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


[πŸ‘£ORTHOSES MYTHS]☝🏻

The infographic and post reposted with permission from @Brad_Beer

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πŸ‘‰πŸ»Most days in clinic I debunk one of these myths with my clients. As @sportspodiatryinfo stated on the Expert Edition of @physicalperformanceshow we recorded earlier in the year - before & after pictures of orthoses ‘correcting’ alignment have no place in contemporary evidence based sports medicine πŸ€”
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☝🏻Having just seen a full age ad in local paper ‘before & after’ felt promoted to report this infographic ✅
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πŸ‘‰πŸ»If you missed it worth tuning in to @physicalperformanceshow where @sportspodiatryinfo shared around all things foot orthoses. Along with exploring mechanisms of effect, discussing the ‘P word’ (pronation)+ much more πŸ—£
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πŸ‘‰πŸ» @sportspodiatryinfo does a fantastic job in debunking these 5️⃣commonly espoused orthoses myths 🧐☝🏻
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πŸ‘‰πŸ»πŸŽ§ Episode 1️⃣7️⃣7️⃣ available now on @itunes @soundcloud @spotify or wherever you get your podcasts
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Keeping it Eclectic...


Sacroiliac Joint Assessment tests that involve palpation of bony landmarks, and palpation of motion are considered some of the least reliable orthopaedic tests. It was identified by Laslett et al as far back as 2005 that we should use provocation testing and a lumbar repeated motions to rule out lumbar and rule in SIJ.


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SIJ Testing

Reposted with permission from @physicaltherapyresearch on instagram.

Looking for a Modern Assessment and Treatment of the SIJ? Check out part 1 of our video series!

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INTRO:
Previous systematic reviews revealed poor reliability and validity for SIJ testing.
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However, these reviews were published nearly 20 years ago and recent evidence has not yet been summarized.
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Klerx et al (2019), conducted an up-to-date systematic review to verify whether clinical recommendations for SIJ mobility tests should be revised. .
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Results:
12 relevant articles.
3 of sufficient methodological quality. .
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These 3 evaluated the reliability of 8 SIJ mobility tests and one test cluster. .
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Including:
(1) Click-clack test (2) Standing flexion test
(3) Seated flexion test
(4) Gillet test
(5) Prone knee flexion test
(6) Heel-bank test
(7) Abduction test
(8) Thumb-PSIS test
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Gillet was the only test evaluated in more than one study.
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Majority of individual tests showed slight to fair agreement in inter-tester reliability.
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Compared to individual tests, the test cluster showed higher reliability, the highest in two positive tests. .
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Although some tests had higher reliability, the confidence intervals around them were large. .
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Furthermore, there were no validity studies of sufficient methodological quality. .
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Conclusion: .

There is no new evidence for the validity of SIJ mobility tests when considering literature of at least fair methodological quality. .

Only low quality and conflicting evidence for inter-rater reliability exists.

Reliability of individual SIJ mobility tests and test clusters is questionable or uncertain. .

The use of SIJ mobility tests in clinical practice is problematic. .
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Thoughts? Questions? Comments?
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Write them below. .
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SOURCE:
Klerx, et al. 2019. Clinimetric properties of sacroiliac joint mobility tests: A systematic review. MSK Science. doi.org/10.1016/j.msksp.2019.102090

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:
@physicaltherapyresearch
@Grapplersperformance
www.grapplersperformance.com

Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

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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...


🧠The triceps brachii muscle is a large muscle located on the posterior aspect of the upper arm that works to extend the elbow. The long head of the muscle also contributes to shoulder extension.

Prior to inventing the Hip Corkscrew Technique with EDGE Mobility Bands, I used to teach and use mobilization belts for hip manual therapy. Here are my favorite variations on using a mobilization belt. They are all effective and comfortable!

