Dalton Urrutia @physicaltherapyresearch

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๐Ÿ“š๐Ÿ”ฌ Sleep, Muscle Gain & Fat Loss โ„น๏ธโ„น๏ธ Some research suggests high quality sleep before and after exercise is important. โ„น๏ธ Deep sleepย has been shown to have impacts on athleticย performanceย as this is when growth hormone is released. โ„น๏ธ Growth hormone can stimulate: Muscle growth. Muscle Repair. Bone building. Fat Loss. โ„น๏ธ Jabekk et al. (2020), investigated the effect of advising sleep health optimization on muscle and fat mass gain/loss, following 10 weeks of resistance exercise training. โ†—๏ธโ†—๏ธ METHODS: 30 untrained healthy men were recruited for the study and 23 were included in the final analysis. . โ†—๏ธ Participants were randomly assigned to: Exercise + Sleep Optimization (ExS). or. Exercise Only (Ex) โ†—๏ธ Both groups performed a whole body resistance exercise program twice a week for 10 weeks. . โ†—๏ธ The ExS group received education on how to improve both sleep quantity and quality. ๐Ÿ“Š๐Ÿ“Š RESULTS: After 10 weeks of training: Both groups increased lean body mass ExS (1.7kg ยฑ 1.1kg) Ex (1.3kg ยฑ 0.8kg) ๐Ÿ“Š Men in ExS group reduced fat mass significantly (-1.8kg ยฑ 0.8kg). ๐Ÿ“Š Ex group did not (0.8kg ยฑ 1.0kg). โœ…โœ… CONCLUSIONS: Optimization of sleep health can provide added benefits to body composition during weight training programs. โœ… This optimization provides a simple and cheap tool, applicable to the general healthy population. ๐Ÿ”ฅ๐Ÿ”ฅ TIPS FOR HEALTHY SLEEP Aim for 7-9 hours of sleep each night. ๐Ÿ”ฅ Go to bed and wake up at the same time every day, even on weekends. . ๐Ÿ”ฅ Find ways to relax before bedtime each night. . ๐Ÿ”ฅ Avoid distractions such as cell phones, computers, and televisions in your bedroom. . ๐Ÿ”ฅ Exercise at regular times each day, but not within 3 hours of your bedtime. . ๐Ÿ”ฅ Donโ€™t eat large meals, or drink caffeine or alcohol late in the day. . ๐Ÿ”ฅ Avoid long naps (over 30 minutes) in the late afternoon or evening. . ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. #physicaltherapyresearch #sleepoptimization #sleep . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCES: Jabekk, et al. 2020. A randomized controlled pilot trial of sleep health education on body composition changes following 10 weeks resistance exercise. doi: 10.23736/S0022-4707.20.10136-1 ๐Ÿ“š http://nia.nih.gov/health/good-nights-sleep

