📚🔬 10 Facts To Know About Back Pain ℹ️ℹ️ Low Back Pain (LBP) is a leading cause of disability worldwide! ℹ️ There are many myths around LBP. ℹ️ Accurate knowledge around back pain can help to manage pain, disability, days off work, and the rehab process. . ❌❌❌❌ 10 Unhelpful MYTHS: 1. LBP is usually a serious medical condition. 2. LBP will become persistent and deteriorate in later life. 3. Persistent LBP is always related to tissue damage. 4. Scans are always needed to detect the cause of LBP. 5. Pain related to exercise and movement is always a warning that harm is being done to the spine. 6. LBP is caused by poor posture when sitting, standing and lifting. 7. LBP is caused by weak 'core' muscles; a strong core protects against future LBP. 8. Repeated spinal loading results in ‘wear and tear’ and tissue damage. 9. Pain flare-ups are a sign of tissue damage and require rest. 10. Treatments such as strong medications, injections and surgery are effective, and necessary, to treat LBP. ✅✅✅✅ 10 Helpful FACTS! 1. LBP is not a serious life threatening medical condition. 2. Most episodes of LBP improve and doesn’t get worse as we age. 3. A negative mindset, fear avoidance, negative recovery expectations, and poor pain coping behaviors are more strongly associated with persistent pain than is tissue damage. 4. Scans do not determine prognosis, the likelihood of disability, or clinical outcomes of LBP. 5. Graduated exercise and movement in all directions is safe and healthy for the spine. 6. Spine posture during sitting, standing and lifting does not predict LBP or its persistence. 7. A weak core does not cause LBP. 8. Graded Spine movement and loading is safe and builds structural resilience. 9. Pain flare-ups are more related to changes in activity, stress and mood rather than structural damage. 10. Effective care for LBP is relatively cheap and safe. This includes: education that is patient-centered, fosters a positive mindset, and optimizes physical and mental health. 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: O’Sullivan PB, Caneiro JP, O’Sullivan K, et al. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:1
07 Jan 2020
📚🔬 Safety of Blood Flow Restriction Training ℹ️ℹ️ INTRO: Blood flow restriction training (BFRT) partially restricts arterial blood flow into the muscle while venous outflow is occluded during exercise. ℹ️ Substantial strength gains can be elicited with lighter loads versus heavy resistance training. ℹ️ Current research has investigated a wide array of BFRT protocols and variables. ℹ️ To address varying advice and guidelines, some research has synthesized best evidence around standardized protocols. ℹ️ The use of BFRT during aerobic training and Resistance Training can be effective to increase muscle strength and size. ℹ️ The physiological mechanisms behind these muscle adaptations include: Acute muscle cell swelling. Increased fiber-type recruitment. Decreased myostatin. Decreased atrogenes. Satellite cell proliferation. ℹ️ It is also important to consider the safety of BFRT. ℹ️ The issue of safety remains inconclusive and inconsistently reported. ℹ️ Given the conflicting literature and lack of a validated, standardized protocol, the consensus on safety of BFRT use in a clinical population is unknown. ℹ️ Minniti et al. (2019) assessed the potential adverse events associated with BFRT. 📊📊 RESULTS: 19 studies were eligible. . 📊 Injuries included: Various knee-related disorders Inclusion body myositis Polymyositis Dermatomyositis Thoracic outlet syndrome Achilles tendon rupture Bony fractures. . 📊 Reports Included: No adverse events (9 Studies) 📊 Rare adverse events (3 Studies) - [Upper lImb DVT and rhabdomyolysis]. . 📊 Common adverse events (3 Studies). - [Acute muscle pain and fatigue]. 📊 BFRT was not more likely to cause adverse event vs normal exercise alone. . ✅✅ CONCLUSIONS: BFRT appears to be a safe strengthening approach. ✅ Improved definitions of adverse events related to BFRT are needed to include clear criteria for differentiating among common, uncommon, and rare adverse events. . ✅ Effective screening for those at risk for rare adverse events is needed. . 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Minniti et al. 2019. Safety of BFRT as a Therapeutic Intervention. The American Journal of Sports Medicine 1–13.