A recent study by Korpon et al 2019 in Am J Otolaryngol examined barometric pressure and the incidence of benign paroxysmal positional vertigo (BPPV).  The aim of this study was to determine the temporal relationship between monthly barometric pressure levels and incidence of BPPV.
The following is what the authors found:
Of all the variables studied (compared to temperature, humidity, tree/mold/grass/ragweed pollen), barometric pressure demonstrates the strongest statistically significant positive correlation, where every one unit increase in barometric pressure leads to an expected increase of 6.1 diagnoses (r = 0.66 [95% CI 0.14–0.90], p = 0.0131).
BPPV diagnoses were observed to be lowest during the summer months (June through August) with a moderate to strong, statistically significant positive correlation between BPPV diagnoses and barometric pressure observed throughout the year.
Therefore, as a clinician, you may find that BPPV diagnosis occur more often in the first of the year (say January – May), which, from this study, is most likely related to barometric pressure (compared to sunlight levels, pollen, etc).
As clinicians, what time of the year do you find BPPV to be more prevalent?
As patients, what time of the year does your BPPV “flare up”?
The authors go on to discuss correlation between BPPV and migraine, which do correlate with barometric pressure.  Recently, pain and barometric pressure has just been shown to be related on an individual level (Fagerlund et al 2019). Even though the research is not strong with correlations of the weather, I would ask your patients what they think!  Most do!
We notice in clinical practice that a certain percentage of patients who have BPPV have a double-entity of cervical impairments too.  This can be as simple as guarding and hypertonicity of the cervical muscles due to avoidance of movements or underlying joint hypomobility and muscular impairments (strength, endurance, etc) that place the proprioceptive system at half capacity.
We do not have a ton of data on prevalence or incidence of persons having Cervicogenic Dizziness besides post-trauma (whiplash, car accident, concussion, sport injury, etc).  However, we can take the above information and relate it to what we already know about time of year and barometric pressure to make correlations between ion channel sensitivity and its affect on Cervicogenic Dizziness.
Considering persons with Cervicogenic Dizziness typically have neck pain & Yacovino and Hain in 2013 determined a 4th pathophysiology for Cervicogenic Dizziness (vestibular migraine), you could potentially see a higher incidence of Cervicogenic Dizziness during the months of January – May as well.  We do not have all of the answers to the association but could be based on pathophysiology of the tissues (such as in headaches, osteoarthritis or inner ear disorders) or affective states (i.e. psychosocial emotional status).  Considering there is conflicting research findings on the associations, we do not fully understand the phenomena.

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

Keeping it Eclectic...


Hi All,

On this talking tendons episode, I dive into the very murky world of isometric exercise and their effect on tendon pain. A new study by Sinead Holden and team brings some (just a little) light to the evidence. I argue that isometrics are useful for managing tendinopathy, but using them for short term pain reduction is just the tip of the iceberg.

Also if you're wanting to earn some extra CPD before Christmas check out my two upcoming workshops in December in Sydney and Melbourne (bookings).

Via - Peter Malliaras - Tendonopathy Rehab



Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

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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...

It's time to save and level up your manual therapy, rehab, and fitness game! 

How's it going?


EDGE Mobility System has a ton of new products, The EDGE Kettle Grip, EDGE Mobility Gun 2.0 - with multiple speeds and upgraded heads, and EDGE Mobility Treatment tables, everything is 15% until Cyber Monday Dec 2nd Midnight EST!


Coupon is auto applied at checkout!


This includes our popular and new EDGE Mobility GunEDGE Suspension TrainerThe all new EDGE Restriction System BFR Cuffs 2.0EDGE Mobility Star - our new IASTM Tool! as well as our classics - The EDGE Mobility ToolMirror Box, and EDGE Mobility Bands!
SALE ENDS CYBER MONDAY DEC 2 MIDNIGHT EST
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25% off on IASTM Technique 2.0 - save $50!

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Save big on our online mentoring program!

The Eclectic Approach to Modern Rehab Mastery is $100 off the normal price, whether you opt for the normal $899 one time payment or 4 payments of $249.99. If you join our next end Nov 2019 Cohort this weekend, you'll get refunded $100!
Click here to save on Modern Rehab Mastery! Join this holiday week and save $100!
With our popular new MMT Webinars, full lectures from my MMT seminars, Q&A, live cases and hundreds of manual techniques, there hasn't been a better time to check out Modern Manual Therapy Premium! Save $20/year on yearly subscriptions and $2.00/month on monthly subscriptions by clicking on the links below.
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I hope to catch you at a live seminar this year or hit me up on facebook, youtube or instagram in a chat or comment! 
As always, Keep it Eclectic....