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Rhodiola Rosea: A Physical Therapist’s Tool or Gimmick? - themanualtherapist.com

 

Rhodiola Rosea: A Physical Therapist’s Tool or Gimmick?

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

Many patients in my practice come to me asking how they can get more energy for their daily activities. Of course, being a holistic physical therapist I talk with them about sleep hygiene, scheduling, daily aerobic exercise, and nutrition. While many of these interventions help significantly, some of my patients with autoimmune disorders often still struggle with energy and fatigue. I also have a subset of patients in my practice that simply just want more performance for their daily activities as well as for sports. Both of these groups of patients are willing to try almost any dietary supplement, which can be both good and bad: The willingness to try new things is good but many supplements are not regulated and can interact with drugs or cause severe Adverse Events.  

Recently I was listening to the Huberman Podcast and Dr Layne Norton was discussing the use of rhodiola rosea. I had heard of this plant before but my last literature review did not yield much to support its use. However, now it appears there is additional literature to support its utilization. Let’s take a look at what this supplement is, how it’s used, and what implications does it have for physical therapy (PT) practice.

Rhodiola rosea is in the crassulaceae family of plants, known for stonecrop and other similar flowering succulents. These plants commonly grow in northern territories like the arctic circle and northern Asia. As such, cultures living in these areas such as Scandinavia and China have been using this plant for many years to address stress and fatigue in the harsh environment.  Traditional Chinese medicine practitioners call it hóng jǐng tiān, but Westerns also call it Golden Root, Rose Root, and Orpin Rose. It is commonly labeled as an “adaptogen,” which is a term for a plant, herb, or mushroom that can help your body with stress, anxiety, and fatigue. The term adaptogen is trendy now in the United States but it has been around for decades with Russian and Chinese producers pushing products like ginseng and Ashwagandha. Other sellers of rhodiola utilize the term nootropic, which is a substance that improves focus, clarity of thought, and reduces stress to improve cognitive performance. Regardless of the term used, rhodiola rosea contains up to 140 different compounds, with this study citing these as the most common active compounds: monoterpene alcohols, cyanogenic glycosides, aryl glycosides, phenylethanoids, phenylpropanoids and their glycosides, flavonoids, flavonlignans, proanthocyanidins and gallic acid derivatives. Rosavins and salidrosides are the two predominant substrates in rhodiola rosea used in studies and supplements. Such compounds have been suggested to physiologically alter the HPA-axis and other pathways via corticotropin-releasing  hormone (CRH), cortisol, nitric oxide, pro-inflammatory cytokines, free radicals, stress-activated protein kinase (SAPK) and heat shock proteins.  

Such physiological responses are why rhodiola rosea has been used both traditionally and in trials to treat fatigue, anxiety, and depression. A recent systematic review analyzed 39 randomized control trials of rhodiola rosea used to treat anxiety, depression, or mood. The authors found a total of 5 RCTs that met inclusion criteria. One trial showed significant improvement in anxiety, another yielded significant results for treatment of mild to moderate depression, while another study did not yield a positive treatment response for major depression. It seems rhodiola may be beneficial in the treatment of mild to moderate depression, but not major depressive disorders. The 2015 Mao et al study showed that rhodiola rosea  offered clinically  meaningful  odds  ratios that indicated that patients taking R. rosea had 1.4 times the  odds  of  improvement,  and  patients  on  sertraline  had  1.9  times  the  odds  of  improvement,  by  week  12  of  treatment  versus those taking placebo. Other research has shown that Rhodiola rosea acts as a MAO-A and MAO-B inhibitor, showing evidence about  the herb’s antidepressant and cognitive enhancing properties. As such, it would seem that rhodiola may have a use in the treatment of anxiety and/or mild/moderate depression, but further data is needed to truly strengthen these findings.

Two other studies analyzed in the systematic review looked at rhodiola rosea use in individuals with burnout or mental fatigue. The first study yielded patients having significant improvements on a standardized burnout scale while on a rhodiola when compared to placebo. The other study looked at  17–19 year old students during the course of a stressful examination period. Rhodiola offered  statistically   significant   improvements   in  self-reported  mental  fatigue and  statistically  significant  improvements  in  general  well-being when compared to placebo. It should be noted no performance gains in regards to speed or accuracy of test-taking were improved.

In terms of fitness and muscle performance the data is more varied and of poorer quality. The Hung, Perry, and Ernst 2016 systematic review looked at some of the trials before 2009. This review cited that two trails with small sample sizes (n = 15 and 12) found rhodiola did not improve blood oxygenation after induced hypoxia and skeletal muscle phosphocreatine recovery after exhaustive exercise, respectively. Another study in the review found significant increases in time to exhaustion (increase of 3% on peak VO2 on a cycle ergometer) with 200mg/day rhodiola use. The authors suggested the improvement may be related to the mental improvements related to fatigue, not to metabolic changes. Two other trials in the review yielded a mean C-reactive protein (CRP) level improvement. 

A few trials have looked at rhodiola since 2009, with this study finding 1500 mg/day of rhodiola having a small improvement in bench press velocity but not endurance. The sample size in this study was very small and the dosage much higher than other studies (most other studies used ~100-680 mg of rhodiola rosea/day). Another trial of 14 trained male athletes yielded improvements in immediate lactate and creatine kinase enzymes, but no improvements in VO2max or other performance measures. The authors state that rhodiola did improve fatty acid metabolism, which deviates from the above cycle ergometer study that found a VO2 improvement. Again, it was another study with a small sample size and it also had a wide range of “trained” participants from 20-35 years who performed either triathlons, roller skating, and/or track/field. Such variability in sport and a small sample size makes it tough to interpret actual results.