06 Dec 2019
📚🔬 Elite Athletes: ACL Reconstruction Return to Sport ℹ️ℹ️ INTRO: Athletes’ who sustain ACL ruptures commonly get a reconstruction to facilitate return to sport. ℹ️ However, some research suggests only 60% of non-elite athletes returned to their pre-injury level of sport after ACL reconstruction. ℹ️ Elite athletes may have a greater chance of returning to sport following ACL reconstruction compared with non-elite athletes. ℹ️ A systematic review and meta-analysis was completed to determine the rate of return to the pre-injury level of sport following ACL reconstruction among elite athletes. ℹ️ Secondary aims included: Assessing how long to return to sport. Rate of ACL graft re-rupture. ℹ️ 24 studies, totaling 1272 elite athletes, met inclusion criteria and were included. . 📊📊 RESULTS: 📊 83% of elite-athletes returned to their previous sport following ACL reconstruction. 📊 5.2% of the ACL grafts re-ruptured. 📊 6 to 13 months was the average time taken to return to sport. 📊 This is less time than previously been reported among non-elite athletes. . 📊 Although athletic performance often deteriorated compared with pre-injury levels, generally it remained comparable with elite athletes who had not sustained an ACL injury. ✅✅ CONCLUSIONS: These results may be used by athletes and their treating clinicians to guide realistic expectations. 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Lai CCH, Ardern CL, Feller JA, et al. Br J Sports Med 2018;52:128–138.
25 Nov 2019
📚🔬 Hip Replacement After Sports Injuries ℹ️ℹ️ INTRO: Knee OA and sport injuries have been linked to higher likelihood of Knee Replacement. ℹ️ The link between sports injury and hip replacement (HR) for OA is not clear. ℹ️ Moderate to strong evidence suggests high- intensity sporting activity is a risk factor for hip OA. ℹ️ Ackerman et al. (2020), aimed to: Quantify the likelihood of Hip Replacement within 10-15 years after sports-related hip or thigh injury. ↗️↗️ METHODS: Tracking Hospital Admissions and Injury Coding sets from 2000-2005 across the 6.4 million people in Victoria Australia. 📊📊 RESULTS: 64,750 sports injuries occurred. 📊 Of these, 815 hip/thigh musculoskeletal injuries. 49% (age 20-29) 23% (age 30-39) 77% Males 📊 410 Femoral fractures (50%) 187 Soft tissue injuries (23%) 106 Unspecified hip injury (13%) 76 Hip dislocations (9%) 36 Multiple injuries (4%) were less common. Neuro-vascular injuries (<1%) 📊 Of thee 815 Hip injuries, 42 received Hip Replacements. 📊 82% that received HR, had a diagnosis consistent with hip OA. 📊 Median time was 5.3 years (0.3-14), from Injury to HR. 📊 Compared to all other sports injuries, having a hip or thigh injury tripled the hazard of subsequent Hip Replacement. 📊 Main hip or thigh injury types significantly associated with HR: Femoral fractures Hip dislocations 📊 Soft tissue/repeat injuries were not associated with an increased likelihood of HR. ✅✅ CONCLUSIONS: Sports-related hip or thigh musculoskeletal injury is associated with a significantly higher likelihood of HR within 15 years. . ✅ Effective injury prevention and management are needed to curtail this population burden. . 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Ackerman, et al. 2020. Quantifying the likelihood and costs of hip replacement surgery after sports injury: A population-level analysis. Physical Therapy in Sport 41, 9e15.
19 Nov 2019
📚🔬 SIJ Testing ℹ️ℹ️ INTRO: Previous systematic reviews revealed poor reliability and validity for SIJ testing. ℹ️ However, these reviews were published nearly 20 years ago and recent evidence has not yet been summarized. ℹ️ Klerx et al (2019), conducted an up-to-date systematic review to verify whether clinical recommendations for SIJ mobility tests should be revised. . 📊📊 Results: 12 relevant articles. 3 of sufficient methodological quality. . 📊 These 3 evaluated the reliability of 8 SIJ mobility tests and one test cluster. . 📊 Including: (1) Click-clack test (2) Standing flexion test (3) Seated flexion test (4) Gillet test (5) Prone knee flexion test (6) Heel-bank test (7) Abduction test (8) Thumb-PSIS test 📊 Gillet was the only test evaluated in more than one study. 📊 Majority of individual tests showed slight to fair agreement in inter-tester reliability. 