Physical Therapy Research

🔬📚
Anatomical risk factors of lateral ankle sprain
ℹ️ℹ️
INTRO:
Lateral ankle sprains (LAS) are the most common musculoskeletal injuries, accounting for about 10%-30% of all athletic injuries.
ℹ️
LAS can have serious consequences for the injured athletes in terms of treatment costs and time lost from the sport.
ℹ️
Up to 70% of cases are persistent and can lead to post-traumatic ankle arthritis.
ℹ️
The highest rate of ankle sprain usually occurs in sports that involve running, cutting, and jumping.
ℹ️
Understanding what increases risk of ankle sprain could improve effective prevention and rehab measures.
ℹ️
Saki et al. (2021) determined the risk of non contact ankle sprains in athletes based on:
Previous ankle sprain history.
Q angle [A].
Knee recurvatum [B].
Navicular drop [C].
Tibia vara [D].
Tibia torsion [E].
Ankle ROM [F].
🔑🔑
METHODS:
152 adolescent male athletes assessed during preseason for 7 risk factors listed above.
🔑
LASs were prospectively recorded and diagnosed for two consecutive seasons (20 months).
📊📊
RESULTS:
34 LASs reported (22.37%).
📊
Logistic regression revealed 3 significant intrinsic predictors of LAS:
Previous ankle sprain history.
Navicular drop.
Knee recurvatum.
📊
None of the other variables were identified as significant risk factors.
📊
Receiver operating characteristic (ROC) analyses revealed predictive potentials:
Previous ankle sprain history [0.706]. Navicular drop [0.906].
Knee recurvatum [0.724].
✅✅
CONCLUSIONS:
Athletes with previous ankle sprain history, knee recurvatum, and especially navicular drop may have a greater risk of LAS injury.
📚📚📚
SOURCE:
Saki et al. 2021. Anatomical risk factors of lateral ankle sprain in adolescent athletes: Aprospective cohort study. PT in Sport. 48(2021), pp.26-34.

🔬📚
SLAP Tears
💭
SLAP tear refers to a specific injury of the superior portion of the Glenoid labrum extending from anterior to posterior in a curved fashion. .
💭
These tears are common in overhead throwing athletes and laborers involved in overhead activities.
💭
SLAP tears are caused by forceful eccentric traction exerted on the biceps tendon
🗓🗓
HISTORY:
Symptoms typically include:
Anterior shoulder pain.
Episodic clicking, particularly in the cocking position of throwing.
Decline in function or throwing velocity.
🗓
Acute trauma cases may involve falling onto an outstretched arm or sudden traction of the arm, while lifting a heavy object with a sudden jerking motion.
🔍🔍
EXAM:
Motion, strength, and basic neurovascular function should be assessed. .
🔍
The proximal biceps tendon should be palpated; focal tenderness suggests tendon injury. .
🔍
Recommended tests for SLAP tears include:
Anterior glide test
Compression rotation test
Active compression (O’Brien’s) test
Crank test
Speeds test .
🔍
SLAP tears are frequently accompanied by other shoulder pathology.
💢💢
DIAGNOSIS:
Definitive diagnosis of a SLAP tear requires arthroscopy or MRA
💢
Clinical diagnosis is often adequate if:
Patient is not a good surgical candidate.

Other differential diagnoses ruled out by examination and ultrasound.
🚫🚫
DIFFERENTIAL DIAGNOSIS:
Rotator cuff tear.
tendinopathy.
Shoulder impingement.
Biceps tendon.
👐🏼👐🏼
MANAGEMENT:
Most cases require orthopedic referral.
👐🏼
Refraining from advanced imaging is important in patients unlikely to be suitable surgical candidates.
👐🏼
The management of SLAP tears depends upon patient age and activity, and the type of tear.
👐🏼
Nonoperative management is preferred given the 6-12 month recovery following surgical repair.

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SOURCE:
Up To Date article. 2017. Superior labrum anterior posterior (SLAP) tears.

