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Untold Physio Stories - I Think It's Time We See Other Clinicians - themanualtherapist.com


In this episode, we have an update about the Rotated Pelvis Placebo or Nocebo case. She is doing very well despite tons of unbelievable Nocebo from her previous clinicians. She has been reluctant to let them go, but we think it's time she broke up with them!


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What Is Nautical Vertigo? - themanualtherapist.com


Vertigo is a sense of movement or rotation of the patient’s own or an external object.

When most people think vertigo, the most common diagnosis is benign paroxysmal positional vertigo (BPPV). This is long for BPPV and the same condition as when people think of crystals being out of place.

Most patients with BPPV report vertigo-like episodes when lying down, extending their head or neck, sitting up from a supine position, and bending over.

Another type of vertigo is nautical vertigo.

Nautical vertigo is defined as a sensory illusion reminding of movements experienced on board a ship in waves. It is not nearly as common and quite frankly, very limited information is out on this type of vertigo.

With that said, many patients may experience nautical vertigo instead of the typical symptoms of BPPV even though BPPV is much more prevalent.

In fact, an observational study in 2013 found nautical vertigo and dizziness are more common than rotatory vertigo in patients with chronic BPPV.

This could be due to individuals who suffer from vertigo can also have neck pain, headache, widespread pain, fatigue, visual disturbances, cognitive dysfunctions, nausea, and tinnitus. The combination of several symptoms, especially if chronic, can present differently.

The treatment for this type of vertigo does not always respond favorably to canalith repositioning procedures. Nautical vertigo will need more than cervical therapy too.

Individuals will most likely need more vestibular rehabilitation, sensorimotor training and cervical spine treatment as a more comprehensive approach. This is part of our Physio Blend for Cervicogenic Dizziness Treatment. Therefore, it can help more than those with just Cervicogenic Dizziness but those too with nautical vertigo.

CERVICOGENIC DIZZINESS COURSES AND CERVICAL VERTIGO COURSES


You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the authors (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 harrisonvaughanpt@gmail.com for prices and discounts.


Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT


Danielle N. Vaughan, PT, DPT, Vestibular Specialist

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Autism and the Gut Biome: What Pediatric PTs Need to Know - themanualtherapist.com


By Dr. Sean M. Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DN

Autism is a condition that affects nearly 1 in 50 children. Covering a wide spectrum of symptoms, autism is often associated with delayed milestones, difficulty socializing, and/or sensitivity to sensory stimuli. The main cause of autism still remains to be seen; however, there is compelling evidence that individuals with autism have a markedly different gut microbiome compared to normally developed children. Such thinking has lead to alternative therapies and treatments, which many parents may pursue to help their child improve their autism symptoms. Fortunately, data from a recent study in Cell sheds light on the gut biome differences and how some alternative therapies may not ideal.

Chloe Yap from Mater Research and The University of Queensland said the team examined genetic material from the stool samples of 247 children, which included 99 children diagnosed with autism. After examining the diet and stool samples the researchers did not find a clear link between the gut biome and autism spectrum disorders (ASD). Yap commented that, "We found that children with an autism diagnosis tended to be pickier eaters, which led them to have a less-diverse microbiome, which in turn was linked to more-watery stools." In essence, their data suggests that behavior and dietary preferences affect the microbiome, not the other way around. 

What may drive the "picky" eating? Well, physios, occupational therapists, and dieticians all know how children with autism may restrict their diet due sensory sensitivities and restricted and repetitive interests. Some children with ASD may have strong preferences for a select few foods, while others find some aromas, tastes, or textures unpleasant or alarming. As such, the sensitivities may restrict their food variety, which in turn reduces their gut biome diversity. Check out this diagram from the Yap et al 2021 article:

gYcXE18iTC6CBwk4gemn_Screenshot_2021-11-15_2.44.34_PM.png

The significance of these findings is profound for those with ASD and for Doctors of Physical Therapy (DPT). Many parents are willing to trial alternative therapies like extreme diets, probiotics, and even fecal transplant in hopes to reduce the symptoms of ASD. Unfortunately most of these therapies are costly, not evidenced-based, and could potentiate harm. As such PTs need to educate family members and parents that such fad therapies are not effective and may actually cause harm. Moreover, it is important for physios to understand that children with ASD have sensory issues around food. Identifying such sensitivities and becoming creative with food choices may be vital to ensuring a child with ASD consumes are varied diet. Consulting and working with OTs and dieticians are also great options for DPTs to consider when meal planning for children with ASD.

In the end, pediatric physical therapists (PTs) are vitally important in the care and management of children with autism. Understanding the literature in regards to the gut biome, fad therapies, and sensory issues are key to managing these little guys the best way!

