Moving Freely With MSK Therapy: Combining Evidence Based Medicine and Clinical Evidence


Shaun Brewster and Caroline Cleary are the founders and directors of Continuing Education Australia (CEA), a professional development seminar business educating manual and exercise therapists. Shaun is a musculoskeletal therapist, exercise physiologist, and running coach ( with a passion for ultra-marathons. Caroline is also a musculoskeletal therapist and a sports physiotherapist, she’s also an ex-elite netball player and worked for many state/national sporting teams over the past 16 years.

  1. Continuing Education Australia supplies great continued professional development classes to allied practitioners around treatment modalities which seem to have limited supportive evidence but very compelling theory. What do you perceive to be the limitations of evidence based medicine? Is it a case that researchers are not spending enough time designing appropriate methods or is it that some interventions need to so individualized and the current system doesn’t allow for this to be taken into account?

Manual therapy involves the consideration of a multitude of patient variables and due to the nature of evidence based research it’s often very difficult to conduct research that provides clear and concise treatment and management protocols. While there has been some great advancements in EBM in our field, our profession is still largely guided by clinical based evidence, our goal is to marry EBM and clinical evidence to produce innovative and patient centred assessment and treatment methodologies.shutterstock_377153422 The limitations in our opinion are monetary, including in part practitioners working in a research capacity; spending many hours each week practicing as a clinician, possibly teaching in higher education (if you’re that way inclined), and finding the time and avenue of working in a  research capacity is all quite taxing and time consuming. Australia needs to make it more accessible for intelligent and hardworking clinicians to spread their time into research. Also, agreeing with your statement above that for research to be quantifiable it’s usually very specific, which is great, but makes it somewhat hard to extrapolate the information out to the mainstream and into treatment techniques manual therapists’ use.

  1. The method of cupping has recently been highlighted to the general public by the display of bruising on prominent Olympic athletes. Can you explain, in reasonably simple terms, the theory behind cupping and more specifically the “functional release cupping” that your business teaches?

Traditionally (Eastern medicine) would describe the markings left behind from the cupping in diagnostic terms, in that the colours would indicate particular types or levels of energy or blood stagnation in the body. Western myofascial cupping however, views the markings simply as minor damage to superficial blood vessels which occurs as a result of the strong vacuum created by the cups. The goal of myofascial cupping is to create a sustained drag on muscle and connective tissue which in turn changes the resting state of that tissue to create improved functionality locally. Functional release cupping (FRC) is the unique combination of myofascial cupping, kinetic chains, and functional movement. FRC seeks to create a more three dimensional and dynamic model for creating faster and more individualised changes in functional movement patterns – whether these be occupational, sporting, or other.

  1. Before cupping was made prominent at the 2016 Olympics in Rio, London introduced us to kinesiology taping (popular referred to by brand name ROCKTAPE) do you see benefits in this taping technique and how would you tend to use this intervention in consults?

Yes we regularly use and teach kinesiology taping and use it to support other therapeutic interventions post treatment. It is a fantastic pain reducing tool, it has been shown to improve lymphatic flow and also to increase the neuromuscular facilitation during sport or rehabilitation exercises.

  1. Acupuncture has been used by alternative medicine sources such as Chinese
    Medicine and Naturopaths’ for centuries/decades, however, allied health professions are restricted in the use of the word acupuncture and must refer to treatment as dry needling. Are you able to describe the differences between the two ideas and how each modality is theoretically supposed to work?

Acupuncture is based on the traditional Chinese medicine (TCM) model of energy flow (Qi) along meridian pathways. Acupuncture involves inserting fine needles into specific acupuncture points along these meridians to assist in the stimulation or balance of the flow of Qi. Dry needling was developed within the last 80 years and is based on a western medical model underpinned by the concept of myofascial trigger points. Myofascial trigger points develop in the body as a result of unwanted stress, excessive load, poor posture, and other factors. Trigger points produce a large percentage of the muscular based aches and pains that we experience from day to day. Dry needling uses needles very similar to acupuncture needles, but these are inserted at the site of the trigger points specifically to eliminate pain and to improve movement.

  1. Continuing Education Australia offer a Mobilisation With Movement course to allied health practitioners, which focuses on the use of mobilisation techniques and the promise of arthrokinematics. Are you able to describe this treatment modality to us, who it is most suitable for and how it can benefit an individual?

Mobilisation with movement (MWM) is an excellent tool for any allied health practitioner that deals with painful or restricted movements coming from incongruent/dysfunctional joints. MWM’s utilises anatomical motions in conjunction with arthrokinematic glides to improve joint functionality with less effort on the behalf of the practitioner. One of the unique tools that we use with this method is the MWM treatment belt which is a thick webbing strap with a high load buckle used to create more specific force with greater leverage.

  1. Where do you see the direction of Allied Health professionals going in the future? How will we reduce the chances of stepping on each other’s toes with the use of EBM and continued professional development expanding practitioner scope of practice?

We see allied health as becoming first contact practitioners more so than ever before. With the growing population of allied health practitioners we see each and every modality becoming more specialised to the general public, along with this there is likely to be an increased expectation around the level of education undertaken by allied health practitioners. Rather than trying to avoid stepping on each other’s toes, we believe the future lies in an integrated multi-modal approach to patient care which encourages and supports a high level of respect and collaboration between the various professions.

To end, if we as health practitioners focus first and foremost on the needs of the patien
t and all components of that person and the presentation, then our clinical decisions will be guided toward a treatment plan that provides the most holistic and individualized approach, regardless of our own personal and professional biases.

If you would like further information on Continuing Education Australia’s up-coming courses you can find it here at:

Until Next Time

Jackson McCosker
Director/ Chief Editor

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