2 hours ago

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๐Ÿ“š๐Ÿ”ฌ BEAR ACL Surgery: โ„น๏ธโ„น๏ธ Results of ACL-R show over 60% of patients return to their pre-injury level of sport. โ„น๏ธ The (IKDC) and (KOOS) are patient-reported outcome instruments used in the athletic population. โ„น๏ธ The IKDC subjective score has been found to increase from: 45 to 60 points 1 year after ACLR 60 to 80 points by 2 years. โ„น๏ธ Uninjured people typically score 86-89. โ„น๏ธ KOOS can increase from: 55 to an average of 80 at 1 and 2 years postoperatively. โ„น๏ธ After ACLR, ~90% of patients have an IKDC objective grade of A (normal) or B (nearly normal). โ„น๏ธ A first-in-human safety study of a bridge-enhanced ACL repair (BEAR) was completed. โ„น๏ธ A suture repair is combined with a scaffold, placed in the space between the 2 torn ends of the ACL, and activated with the patientโ€™s blood. โ„น๏ธ The BEAR technique has shown comparable mechanical properties with ACLR. โ„น๏ธ Also, with hamstring autographs, patents show weakened hamstrings, which BEAR may prevent completely. โ†—๏ธโ†—๏ธ METHODS: BEAR (10 patients) ACLR hamstring autograft (10 patients) โ†—๏ธ 2 Year follow-up. . โ†—๏ธ Outcomes included: International Knee Documentation Committee (IKDC); Subjective and Objective results. Knee anteroposterior (AP) laxity. Functional outcomes. ๐Ÿ“Š๐Ÿ“Š RESULTS: No graft or repair failures in first 24 months after surgery. . ๐Ÿ“Š IKDC subjective scores at 12 & 24 months improved significantly for both groups. ACLR (84.6 ยฑ 17.2) BEAR (91.7 ยฑ 11.7) ๐Ÿ“Š IKDC objective score of grade A (normal) was found at 24 months in: 44% of BEAR group 29% of ACLR group ๐Ÿ“Š The rest were B (nearly normal). ๐Ÿ“Š No patients in either group had C (abnormal) or D (severely abnormal) grd. . ๐Ÿ“Š AP laxity was similar in the 2 groups at 24 months: BEAR (1.94 ยฑ 2.08 mm) ACLR (3.14 ยฑ 2.66 mm) ๐Ÿ“Š Functional hop testing was similar in the 2 groups at 12 and 24 months after surgery. . ๐Ÿ“Š Hamstring strength was significantly higher in the BEAR group. โœ…โœ… CONCLUSIONS: In this small, first-in-human study, BEAR outcomes were similar to ACLR with a hamstring autograft. . ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. - #physicaltherapyresearch #acl #aclrecovery - ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Murray et al. 2019. BEAR, first human st. Ortho J S

27 Mar 2020

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๐Ÿ“š๐Ÿ”ฌ Braces & ACL Surgery โ„น๏ธโ„น๏ธ ACL reconstruction is the primary approach after a tear and is often associated with a high incidence of re-rupture of graft and contralateral ACL. โ„น๏ธ Up to 86% of anterior and rotational forces in the knee are restrained by the ACL. โ„น๏ธ Thus, the knee brace has been commonly used as a device to postoperatively protect the graft to: Limit the range of motion of the knee. Limit excessive varus-valgus forces. Prevent anterior-posterior translation and rotation of the tibia. โ„น๏ธ According to the American Orthopaedic Society for Sports Medicine (AOSSM), a brace is used in about 85% of the cases following ACL reconstruction. โ„น๏ธ There are generally 3 types of knee braces: Prophylactic braces (Injury prevention). Rehabilitative braces (Movement Control). Functional braces (Stability Improvement). โ„น๏ธ Many studies have investigated brace effectiveness post ACL Reconstruction on: Knee functional performance. Stability. Proprioception. and others, which have showed controversial results. โ„น๏ธ In thisย meta-analysis, Yang et al. (2019), identified whether knee braces could provide patients with ACL reconstructions superior clinical outcomes on the knee functional scores and knee stability evaluations. . โœ…โœ… RESULTS: A total of 7 studies with 440 participants were included, with follow-up times up to 5 years. โœ… The IKDC objective score, pooled using the odds ratio (OR) as effect size: Was non-significantly different between the brace and no brace groups. . โœ… All of the other clinical outcomes, including: Lysholm score Tegner score Side-to-side difference Single-leg hop test VAS pain score - were pooled using the standard mean difference and were similar between the brace and non-brace groups. ๐Ÿ“Š๐Ÿ“Š CONCLUSIONS: Knee bracing does not appear to improve the clinical outcomes on the function and stability for ACL-reconstructed knees. . ๐Ÿ“Š Thus, bracing post ACL reconstruction should not be recommended routinely. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Yang, et al. 2019. The effect of knee bracing on the knee function and stability following ACL. Ortho Traum Surg J. 105(6), pp. 1107-1114. #physicaltherapyresearch #acl