📚🔬
Toe Strength and Balance in 60’s +
ℹ️ℹ️
INTRO:
The substantial role of large muscle groups in balance is recognized, such as:
Trunk.
Hips.
Knees.
Ankles.
ℹ️
However, significance of the toe flexor muscles is less well understood.
ℹ️
10 toe flexor muscles contribute to motion of the foot.
ℹ️
Extrinsics:
Flexor digitorum longus.
Flexor hallucis longus.
ℹ️
Intrinsics:
Abductor hallucis
Adductor hallucis
Flexor hallucis brevis.
Flexor digitorum brevis.
Flexor digiti minimi brevis.
Lumbricals.
Interossei.
Quadratus plantae.
ℹ️
Poor toe flexor muscle strength has been implicated in:
Poor postural balance.
Injury risk.
ℹ️
Quinlan et al. (2020), systematically reviewed the research to establish if toe flexor strength related to static and dynamic balance.
📊📊
RESULTS:
9 studies with over 2200 participants met inclusion criteria.
📊
In each study, participants were over sixty years of age, and over 73 % of them were female.
📊
All studies showed direct, proportional, and significant correlations between toe flexor strength and postural balance.
✅✅
CLINICAL SIGNIFICANCE:
Toe flexor strength contributes to improved postural balance for people over the age of 60.
✅
Including specific Toe Flexor Exercises into workouts can have a positive effect on balance
‼️
LIMITATIONS:
No study was found/included for a younger population group.
‼️
Primarily observational studies.
🧠🧠
Thoughts? Questions? Comments?
👇🏽
Write them below. .


📚📚📚
SOURCE:
Quinlan et al. 2020. The evidence for improving balance by strengthening the toe flexor muscles: A systematic review. Gait and Posture, 81, pp. 55-56.

📚🔬
Traction Treatment for Carpal Tunnel Syndrome (CTS)
1️⃣1️⃣
INTRO:
CTS is a compressive disorder in which the nerves are compressed in the carpal tunnel.
1️⃣
This typically leads to numbness and pain, especially in the first three fingers, worsening at night.
1️⃣
Treatment options are either surgical or non-surgical.
1️⃣
Positive surgical outcomes range from 70-80%, however a promising non-surgical treatment for CTS is mechanical wrist traction.
1️⃣
Seems et al. (2017), evaluated the impact of mechanical traction in patients with CTS compared to usual care to avoid surgery.
1️⃣
The main clinical outcome of the study was surgery for carpal tunnel release during 6 months’ follow-up.
⏱⏱
METHODS:
⏱
181 Adults with confirmed CTS participated
All randomized to either:
Intervention group (12 treatments 2x/wk for 6wk; mechanical traction)
Care as usual.
🔑🔑
KEY FINDINGS:
Surgeries Required:
Intervention group (28%)
Care-as-usual group (43%)
🔑
At 6 months:
Symptom severity and functional status scores significantly improved in both groups.
Improvements did not differ between the two groups.
✅✅
MAIN TAKEAWAYS:
✅
Treatment of CTS by means of mechanical traction can possibly prevent progression of symptoms requiring surgery within 6 months in CTS patients.
✅
Because up to 30% of patients who received surgery report (new) CTS symptoms at longer follow-up (1 to 2 years), a longer period of observation is needed to compare the long-term effect of mechanical traction to care as usual (including surgery).
✅
Traction may improve blood microcirculation, reduces edema in the synovial tissue and, therefore, reduces pressure in the carpal tunnel
✅
This approach may result in a substantial reduction in the number of surgeries with similar patient-reported symptoms.
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📚📚📚
SOURCE:
Seems et al. 2017. Mechanical wrist traction as a non-invasive treatment for carpal tunnel syndrome. Trials 18:464.

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🔬📚
Ice for Ankle Sprains?
ℹ️ℹ️
INTRO:
Some documented treatment options after an acute ankle sprains include:
Cryotherapy.
Surgical treatment.
Joint mobilization.
Kinesiotherapy.
Bracing.
Acupuncture.
And many others.
ℹ️
Cryotherapy has often been recommended by clinical practice guidelines and used by health professionals in acute ankle sprain management because it has low cost, easy application, and is considered potentially effective in clinical practice settings.
ℹ️
However, current evidence supporting cryotherapy is still unclear.
ℹ️
Previous systematic reviews (1,2,3 sources below):
Included trials without appropriate comparators (i.e., placebo, sham, waiting list or no intervention).
Failed to investigate whether cryotherapy enhances effects of other treatments (i.e. cryo + exercise).
ℹ️
Thus, a new systematic review is necessary to investigate effectiveness of cryotherapy in the management of acute ankle sprains.
ℹ️
Miranda et al. (2021) investigated the effectiveness of cryotherapy for acute ankle sprains on:
Pain intensity.
Swelling.
Range of motion.
Function.
Recurrence.
📊📊
RESULTS:
377 articles were found.
134 duplicates were removed.
19 potential full texts were assessed.
👇🏽
2 RCTs with high risk of bias met inclusion criteria.
📊
Neither evaluated the effectiveness of cryotherapy compared with placebo, sham, waiting list or no intervention.
📊
Uncertain evidence showed cryotherapy does not enhance effects of other interventions on:
Swelling.
Pain intensity.
Range of motion.
✅✅
CONCLUSIONS:
Current literature lacks evidence supporting the use of cryotherapy on management of acute ankle sprain.
✅
High-quality RCTs are needed.

