Modern Manual Therapy Blog - Manual Therapy, Videos, Neurodynamics, Podcasts, Research Reviews

When most physical therapists think of peripheral vestibular deficits, we typically think of isolation of a condition, such as BPPV.  This, at least since 1926, involves canalith repositioning testing via Dix-Hallpike manuever and treatment, since early 1980s, with Epley Manuever.
A large and sometimes missing link is that individuals with unilateral peripheral vestibular deficits acutely constrain their head movements relative to their trunk to reduce symptoms of oscillopsia, dizziness and nausea.  These altered movement patterns can result in the loss of normal decoupling of head motion from trunk motion while walking and potentially have a less efficient gait pattern and postural activity tolerance.
For the therapists who work in inpatient, home health setting and even outpatient rehabilitation centers, we typically examine dynamic gait tasks and even though not as high priority of movement patterns to a generalist assessment, these movements significantly impact head and trunk requirements.  As you can see from Table 1 below from Paul et al 2017 paper, entitled “Characterization of Head-Trunk Coordination Deficits After Unilateral Vestibular Hypofunction Using Wearing Sensors”, the Functional Gait Assessment, Timed Up & Go Test and 2-minute Walk Test have large influence of head and trunk rotation influences.
Cervical Vertigo, Cervicogenic Dizziness, Neck Imbalance,
Paul et al 2017
Even though this study examined deficits in gaze and postural stability of the head and trunk after surgically induced unilateral peripheral vestibular hypofunction, the physical therapist can relate the head and trunk movements required for any peripheral vestibular disorder and relate the impact of the cervical proprioceptive system in active movement of the head and trunk coupling moments.
You can see in the 3rd column on right above that yaw plane (angular rotation) of the head and trunk that relates to coupling of head and trunk rotation is necessary to accomplish these tasks.  Considering C1-2 (Atlanto-Axial Joint) is 50% of rotation of the cervical spine, this could be a significant limiting factor in your patient.  Read a previous post on how this joint restriction relates to Cervicogenic Dizziness. 
Paul et al 2017 concluded,
A key component to recovery from peripheral vestibular deficits is the regular exposure of head movements that may induce gaze and postural stability errors and therefore facilitate recovery.
If you are a trying to implement regular exposure of head movements but run into a wall of neck pain, restriction of range of motion or even lightheadiness associated with these movements, then our class of diagnosing and treating Cervicogenic Dizziness can be of benefit to you.  Most of our classmates think this class is mostly for post-concussive or whiplash patients; but I disagree that it can be even more important in reducing fall risk and improving movement patterns in the elderly!  The association of cervical disc disease and restriction in mobility of the cervical spine is by far more prevalent in society that trauma-based cervical conditions.
As Paul’s study arose in the literary works, another fantastic investigation by Julia Treleaven & colleagues out of Australia in 2018 suggests that neck pain subjects have difficulty moving their trunk independently of their head.  Her work on altered trunk head co-ordination in those with persistent neck pain indicates that tasks are performed more slowly with neck pain patients, which directly correlates to the speed and accuracy testing of gait testing through Functional Gait Assessment, 2-minute Walk Test and Timed Up and Go Test.
Even if you are not treating “dizziness or vertigo”, but are involved in reducing fall risk in patients in any setting, contact us to see if this course can help your patients.  As you know, the Home Health Physical Therapy industry is performing Vestibular Rehabilitation and continues to focus on Fall Risk Reduction.  A missing link of improving postural control and balance can be limitation to the upper cervical spine.  Specific diagnostic and treatment approaches are available to benefit your patients and continue to raise the bar of rehabilitation.

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 2nd day includes the “Physio Blend”, a multi-faceted physiotherapist approach to the management of Cervicogenic Dizziness, which includes treatments of the articular and non-articular system of manual therapy and the most updated sensorimotor exercise regimen.
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 more information.

Authors

Harrison N. Vaughan, PT, DPT, OCS, Dip. Osteopracic, FAAOMPT    
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
Danielle N. Vaughan, PT, DPT, Vestibular Specialist  
Instructor: Cervicogenic Dizziness for Integrative Clinical Concepts
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When patients or people in general get injured or have pain in a particular joint, they do one of 2 things, completely stop training, or train through it, but not always with the best methods or often with uncertainty.