26 Mar 2020

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๐Ÿ“š๐Ÿ”ฌ Running Biomechanics after ACL Reconstruction โ„น๏ธโ„น๏ธ INTRO: About 250,000 ACL ruptures are reported each year in the USA. โ„น๏ธ Majority undergo reconstruction (ACL-R) followed by extended rehabilitation. โ„น๏ธ Running is a basic tenet of rehab and is critical to return to sport. โ„น๏ธ The rate of return is only ~65%. โ„น๏ธ The incidence of a secondary ACL rupture is up to 40x greater than sustaining a primary ACL rupture. โ„น๏ธ Risk of OA is 4x higher in individuals after ACL rupture. โ„น๏ธ Return to running can begin ~ 6โ€“8ย weeks after surgery. โ„น๏ธ During this period, movement and muscle activation alterations are commonly observed during tasks, such as running. โ„น๏ธ This Systematic review looked at differences in movement and muscle activation for ACL-R and how it may affect running in: Short term (0โ€“6ย months). Mid-term (6โ€“12ย months). Long term (more than 12ย months). โ„น๏ธ This will help clinicians to optimize rehabilitation to improve outcomes and long-term disability after ACL-R. โœ…โœ… KEY HIGHLIGHTS: Running biomechanics alterations are reported from 3ย months to at least 5ย years after anterior cruciate ligament reconstruction (ACL-R). . โœ… Patellofemoral and tibiofemoral joint contact forces differed at least 2.5ย years after ACL-R. โœ… Sagittal plane knee mechanics are the most altered variables during running after ACL-R. . โœ… Targeted strengthening and neuromuscular training for Quadriceps and Hamstring asymmetries should be implemented to improve running biomechanics after ACL-R. ๐Ÿ“Š๐Ÿ“Š CONCLUSIONS: These deficits do not resolve with time and specific clinical interventions may be needed to reduce long-term disability. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ‘‡๐Ÿฝ๐Ÿ‘‡๐Ÿฝ๐Ÿ‘‡๐Ÿฝ What Quad & Glute exercises are best after ACL Surgery? ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ Exercise Examples from @grapplersperformance โœ…โœ…โœ… Online Programming Available ๐Ÿ’ป๐Ÿ“ฒ๐Ÿ’ฌ DM for more info! ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Pairotโ€‘deโ€‘Fontenay, Willy, et al. 2019. Sprt Med, 49:1411โ€“1424. #physicaltherapyresearch #acl #aclrecovery

25 Mar 2020

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๐Ÿ“š๐Ÿ”ฌ Upper Limb Rotation Test: Validity and Reliability โ„น๏ธโ„น๏ธ INTRO: Several risk factors exist for throwing-related shoulder injuries, such as: Glenohumeral Internal Rotation Deficit (GIRD). Reduced total range of motion. Scapular dyskinesia. External/internal rotation strength ratio imbalances. โ„น๏ธ Physical performance tests (PPTs) provide a a functional status of the athleteโ€™s upper extremity. โ„น๏ธ These PPTs are routinely used for: Injury prediction. Performance enhancement. Post-rehabilitation outcome measures. โ„น๏ธ Some PPTs have been developed for closed kinetic chain (CKC), such as: Closed Kinetic Chain Upper Extremity Stability Test (CKCUEST). - and - Open kinetic chain (OKC), such as: Seated medicine ball throw (SMBT). โ„น๏ธ Many PPTs currently used do not fully address specific requirements of overhead throwing, including: A combination of OKC, CKC and a trunk rotation as well as 90ยฐ/90ยฐ shoulder position . โ„น๏ธ To comply with this need, the Upper Limb Rotation Test (ULRT), may be better, as it includes: Weight bearing. Shoulder motor control and stability. Involves the entire kinetic chain. Places the shoulder in 90ยฐ/90ยฐ position. โ„น๏ธ Decleve et al. (2020) test 91 healthy adults to determine the reliability of the ULRT and examined the correlations with two widely used PPTs: CKCUEST SMBT - and . - 2 clinical measurements: Shoulder isometric rotational strength. Trunk rotational range of motion (SRT). โœ…โœ… MAIN FINDINGS: High relative reliability values and clinically acceptable absolute reliability values were found. โœ… The ULRT showed moderate correlations with the CKCUEST and SMBT. โœ… The ULRT is a good physical performance test of: OKC CKC Trunk rotation 90ยฐ/90ยฐ shoulder position. ๐Ÿ“Š๐Ÿ“Š CONCLUSIONS: Very high intra-session reliability. High reliability for test-retest. Clinically acceptable absolute reliability. ๐Ÿ“Š Moderately correlated with: CKCUEST and SMBT. ๐Ÿ“Š Poorly correlated with: Shoulder isometric rotational strength and SRT. . ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Decleve et al. 2020. The โ€œupper limb rotation testโ€: Reliability and validity. There in Sprt. #physicaltherapyresearch

