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[RESEARCH] Is Knee Noise a Problem?
Noises Around the Knee
INTRO: Noise in the knee joint is a common symptom that often leads to outpatient clinic visits. However, there have been no previous review articles regarding noise around the knee despite its high prevalence. Song et al. (2018) reviewed the noise characteristics according to sound nature and onset as well as factors for differentiation between physiological and pathological noises. They also described causes of the physiological and pathological noises and management of noise in the knee. RESULTS: The sounds around the knee have been described using various terms, including: Popping, Snapping, Catching, Clicking, Crunching, Cracking, Creaking, Grinding, Grating, & Clunking. Differentiate between physiological noise and pathological noise by checking for pain and swelling/effusion in the knee joint, as this is often associated with pathological noise. A loud âpopâ with pain at the time of injury usually indicates damage to the ligaments or the meniscus. Crepitus, in the absence of any history of injury, may indicate cartilage lesions in OA or inflammatory arthritis. Physiological noise varies and include:
Buildup or bursting of tiny bubbles in the synovial fluid.
Snapping of ligaments.
Catching of the synovium or physiological plica.
Hypermobile meniscus or discoid meniscus.
Perception of previous noise after knee surgery due to emotional concerns.
If there is no pathological condition, there is no need to be concerned about the noise. Management of pathological noise will depend on the underlying cause. CONCLUSIONS:
Noise around the knee is a common phenomenon.
In most cases, the sound is physiological, and there is generally no reason for concern.
Pathological noise is accompanied by pain, effusion, swelling, and a history of injury.
Healthy patients experiencing physiological noise should be given appropriate information and reassurance.
Careful evaluation of the characteristics of noise and differentiation can provide guidance for patients
SOURCE: Song et al. 2018. Noise Around the Knee. Clinics in Orthopedic Surgery 2018;10:1-8
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Dalton Urrutia, MSc PT
Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.Â
Want to learn more or contact him?
Reach out online:
@physicaltherapyresearch
@Grapplersperformance
www.grapplersperformance.com
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.Â
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/11/research-is-knee-noise-problem.html via http://www.rssmix.com/
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Untold Physio Stories - Rotated Pelvis Placebo or Nocebo?
The modern clinician generally hates hearing "I've been told my pelvis is rotated" or "my vertebrae are out of place." It's often time consuming and can be difficult to educate maladaptive beliefs, but it's worth it if you want better outcomes and to reduce fear avoidance behaviors. What happens to a chronic pain patient who is told by another clinician that her pelvis is rotated? Listen in and find out!
Erson and Andrew are featured in the amazing new compilation text, Movers and Mentors! Click our link to get your copy from amazon! It's full of amazing quotes, useful information from many instructors, researchers, and great clinicians of our profession.
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Modern Manual Therapy Insiders - over 650 Exclusive videos, Research Reviews, Webinars, Online Discussion - learn easy to apply Clinical Practice Patterns, integrate Pain Science with Manual Therapy and Patient Education -Â Join now!
Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/untold-physio-stories-rotated-pelvis.html via http://www.rssmix.com/
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Calorie Restriction and Physical Therapy
By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN
Diet crazes come and go in the hopes to correct health issues and for weight loss. Many diets are merely fads, not backed by evidence, and/or offer only short-term solutions. One dietary pattern that stands out from the pack is calorie restriction (CR), especially in regards to data on longevity. I have 2 peer-review publications in the area of CR and intermittent fasting, so I can share both the data and experiences of this diet. Let's take a quick look at calorie restriction and what physical therapists (PTs) need to know!
Calorie restriction is a dietary regimen where a person consumes typically 25-40% less calories than usual. In order to accomplish this calorie deficit a person must know their total daily caloric needs over several days. Calculating 25-40% of this total calorie needs a client can then reduce their calorie content of each meal in order to hit their calorie deficit. Usually there is not a time restricted component, as seen with the newly popularized time-restricted feeding (TRF). The big focus is eating less throughout the entire day.Â
To most Doctors of Physical Therapy (DPTs) it may seem obvious that eating less will promote a negative calorie balance and reduce body mass, but other physiological effects do occur under CR. The biggest side effect, as seen by countless animal studies, is lifespan expansion. Most data show that in as little as 30% CR many animal organisms, from rats, primates, to grasshoppers, will live extend life by anywhere from 25 to 50%! In fact, of all the diet fads and ridiculous supplements, CR has been consistency one of the only mechanisms researchers have found to extend life. Unfortunately, designing a trial for humans is not in the works, so transferring this lifespan extension data to humans is impossible at this time. Regardless, animal trials have shown lifespan extension as well as significant reductions in chronic diseases and body mass index, two factors that greatly affect mortality and morbidity. Take a look at the data from this recent Pifferi, F., Terrien, J., Marchal, J. et al. article focused on primates:Â
 It clearly shows the positive effects of CR on primates both from a lifespan as well as a lifestyle perspective (e.g. quality of life, chronic disease development, etc). Interestingly in this study, the researchers noted in the primates on CR a reduction in grey matter (white matter was intact). Fortunately those CR primates did not see any appreciable deficits in cognition in memory, so perhaps this grey matter loss is insignificant for them. The monkeys were scheduled to eat 30% less calories but actually obtained only 24% fewer calories over the study. While a primate study is not a human trial it does show promise for us as well opens our eyes to possible mechanisms.
