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5 CARDIAC CHANGES MASTERS RUNNERS EXPERIENCE πŸƒ‍♂️πŸƒ‍♀️

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☝🏻In addition to the musculoskeletal changes that occur as a runner enters the masters years, there are also numerous cardiovascular function and therefore endurance performance changes that occur with ageing πŸ‘€

This post was first found on Brad Beer's instagram


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πŸ‘‰πŸ»Physiologically as a runner enters the masters years the changes shown in this infographic were found* to occur [study looked at 55 runners aged between 30 and 80 years who ran on average 50km per week to occur]πŸ”
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πŸ‘‰πŸ»The researchers concluded that the decline of VO2max with ageing in runners was mainly explained by the central cardiovascular factors represented by the decline of heart rate max and cardiac output πŸ‘Ÿ
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‼️TAKE HOME: Willy and Paquette (2) surmise that although running training cannot completely halt the natural and above outlined age related declines in cardiovascular function, that there is ‘absolutely no doubt that continued endurance training volume and intensity are beneficial to slowing these declines in the masters runner ✅
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Ref: *Eur J Appl Physiol Occup Physiol. 1989;58(8):884-9.
Cardiovascular changes associated with decreased aerobic capacity and aging in long-distance runners.
https://www.ncbi.nlm.nih.gov/pubmed/2504587


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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!

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In this podcast, Jason joins Erson again for their semi quarterly podcast! Foot drop is normally difficult if it's spinal in origin. When your screens are inconclusive and your treatment is ineffective, what's next? Listen to this quick and interesting story for a great differential diagnosis.


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Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com .  Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Andrew Rothschild at Modern Patient Education.

Keeping it Eclectic...


Let me begin by saying – I wish a resource like this existed when I was going through school. Over the years I have spent considerable time trying to improve my own understanding of the best way to approach the management of musculoskeletal pain disorders (MPD) and how to integrate evidence with clinical practice. Often, I felt that I needed a framework to guide me, but lacked a resource that cumulated all the current evidence and practice approaches I had been taught.
Screen Shot 2019-02-19 at 11.00.15 AM.png
In 2018, a group of highly skilled Physiotherapists in Western Australia, collaborated to produce a very special ebook.
“This framework was originally developed to assist clinical teaching on the undergraduate and post-graduate Physiotherapy Clinical Masters programs” (Mitchell, et al., 2018, p.6).
“This book has been written to provide health care practitioners with a contemporary perspective on the management of individuals with musculoskeletal pain disorders” (Mitchell, et al., 2018, p.7).
I was so excited to hear about this book being published and couldn’t wait to read it. This blog is a review of this ebook.
The framework includes:
  1. Individual’s perspective
  2. Diagnosis
  3. Stage of the disorder
  4. Pain features
  5. Psychosocial considerations
  6. Work considerations
  7. Lifestyle considerations
  8. Whole person considerations
  9. Functional behaviours
  10. Clinical decision making
Man, our job is difficult! We have to assess the variables in each of these categories and piece together a puzzle to truly understand the problem. One reason for the lack of translation of EBP into multi-dimensional care is the “tendency towards a reductionist biomedical focus” in our teaching programs (Mitchell, et al., 2018, p.10). 
Ask yourself: what are the influencing factors in the development, maintenance, and resolution of someone’s pain? If you need help deciphering these factors, then this framework is going to help clear up some of the confusion. It has the capacity to teach students how to become clinicians who really understand how to apply the biopsychosocial approach to patient care.
It can’t be don’t quickly.
It can’t be rote learnt.
We need to focus on management > treatment to fix a problem.  
“Understanding the complex interactions between these dimensions, and understanding what to do with that knowledge, is challenging for clinicians especially when conditions persist” (Mitchell, et al., 2018, p.11). To apply this framework to clinical practice clinicians need an understanding of basic science of the elements, an understanding of the connectedness of elements, identify elements which are individual to each presentation, prioritize contributing factors, match management to contributing factors and acknowledge contextual sensitivity.
Where do we begin? We need to change our focus of assessment to developing a patient profile, not providing a diagnostic label.  

INDIVIDUAL PERSPECTIVE:

It starts here – actually listening to the patient’s story about the problem they are presenting with.
Tell me about the problem that brings you here today.”
Impact - how is this problem impacting you? Understanding the problem from the individual’s perspective helps with person-centered goal setting. “Focus on capacity rather than incapacity” (Mitchell, et al., 2018, p.18).

DIAGNOSIS:

Identify red flags – “this represents a critical step in the safe delivery of care, protecting both the individual and the clinician” (Mitchell, et al., 2018, p.20).
Make the distinction between specific and non-specific musculoskeletal pain disorders. Often giving the label of a non-specific pain disorder is unhelpful and poorly received – this is definitely an area where we as educators can improve our delivery of information to the patient. “Rather, HCPs should communicate to the individual that while there is no serious or structural pathology associated with their presentation, their pain problem is real and valid, and is associated with a range of factors identified within the examination” (Mitchell, et al., 2018, p.22). 