The informed advice we can give is how to train through injuries and not to catastrophize as many people can do. Here's a helpful infographic by Dr. Michael Mash of @barbellrehab on instagram.


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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. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...


This post continues the Pre-Op Education Series by Dr. Luke Pederson, DPT. To catch up, check out Part 1 and Part 2.

Pain Science Education

Although some studies show that PE results in reduced post-op pain levels, especially in the acute stages (1, 17, 25, 28, 29), there are also many studies that show no change in post-op pain levels with the addition of PE (1, 3, 4, 9, 11, 30). There are also some studies that show no change in post-op pain levels but do show a decrease in the use of pain medications post-op (9, 12, 26). According to Doering et al. (2000), this is possibly due to the fact that patients who receive PE have a better idea of what to expect and anticipate post-op pain and experiences. This, in turn, leads to better self-efficacy and the ability to better cope with post-op pain (9).

A number of studies also note the limited impact of PE delivery on pain levels may be due to a lack of pain-specific education and overemphasis on pathoanatomy, biomedical models, and surgical correction of anatomical impairments. A focus on anatomy, biomedical models and Cartesian models of pain may actually increase pre-op fears and anxieties (3, 13, 30).

An alternative focus should be on pain neuroscience education. This includes a discussion of the neurophysiology of pain and pain experiences. Content can include a discussion of the sensitivity of the nervous system, peripheral and central sensitization, plasticity of the nervous system, and strategies to calm down the nervous system. The authors discuss how post-op pain can be described by the hypervigilant nervous system and increased nervous system sensitivity rather than persistent tissue pathology (3, 30).

Pain education should also aim to change the overall perception and threatening aspects of pain in order to decrease fears and anxieties. A key to this is a change in pain beliefs. Mainly, reduce beliefs that pain is directly associated with tissue or structural damage or that pain is associated with disability (30).

Reinforcement and Multiple Forms of Delivery
The percentage of information a patient learns via one session of learning is limited, be it from reading, video, verbal instruction or other methods. One must also consider logistically, the limited amount of time that can be dedicated to in-person instruction and teaching. For these reasons, PE should take on multiple forms and be reinforced multiple times.

PE should begin immediately in the physician’s office when the patient schedules her surgery. A simple way to do this is through written material such as a booklet or pamphlet with relevant pictures and diagrams. The patient should also receive relevant logistical information such as addresses, names, and phone numbers, and simple preoperative exercises to perform. Another option is connecting the patient with an online or software-based educational resource. This allows the use of multimedia to create an interactive learning platform (34).

An interactive multimedia platform can cater to multiple learning styles and improve patient adherence and engagement. Written material can be boring and difficult to understand, especially for someone with a lower educational status or reading level, or someone with cognitive impairments (35).

Through a multimedia platform, the patient can read text, view videos, listen to audio, and engage with diagrams. They can view the material as many times and as often as they desire (or don’t desire). Providers can also incorporate things such as individualized patient portals, questionnaires, outcome measures, surveys, and assess individuals’ level of engagement. This also provides an initial exposure to important pre-op information. Now, when patients attend the pre-op educational session, they already have a basic understanding of the information. This makes the session more efficient and directed toward the patients’ specific questions, concerns, and needs.

There are also a number of techniques that can be used to maximize information retention during the educational sessions. One technique is the utilization of technology and multimedia resources during the actual session. Additionally, the session should be relaxed and informal so the patient is comfortable asking questions. The instructor should use examples, pictures, diagrams, and metaphors where appropriate.

When information is recalled or utilized immediately after it’s learned, it’s retained better (35). This can be achieved by completing a simple pre-test and post-test, completing a fill in the blank handout, explaining or teaching-back important information to the instructor, or discussing the information with other patients, a family member, or friend.

After the PE session there should be continued follow-up and reinforcement to ensure that information is optimally absorbed and all concerns are addressed. This can take the form of a follow-up phone call or brief in person meeting as the surgery nears. It can also include reinforcement postoperatively. After surgery, it is important to touch base with the patient to check-in, answer questions, and drive home some of the most important keys to a successful and efficient recovery.

Familiarity

A great qualitative study by Spalding (2003) highlights the importance of making the unknown familiar (5). By helping patients know what to expect, providers help alleviate fears and anxieties of the unknown. This improves patient satisfaction and allows patients to better anticipate and cope with post-op pain and other stressors.

