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FAI Rehab Protocol Part 2 - Postural Exercises - themanualtherapist.com

Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)

[SERIES] 2/5

If you missed part 1, click here. 

  • Postural exercises are used to teach the patient to improve body awareness.
  • Neutral posture can reduce compensation patterns.
  • If swayback posture is present with anterior pelvic tilt, it might further contribute to FAI symptoms.

Common Symptoms include:

  • Clicking
  • Catching
  • Locking
  • Restricting
  • Stiffening of the hip with movement

POSTURAL EXERCISES:

Initial Exercises:
Floor anterior and posterior pelvic-floor tilts.
[Achieve neutral pelvic alignment and improve awareness of pelvic tilt; 50 reps]

Progression #1
Quadrupled lumbar flexion and extension
[Achieve neutral pelvic alignment and improve awareness of pelvic tilt; 50 reps]

Progressions #2
Seated pelvic-girdle tilts, on chair or exercise ball.
[Achieve neutral pelvic alignment and improve awareness of pelvic tilt; 50 reps].

Progression #3
Standing pelvic-girdle tilts.
[Achieve neutral alignment and awareness of pelvic tilt; 50 reps]

NEXT UP:
In the coming posts, more advanced progressions and exercises will be featured, including:

Core Stabilization Exercises
Hip Strength & Motor Control Exercises
Flexibility and Mobility Exercises

Reposted with permission from @physicaltherapyresearch on instagram

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
SOURCES:

Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training 2020;55(11):000–000.

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Is Placebo More Than Just a Feeling? - themanualtherapist.com



Placebo arms in randomized controlled trials are becoming increasingly popular to help control for the various nonspecific effects such as natural history, regression to the mean, and placebo effects.

A placebo effect can be distinguished as a physiological response to the therapeutic context of an intervention delivery, where a placebo response is classified as the improvement of participants in a placebo arm for any reason.


This is where we were led to believe that placebo effects had a particularly strong influence on subjective outcomes (i.e. pain), and therefore we could reduce placebo responses by utilizing objective markers as primary outcomes rather than patient-reported outcomes.

Since this has not been studied as extensively, five RCTs regarding rheumatoid arthritis were retrospectively extracted that were testing a drug trial against a placebo arm. Rheumatoid arthritis drug trials were included in part due to their assessment of patient reported pain levels as well as changes in objective biomarkers (C-reactive protein [CRP] levels or erythrocyte sedimentation rate [ESR]).

Results found that there were statistically significant decreases in both pain and objective biomarkers in all of the 5 RCTs.

It is believed that a majority of these decreases are dominated by natural history and regression to the mean, however, it is clear that placebo responses cannot be limited to a psychological effect alone.

The importance of this study suggests that investigators need to be aware of the natural history in relation to placebo arms and should not replace subjective outcomes with objective measures.

A variety of limitations existed with the biggest one including not involving a no-treatment group. Involving a pure control group where they did not get either the drug or placebo would have given us a better understanding of the true effects of natural history and regression to the mean.


👬Know someone who might find this helpful? Please share!

Via Dr. Cameron Faller's Instagram reposted with permission


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5 Charts Showing Why Therapists Should Learn About Cervicogenic Dizziness - themanualtherapist.com


Science begets more science.

That is how we continue to advance and propel ourselves forward in neuromusculoskeletal rehabilitation.

For over the past decade, we have treated dizzy/vertigo and neck pain disorders.  We have allowed guidelines and clinical expertise guide us to treat these conditions when presented to us independently.  More memorable to us is what we have created together (orthopedic and vestibular therapist) when these symptoms are combined or overlap.  We call this our Physio Blend.

Most clinicians can agree that these symptoms are combined more often than simply independent entities but difficult to “prove” via research.  During our teaching, we discuss the research on the double entity — i.e. multiple systems contributing to symptoms — but today, we present to you 5 charts showing why neck pain and dizziness are correlated in research.

1. Concussion Research

 

Concussion Research (Source: Pubmed) from 1990-2019)

Concussion, in general, has by far had the greatest attention in the medical industry in the past few years.  As you can even see from the graph above, a huge spike starting occurring around 2012 and has skyrocketed over 300%.  For those in the clinic treating Post-Concussion Syndrome, you are well aware of the multiple systems (and professionals) needed to treat the individual entirely.  Read more about this topic from a previous post here and here.

2. “Neck Pain and Dizziness” Research

“Neck Pain and Dizziness” Search from 1990-2019

When I searched for the combined phrase, “Neck Pain and Dizziness”, I did not expect to find such a spike in research over the past several years.  Obviously this does make sense clinically as this is what we see (and teach), but good to see the research catching up.  For you all in the clinic, I know you see an improvement in neck pain patients when treating the neck and could also see a spike in improvements with neck pain when treating the vestibular system. Read more about this topic from a previous post here and here.