24 Mar 2020

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๐Ÿ“š๐Ÿ”ฌ Covid-19 Living on Surfaces and Disinfecting โ„น๏ธโ„น๏ธ INTRO: โ„น๏ธ A novel coronavirus [Covid-19] has recently emerged and is a global health concern causing severe respiratory tract infections in humans. โ„น๏ธ With SARS and MERS coronaviruses, this is the third highly pathogenic human coronavirus that has emerged in the last two decades. โ„น๏ธ Person-to-person transmission has been described both in hospital and family settings. โ„น๏ธ It is therefore of utmost importance to prevent any further spread in the public and healthcare settings. โ„น๏ธ Kampf et al. (2020), summarized all available data (22 studies) on the persistence of all coronaviruses on different types of inanimate surfaces and on the efficacy of commonly used biocidal agents used in surface disinfectants against coronaviruses. โœ…โœ… KEY TAKEAWAYS: โœ… Coronaviruses can be transmitted from contaminated dry surfaces via touching mucous membranes of the nose, eyes or mouth. โœ… Human-to-human transmissions have incubation times between 2-10 days. โœ… Spreading is mainly facilitated via droplets (sneezing/coughing) and contaminated hands or surfaces. . โœ… Human coronaviruses such as: Severe Acute Respiratory Syndrome (SARS) . Middle East Respiratory Syndrome (MERS) . Endemic human coronaviruses (HCoV) . - Can persist on inanimate surfaces like metal, glass or plastic for up to 9 days. - But, can be inactivated within 1 minute by surface disinfection with: Ethanol (62-71%) Hydrogen peroxide (0.5%) Sodium hypochlorite (0.1%) โœ… Other biocidal agents are less effective, such as: Benzalkonium chloride (0.05-0.2% ) or Chlorhexidine digluconate (0.02%) . โœ… As no specific therapies are available for Covid-19, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Kampf, et al. 2020. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J. Hosp. Inf. 104(3), 246-251. #corona #physicaltherapyresearch #coronavirus

23 Mar 2020

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๐Ÿ“š๐Ÿ”ฌ Stability Training: Push-Ups โ„น๏ธโ„น๏ธ INTRO: Stability based exercises are common amongst training programs, especially for the shoulders. โ„น๏ธ Suspension training devices use body weight resistance and unstable support surfaces, which may facilitate muscle recruitment during push-up exercises. โ†—๏ธโ†—๏ธ OBJECTIVE:ย  The authors examined muscle recruitment with surface EMG on 4 shoulder and 4 torso muscles during: 1. Standard push-ups 2. Feet-suspended push-ups 3. Hands-suspended push-ups 4. Dual-instability push-ups (feet suspended and hands on unstable surface). โ†—๏ธ 32 healthy men and women were tested while performing 2 repetitions each of 4 variations of push-ups. โ†—๏ธโ†—๏ธ MAIN OUTCOME MEASURES:ย  Muscle recruitment among specific muscles were tested, including: โ†—๏ธ 4 Shoulder Muscles: - Anterior deltoid - Pectoralis major - Serratus anterior - Triceps brachii โ†—๏ธ 4 Torso Stabilizers: - External oblique - Internal oblique - Rectus abdominis - Upper erector spinae ๐Ÿ“Š๐Ÿ“Š RESULTS:ย  Muscle recruitment during suspended exercises was no greater than during standard push-ups for: Anterior deltoid Pectoralis major Serratus anterior . ๐Ÿ“Š However, torso stabilizer recruitment was significantly greater in the external oblique, internal oblique, and rectus abdominis during all 3 suspended exercises compared with standard push-ups. . ๐Ÿ“Š Dual-instability conditions did not generate greater levels of muscle activation compared with conditions of single instability. โœ…โœ… CONCLUSIONS:ย  Push-ups performed with suspension training systems may enhance core muscle training. . โœ… One unstable surface may be sufficient to challenge the athlete when performing push-up exercises to increase shoulder and/or torso muscle activation. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ‘‡๐Ÿฝ๐Ÿ‘‡๐Ÿฝ๐Ÿ‘‡๐Ÿฝ See exercise example videos @grapplersperformance . ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ Injury Holding you Back? Book a consultation Today ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ @grapplersperformance ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Youdas, et al. 2020. Recruitment of Shoulder Prime Movers and Torso Stabilizers During Push-Up Exercises Using a Suspension Training System,JOSPT. pp. 1-8.