Data do exist on positive short-term effects of calorie restriction and some of the possible mechanisms in humans. Probably the most robust recent human examination of CR in humans was the CALERIETM clinical trial. CALERIETM stands for the Comprehensive Assessment of Long term Effects of Reducing Intake of Energy and is lead by researchers at Duke and in combination with the NIH. The study included 218 young and middle-aged, normal-weight or moderately overweight adults who were randomly divided into two groups. People in the experimental group were told to follow a 25% CR diet for 2 years, while those in the control group followed their usual diet. Unfortunately, humans being humans, the participants only met a 12% calorie deficit for the 2 years of the study. Despite not reaching their 25% target, the subjects still loss 10% of body mass and had other positive health effects, as seen here from the 2019 Kraus et al Lancet article:Â
Physical therapists should see that even a 12% CR induced improvements in blood pressure, blood lipid profiles, and metabolic status in humans. Such improvements could greatly reduce the risk of heart disease, renal failure, cancer, and other chronic but preventable diseases that plague our modern healthcare system. Moreover, could it be that reducing these chronic diseases help to extend life?
Possibly, let's take brief look at some of the mechanisms of CR. Understand the literature is thick with animal data and physiological mechanism for CR, with much of these factors DPTs would never measure in clinical practice. The CALERIE certainly provides compelling evidence in humans that a 12% CR diet significantly reduce chronic inflammation as measured by c-reactive protein (CRP). Less inflammation translates to less heart disease, stroke, and other chronic conditions. In animals studies, researchers have noted improvements in autophagy, a process where the human body cleans out damaged cells. Autophagy is vitally important for the brain and often occurs at night, especially when the body is fasted. Data correlates poor autophagy of the brain with certain neurodegenerative diseases. Other data show a clear impact on the metabolic and hormone systems under CR with a lowering of insulin like growth factor 1 (IGF-1), which associated with cancers. Another potential factor is that CR may alter the gut biome, which may help to control diseases states. Lastly, CR may exert an effect on our genes via Forkhead Box Protein O (FoxO), which may alter transcription factors and mutations. The mechanisms for CR are complex, context-specific, and need further analysis.
In the end, PTs should be aware that CR may benefit their clients but with some obvious caveats and limitations. First, it should be apparent that may humans struggle to follow a calorie reduced diet. We see this nearly everyday and even in major clinical trials. Second, CR diets are not appropriate for those developing (e.g. neonates) or severely ill (e.g. trauma). Most of these individuals need a positive calorie balance, not a negative one. Third, CR may induce bone loss and reduced aerobic capacity, but these could be mitigated through exercise prescribed by a PT! Fourth, CR may not be palatable to many but they might find other diets more palatable with similar outcomes (e.g. intermittent fasting, time restricted feeding, 5:2 fasting). Doctors of Physical Therapy need to educate their clients on the benefits, as well as the risk associated with CR, and work with a patient's primary care or dietician to optimize their diet for life!
If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!
 Via Dr. Sean Wells, lead instructor for Modern Nutritional Rehab
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/calorie-restriction-and-physical-therapy.html via http://www.rssmix.com/
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Introducing Our Newest CE Courses
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Expand your skillset with our latest NCBTMB-approved CE courses! Learn how to implement cupping therapy into your practice, explore the anatomy of the lymphatic system or take an in-depth look at how to modify massages for clients with chronic conditions.
With courses available online 24/7, AMTA is here to support you and your massage therapy practice.
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[RESEARCH] A Cross-sectional Analysis of Persistent Low Back Pain Using Correlations Between Lumbar Stiffness Pressure Pain Threshold and Heat Pain Threshold
Goal of the Study?
In this primary research article1, the authors had two goals: (a) Determine and quantify the relationship between biomechanical and neurophysiology measurements in lower back pain patients and (b) examine if the correlations differ when considered regionally (lumbar back) or segmentally.
 Why are they doing this study?
To improve our understanding of Lower Back Pain etiology, better non-invasive measurement tools and techniques must be established and quantified.Â
 What was done?