3. “Neck Pain and Vertigo” Research

 

“Neck Pain and Vertigo” Search from 1990-2019

Vertigo as a symptom is not nearly as correlated clinically as dizziness as a symptom when speaking of Cervicogenic Dizziness, but can’t deny the overlap of terms in the clinic and research.  Interesting there is a big spike from 2017 to 2019 with articles (almost double) with this phrase.  We have written about the controversy between professions over this topic and you can read more about it here.

4. Cervical Vertigo Research

Cervical Vertigo Search from 1990-2019

Cervical Vertigo should be becoming more antiquated of a term and you can certainly see a drop in this phrase in the research starting in 2014.  One of our most popular articles discusses this topic and you can read more about it here.

5. Cervicogenic Dizziness Research

Cervicogenic Dizziness Search from 1990-2019

You may wonder why we actually left the phrase, “Cervicogenic Dizziness” for last in this article considering this is the main expression or our combined knowledge.  You can see from the chart above that this is the least common terminology and nothing was found of it prior to the year 2000 when Diane Wrisley’s most famous article came out.  I think you can take out of this chart is that if you want to research an article, you need to look at multiple search items and not limit yourself to one phrase.  This is how we created the research behind our Physio Blend — by examining the works of the osteopaths, acupuncturists, chiropractors, physios and surgeons.  We really need to favor conservative care for this condition and you can read more about this topic here.

 So there you go!  You can see a trend towards having knowledge of multiple systems to fully treat someone with dizziness, vertigo and neck pain.

You can learn more about the screening and treatment process of Cervicogenic Dizzinesss through Integrative Clinical Concepts, where the author and his wife, a Vestibular Specialist, teach a 2-day course.  Pertinent to this blog post, the first day provides the most up-to-date evidence review from multiple disciplines to diagnose through the “Optimal Sequence Algorithm” to assist in ruling out disorders and ruling in cervical spine, including determining if single or double entity exists.  

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.

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reposted with permission from In Touch PT Blog

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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FAI Rehab Protocol Part 1 - themanualtherapist.com

Exercise Rehab Protocol

Femoroacetabular Impingement Syndrome (FAI)


INTRO:
FAI syndrome is caused by premature contact of the femur and acetabulum during hip motion.
The 2 classifications of FAIS are cam and pincer impingement. Aspherical deformation of the femoral head occurs with cam deformity, whereas pincer deformity presents with excessive prominence of the outer rim of the acetabulum.

Nonoperative rehab protocols include 4 central goals:
  • Postural positioning.
  • Core strength,
  • Hip strength and motor control,
  • Functional range of motion.
Effective rehab relies on the practitioner’s ability to individualize programming to specific desired outcomes.

Terrell et al. (2020), presented an overview of FAI, including a common protocol for FAI rehab.

In the coming posts, example progressions and exercises will be featured, including:
  • Postural Exercises
  • Core Stabilization Exercises
  • Hip Strength & Motor Control Exercises
  • Flexibility and Mobility Exercises
SOURCES:
Terrell et al. 2020. Therapeutic Exercise Approaches to Nonoperative and Postoperative Management of Femoroacetabular Impingement Syndrome. Journal of Athletic Training 2020;55(11):000–000.

More posts weekly - reposted with permission from @physicaltherapyresearch on instagram

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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COVID, Vitamin D, and Physical Therapy - themanualtherapist.com


Emerging evidence is revealing how Vitamin D can help patients with COVID-19, commonly known as the Coronavirus.  Vitamin D is known as the "sunshine vitamin" as it is produced in the skin with sun exposure. Most Americans are deficient in Vitamin D, possibly due to the lack of optimal sun exposure and/or their poor diets. In order to get peak Vitamin D levels from sun exposure, a person must remain in direct sun with most the body exposed for 20 minutes under peak sun (usually 11am to 1pm). Vitamin D can be found as a fortification in many foods such as cereals, dairy milk, plant-based milks, while it is found naturally in some mushrooms. The specific Vitamin D in focus would be D3, also known as cholecalciferol.

So what's the data on Vitamin D and COVID-19? Well, randomized trials and cross sectional studies have shown that ~60% of patients with COVID-19 were vitamin D deficient upon hospitalization, with men in the advanced stages of COVID-19 pneumonia showing the greatest deficit. More staggering is that those with a serum Vitamin D level below 20 ng/mL had a 3.7 times more likely chance of dying from COVID. That is a serious number! More worrying is that these data are independent of comorbid status, so this shows how important Vitamin D is to proper immune function.