10 Mar 2020

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๐Ÿ“š๐Ÿ”ฌ Best Glute Exercises: โ„น๏ธโ„น๏ธ Hip dysfunction has been associated with low back and various lower extremity pathologies. โ„น๏ธ Hip abduction and lateral rotation weakness has been associated with patellofemoral pain syndrome (PFPS). . โ„น๏ธ Ferber, Kendall, and Farr (2011) found that correcting the hip strength deficits improves lower extremity pain in runners. โ„น๏ธ Emerging data support the important role of the Glute Max and Glute Med during athletic endeavors, and a variety of strengthening exercises have been described. โ„น๏ธ Remain et al. 2012, reviewed the literature to describe which exercises maximize Glute Max and Glute Med activation, based on surface EMG. โ„น๏ธ [GMax] A powerful hip extensor and lateral rotator. โ„น๏ธ It is often used to accelerate the body upward and forward from a position of hip flexion ranging from 45ยฐ to 60ยฐ. โ„น๏ธ For example; Sprinting Squatting Climbing uphill Plant and cut maneuvers โ„น๏ธ [GMed] Stabilizes the femur and pelvis during weight-bearing activities, i.e. during the stance phase of gait. โ„น๏ธ Functionally, it generates an exceptional amount of force given its size. ๐Ÿ“Š๐Ÿ“Š RESULTS: % Maximal Voluntary Isometric Contraction ๐Ÿ“Š [Glute Max Top 5] . - Forward Step Up (74%) . - Single Leg Deadlift (59%) . - Single Leg Squat (59%) . - Wall Squat (59%) . - Retro Step-up (59%) ๐Ÿ“Š [Glute Med Top 5) . - Side Bridge to Neutral Spine (75%) . - Single Leg Squat (64%) . - Single Leg Deadlift (58%) . - Pelvic Drop (57%) . - Side Lying Hip Abduction (56%) โœ…โœ… CONCLUSIONS: Different exercises display a range of muscle contraction for the glutes. . โœ… Strength gains are expected for activation levels equal to or greater than 40% MVIC. โœ… Using exercises above 40% can be helpful when developing glute strength programming. . ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ‘‡๐Ÿฝ๐Ÿ‘‡๐Ÿฝ๐Ÿ‘‡๐Ÿฝ See exercise example videos @grapplersperformance . ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ Injury Holding you Back? Book a consultation Today ๐Ÿ”ฅ๐Ÿ”ฅ๐Ÿ”ฅ @grapplersperformance ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Reiman et al. 2012. Lit Review Eval GAmx and GMin Activation. Physiotherapy Theory and Practice, 28(4):257โ€“268, 2012.