A sample of 132 patients of the Spine Centre of Southern Denmark who had persistent non-specific Lower Back Pain was measured for three different sensitivities: (a) global spinal stiffness (GS) using a VerteTrack Device which applied a rolling weight across the S1 and T12 spine; (b) deep mechanical pressure pain sensitivity threshold (PPT) using pressure algometer which applied bilateral pressure at each lumbar segment and (c) superficial heat pain sensitivity threshold (HPT) using a handheld thermode at the midline of each lumbar segment.Â
A series of statistical tests were performed to determine if there were any correlations between these three quantitative sensory metrics: Global Stiffness (GS), Pressure Pain Threshold (PPT) and Heat Pain Threshold (HPT).
 What did they find?
The correlation coefficients (R) for each pair of these three quantitative sensory metrics; GS, PPT and HPT were calculated and tested for statistical significance.Â
Correlation between GS and HPT were found to be poor and statistically insignificant (R = 0.23)
Correlation between GS and PPT were moderate (R = 0.38) and statistically significant
Correlation between HPT and PPT were good (R= 0.53) and statistically significant
Unexpectedly, the correlation between GS and PPT was positive, meaning participants with higher global stiffness had a higher pressure pain threshold. The authors expected the reverse. They based their explanation of this unexpected relationship on the bodyâs adaptive mechanical protection system. Pain is considered a protective response and a stiffer spine is more resilient to applied forces and therefore can tolerate a higher pain threshold.
The otherâs unexpected anomaly was that for the three QSTâs measured, no differences were found between the individual lumbar segments. This indicates that patients with persistent LBP are probably less able to perceive lumbar stiffness reliably, perhaps due to âCortical Smudgingâ, an overlapping of the cortical homunculus.Â
 Why do these findings matter?
Around four out of five people have lower back pain at some point in their lives. Itâs one of the most common reasons people visit healthcare providers. To successfully evaluate both the extent of LBP and the effectiveness of any treatment plan, a reliable metric must first be established. This study is an attempt to use stiffness (GS), heat (HPT) and pressure (PPT) as this critical metric.
 At Dynamic Disc Designs, we have developed models with varying lumbar stiffness to help in the education of the possible sources of back pain. This new research is important in establishing greater understanding of the causes and solutions of low back pain.
Check out the exclusive Blue Disc Dynamic Model, made exclusively for EDGE Mobility System here!
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A cross-sectional analysis of persistent low back pain using correlations between lumbar stiffness pressure pain threshold and heat pain threshold â©
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/research-cross-sectional-analysis-of.html via http://www.rssmix.com/
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Untold Physio Stories - Fracture or Something Else?
In this episode, Erson talks about a recent young soccer player who was kicked twice in the calf. The antalgic gait, inability to WB or extend his knee, plus overall sensitivity to touch made him think of a fracture as a differential Dx. Listen in to find out what the result was.
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Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual
Keeping it Eclectic...
This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/untold-physio-stories-fracture-or.html via http://www.rssmix.com/
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[RESEARCH] Rotator Cuff Tear - Surgery v. Conservative Rehab for 55+
Rotator Cuff Tear - Surgery v. Conservative Rehab for 55+
INTRO: Non-traumatic rotator cuff tear is a common shoulder problem which can be treated either conservatively or operatively. Kukkonen et al. (2021) investigated the difference between clinical and radiological 5 year outcomes in patients aged over 55 years. METHODS: 180 shoulders with symptomatic, non-traumatic supraspinatus tears were randomly assigned to:
Physiotherapy (Group 1)
Acromioplasty and physiotherapy (Group 2)
Rotator cuff repair, acromioplasty and physiotherapy (Group 3).
Primary Outcome: Constant score. Secondary Outcomes: Visual analog scale for pain and patient satisfaction. Radiological analysis included evaluation of glenohumeral osteoarthritis and rotator cuff tear arthropathy. RESULTS: The average tear size of the supraspinatus was 10 mm in all groups. There were no significant differences in the average change of Constant score:
18.5 points in Group 1
17.9 points in Group 2
20.0 points in Group 3.
There were no statistically significant differences in the change of visual analog scale for pain and patient satisfaction. At follow-up there were no statistically significant differences in the mean progression of glenohumeral osteoarthritis or cuff tear arthropathy between the groups. CONCLUSIONS:
Operative treatment was no better than conservative treatment with regard to small non-traumatic single tendon supraspinatus tears in patients over 55 years of age.
Operative treatment does not protect against degeneration of the glenohumeral joint or cuff tear arthropathy.
Conservative treatment is a reasonable option for the primary initial treatment of this condition.
WANT MORE RESEARCH? Click here! đ»Rapid Review Members Getđ» 3 articles every week, you should be reading Key Points & Main Takeaways Read in less than 5 minutes Sent direct to your inbox Access to full-text Only $1 per week. SOURCE: Kukkonen et al. 2021. OPERATIVE VS. CONSERVATIVE TREATMENT OF SMALL NON-TRAUMATIC SUPRASPINATUS TEARS IN PATIENTS OVER 55 YEARS. Journal of Shoulder and Elbow Surgery
Dalton Urrutia, MSc PT
Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.Â
Want to learn more or contact him?
