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Take It To Heart: Low Fat Versus Plant Based Diet - themanualtherapist.com


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

Since the 1980s many dietary guidelines promoted the notion of a low-fat diet in order to reduce cardiovascular disease (CVD) risk. Over the next 30 to 40 years healthcare providers and nutrition researchers found that simply lowering dietary fat alone is not the only answer to reducing heart disease. This is likely because those consuming a low-fat diet may still include junk foods, meat, and smoking -- which have all be directly correlated with higher risk of heart disease, comorbidities, and mortality. Data show that most plant-based oils and fats from sources like nuts, seeds, and some oils can actually be beneficial in lowering heart disease risk. Could a plant-based diet, which includes fats from plant-sources, be better than a low-fat diet? A recent publication provides physical therapists and other providers just the answer.

The new research, coined Coronary Artery Risk Development in Young Adults study (CARDIA), enrolled 5115 Black and white men and women in 1985-1986. During more than 30 years of follow up, there were 280 cases of cardiovascular disease, 135 cases of coronary heart disease, and 92 cases of stroke among the study participants.

To assess dietary patterns the researchers conducted three detailed diet history interviews over the follow-up period. These diet history questionnaires determined what participants ate. For example, participants who reported eating meat in the past 30 days would be asked what meat items and how much they consumed. This process was done for ~100 areas of the diet. Based on this information, the researchers calculated scores for all participants based on both the Keys Score of the A Priori Diet Quality Score (APDQS).

The researchers, after factoring for various factors including socioeconomic status, educational level, energy intake, history of cardiovascular disease, smoking and body mass index, found that having a more plant-based diet (higher APDQS Scores) and consuming less saturated fat (lower Keys Scores) were both associated with lower LDL levels. However, lower LDL levels did not necessarily correlate with lower future risk of stroke, but we know that lower LDL levels can correlate to lower heart disease risk. Higher APDQS scores, but not lower Keys Scores, were strongly associated with a lower risk for CVD, possibly due to the lower LDL.

Obviously more research is needed and some limitations exist for this current study. First, it was a questionnaire-based study which can often be riddled with errors. Subjects can forget what they've eaten, exaggerate or under-report certain dietary patterns, or simply fabricate data. Second, the lower LDL levels didn't actually translate into lower stroke prevalence within the group; such a finding seems dubious but may suggest that other factors such as exercise, stress management, or smoking, which were controlled for, may be stronger predictors of stroke than what was measured. 

While the study has some limitations the findings are important as it shows that there may be other factors contributing to heart disease than simply fat. Saturated fat does increase LDL and promotes CVD. As such, guidelines were onced focused on simply reducing fat consumption as big priority, without much concern on the source of the fat. As this data show, plant-sources of fat (e.g. from nuts, seeds, and some fish) may be beneficial -- but also the removal of animal products seems to strengthen the CVD risk reduction. Data show that meat contains heme iron, TMAO, and may negatively impact the gut microbiome. Dairy is chock full of naturally occurring bovine hormones and growth factors. Could these factors be the other driving forces for CVD risk? Possibly, but more studies are needed to clearly extract factors for their risk modification.

The study's findings are relevant to doctors of physical therapy (DPTs) and physical therapy practice in several ways. PTs working in cardiac rehabilitation often engage their clients several times per week in order to improve their endurance, strength, and recover from cardiac interventions (like bypass). During such sessions an emphasis on dietary and lifestyle changes is critical, as many who have heart disease will often have a recurrence of that disease again later. For physios working in the general population, prevention ought to be a major aspect of care as it relates to reduce the burden of disease and other conditions. In other words, if you can improve a person's general health and lifestyle you likely will see improvements across many realms and systems (e.g. better health = less pain and better movement). Cardiovascular disease is not just about the heart: it can affect tissue healing peripherally, cognition, sexual function, and muscle performance. Moreover, most of cardiac disease starts in childhood with fatty streaks and foams cells found in teenagers' coronary arteries! Much of this early disease prevalence can be related to poor dietary patterns at school and home. As such, pediatric PTs need to be armed with good nutritional knowledge on how diet can prevent future heart disease for our citizens. In the end, PTs need to work with dieticians, physicians, and nurses to optimize our patients' health through diet, and it seems that choosing a predominantly plant-based diet may just be that mechanism.

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TMJ Clinical Pearls - themanualtherapist.com


In this episode, Erson goes over newer drivers (triggers) of TMJ dysfunction and pain. Andrew gives his take on the findings and they also go over some clinical pearls for TMD Patients


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Foot & Ankle Characteristics Associated with Falls in Older People - themanualtherapist.com



Foot & Ankle Characteristics Associated with Falls in Older People


BACKGROUND:
Falls affect approximately 1 out of 3 Older Adults. Foot problems are amongst the potential modifiable risk factors. Pol et al. (2021) investigated the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults.

