, Muller S, Scharhag J . The intensity and effects of strength training in the elderly . Dtsch Arztebl Int. 2011;108(21):359–64.


Nicola F, Catherine S. Dose-response relationship of resistance training in older adults: a meta-analysis. Br J Sports Med. 2011;45(3):233–4.