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[RESEARCH] Low Rate Loading Regenerated Degenerated Discs - themanualtherapist.com


Goal of the Study?

The regenerative potential of a degenerated disc has been questioned over the years. In this ISSLS prize-winning study1, these researchers looked at a particular low load rate, a special rate they have been investigating for years. Discs have a propensity to degenerate, likely due to their avascularity and nutrient supply routes, but this biomechanical study on the mechanobiology of the disc demonstrated regenerative promise. In this animal model, a low load rate of 0.5Hz (cycle of compression and decompression every 2 seconds) regenerated discs that were experimentally degenerated. You’ll want to see the results.

 

Why are they doing this study?

In 2021, a group of researchers presented the regenerative potential of degenerated intervertebral discs on a low rate load cycle. (Cyclic loading enhances small molecule transport in the 8-week degenerated rabbit intervertebral disc. In: Annual meeting of the orthopedic research society. Orthopaedic Research Society, Virtual.) Capogna E, Walrath E, Brown E, Furst W, Glennon J, and Ledet E have been looking at an animal model to see if they can induce regeneration of a degenerated intervertebral disc in a non-pharmacologic and non-invasive way. They have been exploring the role of convection in disc nutrient transport in an animal model.

Regenerated

Researchers used an animal model; this is a human model.

What was done in this study?

Fifty-six female New Zealand White rabbits were used in this study. With all animals greater than 12 months old, they were randomly assigned into:

  1. Control group
  2. Eight-week degeneration group
  3. Eight-week degeneration group followed by eight-weeks of therapy group

A 16 gauge needle was inserted into the L4-5 disc to induce degeneration. This is a common technique used by researchers called disc puncture, which has shown repeatability of inducing degeneration in animal models demonstrating degeneration at two-week post puncture and gradual increase of the degenerative state over a 24-week period.

In the third group, therapy started at the 8-week post-puncture and was placed in a custom in vivo loading apparatus that controlled the axial load movement at the L4-5 disc. Loads of approximately four times body weight (220 N) were applied cyclically in compression and back to neutral (decompression) at 2-second intervals. The animals underwent continuous loading for 2 hrs a day for five days per week for eight weeks.

An investigation done by microscopy and CT was performed.

What did they find?

Low rate cyclic loading at 2-second intervals demonstrated regeneration in the degenerated induced group.

 

Why do these findings matter?

Degenerated discs often contribute to lower back pain. Importantly, if this work could be extrapolated to humans, then a non-invasive, non-pharmacological therapy could offer a simple strategy for this global problem.  In this study, 8 weeks of cyclic loading, for 2 hrs a day 5 days a week, demonstrated a direct mechanobiological response to regenerating intervertebral discs.

 

At Dynamic Disc Designs, we create dynamic human anatomy models to help reveal the spinal structures that matter in the case of lower back teaching. Often it is difficult for patients to understand the complexities of the anatomy and their respective dynamic symptoms. We assist the professionals in their pursuit to educate the people they care for.

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Untold Physio Stories - Mitigating Passive Stretching - themanualtherapist.com


Sometimes you're better off doing things yourself. While Modern Manual Therapy emphasizes self treatment and Erson teaches all kinds of pain modulation techniques, a recent cases needed a little extra push. This got him beyond sharp pain and severe ROM limits to get ready for surgery after a fall and fracture.


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[RESEARCH] Do We Need to Train to Failure for Max Gains? - themanualtherapist.com


Do we need to train to failure in the gym? What about in the PT clinic?
Untold Physio Stories - Ipsilateral Lumbar Lateral Shifts Are Difficult and Confusing - themanualtherapist.com


Ipsilateral Lumbar Lateral Shifts are a rare occurrence. When truly discogenic, they normally have a poor diagnosis. Erson has lucked out in the past a few times with them, and currently Andrew is treating one. It's more of a case discussion rather than a full story for this episode. Have you ever treated an ipsilateral lumbar lateral shift? Were you successful or not? Let us know!


Untold Physio Stories is sponsored by


Helix Pain Creams - I use Helix Creams in my practice and patients love them! Perfect in combination with joint mobs, IASTM and soft tissue work. Use code MMT2 to get your sample by emaliing helix@helix4pain.com to get started. 