25 Feb 2020

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๐Ÿ“š๐Ÿ”ฌ Whole Body Cryotherapy in Athletes โ„๏ธ . Full body exposure to dry air at temperatures lower than โˆ’110ยฐC has become widely popular in sports medicine to enhance recovery after injuries and to counteract inflammatory symptoms resulting from overuse or pathology โ„๏ธ A review by Lombardi et al. (2017), discusses technical aspects, physiological and functional parameters of whole body cryotherapy (WBC). ๐Ÿ“š FINDINGS SUMMARY: ๐Ÿ”ฌ Technical Aspects * Cooling efficiency and treatment effectiveness influenced by body composition. * Muscle and core temperatures seem to decrease in a similar way in response to both WBC & CWI * Maximum decrease in core temperature occurs 50โ€“60 min post-WBC. ๐Ÿ”ฌ Inflammatory markers * Induces anti-inflammatory effects. * Findings of effect on IL-6 are not always concordant, probably due to differences in exercise protocols. One session of WBC increases IL-6 concentration, while multiple sessions recover it to baseline. * Unknown whether combining training and cold therapy.has beneficial effects on athletes' performance ๐Ÿ’ฅ Muscle damage, fatigue recovery, and pain * Could limit the release of intracellular enzymes, but only after prolonged cycle of consecutive sessions. * Improvements in muscular tiredness, pain, and well-being after strenuous exercise reported in majority of studies. * Enhancement of muscular recovery depends on limitation of exercise-induced inflammatory response. ๐Ÿ’ฅ Performance recovery * Until further research is available, less expensive cooling modality could be used in order to gain the same physiological and clinical effects โ„๏ธ Exposure * The optimum exposure time is 30 s at โˆ’60ยฐC followed by 2 min at โˆ’135ยฐC * A single session is probably not sufficient to exert any significant effect. * 20 sessions minimum * 30 sessions optimum . ๐Ÿ”ฌ๐Ÿ”ฌ CONCLUSIONS: The majority of evidence supports effectiveness on inflammatory conditions that could affect an athlete. ๐Ÿ”ฌ A small number of studies did not report any positive effects ๐Ÿ”ฌ The scientific debate on WBC needs more research and consensus . ๐Ÿ“š๐Ÿ“š SOURCE: Lombardi, et al. (2017). Whole-Body Cryotherapy in Athletes: From Therapy to Stimulation. Front Physiol. (8), pp. 258.

17 Feb 2020

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๐Ÿ“š๐Ÿ”ฌ Chronic Ankle Instability: Strength Deficits โ„น๏ธโ„น๏ธ INTRODUCTION:ย  After ankle injury, some individuals develop chronic ankle instability and repetitively injure their ankle. โ„น๏ธ This can be a frustrating and debilitating problem for many athletes. โ„น๏ธ Understanding if specific strength deficits exist can guide and inform the rehab process to resolve chronic ankle instability. โ„น๏ธ Khalaj et al. (2020), systematically reviewed the literature to determine whether impairments in lower limb muscle strength exist in individuals with chronic ankle instability (CAI) compared with uninjured controls. ๐Ÿ“Š๐Ÿ“Š RESULTS:ย  12,397 unique studies identified. 20 included. 16 eligible for meta-analysis. . ๐Ÿ“Š Meta-analyses showed individuals with CAI (when compared to controls) had lower: Eccentric evertor strength Concentric evertor strength Eccentric invertor strength Concentric invertor strength Concentric knee extensor strength . ๐Ÿ“Š Ankle eccentric dorsiflexor strength was not different between groups. . ๐Ÿ“Š Although pooling was not possible, data from three separate studies indicated individuals with CAI (when compared to controls) had lower:: Hip flexor. Hip Abductor. Hip External rotator strength. ๐Ÿ“Š Hip adductor and extensor strength were not lower in individuals with CAI. โœ…โœ… CONCLUSION:ย  Individuals with CAI have ankle inversion and eversion strength deficits. . โœ… Differences exist between individuals with CAI and controls in hip and knee strength. . โœ… These elements of the kinetic chain should be evaluated by clinicians who rehabilitate individuals with CAI. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Khalajย N,ย Vicenzinoย B,ย Healesย LJ, et al. Is chronic ankle instability associated with impaired muscle strength? a systematic review with meta-analysis. BJSM. Online First:ย 14 January 2020. #physicaltherapyresearch