📊 Compared to individual tests, the test cluster showed higher reliability, the highest in two positive tests. . 📊 Although some tests had higher reliability, the confidence intervals around them were large. . 📊 Furthermore, there were no validity studies of sufficient methodological quality. . ✅✅ Conclusion: . ✅ There is no new evidence for the validity of SIJ mobility tests when considering literature of at least fair methodological quality. . ✅ Only low quality and conflicting evidence for inter-rater reliability exists. ✅ Reliability of individual SIJ mobility tests and test clusters is questionable or uncertain. . ✅ The use of SIJ mobility tests in clinical practice is problematic. . 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Klerx, et al. 2019. Clinimetric properties of sacroiliac joint mobility tests: A systematic review. MSK Science. http://doi.org/10.1016/j.msksp.2019.102090
19 Nov 2019
📚🔬 Oxygen-Ozone Injection for Knee OA ℹ️ℹ️ INTRO: Ozone (O3) gas is currently being injected to treat chronic pain relief in knee osteoarthritis (OA) ℹ️ Injected O3 gas, is thought to improve pain and function in Knee OA through inhibition of the inflammatory process. ℹ️ Sconza et al. (2019), systematically reviewed RCT’s, in the past 20 years, covering ozone intra-articular injection for the treatment of Knee OA. . 📊📊 RESULTS: 11 studies 858 patients (629 female and 229 male). 📊 Control groups included: +Placebo (1 trial) +Hyaluronic acid injection (2 studies) +Hyaluronic acid & PRP injection (1 trial) +Corticosteroid injection (4 studies) +Hypertonic dextrose, Radiofrequency, or Celecoxib + Glucosamine (3 trials). . 📊 Quality of Studies: Cochrane Risk of Bias Tool was Used Good - 0 Fair - 2 Poor - 9 . 📊 No major complications or serious adverse events were reported. 📊 Encouraging pain relief at short-term. . 📊 Encouraging pain relief mid-term. 📊 On the basis of the available data, no clear indication emerged from the comparison with other established treatments for Knee OA. ✅✅ CONCLUSIONS: Available research is of poor methodological quality. ✅ Most studies flawed by relevant bias. ✅ On the basis of the data available: +Can be a safe approach +Encouraging pain control and functional recovery in the short/middle term. 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Sconza et al. 2019. Oxygen–Ozone Therapy for the Treatment of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials. Arthroscopy.
17 Nov 2019
📚🔬 Proton Pump Inhibitors: Reported Risks ℹ️ℹ️ Proton pump inhibitors (PPIs) are among the most prescribed classes of drugs in this day and age. ℹ️ PPI’s are used for patients with an array of GI conditions, including: Gastroesophageal reflux Peptic ulcer disease Helicobacter pylori infection Barrett’s esophagus. ℹ️ Six PPIs are approved by the Food & Drug Administration (FDA): Omeprazole Lansoprazole Dexlansoprazole Esomeprazole Pantoprazole Rabeprazole. ℹ️ Concerns continue to surface regarding their use and potential complications: ✅✅ Below are 10 Reported Concerns with PPI’s: ✅ Bone Fracture: Due to possible interference with the absorption of calcium salts and inhibition of bone remodeling. ✅ Hypomagnesia: Linked to cardiovascular and non-cardiovascular mortality, arrhythmias, muscle weakness, tetany, or convulsions. ✅ Iron Deficiency: Suppression of acid potentially leading to malabsorption. ✅ B12 Deficiency: Inhibits the cleavage of vitamin B12 from dietary proteins, and reduces absorption. ✅ Community Acquired Pneumonia: Acid suppression has lead to increased risk. ✅ Infection: Higher pH, allowing bacteria, such as, C. Difficile, salmonella, etc. to remain stable and increase risk of infection. . ✅ Kidney Disease Linked to acute and chronic kidney disease as well as progression from chronic kidney disease to end-stage renal disease. ✅ Heart Attack Linked in acute cardiac events by inhibiting nitric oxide synthase activity. ✅ Dementia & Alzheimers Lower levels of protective vitamin B12 or direct inhibition of the enzymatic clearance of β-amyloid. 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Brisebois et al.: Risks of Proton Pump Inhibitors. Laryngoscope Investigative Otolaryngology 3: December 2018.
