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Untold Physio Stories - Fracture or Something Else? - themanualtherapist.com


In this episode, Erson talks about a recent young soccer player who was kicked twice in the calf. The antalgic gait, inability to WB or extend his knee, plus overall sensitivity to touch made him think of a fracture as a differential Dx. Listen in to find out what the result was.


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[RESEARCH] Rotator Cuff Tear - Surgery v. Conservative Rehab for 55+ - themanualtherapist.com


Rotator Cuff Tear - Surgery v. Conservative Rehab for 55+


INTRO:
Non-traumatic rotator cuff tear is a common shoulder problem which can be treated either conservatively or operatively. Kukkonen et al. (2021) investigated the difference between clinical and radiological 5 year outcomes in patients aged over 55 years.


METHODS:
180 shoulders with symptomatic, non-traumatic supraspinatus tears were randomly assigned to:
  1. Physiotherapy (Group 1)
  2. Acromioplasty and physiotherapy (Group 2)
  3. Rotator cuff repair, acromioplasty and physiotherapy (Group 3).
Primary Outcome:
Constant score.

Secondary Outcomes:
Visual analog scale for pain and patient satisfaction.
Radiological analysis included evaluation of glenohumeral osteoarthritis and rotator cuff tear arthropathy.

RESULTS:
The average tear size of the supraspinatus was 10 mm in all groups.

There were no significant differences in the average change of Constant score:
  • 18.5 points in Group 1
  • 17.9 points in Group 2
  • 20.0 points in Group 3.
There were no statistically significant differences in the change of visual analog scale for pain and patient satisfaction. At follow-up there were no statistically significant differences in the mean progression of glenohumeral osteoarthritis or cuff tear arthropathy between the groups.

CONCLUSIONS:
  • Operative treatment was no better than conservative treatment with regard to small non-traumatic single tendon supraspinatus tears in patients over 55 years of age.
  • Operative treatment does not protect against degeneration of the glenohumeral joint or cuff tear arthropathy.
  • Conservative treatment is a reasonable option for the primary initial treatment of this condition.
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SOURCE:
Kukkonen et al. 2021.
OPERATIVE VS. CONSERVATIVE TREATMENT OF SMALL NON-TRAUMATIC SUPRASPINATUS TEARS IN PATIENTS OVER 55 YEARS. Journal of Shoulder and Elbow Surgery

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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3 Factors That the Vestibular Therapist Should Know About BPPV and Stroke - themanualtherapist.com


During the differential diagnosis of a patient with vertigo or dizziness, it is pertinent that the clinician determine if the symptoms are benign / non-benign or central / peripheral.

This is our red light or green light system to treat or refer. This is by far the most important decision that comes out of a clinical evaluation and is especially important with neurological symptoms.

The most common benign cause of vertigo is benign paroxysmal positional vertigo (BPPV). There are specific subjective and objective findings that are crucial to ruling in BPPV in the dizzy patient.

A physical therapist trained in vestibular rehabilitation is well aware of these findings and do a splendid job at helping people! We are actually very good at differential diagnosis and use the latest research to help refine our clinical exam!

In some instances, patients who are having dizzy/vertigo symptoms seek out help from physical therapists with thought they are having BPPV but instead it is an early sign for a stroke. Early diagnosis and intervention are crucial for successful treatment in patients with acute ischemic stroke because prompt thrombolytic treatment improves outcomes. We also do not want to propel a spontaneous dissection through a mechanical input, such as with manual therapy, Dix-Hallpike testing or even range of motion.

In fact, ischemic changes affecting the vestibular artery in patients with BPPV could precede a full-blown ischemic stroke. These ischemic changes affecting the vertebrobasilar system could initially produce vestibular symptoms, such as BPPV.

Here are a three factors for the vestibular therapist to know about BPPV and stroke:
  1. The vestibular organs are vulnerable to ischemic obstruction. This is due to the “small creek” that finally lead to the organs from the anterior vestibular artery, which as we know, originate initially from the vertebral-basilar artery. Therefore, a disturbance of adequate hemodynamics to this region could indicate a disruption more proximal, such as in the vertebral-basilar artery.
  2. There are common risk factors associated with both BPPV and ischemic stroke. These can include osteoporosis, smoking, alcohol consumption, anxiety, cardiovascular disease and diabetes. Conditions such as obesity, cardiovascular disease, and diabetes are chronic diseases and related to stroke onset. Therefore, a correlation can be made that BPPV increases the risk of ischemic stroke.
  3. BPPV is recurrent and can lead to lifestyle changes. One lifestyle change can be physical inactivity. Physical inactivity following BPPV might increase the risk of an ischemic stroke. A sedentary lifestyle due to avoidance of activities from fear or provocation of vertigo/dizzy symptoms can occur in these patients over time. Our goal is to educate our patients to stay active with proper recommendations based off of the patient’s presentation. Our goal too is to get them better so they do not have impairments!
These are just 3 factors that we believe a vestibular therapist should be aware concerning ischemic stroke while treating a dizzy patient. Having this knowledge helps us go beyond the thinking of pathophysiology of cupulolithiasis and canalolithiasis. These factors can lead to knowledge of not only signs and symptoms associated with non-mechanical and mechanical causes of dizziness, but also education for our patients for the long term, especially for those with recurrent 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.