11 Feb 2020

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๐Ÿ“š๐Ÿ”ฌ Calf Muscle Tears and Return to Play Times โ„น๏ธโ„น๏ธ INTRODUCTION: โ„น๏ธ Cal injuries are common amongst athletes and the time required to return to play can vary depending on injury severity. โ„น๏ธ Understanding average return to play and healing times can help set realistic expectations for athletes and coaches and prevent re-injury if returning too soon. . โ†—๏ธโ†—๏ธ METHODS: Entwisle & Schneider, et al. (2018), assessed a group of patients with calf muscle tears and evaluated the integrity of the connective tissue. . โ†—๏ธ They also used MRI to determine injury severity and assess any correlation between the grading score and time to return to play. . . โ†—๏ธ 100 patients with clinical suspicion and MRI confirmation of calf muscle injury were evaluated. . โ†—๏ธ Each calf muscle tear was evaluated with MRI for: Particular muscle injured Location of injury Integrity of the connective tissue โ†—๏ธ The muscle tears were graded 0โ€“3 depending on the degree of muscle and connective tissue injury. . โ†—๏ธ Return to play for each patient was tracked. . ๐Ÿ“Š๐Ÿ“Š RESULTS: In 100 patients, 114 injuries were detected. . ๐Ÿ“Š Connective tissue involvement was observed in 63 out of 100 patients. . ๐Ÿ“Š 18 patients had Grade 3 Tears (Full Failure). ๐Ÿ“Š Mean time to return to play: Grade 0: 8 days Grade 1: 17 days Grade 2: 25 days Grade 3: 48 days โœ…โœ… CONCLUSION: The integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE:โ€จEntwisle & Schneider, et al. Connective tissue injury in calf muscle tears and return to play: MRI correlation. British Journal of Sports Medicineย 2018;52:929-933.

10 Feb 2020

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๐Ÿ“š๐Ÿ”ฌ 10 Facts To Know About Back Pain โ„น๏ธโ„น๏ธ Low Back Pain (LBP) is a leading cause of disability worldwide! โ„น๏ธ There are many myths around LBP. โ„น๏ธ Accurate knowledge around back pain can help to manage pain, disability, days off work, and the rehab process. . โŒโŒโŒโŒ 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 โ€˜wear and tearโ€™ 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. โœ…โœ…โœ…โœ… 10 Helpful FACTS! 1. LBP is not a serious life threatening medical condition. 2. Most episodes of LBP improve and doesnโ€™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. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Oโ€™Sullivanย PB, Caneiroย JP, Oโ€™Sullivanย K, etย al. Br J Sports Med Epub ahead of print: [please include Day Month Year]. doi:1

08 Jan 2020

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๐Ÿ“š๐Ÿ”ฌ Safety of Blood Flow Restriction Training โ„น๏ธโ„น๏ธ INTRO: Blood flow restriction training (BFRT) partially restricts arterial blood flow into the muscle while venous outflow is occluded during exercise. โ„น๏ธ Substantial strength gains can be elicited with lighter loads versus heavy resistance training. โ„น๏ธ Current research has investigated a wide array of BFRT protocols and variables. โ„น๏ธ To address varying advice and guidelines, some research has synthesized best evidence around standardized protocols. โ„น๏ธ The use of BFRT during aerobic training and Resistance Training can be effective to increase muscle strength and size. โ„น๏ธ The physiological mechanisms behind these muscle adaptations include: Acute muscle cell swelling. Increased fiber-type recruitment. Decreased myostatin. Decreased atrogenes. Satellite cell proliferation. โ„น๏ธ It is also important to consider the safety of BFRT. โ„น๏ธ The issue of safety remains inconclusive and inconsistently reported. โ„น๏ธ Given the conflicting literature and lack of a validated, standardized protocol, the consensus on safety of BFRT use in a clinical population is unknown. โ„น๏ธ Minniti et al. (2019) assessed the potential adverse events associated with BFRT. ๐Ÿ“Š๐Ÿ“Š RESULTS: 19 studies were eligible. . ๐Ÿ“Š Injuries included: Various knee-related disorders Inclusion body myositis Polymyositis Dermatomyositis Thoracic outlet syndrome Achilles tendon rupture Bony fractures. . ๐Ÿ“Š Reports Included: No adverse events (9 Studies) ๐Ÿ“Š Rare adverse events (3 Studies) - [Upper lImb DVT and rhabdomyolysis]. . ๐Ÿ“Š Common adverse events (3 Studies). - [Acute muscle pain and fatigue]. ๐Ÿ“Š BFRT was not more likely to cause adverse event vs normal exercise alone. . โœ…โœ… CONCLUSIONS: BFRT appears to be a safe strengthening approach. โœ… Improved definitions of adverse events related to BFRT are needed to include clear criteria for differentiating among common, uncommon, and rare adverse events. . โœ… Effective screening for those at risk for rare adverse events is needed. . ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Minniti et al. 2019. Safety of BFRT as a Therapeutic Intervention. The American Journal of Sports Medicine 1โ€“13.