14 Nov 2019
📚🔬 Increase Running Step-Rate 10% ℹ️ℹ️ INTRO: Excessive frontal-plane hip and pelvis movement have been frequently observed in runners with patellofemoral joint pain (PFJP). . ℹ️ Gait retaining interventions have been shown to be beneficial in runners with PFJP. ℹ️ Bramah et al. (2019) investigated whether a 10% increase in the running step rate influences frontal-plane kinematics of the hip and pelvis as well as clinical outcomes in runners with PFJP. ↗️↗️ METHODS: Runners with PFJP underwent 3D gait analysis to confirm the presence of aberrant frontal-plane hip and/or pelvis kinematics at baseline. . ↗️ 12 participants were eligible and invited to undergo the gait retraining intervention. . ↗️ Running kinematics along with clinical outcomes of pain and functional outcomes were recorded at: Baseline 4 weeks after 3 months after ↗️ Gait retraining consisted of a single session where step rate was increased by 10% using an audible metronome. . ↗️ Participants were asked to continue their normal running while self-monitoring their step rate using GPS smartwatch and audible metronome. 📊📊 RESULTS: Significant improvements in running kinematics and clinical outcomes were observed at 4-week and 3-month follow-up. . 📊 Significant reductions were observed in: Peak contralateral pelvic drop Hip adduction Knee flexion 📊 Significant increases were found in: Self-reported weekly running volume Longest run pain-free 📊 Significant Improvements were found in: Worst pain in the past week. Lower Extremity Functional Scale. ✅✅ CONCLUSION: A 10% increase in step rate resulted in significant improvements in running kinematics, pain, and function in runners with PFJP. . ✅ These improvements were maintained at 3-month follow-up. . 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Bramah, C., et al. 2019. A 10% Increase in Step Rate Improves Running Kinematics and Clinical Outcomes in Runners With Patellofemoral Pain at 4 Weeks and 3 Months. AJSM. 2019 October 28, : 363546519879693
05 Nov 2019
📚🔬 Best Treatments for Chronic Low Back Pain ℹ️ℹ️ INTRO: Low back pain is the leading cause of disability ℹ️ While Chronic Low Back Pain (CLBP) makes up approximately 20% of all low back pain cases, it generates approximately 80% of the direct costs. ℹ️ Owen et al. (2019), evaluated the efficacy of interventions best capable of treating nonspecific CLBP. 📋📋 METHODS: A Systematic Review and Meta-Analysis was performed, including effects on: Pain Physical function Mental health 📋 Interventions Investigated: Exercise training Manual Therapy Hands-Off (Education, and general practitioner management). 📊📊 RESULTS: 9543 records we found. 89 studies, including 5578 patients were eligible for qualitative synthesis. 📊 Studies included for Network Meta-analyis: 70 (pain) 63 (physical function) 16 (mental health) 4 (trunk muscle strength) ✳️✳️ Most Beneficial Exercise Training Modalities: Pilates for pain. ✳️ Resistance and stabilization/motor control for physical function. ✳️ Resistance and Aerobic for mental health. . ❗️❗️ Least Beneficial Modalities in Order: True control was most likely to be the worst treatment for all outcomes. ❗️ Hands-off treatments for pain and physical function. ❗️ Manual Therapy for mental health. ❗️ Stretching and McKenzie exercise effect sizes did not differ to true control for pain or function. . ✅✅ CONCLUSIONS: Low quality evidence Suggests: Pilates, Stabilization/motor control, Resistance training and Aerobic exercise training are the most effective treatments, for adults with Non-specific CLBP. . ✅ Exercise training may also be more effective than therapist hands-on treatment. . 🔗🔗 LIMITATIONS: Low Quality Evidence according to Grading of Recommendations Assessment, Development and Evaluation criteria. . 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Owen PJ, Miller CT, Mundell NL, et al. Br J Sports Med. doi:10.1136/ bjsports-2019-100886
05 Nov 2019
📚🔬 ACL Tear Risk…Is it Predictable? ℹ️ℹ️ INTRO: The vertical drop jump (VDJ) test is widely used for clinical assessment of ACL injury risk. ℹ️ Based on landing mechanics and control of the trunk and lower limb, it is proposed risk of ACL rupture can be identified. ℹ️ However, whether such assessments are valid is unclear. ℹ️ Mørtvedt et al (2019), examined if various sports medicine professionals and coaches were able to identify ACL injury risk in players, by visually assessing a VDJ test. 👀👀 METHODS: 102 video clips of elite female handball and football players performing a VDJ test were randomly selected from 738 recorded VDJ tests. 👀 20 out of 102 went on to suffer an ACL injury. . 👀 Sports medicine professionals and coaches were invited to rate each clip with a risk-level of ACL tear between 1 and 10 1=Low 10=High 📊📊 RESULTS: 237 assessors completed the survey. . 📊 Accuracy ranged from 36-60% 📊 Average was 47%, which is similar to random guessing. . 📊 No signifiant differences in classification between professionals: Physicians Coaches Certified Athletic Trainers Researchers Physical Therapists ✅✅ CONCLUSION: There was poor predictive ability (no better than chance). ✅ Visual assessment of a VDJ test, alone, is a poor test for assessing ACL injury risk in elite female handball and football players. ✅ Is there a battery of tests which could have better predicted ACL Injury? 🧠🧠 Thoughts? Questions? Comments? 🧠 Write them below. . 📚📚📚 SOURCE: Mørtvedt, et al. 2019. BJSM. 2019 Oct 14. doi: 10.1136/bjsports-2019-100602
