Alessandro Compagnin – one of eight rehabilitation physiotherapists working at the prestigious London-based Isokinetic clinic – won the best case report award at this summer’s prestigious Football Medicine event.

A key event in the annual sports medicine calendar, the annual conference has a pedigree dating back to 1992. Organised by Isokinetic staff, this year’s conference took place in Athletic Madrid FC’s iconic stadium over three days in May. It attracted several thousand delegates from 65 countries around the world.

With anterior cruciate ligament [ACL] injuries being the bane of many top athletes’ lives, the title of Alessandro’s study – ‘Return to play after multiple, bilateral, ACL [anterior cruciate ligament] injuries and reconstructions’ – was always likely to catch the delegates’ and judges’ attention.

A second member of the London-based team, rehab and performance coach Filippo Picinini, picked up third prize for his study, which was titled ‘Spontaneous healing of the ACL: myth or reality?’. A total of 14 professionals attempted to win the contest, with awards being presented at a ceremony on the second day of the conference at the Civitas Metropolitano Stadium.

Sports physiotherapist Vittoria Marin was a third member of the London team to present a 12-minute report at the conference, which was titled ‘Complex three-year rehabilitation journey in a professional ballet dancer’.

Colleagues at the tightly-knit Isokinetic clinic – which is sited on the internationally famous Harley Street in London’s West End – celebrated the physiotherapy team’s success, according to managing director, Andrea Tartaglia.

Physios offer therapy in four areas

Now happily settled in the UK with his wife and two daughters, Andrea’s origins lie in Italy, where the first Isokinetic was established in the northern city of Bologna in 1987. Thirty seven years later, Isokinetic runs clinics in six Italian cities: as well as Bologna (the oldest and largest), there are clinics in Milan (which hosts two), Rimini, Rome, Turin and Verona. London is currently Isokinetic’s sole clinic outside Italy, but more could be in the offing, Andrea hints, tantalisingly.

Andrea is proud of the clinic’s continuing professional development record, pointing out that two physios are undertaking PhD studies with another on a part time master’s programme.

The physiotherapy team is led by Elisa Pirotti, who was first introduced to the Isokinetic approach as a student physiotherapist on placement in Bologna. Her team operates in four discrete areas: there’s an impressive hydrotherapy pool in the basement, a well-equipped gym with therapy tables on three levels, the Green Room (replete with an exercise area that’s large enough to accommodate short sprints and a huge TV screen displaying sophisticated digital bio-mechanical results). Finally, sports pitches in the nearby Regent’s Park offer physios an opportunity to gauge their clients’ progress outdoors on a variety of surfaces, including grass.

Where does Elisa stand on the long-running debate about the importance of delivering ‘hands-on’ therapy compared to exercise regimens? ‘I think both are necessary, though, of course, it depends on the injury and where the patient is in the rehab process,’ she told PhysioUpdate during a recent visit. ‘But I do agree that manual therapy on its own is generally not going to be enough. It might make the patient feel better in a way, but the results are not that likely to be long-lasting.’

The aim is to discover the nature of the client’s “therapeutic ambition”. They might want to return to the level they were at previously, or they might be aiming even higher [Andrea Tartaglia]

Psychological support

While mental health is not a core service at the clinic, Andrea stresses that Isokinetic recognises the importance of mental health in the recovery process. He points out that while the clinic does not offer psychological treatments – though clients can be referred on for expert help when appropriate – assistance can come from unexpected sources.

For example, clients often offer moral support to each other, often based on having experienced similar challenges themselves. Many athletes thrive from rehabbing alongside their peers – particularly as they might have been working in relative isolation before. ‘There are some very beautiful stories and nice exchanges, where clients help each other when they see someone is struggling.’

If we feel we feel there is an issue that’s compromising the patient’s recovery, we will communicate this with their case manager and it’s likely to be discussed at their next meeting and action agreed [Elisa Pirotti]

As well as physios – who are supported by assistants who are often student physios on placement from local universities – the clinic also employs two osteopaths on a part-time basis. There are three full-time sports medicine doctors and six reception staff (whose role in providing a welcome and communicating with clients is crucial, Andrea stresses). There are no mental health professionals on site, however, he explains.  

‘Our primary goal is to look after the patient from a clinical point of view, but we do that with a smile, some levity, and by creating a nice environment around them – without ever minimising the seriousness of their condition, of course,’ he says. 

Elisa believes that supporting patients’ wellbeing and finding ways to motivate them is part of the physio’s role. ‘But,’ she says, ‘we aren’t trained to offer psychological support as such. If we feel we feel there is an issue that’s compromising the patient’s recovery, we will communicate this with their case manager and it’s likely to be discussed at their next meeting and action agreed.’

One aspect of the Isokinetic approach that marks it out from competitors is that every patient is first seen by a member of the medical team for an in-depth assessment, which can include the doctor conducting investigations such as ultrasound and requesting scans or X-rays, for example. Andrea says the aim is to discover the nature of the client’s ‘therapeutic ambition’. ‘They might want to return to the level they were at previously, or they might be aiming even higher,’ he notes.

Key phases in the Isokinetic ‘recovery path’ 

•      pain control
•      recovery of joint mobility
•      recovery of strength
•      recovery of co-ordination
•      recovery of specific movements of sport
•      the final phase is the prevention of re-injury, using the latest technology and neuromotor exercises

Case manager system

The doctor – the ‘case manager’ – sets out a recovery programme and goal, which is given to the rehab team, and then charts their progress at follow-up appointments. Elisa says she and her colleagues have the autonomy to develop individual exercise and rehab programmes with the patient, working towards the agreed goal. ‘What does the patient need to do to get back to playing their sport again after knee surgery, for example?’

Some people find Isokinetic themselves on the internet or via word-of-mouth from a satisfied customer. Many come from overseas, from countries such as Israel, the Middle East and eastern Europe.

The ‘biggest perk’?

The cost of an initial assessment is surprisingly modest, given the clinic’s location and reputation. Referrals also come from other healthcare professionals, such as GPs, orthopaedic surgeons, dentists and nutritionists, while others come from football clubs, sporting bodies and players’ agents. The youngest patient is typically about 12, and at the other end of the spectrum the clinic has treated patients in their eighties and beyond. ‘It’s the same methodology whether it’s an elderly patient or an elite athlete – they all get the same attention,’ says Andrea.

A keen runner and cyclist in his spare time, Andrea was nursing a minor injury that was curtailing some of his activities when PhysioUpdate visited. Does working at the clinic have its perks, in terms of getting some informal rehab advice, for example? Though Andrea was not giving anything away, he noted with a smile: ‘The biggest perk of working here is being able to help people.’ And you could tell he was being utterly sincere.

The Isokinetic approach

Isokinetic gathers intelligence from treating 10,000 patients a year to tailor-make a rehabilitation programme for an individual patient. ‘We do not just treat a knee, but the patient who is suffering a knee problem,’ its brochure stresses.

The Isokinetic Medical Group is recognised as a FIFA ‘Medical Centre of Excellence’ for the prevention and treatment of sports injuries. Its Education and Research Department keeps staff up to date with the latest research findings and helps them to make their own contribution to sports medicine globally.