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!


Now certified in 39 states for CEUs and counting - the remaining states we give you everything you need to get your CEUs!

 

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[RESEARCH] Symptoms of Lumbar Spinal Stenosis in People With Knee or Hip Osteoarthritis or Low Back Pain - themanualtherapist.com

Goal of the Study?

In this exploratory cross-sectional study pre-proof article (prior to publication) to be published in the Journal of Osteoarthritis and Cartilage 1 the authors’ goals were twofold:

Report on the proportion of patients in a Danish OsteoArthritis (OA) primary care program that had knee OA, hip OA and persistent Lower Back Pain (LBP).

Identify what proportion of these 3 categories also had symptoms associated with Lumbar Spinal Stenosis (LSS)

Why are they doing this study?

Musculoskeletal comorbidities are common in people with back pain and OsteoArthritis (OA) and associated with increased disability. Musculoskeletal comorbidities are also present in people with Lumbar Spinal Stenosis (LSS), a disabling low back condition primarily affecting older people. Evidence suggests that LSS and knee and hip OA often occur. In one Canadian study, 77% of patients undergoing surgical decompression for LSS reported knee and hip OA. In a US study, clinically defined knee and hip OA was reported in 32% and 17% of LSS patients. However, it is not known if symptoms associated with LSS are common in people with knee and hip OA in primary care programs.

A total of 11,125 people with a primary complaint of persistent lower back pain and/or knee or hip OA from a registered in a Danish group-based education and exercise program called Good Life with osteoArthritis in Denmark (GLA:D®), were given a questionnaire to identify the symptoms of LSS. Two sets of clinical criteria were used to build the self-reporting questionnaire; Tomkins-Lane Criteria and the Genevay Criteria. Both these LSS classification tools use clustering of symptoms of leg and buttock pain during a series of activities to define the level of LSS.


What was done?


A total of 11,125 people with a primary complaint of persistent lower back pain and/or knee or hip OA from a registered in a Danish group-based education and exercise program called Good Life with osteoArthritis in Denmark (GLA:D®), were given a questionnaire to identify the symptoms of LSS. Two sets of clinical criteria were used to build the self-reporting questionnaire; Tomkins-Lane Criteria and the Genevay Criteria. Both these LSS classification tools use clustering of symptoms of leg and buttock pain during a series of activities to define the level of LSS.


What did they find?

Despite the high prevalence of LSS symptoms in the 10,234 GLA:D patients surveyed, less than 10% were considered to have LSS by either the Tomkins-Lane or Geneway classification criteria. When looking at the individual symptoms the prevalence of self-reported LSS symptoms varied greatly between the three cohorts; Knee OA, Hip OA and persistent LBP. LSS symptoms of transient pain or numbness associated with the lower extremity items were found in 71% of patients with persistent LBP versus 50% for hip OA and 40% for knee OA. This pattern was observed for all LSS symptoms except for numbness in the soles of both feet. Only 10-11% of all three cohorts had this LSS symptom.

Why do these findings matter?


Self-reported LSS symptoms are commonly reported by people treated in primary care for hip or knee OA, although not as frequently as those with persistent LBP. Despite symptoms of LSS being common, only a small percentage actually meet the Tomkins-Lane and/or Geneway clinical LSS threshold.

Symptoms of lumbar spinal stenosis in people with knee or hip osteoarthritis or low back pain: a cross-sectional study of 10,234 participants in primary care

Via Dr. Jerome Fryer - Dynamic Disc Designs
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[RESEARCH] 3 Simple Exercises for Better Leg Strength After ACL Surgery - themanualtherapist.com


3 Simple Exercises for Better Leg Strength After ACL Surgery


The goal after an ACL reconstruction (ACLR) is to regain mobility and muscle function and ultimately to return to sports participation. Deficits in muscle function persist up to several years post-surgery, which is important to dynamic joint stability. Quadriceps strength is an important determinant for successful ACLRs The aim of the ACL-reconstruction surgery is to create a mechanically stable knee and the aim of the rehabilitation is to create a functionally stable knee.

Bieler et al. (2014) investigated whether ACLR patients, who perform high-intensity resistance training (HRT), will achieve greater leg extensor muscle power and knee function vs. low-intensity resistance training (LRT) without any negative effect on mechanical instability.