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SOURCE:
Miranda et al. 2021. Effectiveness of cryotherapy…Pt in Sport. (49), pp. 243-249.
📚
Noted Systematic Reviews
1: Bleakley, McDonough, & MacAuley, 2004
2:Van den Bekerom et al., 2012
3: Doherty et al., 2017

📚🔬
Balance & Strength Training to Improve Chronic Ankle Instability
1️⃣1️⃣
INTRO:
Lateral ankle sprains most prevalent musculoskeletal injuries in sport.
1️⃣
Without appropriate rehab, risk increases for chronic ankle instability (CAI), and osteoarthritis (OA).
1️⃣
Prolonged symptoms of CAI include pain, weakness, or instability, which can lead to range-of-motion (ROM), strength, balance, and functional performance deficits.
1️⃣
Hall et al. (2018) determined if balance- and strength-training protocols would improve the strength, balance, and functional performance deficits associated with CAI.
📊📊
METHODS:
39 volunteers with CAI, 3 groups, all completed 20-minute sessions, 3x/week, for 6 weeks:
Balance-training protocol
Strength-training protocol
Control
🔑🔑
KEY FINDINGS:
🔑
Time-by-group interactions were found in:
Concentric & eccentric inversion
Eccentric eversion
Concentric & eccentric plantar flexion
Balance Error Scoring System (BESS)
Star Excusrion Balance Test (SEBT)
Side hops
🔑
Improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop.
🔑
Only the strength-training protocol group improved in eccentric eversion.
🔑
The control group did not improve in any dependent variable
✅✅
MAIN TAKEAWAYS:
✅
The balance- and strength-training groups improved their strength, balance, and functional performance.
✅
The control group did not improve, suggesting that bicycling alone or increasing passive motion did not improve strength, balance, and functional performance.
✅
Combining resistance-band and proprioceptive neuromuscular facilitation strength training was an effective intervention.
✅
More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with chronic ankle instability.
📚📚📚
SOURCE:
Hall et al. 2018. Balance- and Strength-Training Protocols to Improve CAI. Journal of Athletic Training 2018;53(6):568–577.

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📚🔬
Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)
[SERIES] 5/5
ℹ️ℹ️
FLEXIBILITY & MOBILITY
ℹ️
Flexibility and mobility exercises should not elicit pain and should be performed at least 1 to 2 times per day.
ℹ️
Static stretches should be held for 15 to 30 seconds.
ℹ️
Static stretching, myofascial release using lacrosse balls and foam rollers, and self-mobilization techniques can improve flexibility and mobility in all of the hip and lower extremity muscles.
❗️
Dynamic drills should be performed within a painfree ROM with proper posture, such as:
Internal and external hip rotation.
Pendulum swings.
Kickers.
Traveling lunges.
❗️
Flexibility of the lower extremity muscles can be evaluated using:
Thomas test.
Ober test.
Hamstring Flexibility test.
Hip External Rotation test.
❗️
Patients who pursue nonoperative approaches often have the same goals as patients who choose surgery: to return to the preinjury or sport-performance level.
❗️
In 6 weeks, some successful outcomes could include:
Pain levels at 0 - 2/10 with repetitive transitions from supine to sitting and sitting to standing.
Able to walk on varied terrain.
Jog for at least 30 minutes.
Complete sport-specific tasks that involve cutting, jumping, and pivoting.
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SOURCES:
Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training 2020;55(11):000–000