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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Untold Physio Stories - Let's Review Those Exercises - themanualtherapist.com


In all of his initial evaluations, Erson goes over resets and any prescribed exercises 20-30 times minimum. When a patient gets relief from an end range loading reset, he makes sure they understand the how's and why's of the movements. When the same resets spontaneously start worsening the complaints after 2 weeks of relief, something is probably going wrong...

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Accuracy of ACL Special Tests - themanualtherapist.com


Accuracy of 3 ACL Diagnostic Tests


INTRO:
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee. 

In America, estimates of ACL injury cases range from 80,000 to 250,000 per year, with approximately 100,000 of these patients undergoing ACL reconstruction surgery. 

The 3 primary diagnostic assessments of these manual tests are:
  • Anterior drawer test.
  • Lachman test.
  • Pivot shift test.
Hunag et al. (2016), performed a meta-analysis, looking at diagnostic sensitivity and specificity of the 3 assessments to evaluate the diagnostic accuracy of the anterior drawer, Lachman, and pivot shift tests. 

RESULTS:
  • 16 studies assessed the accuracy of the 3 tests for diagnosing ACL ruptures & met the inclusion criteria. 
  • Lachman test; most sensitive test to determine ACL tears (87.1%).
  • Pivot shift test; most specific test (97.5%) & has the highest positive likelihood ratios (LR+) of 16.00.
  • Lachman test has the lowest negative likelihood ratios (LR−) of 0.17. 
CONCLUSIONS:
In cases of suspected ACL injury:
  • Perform the pivot shift test, as it is very specific and has greater likelihood ratios in diagnosing ACL rupture. 
  • The Lachman test has favorable efficacy in ruling out a diagnosis of ACL rupture.
  • The anterior drawer test is the least proven of the 3 approaches in diagnosing ACL rupture.
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SOURCE:
Huang et al. 2016. Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 2016;50(1):22–31 doi: 10.3944/AOTT.2016.14.0283.

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. 
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  • over 600 videos - hundreds of techniques and more! 
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[RESEARCH] Safety of Blood Flow Restriction Training - themanualtherapist.com


Blood Flow Restriction Training Safety


Background:
Blood flow restriction training (BFRT) is defined as the partial restriction of arterial blood flow into the muscle while venous outflow is occluded during a bout of exercise.

BFRT is used for physical training and performance in healthy individuals, as well as an adjunct to physical rehabilitation in injured individuals.

Current understanding of the physiological mechanisms of BFRT and related performance includes:
  • Acute muscle cell swelling.
  • Increased fiber-type recruitment
  • Decreased myostatin.
  • Decreased atrogenes.
  • Satellite cell proliferation.

With the increasing use of BFRT in clinical populations, Minniti et al. (2020) systematically reviewed the research to assess the potential adverse events associated with BFRT when used clinically in the treatment of patients with musculoskeletal disorders.

RESULTS:
  • 19 studies with 322 pooled participants.
  • 9 studies reported no adverse events.
  • 3 reported rare adverse events, including an upper extremity deep vein thrombosis and rhabdomyolysis.
  • 3 case studies reported common adverse events, including acute muscle pain and acute muscle fatigue.

Individuals exposed to BFRT were not more likely to have an adverse event than individuals exposed to exercise alone.

Adverse Events Overall:
  • Overall (14 of 322).
  • Rare Overall (3 of 322).
  • Rare BFRT (3 of 168).
  • Rare Control Group (0 of 154)
  • Any adverse BFRT (10 of 168).
  • Any adverse control (4 of 154).

CONCLUSIONS:
BFRT appears to be a safe intervention and even more so when used according to evidence-based guidelines and in patients with knee-related musculoskeletal disorders.

Further research is needed to make definitive conclusions about the absolute safety in all patient populations.

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SOURCE:
Minniti et al. 2020. AmJ Sprt Med 2020;48(7):1773–1785 DOI: 10.1177/0363546519882652

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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

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 - Bias vs Experience - themanualtherapist.com


In this episode, Erson goes over a recent seemingly clear cut case of an ankle injury. Don't let your biases prevent you from being thorough! 



Untold Physio Stories is sponsored by


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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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Untold Physio Stories - Correcting an Ipsilateral Lumbar Lateral Shift - themanualtherapist.com


If you have ever seen a lumbar patient with a true lateral shift, you would know they're not the easiest or straight forward patients. An ipsilateral lumbar lateral shift usually has poor outcomes. If it's actually discogenic and you have to shift away from the side of symptoms (they are shifted toward the pain instead of away) to correct the shift, this could make the disc protrude or herniate worse. In the 200th episode of Untold Physio Stories, Erson goes over the problem solving he used to treat an ipsilateral lateral shift case he saw recently.

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...