Reach out online:
@physicaltherapyresearch
@Grapplersperformance
www.grapplersperformance.com
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.Â
NEW - Online Discussion Group
Live cases
webinars
lecture
Live Q&A
over 600 videos - hundreds of techniques and more!Â
Check out MMT Insiders
Keeping it Eclectic...
This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/research-rotator-cuff-tear-surgery-v.html via http://www.rssmix.com/
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3 Factors That the Vestibular Therapist Should Know About BPPV and Stroke
During the differential diagnosis of a patient with vertigo or dizziness, it is pertinent that the clinician determine if the symptoms are benign / non-benign or central / peripheral. This is our red light or green light system to treat or refer. This is by far the most important decision that comes out of a clinical evaluation and is especially important with neurological symptoms. The most common benign cause of vertigo is benign paroxysmal positional vertigo (BPPV). There are specific subjective and objective findings that are crucial to ruling in BPPV in the dizzy patient. A physical therapist trained in vestibular rehabilitation is well aware of these findings and do a splendid job at helping people! We are actually very good at differential diagnosis and use the latest research to help refine our clinical exam! In some instances, patients who are having dizzy/vertigo symptoms seek out help from physical therapists with thought they are having BPPV but instead it is an early sign for a stroke. Early diagnosis and intervention are crucial for successful treatment in patients with acute ischemic stroke because prompt thrombolytic treatment improves outcomes. We also do not want to propel a spontaneous dissection through a mechanical input, such as with manual therapy, Dix-Hallpike testing or even range of motion. In fact, ischemic changes affecting the vestibular artery in patients with BPPV could precede a full-blown ischemic stroke. These ischemic changes affecting the vertebrobasilar system could initially produce vestibular symptoms, such as BPPV. Here are a three factors for the vestibular therapist to know about BPPV and stroke:
The vestibular organs are vulnerable to ischemic obstruction. This is due to the âsmall creekâ that finally lead to the organs from the anterior vestibular artery, which as we know, originate initially from the vertebral-basilar artery. Therefore, a disturbance of adequate hemodynamics to this region could indicate a disruption more proximal, such as in the vertebral-basilar artery.
There are common risk factors associated with both BPPV and ischemic stroke. These can include osteoporosis, smoking, alcohol consumption, anxiety, cardiovascular disease and diabetes. Conditions such as obesity, cardiovascular disease, and diabetes are chronic diseases and related to stroke onset. Therefore, a correlation can be made that BPPV increases the risk of ischemic stroke.
BPPV is recurrent and can lead to lifestyle changes. One lifestyle change can be physical inactivity. Physical inactivity following BPPV might increase the risk of an ischemic stroke. A sedentary lifestyle due to avoidance of activities from fear or provocation of vertigo/dizzy symptoms can occur in these patients over time. Our goal is to educate our patients to stay active with proper recommendations based off of the patientâs presentation. Our goal too is to get them better so they do not have impairments!
These are just 3 factors that we believe a vestibular therapist should be aware concerning ischemic stroke while treating a dizzy patient. Having this knowledge helps us go beyond the thinking of pathophysiology of cupulolithiasis and canalolithiasis. These factors can lead to knowledge of not only signs and symptoms associated with non-mechanical and mechanical causes of dizziness, but also education for our patients for the long term, especially for those with recurrent vertigo.
CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES
You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husbandâa manual therapist a wifeâa vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course. Pertinent to this blog post, the entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the âOptimal Sequence Algorithmâ and treat through the âPhysio Blend.â If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at [email protected] for prices and discounts. Authors Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts Danielle N. Vaughan, PT, DPT, Vestibular Specialist Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
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Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.Â
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/3-factors-that-vestibular-therapist.html via http://www.rssmix.com/
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Untold Physio Stories - Let's Review Those Exercises
In all of his initial evaluations, Erson goes over resets and any prescribed exercises 20-30 times minimum. When a patient gets relief from an end range loading reset, he makes sure they understand the how's and why's of the movements. When the same resets spontaneously start worsening the complaints after 2 weeks of relief, something is probably going wrong...
Untold Physio Stories is sponsored by
EDGE Health and Tech Solutions - we level up your website with full SEO optimization, turn it into a referral generating machine and do full Google Workspace and Telehealth integrations
Modern Manual Therapy Insiders - over 650 Exclusive videos, Research Reviews, Webinars, Online Discussion - learn easy to apply Clinical Practice Patterns, integrate Pain Science with Manual Therapy and Patient Education -Â Join now!
Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded IndividualÂ
Keeping it Eclectic...