METHODS:
  • 38 ACLR patients completed a 20 week rehab program.
  • Strength program initiated 8 weeks for HRT group.
The HRT-program included bilateral and unilateral exercises:
  • Leg Press (from 90 to 0 degrees in knee).
  • Prone Leg Curls (0–90 degrees).
  • Seated Knee Extension (90–0 degrees).
FOR SETS/REPS

RESULTS:
  • Power in the injured leg was 90% of the non-injured leg, decreasing to 64% 7 weeks after surgery.
  • During the resistance training phase there was a significant group by time interaction for power.
Power was regained more with HRT compared to LRT without adverse effects on joint laxity:
  • Week 14 (84% versus 73% of non-injured leg)
  • week 20 (98% versus 83% of non-injured leg)
No other between-group differences were found.

CONCLUSIONS:
  • High-intensity resistance training as part of early rehabilitation after ACLR may contribute to a faster recovery of leg extension muscle power compared with low-intensity resistance training without introducing any adverse effect on knee joint stability.
  • Most likely, the accelerated/amplified gains observed with high-intensity resistance training were caused by more marked neuromuscular adaptations and/or greater muscular regrowth induced by this training modality.
SOURCE:
Bieler et al. 2014. BioMed Research International Volume 2014


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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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Untold Physio Stories - A New TMJ Differential Diagnosis - themanualtherapist.com


Severe pain with eating, along with unilateral jaw and facial swelling. Other than TMJ Dysfunction, what could be some possible differential diagnoses? Erson goes over a recent bout of "TMJ."


Become a TMJ Specialist with our fully online 10.5 hour seminar! Now certified for CEUS in 39 states!



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


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Low Back-Related Leg Pain and Axial Loading With MRI – Using the Visual Analog Scale and Pain Drawings - themanualtherapist.com


Goal of the Study?

Low back-related leg pain is thought to be neuropathic in origin due to compromise of a nerve root(s) and is also commonly known as sciatica. In a study published in the Journal of Clinical Medicine 1 a group of authors looked to see if loading the spine during MRI imaging (axial loaded MRI) would help discern more specificity to the anatomical cause of the low back-related leg pain. These leg pain sufferers will often undergo recumbent MRI while their symptoms are in the vertical or axially loading posture. 

Why are they doing this study?

Many cases of sciatica can be challenging to diagnose because of the complexity of the disc mechanics and physiology. There are many nuances of sciatica, and each case can bring its own set of complexities. Learning to determine the source(s) of sciatica more accurately can be helpful in its therapeutic management.

What was done?

Ninety patients were recruited for this retrospective observational study. The participant’ ages ranged from 21-89 years and were screened by an orthopedic surgeon to exclude those with hip and knee problems from the study. Participants were asked to fill out a self-evaluation including the visual analog scale along with a pain drawing. Each participant was evaluated by an attending physician and underwent an axial-loaded 1.5T MRI with added weight. As a comparison, each participant.

The investigators looked for these variables:
  •  Cross-section of the dural sac
  •  Lumbar spinal stenosis grade with axial loading
  •  Disk herniation with axial loading
  •  Size of herniated disc with axial loading
  •  Size of hyperintensity zone with axial loading
  •  Ligamentum flavum ‘type’ with axial loading
  •  Intervertebral foraminal size with axial loading
  •  Foraminal stenosis
  •  Degenerative disc classification
  •  Degenerative facet arthropathy
  •  Edema of facet joint and effusion with axial loading
  •  Synovial cyst area with axial loading 

What did they find?

The authors found that axial-loading subjects played a significant role in extracting findings that would otherwise not be seen with conventional recumbent MRI. Specifically, they found facet joint edema, atypical ligamentum flavum, was associated with low back-related leg pain.

Why do these findings matter?

Often, sciatica patients undergo MRI to identify a cause. However, recumbent MRI does not tell the whole picture as patients often report a worsening of symptoms when they are axially loaded. This study helped reveal the changes in the loaded state and can help clinicians make informed decisions about the symptoms patients express in a clinical setting. Understanding that the facets are under more load and the ligamentum flavum can buckle inwards towards the spinal canal can help the clinician understand the anatomy when assessing patients. Notably, the authors summarized that these axial-loaded findings could offer a dynamic picture of the instability contributing to sciatica.

At Dynamic Disc Designs we have developed models to help demonstrate load related changes to the spine. We believe that our models not only help the patients understand their symptoms better so they can make the appropriate adjustments to improve their sciatica, but they also help in the context of the education of spine pain in general.

Axially Loaded Magnetic Resonance Imaging Identification of the Factors Associated with Low Back-Related Leg Pain ↩



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Untold Physio Stories - You Have No Tendons in Your Feet - themanualtherapist.com



In this episode, we're joined by guest Dr. Michael Loebelenz. His story of a patient who was told what can best be described as nocebo at best and stupid at worst. What happens with this foot pain patient and what was the solution?

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...