31 Oct 2019
📚🔬 Iliotibial band syndrome (ITBS): ✅✅✅ 3 Conflicting Causes: 1. Friction of ITB over epicondyle 2. Compression of Fat Pad and Pacinian Corpuscle 3. Inflammation 💡 ANATOMIC CONSIDERATIONS: Proximally, provides an insertion for the TFL and gluteus maximus. 💡 Distal attachments include: Biceps femoris Vastus lateralis Lateral patellar retinaculum Patellar tendon 🏃 BIOMECHANICS During weight bearing: Greater peak hip adduction and knee internal rotation 🏃 Lower tibial internal rotation 🏃 Femoral external rotation. 🏃 Abnormal mechanics at the foot and the tibia and strain rate may play a role. 🏃 Leg-length discrepancies have been reported as a factor in developing ITBS also. 💪🏼 MUSCLE PERFORMANCE TFL may dominate the weaker gluteus medius posterior and gluteus maximus, resulting in Trendelenburg pattern. 💪🏼 Which could result in: Poor control of the hip and femur during stance Excessive hip adduction Knee Valgus or Varus 📚 EXTRINSIC FACTORS: Repetitions at 30° of knee flexion in a closed-chain and weight-bearing position. 📚 Rapid increases in mileage/hill training 🔬 CLINICAL EXAMINATON Patient History 🔬 Tenderness localized at lateral epicondyle No symptoms indicating lateral joint line, popliteal tendon, or intra-articular disorders. 🔬 Ober test: Flexibility of lateral hip musculature . 🔬 Noble test: Compression over the lateral epicondyle at 30° knee flexion; elicits pain reproduction. 🔬 Functional tests: Trunk and lower-extremity strength Excessive femur internal rotation Ipsilateral hip adduction Contralateral hip drop during a step-down test or Trendelenburg test 🙌🏼🙌🏼 TREATMENT 🙌🏼 Recommended Exercises: Lateral hip stretch Side-lying hip abduction and pelvic drops Progressive closed chain exercises 🙌🏼 Bilateral closed chain exercises: Relatively low vigor and used early to promote technique in squats 🙌🏼 Single-leg activities: Higher vigor intended for strengthening the gluteal muscles. 📚📚📚 Read the full article for more info! SOURCE: Baker, Souza, and Fredericson, 2011. Iliotibial Band Syndrome: Soft Tissue and Biomechanical Factors in Evaluation and Treatment. PMR. 3(6), 550–561.
24 Oct 2019
📚🔬 Hip Strength and Knee Pain ℹ️ PatelloFemoral joint pain (PFJP) is a common cause of anterior knee pain that many people suffer with. ℹ️ Common complaints include pain sitting with a bent knee, going up/down stairs, and running/jumping. ℹ️ Nunes et al (2019), looked at the difference in functional ability between people with and without PFJP, and how hip strength relates. . ✅✅ HIGHLIGHTS (If you read nothing else): - People with PFP have objectively measured functional impairments. - Objective function is associated with hip strength and power in people with PFP. - Progressive resistance training may help address functional impairments. 👀👀 METHODS: Functional assessments included: Stair climbing (time) Single-legged chair stand (repetitions) Step down (repetitions) Forward hop for distance Side hop (repetitions). . 👀 Hip abductor and extensor tests included: Power Endurance Isometric Dynamic strength. . 👀 Self-reported function included: Kujala scale. KOOS-PF. 📊📊 RESULTS: The PFP group was: 15% slower climbing stairs. 12% fewer chair stands performed. 20% shorter forward hop. Lower hip strength and power correlated with lower function. Lower Kujala scores correlated with longer stair climbing time. 🧠🧠 CONCLUSION: People with PFJP have functional impairments, associated with reduced hip muscle capacity. Progressive hip muscle resistance training may be beneficial. Assessment of objective and subjective capacity is warranted. 📚📚📚 SOURCE: Nunes, G., et al. 2019. People with patellofemoral pain have impaired functional performance, that is correlated to hip muscle capacity. Physical Ther Sport. 40, pp. 85-90.
29 Sep 2019
Great post from @physionetwork ℹ️ Tendon pathologies can be one of the most frustrating rehab processes for athletes. ℹ️ Optimal progressive over-loading is key. ✅✅ The above infographic showcases and example progression of loaded exercises to slowly increase the load demand on the Achilles tendon.