METHODS:
  • 187 community-dwelling older adults aged 62–90 years were studied.
  • Foot & ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured.
  • Fall history was documented in the preceding year.
RESULTS:
74 Participants experienced a fall (~40%).

Factors significantly and independently associated with these falls:
  • Less first metatarsophalangeal joint extension.
  • Less plantarflexor muscle strength.
  • Greater pressure-time integral in the medial forefoot.
  • Greater center of pressure velocity in the forefoot.
  • Greater foot pain.

CONCLUSIONS:
Several structural and functional foot and ankle characteristics were associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.

WANT MORE RESEARCH? Check out @physicaltherapyresearch on Instagram!

SOURCE:
Pol et al. 2021. Structural and functional foot and ankle characteristics associated with falls in older people. Gait & Posture. (88), pp. 78-83.

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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  • over 600 videos - hundreds of techniques and more! 
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4 Full Body Combo Exercises - themanualtherapist.com


⚡️Full-Body Combo Exercises⚡️


When it comes to loading in order to achieve a desired adaptation, there are many ways to “skin the cat” in a training program for your athletes.
Untold Physio Stories - Intermittent and Recurrent Leg Weakness - themanualtherapist.com


In this episode, Andrew goes over a recent case of intermittent leg weakness. All things being equal, if pain, balance, stability and function are improving, patients shouldn't regress for no reason. Especially with a previous history of Cancer.



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

 
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Hip Abductor Strength & Patellofemoral Pain - themanualtherapist.com


Hip Abductor Strength & Patellofemoral Pain


INTRO:
Patellofemoral pain (PFP) is one of the most common knee conditions experienced by adolescents and young adults. PFP is characterized by pain around or behind the knee cap, aggravated by squatting, climbing stairs, running or jumping. Individuals with PFP present hip muscle strength deficits, specifically concerning hip abductors, extensors, and external rotators.

Van Cant et al. (2021), compared clinical measures of
Hip abductors function [isometric strength, isometric endurance, and dynamic endurance]
between Individuals with PFP [More severe v. less severe symptoms].

METHODS:
60 participants with PFP were divided 3 times into 2 groups according to three symptomatology criteria:
  • Functional capacity.
  • Pain frequency.
  • Pain severity.
Main outcome measures:
  • Isometric strength.
  • Endurance [max reps & max holding time].
  • Functional capacity [Anterior Knee Pain Scale].
  • Pain frequency.
  • Pain severity [Numeric Pain Rating Scale].

RESULTS:

Functional Capacity:
No significant differences between the two subgroups for the three hip muscle function measurements.

Pain Frequency:
No between-subgroup differences were found in general characteristics.

On average, participants with more frequent vs. less frequent symptoms had a decrease of:
  • 10% in isometric strength.
  • 17% in isometric endurance.
  • 13% in dynamic endurance
Pain Severity:
No significant between-subgroups differences in general characteristics.

Participants with more severe vs. less severe symptoms had a decrease of:
  • 16% in isometric strength.
  • 24% in isometric endurance.
  • 23% in dynamic endurance.

CONCLUSIONS:
Clinicians should incorporate assessment of hip abductor strength and endurance for individuals with PFP.

They should expect that patients with more frequent or more severe pain will have weaker, less enduring hip abductor muscles.

SOURCE:
Van Cant et al. 2021. Influence of symptom frequency and severity on hip abductor strength and endurance in individuals with patellofemoral pain. PT in SPRT, (49), pp. 83-89.

Dalton Urrutia, MSc PT

Dalton is a Physical Therapist from Oregon, currently living and running the performance physiotherapy clinic he founded in London for Grapplers and Strength & Conditioning athletes. Dalton runs the popular instagram account @physicaltherapyresearch, where he posts easy summaries of current and relevant research on health, fitness, and rehab topics. 
Want to learn more or contact him?
Reach out online:
@Grapplersperformance

Learn more online - new online discussion group included!


Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. 
  • NEW - Online Discussion Group
  • Live cases
  • webinars
  • lecture
  • Live Q&A
  • over 600 videos - hundreds of techniques and more! 
  • Check out MMT Insiders
Keeping it Eclectic...

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As a coach, it’s always resourceful to have a few catch-all movements in your back pocket from both a screening and coaching standpoint.
Untold Physio Stories - When Starting Your Own Business Isn't For You - themanualtherapist.com


In this episode, Erson is joined by frequent guest Dr. Alex Kirbach. Alex goes over what made him pivot from a OON Cash based practice he recently started to a corporate PT job.



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...