Noises Around the KneeINTRO: 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 “pop” 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:
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:
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.
Want to learn more or contact him?
Reach out online:
@Grapplersperformance
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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. 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 - 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
Keeping it Eclectic…
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from Beauty https://www.themanualtherapist.com/2021/10/untold-physio-stories-rotated-pelvis.html via http://www.rssmix.com/ via Tumblr Untold Physio Stories - Rotated Pelvis Placebo or Nocebo? 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. 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: 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: 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!
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from Beauty https://www.themanualtherapist.com/2021/10/calorie-restriction-and-physical-therapy.html via http://www.rssmix.com/ via Tumblr Calorie Restriction and Physical Therapy 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. ]]>from Beauty http://feedproxy.google.com/~r/AmericanMassageTherapyAssociationNewsFeed/~3/yKhkc0W5N0s/ via http://www.rssmix.com/ via Tumblr Introducing Our Newest CE Courses 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. 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 © superficial heat pain sensitivity threshold (HPT) using a handheld thermode at the midline of each lumbar segment. 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 ® for each pair of these three quantitative sensory metrics; GS, PPT and HPT were calculated and tested for statistical significance.
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. 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.
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This article was originally posted on Modern Manual Therapy Blog
from Beauty https://www.themanualtherapist.com/2021/10/research-cross-sectional-analysis-of.html via http://www.rssmix.com/ via Tumblr [RESEARCH] A Cross-sectional Analysis of Persistent Low Back Pain Using Correlations Between Lumbar Stiffness Pressure Pain Threshold and Heat Pain Threshold 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. 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 - 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
This article was originally posted on Modern Manual Therapy Blog
from Beauty https://www.themanualtherapist.com/2021/10/untold-physio-stories-fracture-or.html via http://www.rssmix.com/ via Tumblr Untold Physio Stories - Fracture or Something Else? 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:
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:
CONCLUSIONS:
?Rapid Review Members Get? 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.
Want to learn more or contact him?
Reach out online:
@Grapplersperformance
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. Keeping it Eclectic…
This article was originally posted on Modern Manual Therapy Blog
from Beauty https://www.themanualtherapist.com/2021/10/research-rotator-cuff-tear-surgery-v.html via http://www.rssmix.com/ via Tumblr [RESEARCH] Rotator Cuff Tear - Surgery v. Conservative Rehab for 55+ 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:
CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSESYou can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (husband–a manual therapist a wife—a 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 “Optimal Sequence Algorithm” and treat through the “Physio Blend.”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. Keeping it Eclectic…
This article was originally posted on Modern Manual Therapy Blog
from Beauty https://www.themanualtherapist.com/2021/10/3-factors-that-vestibular-therapist.html via http://www.rssmix.com/ via Tumblr 3 Factors That the Vestibular Therapist Should Know About BPPV and Stroke
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…
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from Beauty https://www.themanualtherapist.com/2021/10/untold-physio-stories-lets-review-those.html via http://www.rssmix.com/ via Tumblr Untold Physio Stories - Let's Review Those Exercises Accuracy of 3 ACL Diagnostic TestsINTRO: 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:
RESULTS:
In cases of suspected ACL injury:
?3 articles every week ?Key Points & Main Takeaways ⏱Read in less than 5 minutes ?Sent direct to your inbox ?Access to full-text ?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):22–31 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.
Want to learn more or contact him?
Reach out online:
@Grapplersperformance
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. Keeping it Eclectic…
This article was originally posted on Modern Manual Therapy Blog
from Beauty https://www.themanualtherapist.com/2021/10/research-accuracy-of-acl-special-tests.html via http://www.rssmix.com/ via Tumblr [RESEARCH] Accuracy of ACL Special Tests |