24 Sep 2019
🔬📚 ACL RECONSTRUCTION: Patellar tendon Vs. Hamstring Autograft 💡 The 2 most common autografts used are 1. Bone–patellar tendon–bone (BPTB) 2. Quadrupled hamstring (HS) 💡 Numerous studies compare these graft types, but most focus on short-term outcomes with follow-ups of 2 years or less. 💡 Substantive evidence favoring one technique over another is lacking. 💡 Poehling-Monaghan et al. (2017), systematically reviewed current literature comparing BPTB autograft versus HS autografts with a minimum of 5-year follow-up and compared long-term outcomes with regard to: 1. Knee stability or graft failure 2. Complications 3. Functional outcome 4. Radiographic evidenced osteoarthritis 🔬🔬 RESULTS: (12) Studies (953) Participants (9 yrs) Avg. Follow-up time . 🔬 1. No differences in graft failure or manual or instrumented laxity were seen in any studies. 2. Lower clinical outcomes scores and greater motion loss were seen in BPTB patients in 1 and 2 studies, respectively. 3. 2/4 reported on anterior knee pain, and 3/7 recorded on kneeling pain; found more frequently among BPTB patients. 4. 1 study reported a significant increase in contralateral ACL tears in BPTB patients. 5. 3/5 studies reporting on radiographic evidence of osteoarthritis noted significantly increased rates in BPTB patients. 💭💭 CONCLUSIONS: No significant differences in manual/instrumented laxity and graft failures between graft types. An increase in long-term anterior knee pain, kneeling pain, and higher rates of osteoarthritis were noted with BPTB graft use. 💥💥 LIMITATIONS: Variety of concomitant pathology was encountered at the time of index surgery Not enough consistency in the description of surgical technique Did not uniformly address patient activity level or sport; or return to sport or preinjury activity level with any consistency 📚📚 SOURCE: Poehling-Monaghan et al. (2017). Long-Term Outcomes in ACL Reconstruction: A Systematic Review of Patellar Tendon Versus Hamstring Autografts. Orthop J Sprts Med. 5(6).
03 Sep 2019
🔬📚 Meniscus Tears and Osteoarthritis 💡 Prevalence of meniscal tears is estimated as ~24-31% of some populations, increasing with age and ranging from 19% in women aged 50–59 years to 56% among men between 70 and 90 years and is markedly higher in established OA subjects. 💡 Medial meniscus and/or the posterior horn tears make up 66% of cases, with horizontal and complex tears being the most common. . 💡 Most subjects with a meniscal tear are asymptomatic. 💡 Regardless of morphologic type, meniscal tears are strongly associated with OA cross-sectionally and predict OA longitudinally and are considered to be part of the spectrum of early or pre-radiographic disease 📝📝📝 TEAR TYPES INFO: Often enough, meniscal tear types are categorized into varying groups for comparison rather than separately compared to each other. . 📝 There is a striking lack of data on the relevance of different morphologic types of meniscal tears in OA. 📝 Horizontal and complex tears are common findings in knees with OA 📝 Posterior radial tears of the medial meniscus are associated with a high degree of cartilage loss and meniscal extrusion, and appear to be a highly relevant event in the progression of OA in the knee. 📝 Lateral meniscus radial tears affect younger individuals and are considered post-traumatic. . 📝 Despite their suggested high relevance, radial tears are more commonly misdiagnosed on MRI than any other type of tear. . 📝 While medial meniscus posterior root tears are of “radial” morphology, there is growing interest in regarding them as a separate entity. 📝 Longitudinal and bucket handle tears affect younger individuals and are highly associated with ACL injuries, favoring a traumatic etiology. 📝 MRI is important to detect and locate a possible displaced tear. . 📝 Further epidemiologic studies should focus on the morphology of specific meniscal tears to better understand their relevance in the genesis and progression of knee OA. . 📚📚📚 SOURCE: Jarraya et al. 2017. Meniscus morphology: Does tear type matter? Seminars in Arthritis and Rheumatism. 46(5), pp. 552-561. Photo Credit: on photo to right
25 Aug 2019
