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Letters

Encouraging Exercise I AM responding to the leading article on exercise in the March.Journa1 (Kerr, 1999). Working at Wirral Hospital’s Back Pain

Kehabilitation Unit, we deal with patients with chronic mechanical spinal pain. Here we sec’ a need to encourage our patients to embark on an exercise programme designed to improve specific ‘fitness’ of tlie particular spinal area, and to improve their general fitness and well-being. Our aims, similar to those of colleagues in other areas of physiotherapy, arc for this improved fitness to translate into improved functional activity and quality of life.

excrcise?’ arid ‘What exercises do I need t o do?’ Both questions on reflection are not s o straightforward to answer.

S o Far as the first question is concerned, a relevant answer for our patients would be that any physical activity could be seen as an ‘exercise’ and could be worth while. 1t is the attitude of mind that makes something - in this case physical activity and rxercise - a challenge, worth while, rclcuant and of value to the patient.

What makes the difference between somcthing being an cxcrcisc and a chore? For instance, clraning the kitchen, rowing, mowing the grass, and hillwalking all involve physical activity and sometimes they all could be satisfying, could improve ‘fitness’ and sometimes they all could be a chore. It partly depends on attitude of mind, which again affects endorphin relrase.

The Irad-np to an Olynipic final could 1)c an effort or “.joy, and which it is may iif‘l‘ect tlie erid result. My guess is that a sports psychologist would feel comfortable with the principles of working with chronic pain sufferers.

By encouraging our patients to see any form (and degree) of physical activity, eg getting out of bed, putting on shoes, shopping or swimming, in a positive exercise/challenge way rather than as an cffort/cliore, hopefully we can niake ‘exercise’ more accessible and a more realistic target to attain.

We are sometimes asked: ‘What is

Of course, specific exercises for specific areas and levels of fitness (from foot to hand, suppleness to strength and ligament to athlete, etc) are important and integral to what we do. Our patients are taught exercises for stamina, local and general, for flexibility, strength and coordination, etc, but thew is a continuum betwecn this, rehabilitation end of the spectrum, through to ‘everyday life’ and beyond into ‘sport’ and this continuum works at least two ways, eg from ‘exercise’ to regain function, from function to regain ‘fitness’.

Any definition of ‘sport’ would probably have to include the element of ‘competition’ in its explanation. It is this competition that gives the activity its value, its challenge. Our patients in a sense have to learn to compete against their pain, their ‘life’, themselves, to get ‘value’ and achievement back into what they do.

If this is so , this is in agreement with the American College of Sports Medicine and ICate Kerr’s comment: ‘Perhaps we should move away from such a concept of exercise [“gymnasiums”, “pumping iron”] to a concept of physical activity, which can be incorporated more easily into a daily routine.’

One final thought. Maybe one of the reasons musculoskeletal problems are s o common is that our bodies do not normally perform the variety of movements we were designed for, or we do too many of a few movements without the balance of others. Maybe ‘exercise’/p~iysical activity should be seen and encouraged as a way of restoring that balance and variety.

We were designed for big and little movements, Fast arid slow, lots and sometimes no movement at all. That is why any advice on exercise should also include advice on relaxation, as the two go hand in hand.

Peter D Roach MCSP Clatterbridge, Wirral

Reference Kerr, K (1999). ‘Exercise - No easy option’, Physiotherapy, 85, 3, 114-115.

Seeing Should Not Be B e I i evi n g

THE authors ofthe article ‘Comparison of visual estimation and goniometry for assessment of metacarpophalangeal joint angle’ (Bruton et al, 1999) are to be commended for this valuable and pertinent work. They provide good evidence showing the unreliability of’ the visual estimation ofjoint angles.

They note that this conforms with my earlier piece of work (Low, 1976 - not 1978 as quoted in the article). Although I did not comment at the time (because I did not specifically collect these data) I atso formed the impression that there was no positive correlation between the accuracy of visual estimation and experience. As these writers suggest, repetition without feedback appears to reinforce an unjustified optimism concerning accuracy.

It is rather surprising to find such a large proportion oftheir sample of hand therapists (40%) using visual estimation of joint angles and, presumably,joint ranges. Aside from goniometry there are numerous other methods with evidently better reliability (and probably better validity) that have been widely described, eg Low and Reed (1996) and references therein.

John Low FCSP Thorpe Bay Essex

References Bruton, A, Ellis, B and Goddard, J (1999). ‘Comparison of visual estimation and goniometry for assessment of metacarpophalangeal joint angle’, Physiotherapy, 85, 4, 201-208. Low, J L (1976). ‘The reliability ofjoint measurement’, Physiotherapy, 62, 7,

Low, J and Reed, A (1996). Basic Biomechanics Explained, Butterworth- Heinemann, Oxford.

227-229.

Physiotherapy,June lSSS/vol 85/no 6