So how do these findings translate in the world of sport and physical therapy? In brief, the sport physio needs to be skeptical of the actual performance benefits of rhodiola rosea. While the supplement appears to be safe, with only 3 mild adverse events (headache and hypersalivation) in 8 trials, the benefits to sports performance may not be present. However, in the world of precision or individualized medicine, a patient or athlete may want to trial rhodiola rosea in their training regime and see if they see actual performance benefits. In this case, most studies used rhodiola on a chronic basis taking on average 300-600 mg of extract per day. If clients are to use rhodiola, I would recommend using a reputable supplement company that is GMP certified, NSF certified, and 3 party independently tested. Obviously supplements are not regulated, and some authors have cited issues with quality control and environmental issues related to rhodiola rosea – caveat emptor.

General PTs and PTs that work with patients that have chronic pain, autoimmune disorders, or other neurocognitive issues with mental fatigue may also want to examine rhodiola use for their clients. Patients with chronic pain often present with mild to moderate depression and anxiety; utilizing rhodiola, in combination with other common physical therapy interventions, may improve a patient’s condition more rapidly than without supplementation. Have we seen a trial regarding this yet? Unfortunately, no, but perhaps this could be an awesome DPT student’s study! Clients with autoimmune and other neurocognitive conditions may see improvements in mental fatigue and resiliency. Such improvements may be the difference between getting out of bed, off the couch, or engaging in social activities – all positive interactions.

In the end, rhodiola rosea offers some promising impacts to our clients, and perhaps this is why traditional medicine practitioners used it; however, I caution PTs that the benefits of this adaptogen may not be as strong for some (athletes) as for others (those with depression).

 

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!

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Untold Physio Stories - Preventing Low Back Pain After 7 Hours of Shoveling - themanualtherapist.com



Buffalo NY was just hit with a crazy amount of snow. Erson talked about his experience with Snowvember 2022, shoveling for 7 hours over two days and how he prevented a major onset of low back and neck pain. 


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 and get an additional revenue stream for your practice. Click here to get started.


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Untold Physio Stories - Enough with the Soft Tissue Work Already! - themanualtherapist.com


A former patient who loves soft tissue work was having it done for some "wrist tightness." She saw Erson years ago, and kept lamenting she wanted the "Old Erson Back." But was it wrist tightness, or something else? This was definitely a case of active strategies working over passive. What do you think? Have you ever had a former patient come back who subscribes to a treatment or assessment you no longer use?



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 and get an additional revenue stream for your practice. Click here 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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Words and Diagnostic Labels of LBP Prognosis - themanualtherapist.com


Goal of the Study?

The goal of this study is to learn more about a patient’s perception and expected outcome when a diagnosis is shared with them regarding their low back pain. In a recent paper published in the European Spine Journal1 the authors wanted to know how diagnostic labels influenced the participants. Did labelling a patient with a common diagnosis create poorer expectations and outcomes?

Untold Physio Stories - Hyper-Focused on Pain - themanualtherapist.com


In this episode Andrew and Erson discuss a patient who is very focused on her pain. Her evaluation is not straight forward and nothing really stands out for her point tender right lower rib pain. What are your thoughts?


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 and get an additional revenue stream for your practice. Click here 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...

Best Practices in PT for Hip and Knee OA Includes Dietary Interventions - themanualtherapist.com


Best Practices for Hip and Knee OA Includes Dietary Interventions

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

A few months back a major article was published regarding osteoarthritis treatment guidelines from 6 major professional organizations. Physical therapists (PTs), athletic trainers (ATs), occupational therapists (OTs), and Physicians use these professional guidelines to help direct our care. As many of us know, OA  can lead to great loss of function, increased pain, and higher expenses. As such, having the most current and best evidence is vitally important to helping our patients move better, have less pain, and reduce costs.

For years the mainstay treatment in physical therapy has been exercise and manual therapy. Obviously these treatments depend on the specific joint, as many DPTs often use aquatic therapy to help with hip osteoarthritis. Lately the utilization of dry needling has helped patients with knee OA. The use of other therapies like non-steroidal anti-inflammatory drugs (NSAIDs) and corticosteroid injections have been questioned more, although their utilization still exists.

Looking at this new publication it's clear that physical therapists need to be engaging their patients with hip and knee osteoarthritis in the discussion of weight loss. The professional organizations included in this article's analysis includes the American Academy of Orthopedic Surgeons, the Veterans Affairs / Department of Defense,The American College of Rheumatology, and the European Society for Clinical and Economic Aspects of OA.  Take a look at these two tables and see what the authors’ recommendations are for knee and hip OA, particularly the ones encircled:

Clearly the best practices for hip and knee OA include education around weight loss. Such guidance is also consistent with the JOSPT Clinical Practice Guidelines for hip OA. Most data show that in order to achieve weight loss, patients need to focus on dietary changes. Dietary modifications contribute to 60-80%  of weight loss, despite PTs and fitness gurus thinking that exercise contributes the most. Much of the benefits of weight loss for clients with OA comes not just in the mechanical unloading of the joints but also the reduction in inflammation and improved metabolic functioning. 

It's apparent, from this research, that exercise is also important for hip and knee OA – but perhaps we need to talk more about the fork than the barbell?

If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60!




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 - Pro Tips from Aaron LeBauer - themanualtherapist.com


In this very special episode of Untold Physio Stories, Erson is joined by his good friend and CashPT expert Dr. Aaron LeBauer of LeBauer Consulting. Aaron tells an early career story and gives some great pro tips on connecting with patients. If you are thinking about starting a Cash PT practice get your free copy of the Cash PT Blueprint here!


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 and get an additional revenue stream for your practice. Click here 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...