Spalding notes three key ways that PE can help make the unknown familiar. First, by helping the patient understand the experiences they will have peri-operatively and post-operatively. She suggests chronologically describing the different events the patient will go through during the surgery and while at the hospital. Second, she notes the importance of the patient meeting the staff and people they will be seeing and working with in the hospital. This improves comfort and trust between the staff and patient and increases the personal connection. Lastly, Spalding says the patient should be familiarized with the different environments they will be exposed to including where they will be staying in the hospital. This can be accomplished by holding PE sessions in the hospital facility and by spending time touring some of the different parts of the hospital (5). 

Past Patients’ Perspectives
Many articles highlight the importance of including perspectives from past patients. This can be done through video format, having past patients volunteer to attend PE sessions, or having past patients meet with current patients during a separate time. This serves many purposes. The patient is able to speak with someone who has gone through the surgical process and had a positive outcome. It also decreases fears and anxieties. Past patients’ are able to answer certain experiential questions that healthcare providers cannot. They also provide a support system built on shared experiences.

Logistics

It’s also important for logistical details regarding PE to be optimized. When is the best time to provide the PE session? There is no definitive answer but about 3-6 weeks pre-op seems to be ideal. The patient has enough time to absorb the material through reinforcement but not too much time that they forget important information. This also allows time to make final adjustments and preparations before surgery.

How long should the PE session be? Again, there is no definitive answer. Most resources suggest no more than 1-2 hours. You must consider that typical humans have a limited attention span and it’s likely the longer an educational session runs, the less information they absorb and remember. In the spirit of education that is individualized, PE sessions should take as long or as short a time as they need to. Ensuring that all of the patient’s needs are met is more important than trying to fit the session into a certain time frame.

Who should administer the PE sessions? Besides verbal instruction/classes, a majority of PE can be self-administered by the patient. In-person sessions should ideally be administered by someone who is going to work with the patient during their hospital stay. This provides the added benefit of developing trust and connection between the patient and one or more staff members.

Either nurses, physical therapists, or occupational therapists are the best options to provide PE. These are typically the individuals who will spend the most time with the patient postoperatively and have an intimate understanding of the pragmatic aspects of post-op pain management, rehabilitation, and recovery.

Where should PE sessions take place? Ideally, in the same facility as the surgery and the acute care stay. As discussed above, familiarity with the hospital environment where they’ll be staying can help decrease patients fears and anxieties.

Should PE sessions be mandatory or voluntary? The answer to this question can be argued either way. Voluntary participation provides a sense of control for the patient. Someone may not want to attend PE sessions because the information will further increase the fears and anxieties they already have. Alternatively, someone in denial may benefit from attending an educational session because it will arouse a level of anxiety that encourages more active participation in the surgical process. One suggestion is to make PPE sessions necessary by coordinating them with pre-op labs, MRSA swabs, and/or handing out of antiseptic soaps (35).

It is my opinion that attending an educational session preoperatively should be mandatory, especially for more significant surgical procedures. If a patient isn’t involved enough in the surgical process to attend a PE session, how active and involved will they be postoperatively when it comes to attending physical therapy and follow-up appointments, following precautions/ contraindications, or with other necessary self-care. Surgeons and healthcare systems alike are rated on their outcomes and more and more this is being tied directly to financial compensation. There are many surgeons who won’t operate on a patient if they are a smoker or if they are too overweight/obese. For something as simple as a couple hour time commitment, it’s perfectly reasonable to make attendance mandatory.

Another logistical consideration is the course of clinical care both pre and postoperatively. This must work in concert with the goals of PE. There are typically standardized order sets that are widely used in hospitals to direct post-op treatment. For example, patients having a knee replacement often follow a very similar clinical pathway after surgery.

If one of the goals is reduced medical utilization and reduced hospital length of stay, then hospitals should have practices in place to facilitate sooner discharge when appropriate. This means instead of time-based discharge criteria, utilizing specific objective outcomes to determine appropriateness for discharge. This also means initiating discharge planning early preoperatively. This includes preparation of the patient’s home environment for return from the hospital and establishing appropriate social supports via family or friends. On a grander scale, this may mean adjustments to insurance companies qualifications and coverage for surgeries, hospital stays, inpatient rehab (when appropriate), and outpatient services.