This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/untold-physio-stories-lets-review-those.html via http://www.rssmix.com/
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[RESEARCH] Accuracy of ACL Special Tests
Accuracy of 3 ACL Diagnostic Tests
INTRO:The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. In America, estimates of ACL injury cases range from 80,000 to 250,000 per year, with approximately 100,000 of these patients undergoing ACL reconstruction surgery. The 3 primary diagnostic assessments of these manual tests are:
Anterior drawer test.
Lachman test.
Pivot shift test.
Hunag et al. (2016), performed a meta-analysis, looking at diagnostic sensitivity and specificity of the 3 assessments to evaluate the diagnostic accuracy of the anterior drawer, Lachman, and pivot shift tests. RESULTS:
16 studies assessed the accuracy of the 3 tests for diagnosing ACL ruptures & met the inclusion criteria.Â
Lachman test; most sensitive test to determine ACL tears (87.1%).
Pivot shift test; most specific test (97.5%) & has the highest positive likelihood ratios (LR+) of 16.00.
Lachman test has the lowest negative likelihood ratios (LRâ) of 0.17.Â
CONCLUSIONS:In cases of suspected ACL injury:
Perform the pivot shift test, as it is very specific and has greater likelihood ratios in diagnosing ACL rupture.Â
The Lachman test has favorable efficacy in ruling out a diagnosis of ACL rupture.
The anterior drawer test is the least proven of the 3 approaches in diagnosing ACL rupture.
đ»Rapid Review Membershipđ»đ3 articles every weekđKey Points & Main Takeawaysâ±Read in less than 5 minutesđ„Sent direct to your inboxđAccess to full-textđ°Only $1 per week.SOURCE:Huang et al. 2016. Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 2016;50(1):22â31 doi: 10.3944/AOTT.2016.14.0283.
Dalton Urrutia, MSc PT
Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.Â
Want to learn more or contact him?
Reach out online:
@physicaltherapyresearch
@Grapplersperformance
www.grapplersperformance.com
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.Â
NEW - Online Discussion Group
Live cases
webinars
lecture
Live Q&A
over 600 videos - hundreds of techniques and more!Â
Check out MMT Insiders
Keeping it Eclectic...
This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/10/research-accuracy-of-acl-special-tests.html via http://www.rssmix.com/
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[RESEARCH] Safety of Blood Flow Restriction Therapy/Training
Blood Flow Restriction Training Safety
Background: Blood flow restriction training (BFRT) is defined as the partial restriction of arterial blood flow into the muscle while venous outflow is occluded during a bout of exercise. BFRT is used for physical training and performance in healthy individuals, as well as an adjunct to physical rehabilitation in injured individuals. Current understanding of the physiological mechanisms of BFRT and related performance includes:
Acute muscle cell swelling.
Increased fiber-type recruitment
Decreased myostatin.
Decreased atrogenes.
Satellite cell proliferation.
With the increasing use of BFRT in clinical populations, Minniti et al. (2020) systematically reviewed the research to assess the potential adverse events associated with BFRT when used clinically in the treatment of patients with musculoskeletal disorders. RESULTS:
19 studies with 322 pooled participants.
9 studies reported no adverse events.
3 reported rare adverse events, including an upper extremity deep vein thrombosis and rhabdomyolysis.
3 case studies reported common adverse events, including acute muscle pain and acute muscle fatigue.
Individuals exposed to BFRT were not more likely to have an adverse event than individuals exposed to exercise alone. Adverse Events Overall:
Overall (14 of 322).
Rare Overall (3 of 322).
Rare BFRT (3 of 168).
Rare Control Group (0 of 154)
Any adverse BFRT (10 of 168).
Any adverse control (4 of 154).
CONCLUSIONS: BFRT appears to be a safe intervention and even more so when used according to evidence-based guidelines and in patients with knee-related musculoskeletal disorders. Further research is needed to make definitive conclusions about the absolute safety in all patient populations.
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SOURCE: Minniti et al. 2020. AmJ Sprt Med 2020;48(7):1773â1785 DOI: 10.1177/0363546519882652
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Dalton Urrutia, MSc PT
Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.Â
Want to learn more or contact him?
Reach out online:
@physicaltherapyresearch
@Grapplersperformance
www.grapplersperformance.com
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.Â
NEW - Online Discussion Group
Live cases
webinars
lecture
Live Q&A
over 600 videos - hundreds of techniques and more!Â
Check out MMT Insiders
Keeping it Eclectic...
This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/09/research-safety-of-blood-flow.html via http://www.rssmix.com/
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Untold Physio Stories - Bias vs Experience
In this episode, Erson goes over a recent seemingly clear cut case of an ankle injury. Don't let your biases prevent you from being thorough!Â
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Untold Physio Stories - Correcting an Ipsilateral Lumbar Lateral Shift
If you have ever seen a lumbar patient with a true lateral shift, you would know they're not the easiest or straight forward patients. An ipsilateral lumbar lateral shift usually has poor outcomes. If it's actually discogenic and you have to shift away from the side of symptoms (they are shifted toward the pain instead of away) to correct the shift, this could make the disc protrude or herniate worse. In the 200th episode of Untold Physio Stories, Erson goes over the problem solving he used to treat an ipsilateral lateral shift case he saw recently.