06 Dec 2019

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๐Ÿ“š๐Ÿ”ฌ Elite Athletes: ACL Reconstruction Return to Sport โ„น๏ธโ„น๏ธ INTRO: Athletesโ€™ who sustain ACL ruptures commonly get a reconstruction to facilitate return to sport. โ„น๏ธ However, some research suggests only 60% of non-elite athletes returned to their pre-injury level of sport after ACL reconstruction. โ„น๏ธ Elite athletes may have a greater chance of returning to sport following ACL reconstruction compared with non-elite athletes. โ„น๏ธ 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. โ„น๏ธ Secondary aims included: Assessing how long to return to sport. Rate of ACL graft re-rupture. โ„น๏ธ 24 studies, totaling 1272 elite athletes, met inclusion criteria and were included. . ๐Ÿ“Š๐Ÿ“Š RESULTS: ๐Ÿ“Š 83% of elite-athletes returned to their previous sport following ACL reconstruction. ๐Ÿ“Š 5.2% of the ACL grafts re-ruptured. ๐Ÿ“Š 6 to 13 months was the average time taken to return to sport. ๐Ÿ“Š This is less time than previously been reported among non-elite athletes. . ๐Ÿ“Š Although athletic performance often deteriorated compared with pre-injury levels, generally it remained comparable with elite athletes who had not sustained an ACL injury. โœ…โœ… CONCLUSIONS: These results may be used by athletes and their treating clinicians to guide realistic expectations. ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š SOURCE: Laiย CCH, Ardernย CL, Fellerย JA, etย al. Br J Sports Med 2018;52:128โ€“138.

25 Nov 2019

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๐Ÿ“š๐Ÿ”ฌ Hip Replacement After Sports Injuries โ„น๏ธโ„น๏ธ INTRO: Knee OA and sport injuries have been linked to higher likelihood of Knee Replacement. โ„น๏ธ The link between sports injury and hip replacement (HR) for OA is not clear. โ„น๏ธ Moderate to strong evidence suggests high- intensity sporting activity is a risk factor for hip OA. โ„น๏ธ Ackerman et al. (2020), aimed to: Quantify the likelihood of Hip Replacement within 10-15 years after sports-related hip or thigh injury.โ€จโ†—๏ธโ†—๏ธ METHODS: Tracking Hospital Admissions and Injury Coding sets from 2000-2005 across the 6.4 million people in Victoria Australia. ๐Ÿ“Š๐Ÿ“Š RESULTS: 64,750 sports injuries occurred. ๐Ÿ“Š Of these, 815 hip/thigh musculoskeletal injuries. 49% (age 20-29) 23% (age 30-39) 77% Males ๐Ÿ“Š 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%) ๐Ÿ“Š Of thee 815 Hip injuries, 42 received Hip Replacements. ๐Ÿ“Š 82% that received HR, had a diagnosis consistent with hip OA. ๐Ÿ“Š Median time was 5.3 years (0.3-14), from Injury to HR. ๐Ÿ“Š Compared to all other sports injuries, having a hip or thigh injury tripled the hazard of subsequent Hip Replacement. ๐Ÿ“Š Main hip or thigh injury types significantly associated with HR: Femoral fractures Hip dislocations ๐Ÿ“Š Soft tissue/repeat injuries were not associated with an increased likelihood of HR. โœ…โœ… CONCLUSIONS: Sports-related hip or thigh musculoskeletal injury is associated with a significantly higher likelihood of HR within 15 years. . โœ… Effective injury prevention and management are needed to curtail this population burden. . ๐Ÿง ๐Ÿง  Thoughts? Questions? Comments? ๐Ÿง  Write them below. . ๐Ÿ“š๐Ÿ“š๐Ÿ“š 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.

20 Nov 2019