Where Does this Leave Us?
There are certainly still many logistical considerations and difficulties when it comes to implementing preoperative patient education, especially when trying to address multiple considerations. A specific difficulty is that in most cases healthcare professionals’ time is already being thinly spread between multiple tasks and duties. Plus, financial resources must be divided among multiple needs. When trying to maximize effectiveness and efficiency, it’s imperative that pre-op patient education is worth the time and financial investment. The current research does not definitively prove this, but by synthesizing the literature, we can at least hypothesize a number of best practices.

The saying goes “if you’re going to do something, do it well.” When hospital systems create and implement preoperative patient education it’s a disservice to themselves if they only utilize clinical experience and what intuitively makes sense. It’s extremely important to assess the literature to better inform clinical strategies and techniques. It’s also important to consider preoperative education within the bigger picture of hospital systems and clinical pathways. In this way, financial resources aren’t wasted on something that “just seems good to do,” and instead, resources are utilized efficiently and optimally. 

Via Dr. Luke Pederson, DPT
References

  1. McDonald, Steve, et al. "Preoperative education for hip or knee replacement." Cochrane Database of Systematic Reviews 5 (2014).
  2. Jordan, R. W., et al. "Enhanced education and physiotherapy before knee replacement; is it worth it? A systematic review." Physiotherapy 100.4 (2014): 305-312.
  3. Louw, Adriaan, et al. "Preoperative education addressing postoperative pain in total joint arthroplasty: review of content and educational delivery methods." Physiotherapy theory and practice 29.3 (2013): 175-194.
  4. Johansson, Kirsi, et al. "Preoperative education for orthopaedic patients: systematic review." Journal of advanced nursing 50.2 (2005): 212-223.
  5. Spalding, Nicola Jane. "Reducing anxiety by pre‐operative education: Make the future familiar." Occupational therapy international 10.4 (2003): 278-293.
  6. Papanastassiou, Ioannis, et al. "Effects of preoperative education on spinal surgery patients." SAS journal 5.4 (2011): 120-124.
  7. Shuldham, Caroline. "1. A review of the impact of pre-operative education on recovery from surgery." International journal of nursing studies 36.2 (1999): 171-177.
  8. Ronco, Monica, et al. "Patient education outcomes in surgery: a systematic review from 2004 to 2010." International Journal of Evidence‐Based Healthcare 10.4 (2012): 309-323.
  9. Doering, Stephan, et al. "Videotape preparation of patients before hip replacement surgery reduces stress." Psychosomatic Medicine 62.3 (2000): 365-373.
  10. Giraudet-Le Quintrec, Janine-Sophie, et al. "Positive effect of patient education for hip surgery: a randomized trial." Clinical Orthopaedics and Related Research® 414 (2003): 112-120.
  11. Kearney, Marge, et al. "Effects of preoperative education on patient outcomes after joint replacement surgery." Orthopaedic Nursing 30.6 (2011): 391-396.
  12. Daltroy, Lawren H., et al. "Preoperative education for total hip and knee replacement patients." Arthritis & Rheumatism: Official Journal of the American College of Rheumatology 11.6 (1998): 469-478.
  13. O'donnell, Katherine F. "Preoperative pain management education: A quality improvement project." Journal of PeriAnesthesia Nursing 30.3 (2015): 221-227.
  14. Tait, M. A., C. Dredge, and C. L. Barnes. "Preoperative patient education for hip and knee arthroplasty: financial benefit?." Journal of surgical orthopaedic advances 24.4 (2015): 246-251.
  15. Belleau, France Provenรงal, Louise Hagan, and Benoรฎt Masse. "Effects of an educational intervention on the anxiety of women awaiting mastectomies." Canadian Oncology Nursing Journal/Revue canadienne de soins infirmiers en oncologie11.4 (2001): 177-180.