Untold Physio Stories is sponsored by
EDGE Health and Tech Solutions - we level up your website with full SEO optimization, turn it into a referral generating machine and do full Google Workspace and Telehealth integrations
Modern Manual Therapy Insiders - over 650 Exclusive videos, Research Reviews, Webinars, Online Discussion - learn easy to apply Clinical Practice Patterns, integrate Pain Science with Manual Therapy and Patient Education -Â Join now!
Also, be sure to check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/09/untold-physio-stories-correcting.html via http://www.rssmix.com/
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Should PTs Use a New Model for Weight Loss?
By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN
For decades the predominant model that dictated weight gain, loss, or maintenance was the energy balance model (EBM). The EBM is rooted in one of the basic laws of thermodynamics. It goes without saying that food contains energy and it is typically measured in a unit known as calories (kilocalories in the dietary world). As a person consumes food it provides energy to do work such as exercise, activities of daily living (ADL), physical therapy, basic living functions, or even sport. Energy can come from recently consumed food or stored energy (e.g. fat, glycogen, or protein) from previously eaten food.Â
Clinicians often explain weight loss to patients as âcalories-in versus calories-outâ or CICO, which directly relates to the EBM. In brief, CICO helps rehab professionals to explain to clients the balance between the energy coming into their body versus the energy they expend: too much food coming in and not enough expenditures means weight gain, while too little food or excessive exercise means weight loss. Simple, right?
Well, a new model of weight maintenance has been postulated which focuses on the consumption of carbohydrates and their interaction with hormones. The carbohydrate-insulin model (CIM) asserts that our obesity epidemic has only worsened with greater emphasis on CICO and that we as clinicians ought to focus more on reducing refined carbohydrates. The alternative paradigm proposes that increasing fat deposition in the bodyâresulting from the hormonal responses to a high-glycemic-load dietâdrives a positive energy balance. In other words, consuming highly refined carbohydrates can increase fat deposition and alter hormones that further drive more fat mass gain.
Whatâs the evidence for this new alternative paradigm and how should it impact Doctors of Physical Therapy (DPT)? Letâs take a quick glance at the data and see whatâs really happening.
The CIM model weighs heavily on a notion known as glycemic load (GL). A GL can be calculated based on the quantity and glycemic index (GI) of a food. Thus, a meal with only a few bites of a white bread has a relatively low GL versus a meal with a giant bowl of refined pasta. Starchy vegetables like potatoes and cassava, while not refined, may also deliver a high GL if eaten on their own or in very large quantities.Â
Why does the GL matter? Well, according to the new CIM it is this GL which drives an post-prandial anabolic state. In this anabolic state we see an increase in insulin secretion, suppression of glucagon secretion, and facilitation of a glucose-dependent insulinotropic polypeptide (GIP)-dominant incretin response. Initially, after a large GL meal, these hormonal factors help with absorption. However, eventually this strong anabolic state may drive a significant release of glucose from the liver and muscles. Such a release of glucose from the liver and muscles may trigger the central nervous system to activate a hunger response. Studies show that a hunger response from the CNS often drives individuals to seek out rapid energy sources of food (e.g. more refined carbs). And so goes the cycle, purportedly, that a person eats refined carbs â gets hungry â eats more refined carbs with obesity being the end product. Hereâs a representation of the CIM from Ludwig et al 2021:
Data to support CIM is still evolving. Authors of a recent review by Ludwig et al provide evidence against EBM, limited evidence supporting CIM via trials, but cite evidence supporting many of the hormonal notions above in animal and lab modeling studies. Ludwig et al do go further by providing arguments against the CIM but with the intention of refuting such arguments. Many of the arguments are sound but leave the reader open with much interpretation as nutrition science has many facets, is multifactorial, and often full of confounding factors.
One big factor I see as a limitation of the CIM is that most dietary guidelines do not support the consumption of highly refined grains. Other organizations, such as the American Heart Association and the American Diabetes Association, put recommended limits on added sugar in much of their literature. The 2020 Dietary Guideline for Americans (DGA), while rife with industry influence, also discourages the consumption of refined grains. As such, our guidance and clinicians already engage and educate clients on reducing their refined carbs and added sugar intake. Palatability of such foods is addressed by Ludwig et al, but I argue that many of these foods are consumed out of convenience, due to lacking food supplies (e.g. food deserts), and/or familial patterning with meals/snacks. I agree with the authors that palatability of foods can be changed -- it takes time, exposure, and education!Â
Another severe limitation with the publication is the underlying bias of the ketogenic diet. Currently the evidence supports the use of the keto diet for epilepsy. Keto has grown in popularity, partially because of short term weight loss studies and success stories, and the fact that the food can be very tasty (lots of fat!). Adding excessive fat can be detrimental to the gut biome and potentially have other untoward effects (e.g. heart disease from excess saturated fat). Moreover, many keto dieters struggle with bowel movements and micronutrient deficiency due to the lack of fiber and variety of foods. As such, I question whether the authors, such as Gary Taubes, have financial ramifications for publishing a CIM article. Afterall, there are huge financial gains for developing a model for weight loss that helps to support a diet (keto) that is sold in your books, subscriptions, and diet programs.