📚🔬
Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)
[SERIES] 4/5

HIP STRENGTH & MOTOR CONTROL
ℹ️ℹ️
Hip-abductor weakness is often present in patients with FAIS.
ℹ️
3 primary hip abductors include:
Gluteus maximus, minimus, and medius.
ℹ️
The tensor fascia-lata functions as an abductor, but has strong internal-rotation capabilities.
ℹ️
More internal rotation tends to increase the symptoms of FAIS.
📊
Restoring gluteal strength can start with floor exercises, such as:
Side-lying hip abduction.
Clamshells.
Bridging variations.
📊
Progress to standing and dynamic exercises that increase both strength and motor control, i.e.
Side stepping with a resistance band positioned at the feet.
📊
Progress to unilateral tasks, such as:
📊
Step-downs in multiple planes.
📊
Clinicians should monitor pelvic control during the advance to dynamic activities.
📊
Variations, help the patient achieve strength and motor control, such as:
Reverse lunges with front tap.
Ipsilateral Romanian deadlift with a dowel rod.
Lateral step-down with heel hovers.
📊
Complete 3 sets of 10 repetitions, 3 to 4 days per week.
Medicine balls, kettlebells, or dumbbells can be added to promote hip strength and motor control.
✅✅

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Flexibility and Mobility Exercises
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SOURCES:
Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training 2020;55(11):000–000.

📚🔬
Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)
[SERIES] 3/5
✅✅✅
CORE STABILIZATION:
ℹ️ℹ️
Teaching patients to improve core stabilization is another key intervention, as it is the fulcrum of the functional kinetic chain.
ℹ️
Recruitment of the ‘core’ stabilizes the abdomen and lumbar spine and facilitates movement of the extremities and spine.
ℹ️
Early stages should involve work in the supine position to coordinate breathing with abdominal drawing or hollowing, similar to the postural exercise focus.
ℹ️
Quadruped bird-dog
Supine dead- bug
exercises offer challenges to core stabilization.
ℹ️
The Watkins-Randall exercise progression provides a continuum for the dead-bug exercise.
ℹ️
Next, upper or lower extremity motion can be sequentially added before advanced variations of simultaneous upper and lower extremity motion are implemented.
ℹ️
prone and side-plank variations challenge core stabilization.
ℹ️
Next, progress to rotational exercises from seated, kneeling, and standing postures.
ℹ️
Using a nonoperative protocol, patients demonstrated improved core strength and endurance when they achieved a score of 4/5 on the double straight-legged raise test and maintained neutral alignment for 60 seconds while in a prone plank.
ℹ️
A timed side plank has also been used to assess patient progress.
ℹ️
In the coming posts, more advanced progressions and exercises will be featured, including
✅✅
Hip Strength & Motor Control Exercises
Flexibility and Mobility Exercises
↗️↗️↗️

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SOURCES:
Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training 2020;55(11):000–000.

📚🔬
Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)
[SERIES] 2/5
ℹ️ℹ️
Postural exercises are used to teach the patient to improve body awareness.
ℹ️
Neutral posture can reduce compensation patterns.
ℹ️
If swayback posture is present with anterior pelvic tilt, it might further contribute to FAI symptoms.
👇🏽👇🏽
Common Symptoms include:
Clicking
Catching
Locking
Restricting
Stiffening of the hip with movement
💪🏾💪🏾
POSTURAL EXERCISES:
✅
Initial Exercises:
Floor anterior and posterior pelvic-floor tilts.
[Achieve neutral pelvic alignment and improve awareness of pelvic tilt; 50 reps]
✅
Progression #1
Quadrupled lumbar flexion and extension
[Achieve neutral pelvic alignment and improve awareness of pelvic tilt; 50 reps]
✅
Progressions #2
Seated pelvic-girdle tilts, on chair or exercise ball.
[Achieve neutral pelvic alignment and improve awareness of pelvic tilt; 50 reps].
✅
Progression #3
Standing pelvic-girdle tilts.
[Achieve neutral alignment and awareness of pelvic tilt; 50 reps]
🔻🔻
NEXT UP:
In the coming posts, more advanced progressions and exercises will be featured, including:
✅✅
Core Stabilization Exercises
Hip Strength & Motor Control Exercises
Flexibility and Mobility Exercises
↗️↗️↗️

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Find the Full-Text in my Free Dropbox
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Link in Highlights
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📚📚📚
SOURCES:
Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training 2020;55(11):000–000.