📚🔬 Exercise Protects your Brain ℹ️ℹ️ INTRO A growing body of evidence suggests exercise can enhance brain function and reduce neuro-degeneration. ℹ️ Exercise improves neuroplasticity via affecting synaptic structure and function in multiple brain regions ℹ️ Exercise also helps to regulate neuroinflammation and glial activation. ℹ️ Microglia and Pro-inflammatory cytokines play significant roles in the development of neurodegenerative disease, such as Alzheimer’s, Parkinsons, etc. . ℹ️ Mee-inta, et al. (2019), highlighted the impacts of exercise on microglia activation, which offers potential to improve the brain health where pharmacological intervention has failed. . ✅✅ HIGHLIGHTS 🧠🧠 MICROGLIA: When exposed to pathological insult, microglia transform from a resting stage into a spectrum of activated stages. .. 🧠 Activated microglia can lead to neuroinflammation, affecting neurogenesis, neuronal synaptic morphology, and synaptic plasticity. ✅✅ *Exercise Regulates Microglial Activation by Increasing Anti-Inflammatory Factors, such as... 📌 - Anti-inflammatory Cytokines 📌 - CD200-CD200R - (immunomodulatory factor expressed by neurons in the brain). 📌 - TREM2 - (Immunoglobulin receptor, reduced function can increase risk of Alzheimers) 📌 - Heat Shock Proteins - (maintain cellular homeostasis and protein stability) 📌 - Antioxidants 📌 - Brain Derived Neurotrophic Factor - Can regulate neuronal cell survival, adult hippocampal neurogenesis, and neuroplasticity . 📌 - Glymphatic System - ‘Brain waste system’ 📌 - Gut Microbiome - can influence the activation status of microglia, as well as performance of learning and memory. . 📊📊 CONCLUSIONS Low-intensity exercise can regulate microglial activation via expressions of various factors. . 📊 Some of these factors subsequently prevent neuroinflammation in the CNS. . 📊 Physical activity represents a natural strong anti-inflammatory strategy to improve brain function. 📚📚📚 SOURCE: Mee-inta, O. et al. 2019. Physical Exercise Inhibits Inflammation and Microglial Activation. Cells 2019, 8, 691. PhotoCredit:unknown
22 Aug 2019
🔬📚 Disc Herniation Resorption Rate 💡 Lumbar disc herniation (LDH) is the most common type of degenerative discogenic disease and can be treated surgically or conservatively. 💡 Zhong et al (2017), investigated the incidence of spontaneous resorption of LDHs with conservative treatment using meta-analysis. 💡 11 trials were included in the meta-analysis (Majority from Uk and Japan) 🔬🔬 RESULTS: 587 LDH patients managed conservatively and 380 experienced resorption. 🔬 Incidence of spontaneous resorption after LDH: . 🌎 Overall - 66% . 🇬🇧 United Kingdom - 82.94% . . 🇯🇵 Japan - 62.58% . 💭 LIMITATIONS: Data extracted from small number of sources. 💭 No randomized controlled trials met inclusion criteria. . ❗️❗️ CONCLUSIONS: Conservative treatment may become the first choice for treating LDH. . ❗️ The cost reduction should benefit patients and society. . ❗️ Research on spontaneous resorption is sparse. Future studies are required to investigate phenomenon of spontaneous resorption of LDH. . 📚📚📚 SOURCE: Zhong, et al. 2017. Incidence of Spontaneous Resorption of Lumbar Disc Herniation: A Meta-Analysis
15 Aug 2019
📚🔬 Sleep, Recovery, and Performance in Sports ℹ️ More and more frequently athletes and healthcare professionals are realizing the importance of adequate sleep duration and quality for athletic performance and recovery. ℹ️ Sleep specialists are used by many professional teams to aid athletes suffering from sleep issues, including: Sleep deprivation Insomnia Jet lag. ℹ️ As more is discovered about the impact of sleep duration, timing, and quality on human performance and recovery, more athletes are adopting the principles. ℹ️ Also, sleep plays a prominent role in concussion management. ℹ️ Sleep complaints are commonly noted after mild traumatic brain injury, and may play a role in exacerbating other concussion symptoms and slowing recovery. ℹ️ Malhorta (2017), published an article highlighting recent research covering the important effects of adequate sleep for athletes. . ✅✅ KEY POINTS: Poor duration, quality, and timing of sleep can lead to: Poor performance Slower recovery Higher risk of injury ✅ Athletes commonly suffer from: Insomnia Insufficient sleep Jet lag Obstructive sleep apnea. . ✅ Improving sleep in athletes has been shown in some studies to improve performance on the field. . ✅ Sleep symptoms are commonly seen after concussion and should be managed appropriately, as poor sleep can exacerbate or prolong any concussion symptoms. ✅ Recently, evidence-based consensus recommendations have been published stating that adults need at least 7 hours of sleep for optimal health. 🧠🧠🧠🧠 THOUGHTS? REACTIONS? ARGUMENTS? Let us know…Comment Below! 🧠🧠🧠🧠 📚📚📚 SOURCE: Malhotra, R.K., 2017. Sleep, Recovery, and Performance in Sports. Neurologic Clinics. 35(3), pp. 547-557.