My final perspective on the CIM is that it still comes back to energy balance. While refined carbohydrates may alter hormones which drive more refined carbohydrate consumption, there still exists the will to change this behavior, eliminate the refined carbs in the diet, and avoid or reduce the weight gain over time. Physios working in wellness or with clients wanting to lose weight should educate their patients to avoid purchasing refined grains and sugars. Have your clients stick with a variety of whole plant based foods and they will feel full thanks to the fiber, lower GL, and small bits of protein. I completely agree, along with many other dietary guidelines, with Ludwig et al in that quality of food matters. However, the food quality does not change the laws of thermodynamics.Â
In my opinion, we do not have sufficient evidence for PTs and rehab professionals to incorporate the CIM as the best weight loss model available. I think Ludwig et al have detailed a feedback mechanism for why people may repeatedly consume refined foods, which drives a positive calorie balance and weight gain, but they didnât derive a whole new paradigm for weight loss. The CIM is merely EBM plus a feedback mechanism -- calories in, calories out!
If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!
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from Wellness https://www.themanualtherapist.com/2021/09/should-pts-use-new-model-for-weight-loss.html via http://www.rssmix.com/
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Top 5 Fridays! 5 Symptoms of Cervicogenic Dizziness
There are a range of symptoms and variety of potential descriptions of cervicogenic dizziness. Cervicogenic Dizziness symptoms can vary from one person to another and still carries the weight of controversy.
The description of dizziness, including a sensation of spinning and/or dysequilibrium is common (Krabak et al 2000, Kalberg 1996). It has even been described generally as dizziness that may be associated with headache, cervical pain, nausea, cold sweats and/or nonspecific complaints (Morinaka 2006).
With that said, the following are the top 5 symptoms of Cervicogenic Dizziness.
Lightheadiness
Drunkenness
Unsteadiness
Feeling of imbalance
Room spinning
It is highly recommended to exclude other sources of dizziness prior to making a diagnosis of cervical origin. We recommend using the Optimal Sequence Algorithm, a detailed subjective and objective screening process.
There are some fine details in symptom and presentation characteristics between several types of dizziness. The differential diagnosis can mean a difference between referring out or greenlight to treat in an outpatient setting.
If benign disorders of the dizziness are found, then the patient could have a double entity, which is both a vestibular disorder and cervical disorder. That is why the patientâs symptoms may vary or change between several of the descriptors above.
CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES
You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husbandâa manual therapist a wifeâa vestibular specialist), teach a very unique course combining both the theory and practice of vestibular and manual principles in their 2-day course.  Pertinent to this blog post, the entire weekend includes the most up-to-date evidence review from multiple disciplines to diagnose through the âOptimal Sequence Algorithmâ and treat through the âPhysio Blendâ.Â
If you would like to host a course for your staff (either a vestibular, neuro, sports or ortho clinic), please do not hesitate to contact me at [email protected] for prices and discounts.
Authors
Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT Â Â
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist Â
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
via In Touch PT
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from Wellness https://www.themanualtherapist.com/2021/09/top-5-fridays-5-symptoms-of.html via http://www.rssmix.com/
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[RESEARCH] Evaluation Is Treatment for Low Back Pain
Goal of the study?
In this study,1 the purpose is to investigate if the physical therapy (PT) evaluation process of history taking and physical exam results in a meaningful change for patients with low back pain (LBP), even before implementing treatment interventions.Â
 Why are they doing this study?
Low back pain (LBP) is the most widely reported musculoskeletal disorder globally and has significant healthcare expenditures. In the US, LBP accounts for 25% of outpatient physical therapy (PT) visits, with an estimated 170,000 people daily seeing a PT for this issue.Â
With a shift toward a biopsychosocial model, more focus has been put on the therapeutic alliance (TA) and its impact on patient outcomes. TA is essentially the working social connection between a patient and clinician, blending clinical skills, verbal and non-verbal communication, a sense of warmth, collaboration, and trust. There is increasing evidence that TA and trust play a significant role in patientsâ pain outcomes before any formal treatment is started.
  What did they do?