Check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual


My PT Insurance - Insurance just got easier. check out the self employed and employed plans. Easy sign up and coverage that follows you wherever you practice in the United States. Save $20 if you sign up using our link.


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[RESEARCH] Facet Joint Injections With and Without Endplate Damage—A Prospective Cohort Study - themanualtherapist.com



Goal of the Study?

Lower back pain contributes to a lot of pain and disability on this planet. One of the strategies for dealing with it is using facet joint injections with corticosteroids to reduce the pain. However, facet joint injections do not always work. In this prospective cohort study published in The Spine Journal1 these researchers questioned whether having another finding, namely, endplate damage, along with facet joint degeneration, could alter the outcome when using facet joint injections as a therapeutic approach.

 

Why are they doing this study?

These authors were curious whether having both endplate changes and facet joint degeneration gave a poorer outcome for facet joint injections compared to having only facet joint degeneration alone.


What was done?

In this prospective cohort study, all low back pain subjects underwent PET/MRI and conventional MRI to determine which of the 42  had endplate damage and facet joint degeneration. All subjects were treated with facet joint injections. Outcomes were measured using the conventional graphical numerical 0-10 point pain scale.



 

What did they find?

Facet joint degeneration is a common cause of lower back pain with the strategy to relieve it using corticosteroid injections. However, in this study, they found that subjects with BOTH facet joint degeneration AND endplate damage did not respond as well compared to those with only facet joint degeneration alone.

 

Why do these findings matter?

In selecting who may benefit from facet joint injections, these findings matter because they highlight that those who have endplate damage and facet degeneration may not benefit as much. This important finding should be considered when realistic outcomes are shared with low back pain patients.

 

At Dynamic Disc Designs, we have human anatomy models of both facet joint degeneration and endplate damage when going over potential treatment strategies with patients seeking out care for their lower back pain. Our patient education models are dynamic and realistic to help spine professionals in their clinical consults.

 

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

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. 
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  • Live cases
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  • over 600 videos - hundreds of techniques and more! 
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Untold Physio Stories - Now That's Flexion Sensitive! - themanualtherapist.com


When a post op knee patient develops contralateral severe thigh and radiating pain and difficulty WB and walking, it takes some sleuthing and several visits for Erson to figure out exactly what is going on. Have you ever had a patient leave completely better, sometimes for days only to have it recur? In these cases it's often not the treatment or home program, but things the patient is doing to negate their progress.



Untold Physio Stories is sponsored by


Helix Pain Creams - I use Helix Creams in my practice and patients love them! Perfect in combination with joint mobs, IASTM and soft tissue work. Use code MMT2 to get your sample by emaling helix@helix4pain.com to get started. 


Check out EDGE Mobility System's Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual


My PT Insurance - Insurance just got easier. check out the self employed and employed plans. Easy sign up and coverage that follows you wherever you practice in the United States. Save $20 if you sign up using our link.


Keeping it Eclectic...

[RESEARCH] The Importance of Grip Strength - themanualtherapist.com


Grip strength, it's kind of a big deal.

Here are some of the associations a recent study found with grip strength:

  • Higher handgrip values at baseline were associated with a minor reduction in mortality risk in the general population; cardiovascular death in mixed populations (e.g., diabetes, general, and other conditions), and incidence of disability.
  • Chair rise performance over time has suggestive evidence
  • Five other outcomes (walking speed, inability to balance, hospital admissions, cardiac death, and mortality in those with chronic kidney disease) have weak evidence.
  • Two associations were found to be nonsignificant (incident hip fracture and cancer mortality).
Tap on the arrows to progress the slides


Two big points: While grip strength can help with many tasks (e.g. carrying objects) build grip strength will not reduce all-cause mortality, rather, grip strength is a marker of overall strength and health.

Grip strength should be routinely included in patient assessments.

Via Dr. Zach Walston on instagram
Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below!

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...

Untold Physio Stories - A Rare Case of SIJ Dysfunction - themanualtherapist.com


In this episode, Andrew goes over a recent and interesting case of a young male after a hip trauma. Could it be the elusive (to us😎) SIJ Dysfunction?



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