Short Steven, Tuttle Matthew, Youngman Dillon
Denver Nuggets Basketball Club.
New York Red Bulls.
Int J Sports Phys Ther. 2023 Feb 1;18(1):262-271. doi: 10.26603/001c.67936. eCollection 2023.
Symptom modification techniques have been recently dichotomously labeled as either passive or active therapies. Active therapy such as exercise has been rightfully advocated for while "passive" therapies, mainly manual therapy have been regarded as low value within the physical therapy treatment spectrum. In sporting environments where physical activity and exercise are inherent to the athletic experience, the utilization of exercise-only strategies to manage pain and injury can be challenging when considering the demands and qualities of a sporting career which include chronically high internal and external workloads. Participation may be impacted by pain and its influence on related factors such as training and competition performance, career length, financial earning potential, educational opportunity, social pressures, influence of family, friends, and other key stakeholders of their athletic activity. Though highly polarizing viewpoints regarding different therapies create black and white "sides," a pragmatic gray area regarding manual therapy exists in which proper clinical reasoning can serve to improve athlete pain and injury management. This gray area includes both historic positive reported short-term outcomes and negative historical biomechanical underpinnings that have created unfounded dogma and inappropriate overutilization. Applying symptom modification strategies to safely allow the continuation of sport and exercise requires critical thinking utilizing not only the evidence-base, but also the multi-factorial nature of sports participation and pain management. Given the risks associated with pharmacological pain management, the cost of passive modalities like biophysical agents (electrical stimulation, photobiomodulation, ultrasound, etc), and the indications from the evidence-base when combined with active therapies, manual therapy can be a safe and effective treatment strategy to keep athletes active.
症状改善技术最近被二分法标记为被动疗法或主动疗法。诸如运动等主动疗法已得到合理倡导，而“被动”疗法，主要是手法治疗，在物理治疗范围内被视为价值较低。在体育活动和运动是体育体验固有组成部分的体育环境中，当考虑到体育生涯的要求和特质（包括长期高负荷的内部和外部工作量）时，仅采用运动策略来管理疼痛和损伤可能具有挑战性。参与度可能会受到疼痛及其对相关因素的影响，如训练和比赛表现、职业生涯长度、经济收入潜力、教育机会、社会压力、家庭、朋友以及他们体育活动的其他关键利益相关者的影响。尽管对于不同疗法存在高度两极分化的观点，形成了非黑即白的“阵营”，但手法治疗存在一个务实的灰色地带，在这个地带，恰当的临床推理有助于改善运动员的疼痛和损伤管理。这个灰色地带既包括历史上报告的积极短期结果，也包括负面的历史生物力学基础，这些基础造成了毫无根据的教条和不恰当的过度使用。应用症状改善策略以安全地允许继续进行运动和锻炼需要批判性思维，不仅要利用循证依据，还要考虑到体育参与和疼痛管理的多因素性质。鉴于药物性疼痛管理的风险、生物物理因子（电刺激、光生物调节、超声等）等被动治疗方式的成本，以及与主动疗法结合时循证依据所给出的指征，手法治疗可以是一种安全有效的治疗策略，能让运动员保持运动状态。
5级。