This observational study included 34 patients with LBP with/without leg pain who went to four different outpatient PT clinics over a 3-month period. They had one PT at each site do the history taking and physical exam, and a different PT does the outcome measurements. Before the examination, all participants completed a demographic survey, disability index, and outcome measurements, including pain (low back and leg; numeric pain rating scale â NPRS), fear-avoidance beliefs (FABQ), Pain catastrophization (PCS), lumbar flexion, nerve sensitivity â pressure pain thresholds (PPT). After completing this pre-assessment, history taking and physical exams were done on each patient.Â
All data were analyzed using statistical software.
 What did they find?
This study found that for patients with LBP, the process of history taking and a physical exam had a significant therapeutic effect regarding fear-avoidance, pain catastrophization, movement and sensitivity of the nervous system. However, while some changes met or exceeded clinically significant differences, these were not correlated to physical exam duration and perceived connection by the PT.
Following history taking, the authors also found that NPRS for leg pain, PCS, trunk flexion, and PPT measurements showed a significant change from the initial intake. While adding a physical exam generated some improvement, only active trunk flexion and PPT for the low back were significantly improved compared to the measurements after history taking alone. Overall, they found that history taking resulted in the most significant changes seen in the evaluation process. The authors suggest that in line with existing research, this finding may result from the fact that history-taking happens at first contact and therefore provides an opportunity for a connection to alleviate patient fears and establish a TA.Â
They did not find that the PTâs connection with the patient altered changes in pain or function.
 Limitations?
The main limitation of this study is the study design. Being observational, the findings cannot speak to any causal relationships between the changes and outcome measures. Additionally, as there were no strict controls on the history taking and physical exam, with each PT doing them their own way may have affected the findings.
 Why do these findings matter?
Understanding what factors provide the most significant treatment outcomes for patients with LBP can help address patient pain and function and reduce overall healthcare costs.
Evaluation is Treatment for Low Back Pain â©
via Dynamic Disc Designs/Dr. Jerome Fryer
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This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/09/research-evaluation-is-treatment-for.html via http://www.rssmix.com/
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[RESEARCH] Greater Trochanteric Pain Syndrome
Greater Trochanteric Pain Syndrome
INTRO:
Greater trochanteric pain syndrome (GTPS) is a general term used to describe disorders of the peritrochanteric space, including:
Trochanteric bursitis.
Abductor tendon pathology.
External coxa saltans.
GTPS is a common cause of lateral hip pain and tenderness. While GTPS is seen in all age groups, it most commonly affects patients between 40-60 years old. While conservative treatment is effective for most patients with GTPS, many demonstrate symptoms refractory to physical therapy, non-steroidal anti-inflammatory drugs (NSAIDs), and corticosteroid injections (CSIs). Accurate diagnosis of the specific etiology of GTPS and the degree of gluteal tendon injury are critical to guiding appropriate treatment. Pink et al. (2021), systematically reviewed the research and highlighted the clinical and radiographic findings that can differentiate GTPS from other causes of lateral hip pain and guide management. RESULTS: Clinical Tests:
Tenderness to palpation over the greater trochanter (Sensitivity 80%; Specificity 47%)
Pain with abduction against resistance (Sensitivity 38%; Specificity 93%)
Pain with internal rotation against resistance (Sensitivity 44%; Specificity 93%).
Pain with single leg stance (Sensitivity 38%; Specificity of 100%)
Abductor tendon tears often present with abnormal gait and weak hip abduction. Differential Diagnoses: Intraarticular sources include: OA, avascular necrosis, labral tears, FAI, femoral neck stress fractures, and loose bodies. Extra-articular causes include: Lumbar stenosis, and meralgia paresthetica. CONCLUSIONS:
GTPS encompasses a spectrum of pathologies and diagnosis can be challenging. Proper evaluation relies primarily on careful clinical examination. Traditional nonoperative management with activity modification, physical therapy, NSAIDs, and CSI remains the mainstay of treatment. In chronic symptoms operative techniques have demonstrated excellent outcomes. SOURCE: Pianka et al. 2021. Greater trochanteric pain syndrome: SAGE Open Medicine Volume 9: 1â12.
WANT INFO LIKE THIS SENT TO YOU?Click here!SOURCE:Dattilo et al. 2020. Effects of Sleep Deprivation on Acute Skeletal Muscle Recovery after Exercise. ACSM
Dalton Urrutia, MSc PT
Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics.Â
Want to learn more or contact him?
Reach out online:
@physicaltherapyresearch
@Grapplersperformance
www.grapplersperformance.com
Learn more online - new online discussion group included!
Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.Â
NEW - Online Discussion Group
Live cases
webinars
lecture
Live Q&A
over 600 videos - hundreds of techniques and more!Â
Check out MMT Insiders
Keeping it Eclectic...
This article was originally posted on Modern Manual Therapy Blog
from Wellness https://www.themanualtherapist.com/2021/09/research-greater-trochanteric-pain.html via http://www.rssmix.com/
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