  16. Bondy, Lois R., et al. "The effect of anesthetic patient education on preoperative patient anxiety." Regional Anesthesia and Pain Medicine 24.2 (1999): 158-164.
  17. Cheung, Li Ho, Patrick Callaghan, and Anne M. Chang. "A controlled trial of psycho-educational interventions in preparing Chinese women for elective hysterectomy." International journal of nursing studies 40.2 (2003): 207-216.
  18. Lin, Pi-Chu, Li-Chan Lin, and Jin-Jen Lin. "Comparing the effectiveness of different educational programs for patients with total knee arthroplasty." Orthopedic nursing 16.5 (1997): 43-49.
  19. Clode-Baker, Edward, et al. "Preparing patients for total hip replacement: A randomized controlled trial of a preoperative educational intervention." Journal of Health Psychology 2.1 (1997): 107-114.
  20. Mancuso, Carol A., et al. "Randomized trials to modify patients’ preoperative expectations of hip and knee arthroplasties." Clinical orthopaedics and related research466.2 (2008): 424-431.
  21. Heikkinen, Katja, et al. "A comparison of two educational interventions for the cognitive empowerment of ambulatory orthopaedic surgery patients." Patient education and counseling 73.2 (2008): 272-279.
  22. Heikkinen, Katja, et al. "Ambulatory orthopaedic surgery patients' emotions when using two different patient education methods." Journal of perioperative practice 22.7 (2012): 226-231.
  23. Yoon, Richard S., et al. "Patient education before hip or knee arthroplasty lowers length of stay." The Journal of arthroplasty25.4 (2010): 547-551.
  24. McGregor, Alison H., et al. "Does preoperative hip rehabilitation advice improve recovery and patient satisfaction?." The Journal of arthroplasty 19.4 (2004): 464-468.
  25. Pellino, Teresa, et al. "Increasing self-efficacy through empowerment: preoperative education for orthopaedic patients." Orthopaedic Nursing 17.4 (1998): 48.
  26. Kruzik, Nancy. "Benefits of preoperative education for adult elective surgery patients." AORN journal 90.3 (2009): 381-387.
  27. Huang, S-W., P-H. Chen, and Y-H. Chou. "Effects of a preoperative simplified home rehabilitation education program on length of stay of total knee arthroplasty patients." Orthopaedics & Traumatology: Surgery & Research 98.3 (2012): 259-264.
  28. Douglas, Tania S., N. Horace Mann, and Arleen L. Hodge. "Evaluation of preoperative patient education and computer-assisted patient instruction." Journal of spinal disorders 11.1 (1998): 29-35.
  29. LaMontagne, Lynda, et al. "Effects of coping instruction in reducing young adolescents’ pain after major spinal surgery." Orthopaedic Nursing 22.6 (2003): 398-403.
  30. Louw, Adriaan, et al. "Preoperative pain neuroscience education for lumbar radiculopathy: a multicenter randomized controlled trial with 1-year follow-up." Spine 39.18 (2014): 1449-1457.
  31. Arthur, Heather M., et al. "Effect of a preoperative intervention on preoperative and postoperative outcomes in low-risk patients awaiting elective coronary artery bypass graft surgery: a randomized, controlled trial." Annals of internal medicine 133.4 (2000): 253-262.
  32. Rรถnnberg, Katarina, et al. "Patients' satisfaction with provided care/information and expectations on clinical outcome after lumbar disc herniation surgery." Spine 32.2 (2007): 256-261.
  33. Mind Tools Content Team. “The inverted-U theory balancing performance and pressure with the Yerkes-Dodson law.” Mind Tools. November 2016, www.mindtools.com/pages/article/inverted-u.htm
  34. Huber, Johannes, et al. "Multimedia support for improving preoperative patient education: a randomized controlled trial using the example of radical prostatectomy." Annals of Surgical Oncology 20.1 (2013): 15-23.
  35. Mcclure, Grace. “How to Run a Successful Preoperative Class.” PeerWell. PDF. 15 May 2019.


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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. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

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Did you know money is not your most valuable asset? In today’s post, I wanted to share how important something else is...