Physical therapists should be advocating for adult patients to be taking 4,000 IU per day of Vitamin D3 (2,000 IUs for children). The ideal mechanism for patients to reach such targets would be through supplementation or a combination of supplementation with fortified foods. Exact mechanisms of how Vitamin D may improve health function for those with COVID remains to be seen; however, some authors have suggested that Vitamin D helps to prevent severe cytokine storming, which leads to aggressive lung failure and ultimately the need for ventilatory support.

Doctors of Physical Therapy (DPTs) and Physical Therapy Assistants (PTAs) need to be up to date on such current data for optimal treatment, prevention, and collaboration with other healthcare team members. Stay tuned for more info on this an other COVID related nutrition facts. Stay safe and Happy New Year!

Via Dr. Sean Wells, Lead Instructor - Modern Nutritional Rehab

Get Certified in Nutritional Physical Therapy - Earn your CNPT Online!






Disclaimer: The above article is written as opinion piece and does not convey specific legal, medical, and/or practice act advice. 
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The 5+ Villains of Evidenced Based Practice - themanualtherapist.com


🔥TOP 5 FRIDAY & HAPPY NEW YEAR🔥

Okay, this week’s Top 5 is super corny, but I had fun thinking about some of the most common ways our evidence suffers due to illogical thinking.

Applying evidence to practice relies on finely tuning a fluid combination of what the best literature tells us, what our clinical experience tells us, and what the patient’s values are.
Villians of Evidence Based Practice by Cameron Faller 

Some common pitfalls get in the way of this and can create scenarios where clinicians become skewed in their thoughts and interpretations of certain events.
  • Post-Hoctopus - This villain has allowed for the continuation of individuals placing a high value on certain low-supported interventions such as KT tape, MET, ultrasound, etc. despite not understanding the true effect of these interventions.
  • Sir Please-A-lot - It is important to include the patient's values as part of your treatment, but we are also doing them a disservice if we aren’t fully educating around their uninformed knowledge and only giving them what they want.
  • Old Dog - The claim that his experience tells us otherwise is his famous statement. The problem with this thinking is that most theories get proven wrong eventually, so instead of trying to be right, focus on being less wrong.
  • Dichotomous Anonymous - Most controversial topics in our world don’t have a right and wrong answer, but more so lie on a spectrum with the best information sitting somewhere in the middle of that spectrum.
  • Ms. Popularity - You see her on TV, all over social media, even when you are driving on the highway. The media loves to infiltrate popular products and gets higher figures to promote it in order to make a better profit. Don’t be fooled by their tricks, just because it looks good, doesn’t mean it is good.
  • Anecdotalopous - It may be tempting to trust anecdotal evidence, but until better high-quality evidence is published, don’t waste your time and money thinking that the next best thing actually is the next best thing.
Our way of gaining information has expanded profoundly and has created new challenges with our thinking.  So as you try to learn on being less wrong, beware of these villains that will likely try to get in your way!

Via Dr. Cameron Faller's Instagram


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No Red Flags But Things Don't Add Up - themanualtherapist.com


In this episode, Andrew goes over a recent interesting case where he treated a young woman in her early 30s with no red flags. However, her hip and LBP just didn't add up, even though things were progressing well for her back pain, the hip pain was not responding.


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Back Squat v Front Squat v Transformer-bar Squat: Part 3 - Implications - themanualtherapist.com


Click here for Parts 1 and 2 if you missed them or want a review!

Squats with more anteriorly placed loads resulted in:
  • Decreased trunk flexion.
  • Decreased pelvis anterior tilt angles.
  • Increased low-back moments.
  • Similar lower extremity moments compared to squats with more posteriorly placed loads.


FIRST:

  • The transformer bar imposes similar lower extremity loading as a straight-bar back squat.
  • Therefore, can be considered as an alternative training strategy for people with upper extremity limitations.

SECOND:

  • Changing anterior-posterior load placement may not induce as many changes in low-back and lower extremity moments as thought.
  • As individuals can adjust their trunk and pelvis angles to mediate the effects of load placements on joint moments.
  • Additional instruction and feedback may be needed to achieve greater effects of load placement manipulation on low-back and lower extremity joint moments.

THIRD:

  • The straight-bar front squat has more knee loading, but less ankle and hip loading in the descending phase compared to the other squats.

LAST:

  • Anteriorly placed loads may result in greater low-back moments.
  • While, posteriorly placed loads may demonstrate greater trunk flexion and pelvis anterior tilt.
  • This should be taken into consideration for people with low-back impairment.

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...