06 Aug 2019
📚🔬 ACLR, Which Graft is Best? ℹ️ℹ️ INTRODUCTION Anterior cruciate ligament (ACL) reconstruction is one of the most common orthopedic surgeries in the world for active individuals. ℹ️ The type of graft used is an important decision for ACL reconstructions. ℹ️ Despite extensive research on the best graft choice, discrepancy still exists among, hamstring, patellar tendon and quad tendon grafts. ℹ️ Xerogeanes (2019), makes an argument the quad tendon is the best graft choice. 📊 Recently, Quad tendon grafts have has gained popularity. 📊 The ‘all soft tissue’ quadriceps graft offers many advantages over other autograft choices. . 📊 There are 20% more collagen fibrils per cross-sectional area than the patellar tendon (PT). . 📊 Biomechanically, its ultimate load is 70% > than similar width PT grafts. 📊 Also, it’s modulus is more similar to the native ACL than either PT or hamstring grafts. 📊 Anatomically the quadriceps tendon has significantly more volume than the PT. . 📊 Following harvest, the quadriceps tendon is still 80% stronger than the intact PT. 📊 The length and cross-sectional area of the quadriceps tendon graft can be tailored to the needs of the patient. . 📊 On any patient over 5 feet tall, a graft length of 7 cm can be obtained. . 📊 Commonly Quad graft thickness is almost 2x thicker than the same patients PT, making it easy to harvest a graft diameter from 7 to 11 mm. 📊 Thus, this graft can be customized for both primary and revision surgeries. 📊 Harvest site morbidity is minimal. . 📊 An incision less than 2 cm in an area with no significant cutaneous nerves without harvest of any patella bone leads to no significant harvest site pain, numbness, or palpable defect. 📊 Clinical outcomes using this graft are excellent. . 📊 The prospective data on nearly 1,000 quad grafts, with a mean patient age being 20 years old, show a 4.2% failure rate. . ✅✅ IMPLICATIONS: Xerogeanes (2019), argues soft tissue quadriceps graft will be the surgical choice for ACL reconstruction for future athletes. 🧠🧠🧠🧠 THOUGHTS? REACTIONS? ARGUMENTS? Let us know! Comment Below! 📚📚📚 SOURCE: Xerogeanes, J., 2019. Quadriceps Tendon Graft for Anterior Cruciate Ligament Reconstruction
28 Jul 2019
📚🔬 Risk Factors for Achilles Tendinopathy ℹ️ℹ️ The presence of Achilles tendon pain, swelling and an impaired load-bearing capacity indicate Achilles Tendinopathy (AT). ℹ️ AT is most frequently seen in elite running athletes, with a lifetime risk of 52%. ℹ️ It should, however, be noted that one-third of all patients with AT have a sedentary lifestyle. ℹ️ This highlights a broad spectrum of potential risk factors for AT, yet the exact aetiology remains uncertain. ℹ️ Van Der Vlist, et al. (2019), systematically reviewed the literature regarding the potential clinical risk factors that have been investigated for AT. 📈📈 RESULTS: 📈 WHAT IS KNOWN? Achilles tendinopathy is considered an overuse injury. However, the aetiology is unclear. 📈 Most commonly affects runners and running sports from 30 years old to 60 years old. 📈 Generally Accepted Risk Factors: Being overweight. Chronic diseases affecting tendon quality. Use of fluoroquinolones or statins. Weak plantar flexor strength. Reduced ankle dorsiflexion. 📈 To date, conclusive evidence is missing. 📊📊 NEW FINDINGS! A lack of high-quality studies explaining risk factors for Achilles tendinopathy. 📊 10 cohort studies identified, all with high risk of bias. 📊 Limited evidence exists for 9 Risk Factors for Achilles tendinopathy: 1. Prior lower limb tendinopathy or fracture 2. Use of ofloxacin antibiotics 3. Increased time between heart transplantation and initiation of quinolone treatment for infectious disease 4. Moderate alcohol use 5. Training during cold weather 6. Decreased isokinetic plantar flexor strength 7. Decreased forward propulsion in gait 8. Lateral rollover at forefoot flat phase 9. Creatinine clearance of <60 mL/min in heart transplant patients. ✅✅ CONCLUSIONS: 9 clinical factors were identified, which increase a person’s risk of Achilles tendinopathy. . ✅ When treating Achilles Tendinopathy, ofloxacin use, alcohol consumption and a reduced plantar flexor strength are modifiable risk factors. ⭕️⭕️ See the last post from @grapplersperformance for 1 of my favorite plantar flexion strength exercises. . 📚📚📚 SOURCE: Van Der Vlist, et al. 2019. Clinical Risk Factors for Achilles Tendinopathy. BJSM
25 Jul 2019