Is knee pain during adolescence "normal?" What are the implications and long term effects of having knee pain as an adolescent? Brad Beer relates his own experience and as usual provides great information in his post and infographic.
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[5 IMPLICATIONS OF ADOLESCENT KNEE PAIN] ๐Ÿ“ _ ๐Ÿ‘‰๐ŸปAs a junior triathlete I experienced ongoing knee pain (patello-femoral pain) from 15years-23years of age. It was debilitating and persistent-& one of the chief reasons I quit triathlon. I went through very emotional lows due to its affect on my quality of life ๐Ÿค• _ ๐Ÿ‘‰๐ŸปWith 1 in 3 adolescents experiencing knee pain, and knee pain being the 4th most common musculoskeletal related condition that adolescents seek GP assistance for, I wasn’t alone ๐Ÿ‘€ _ ๐Ÿ‘‰๐Ÿป Concerningly there continues to be a view that knee pain in adolescents is a ’normal’ part of development that is self-limiting and has no longer term impact ‼️ _ ๐Ÿ‘‰๐ŸปThe above assumption has recently been tested by a study of 504 adolescents in Denmark. The study found that 4 out of 10 adolescents with knee pain still experienced frequent and intense knee pain 5 years later, severe enough to negatively impact quality fo life, sports participation, and in one out of seven affect career choices and education ⚠️ _ ๐Ÿ‘‰๐Ÿป The study found the below affects for those who continued to suffer from knee pain at the 5year follow up mark: . 1️⃣ poorer physical health ⬇️ . 2️⃣ stopped sports participation ๐Ÿšซ๐Ÿƒ‍♂️ . 3️⃣ reduced sports participation ⚽️ . 4️⃣ worse sleep quality ๐Ÿ˜ด . 5️⃣ worse knee-related & general quality of life ๐Ÿ˜ฆ _ ๐Ÿ“ŒTAKE HOME: with almost 50% of adolescents who had knee pain continuing to experience persistent pain into adulthood, the researchers concluded that when clinicians are presented with an adolescent suffering from knee pain they should not assume that adolescent knee pain will resolve itself ✅ _ ๐Ÿ–ฅ*Ref: Rathleff et al. Five-year prognosis & impact of adolescent knee pain: a prospective population based cohort study of 504 adolescents in Denmark (2019) BMJ . . #sportsphysio #sportsmedicine #physio #kneepain #rehabilitation

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Keeping it Eclectic...


We all need to work on our weaknesses. Part of improvement is adapting from failures. Listen in on this particular and recent EPIC failure as Erson tries to actively listen to a patient who quite possibly never told her entire story.


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Keeping it Eclectic...




PREVENTION

In 2018 Arundale, Bizzini, Giordano et al published a CPG reviewing the current injury prevention programs for ACL and knee ligament injuries. The results were extremely positive and state that “there is strong evidence for the benefits of exercise-based knee injury prevention programs, including reduction in risk for all knee injuries and for ACL injuries specifically, with little risk of adverse events and minimal cost” (Arundale, Bizzini, Giordano et al., 2018, p. A7).


If you treat runners, you need to know their risks for Bone Stress Injury, how prevalent it is, and also predictors of return to sport. 


Here are 5 Predictors of Return to Sport for BSI

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[RETURN TO SPORT TIMELINES FOLLOWING BONE STRESS INJURIES] ๐Ÿฆด _ ๐Ÿ‘‰๐ŸปWhat determines how long it will take an athlete to return to sport following a bone stress injury? ๐Ÿค” _ ๐Ÿ‘‰๐ŸปIn a study 212 college track and field + cross country athletes were followed prospectively through their competitive seasons after having bone density scans, answering questionnaires on nutritional behaviours & menstrual patterns & prior injuries + other tests ๐Ÿ‘€ _ ๐Ÿ‘‰๐Ÿป34 (12 male, 22 female) of the 211 athletes sustained 61 bone stress injuries across the 5 years study period ๐Ÿฆด _ ☝๐ŸปThe above 1-5 were associated with delayed recovery from bone stress injury and MRI bone stress injury grading ⌛️ _ ‼️TAKE HOME: The authors concluded that when a bone stress injury is diagnosed or suspected, MRI imaging, measuring bone mineral density (BMD), identifying the site of injury (cortical or trabecular), and obtaining a cereal history of nutritional and menstrual status should be utilised. The results also provide evidence that optimising bone mass may not only reduce the risk of sustaining a bone stress injury, but also contribute to reduced recovery time ๐Ÿ”Ž _ *Ref: Nattiv et al. (2013) Correlation of MRI grading of bone stress injures with clinical risk factors and return to play: a 5-year prospective study in collegiate track and field athletes (Am J Sports Med) . . . . . . #sportscience #training #fitness #physio #sportsphysio #marathontraining #training #bonestress #rehabilitation
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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. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...