📚🔬
Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)
[SERIES]
ℹ️ℹ️
INTRO:
FAI syndrome is caused by premature contact of the femur and acetabulum during hip motion.
ℹ️
The 2 classifications of FAIS are cam and pincer impingement.
ℹ️
Aspherical deformation of the femoral head occurs with cam deformity, whereas pincer deformity presents with excessive prominence of the outer rim of the acetabulum.
ℹ️
Nonoperative rehab protocols include 4 central goals:
Postural positioning.
Core strength,
Hip strength and motor control,
Functional range of motion.
ℹ️
Effective rehab relies on the practitioner’s ability to individualize programming to specific desired outcomes.
ℹ️
Terrell et al. (2020), presented an overview of FAI, including a common protocol for FAI rehab.
ℹ️
In the coming posts, example progressions and exercises will be featured, including:
✅✅
Postural Exercises
Core Stabilization Exercises
Hip Strength & Motor Control Exercises
Flexibility and Mobility Exercises
↗️↗️↗️

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Find the Full-Text in my Free Dropbox
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Link in Highlights
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📚📚📚
SOURCES:
Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training

📚🔬
UNDERSTANDING TENNIS ELBOW SERIES
ℹ️ℹ️
(5/5): CONCLUSIONS
✅
Tennis Elbow or Lateral Epicondylitis is a common cause of pain and disability affecting a broad range of patients.
✅
Most cases have a self-limiting course of between 12 and 18 months.
✅
However, symptoms can be persistent and refractory, thus needing interventional measures.
✅
Nonoperative treatment remains the priority and mainstay for LE.
✅
Most cases can be well treated with multiple nonoperative treatments, with as high as 90% success rate.
✅
These treatment should mainly revolve around progressive overload based exercises for the affected tendon(s), musculature, and other soft tissue.
✅
See a Physical Therapist or other exercise based healthcare provider for an accurate assessment and tailored treatment plan.
✅
When nonoperative treatment fails, 3 surgical interventions can be recommended for patients with lateral LE, including open, percutaneous, and arthroscopic approaches.
✅
Similarly, no conclusions on the effectiveness of surgical interventions can be reached mainly due to a lack of high-quality evidence and inconsistent outcome measures.
↗️↗️↗️

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Link in Highlights
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📚📚📚
SOURCES:
Ma and Wang, 2020. Management of Lateral Epicondylitis: A Narrative Literature Review. Pain & Research Mngmt. doi.org/10.1155/2020/6965381https

📚🔬
UNDERSTANDING TENNIS ELBOW SERIES
ℹ️ℹ️
(4/5): TREATMENT
ℹ️
A variety of treatment options have been recommended for LE.
ℹ️
Treatment usually has 5 therapeutic goals:
Control pain.
Preserve movement.
Improve grip strength and endurance.
Restore normal function.
Preventing further deterioration.
💪🏽💪🏽
NONOPERATIVE:
Resolves 90% of cases.
💪🏽
Includes:
Activity modification.
Physical Therapy (Progressive Overloading exercises).
NSAIDS.
Counter Force Bracing.
ECSWT.
Acupuncture.
💪🏽
With a promising result, biotherapy method has been very popular in recent years, including autologous blood injections (ABI) and platelet-rich plasma injections (PRP).
💪🏽
Recently, eccentric exercise (EE) has gradually been a first-line conservative treatment for LE.
💪🏽
Acupuncture has conflicting results in the literature as to it’s effectiveness.
💪🏽
Autologous Blood Injection has been proved effective and widely used for treatment of LE in the short term.
👌🏽
Platelet-Rich Plasma has gained popularity in recent years in the treatment for LE and available studies have reported conflicting results, which make it difficult to draw clear conclusions on PRP for LE.
🔪🔪
OPERATIVE TREATMENT:
Surgical intervention can be an option for patients with persistent pain and disability that have failed appropriate nonoperative management.
🔪
The number of patients requiring surgical treatment is estimated about 4% to 11%.
🔪
There are mainly 3 surgical approaches:
Open.
Percutaneous.
Arthroscopic techniques.
🔪
The surgical focus is to debride the degenerated portion of the ECRB with or without repairing the ECRB tendon.
🔪
Evidence in the literature indicates fair to good results for these procedures, presenting surgeons with many options for treatment.
🔪
Elbow arthroscopy has been used with quick return to work time and the ability to treat the potential intra-articular pathology through visualization of the entire elbow joint.
✅✅
NEXT UP
5️⃣Conclusions
↗️↗️↗️

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Link in Highlights
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SOURCES:
Ma and Wang, 2020