PAIN FEATURES:

Type, characteristics and sensitization. This ebook clearly describes three types of pain - nociceptive, neuropathic and nociplastic. This last term is relatively new to our description of pain types. The continue to explore the characteristics of pain and finish by exploring the meaning of sensitization. Not all sensitization is bad – sensitisation is not always a pathological response. But, when it persists, we can say “the pain is real but biologically unhelpful, as it no longer serves as a useful, protective function” (Mitchell, et al., 2018, p.31)
This is another area for improvement – explaining to patients that “pain is a conscious emergent experience that can and does exist without nociceptive input” (Mitchell, et al., 2018, p.27) so that people don’t hear it’s all in your head. The development of this phrase is one of the biggest undesirable effects resulting from ineffective education about pain and poor choice of working. Pain is real and valid!
Other areas in this framework
  • Psychosocial considerations (yellow flags)
    • This is where screening tools are super helpful such as the short form Orebro, FABQ, TSK, and DASH. Use them!
  • Work considerations (blue and black flags)
    • Blue flags – perceptions of work
    • Black flags – workplace factors
  • Lifestyle considerations
    • Level of physical activity, sleep hygiene, diet, smoking and alcohol.  
  • Person considerations
    • “Pain is a living experience and requires considerations from a whole-person perspective” (Mitchell, et al., 2018, p.37). Looking at other co-morbidities and influencing factors.
  • Functional behaviours
    • “Physical manifestations of an individuals pain experience” (Mitchell, et al., 2018, p.39). These included impairments of control and movement impairments, helpful (protective) and unhelpful (provocative) functional behaviours.
It is so exciting to see a framework published, which is designed to help clinicians improve their process of examination, to refine their clinical reasoning process, to highlight areas where our education can lead to a backfire effect, and to ultimately become better educations to patients. Thank you Tim, Darren, Helen & Peter for helping us help other.
Sian Smale is an Australian-trained Musculoskeletal Physiotherapist. Sian completed her Bachelor of Physiotherapy through La Trobe University in 2009 and in 2013 was awarded a Masters in Musculoskeletal Physiotherapy through Melbourne University. Since graduating from her Masters program, Sian has been working in a Private Practice setting and writing a Physiotherapy Blog "Rayner & Smale". Prior to moving to San Francisco, Sian worked at Physical Spinal and Physiotherapy Clinic and has a strong background in manual therapy and management of spinal spine, headaches and sports injuries. Since moving to the Bay area, Sian has become a Physiotherapist for the Olympic Winter Institute of Australia, traveling with their Para Alpine teams. Sian currently works full time at TherapydiaSF as a physical therapist and clinical pilates instructor. 
instagram @siansmale_SF

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

Learn more online!


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...


πŸ’₯𝐀𝐧𝐀π₯𝐞 π’π©π«πšπ’π§πŸ’₯
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πŸ‘£Shown here are a few strategies that are often helpful when recovering from an inversion ankle sprain. It should be noted that this is only a short list of options and different interventions may be appropriate given an individual’s stage of healing and unique clinical presentation.

Abnormal cervical range of motion (ROM) has been used as part of the clinical decision making for the diagnosis of Cervicogenic Dizziness.  The limitation in range of motion, as well as pain to palpation to upper cervical spinal structures, can help the clinician differentiate between dizziness of vestibular origin vs cervical origin.
I am classically more of an “eye-ball” kind of ROM guy but continuing to look for objective ways to assess cervical dysfunction to not only prove a difference to the patient, but also for goal setting.
Currently the gold standard and most objective way to clinically measure the ROM is the CROM device (Cervical Range of Movement).  I was part of a study about a decade ago and used the device, but it is expensive (upwards to $400) and potentially necessary in a clinical environment.   Plus — its ugly and patients feel weird with it on!  I mean — she doesn’t look too happy does she πŸ™‚
Credit: Fabrication Enterprises PA CROM
Cervical ROM is common in clinical assessment to examine individuals with pain.  Nothing has really changed in the procedure for decades. However, the use of smartphone applications to measure ROM is gaining popularity.  Considering majority, if not all, therapists have the phone handy throughout a session, it is time to utilize the technology.
I have found that patients perceive the phone technology as a higher value in clinical assessment, which could potentially place higher value on your overall treatments.  This is anecdotal evidence but also seeing this more with applications to assess posture, running mechanics, etc that is more feasible in clinical practice vs laboratory settings.   However, even with higher perceived value, we need to make sure the technology holds up to our gold standard—the CROM. 
**Back story—I was part of an initial project about 10 years ago comparing different applications in a ceased website—therefore, have had the interest in other ways to measure ROM for years.  The evidence out now of reliability and validity was not available back then**
A recent study by Rodriguez-Sanz et al 2018 examined two smartphone applications (Clinometer & Compass) against CROM for individuals with chronic pain and found:
Cervicogenic Dizziness, Cervical Vertigo, Neck Pain, Proprioception
Courtesy: Rodriguez-Sanz J et al 2018
  • Excellent validity (>0.75) of lower and upper cervical spine movements
  • Excellent intra-rater reliability (>0.75) of lower cervical spine movements
  • Excellent inter-rater reliability (>0.75) of lower cervical spine movements
  • Excellent intra- and inter-rater reliability of upper cervical spine extension movements
  • Good intra-rater reliability (0.65-0.75) of upper cervical spine flexion movements
Cervicogenic Dizziness, Cervical Vertigo, Neck Pain, Proprioception
Courtesy: Rodriguez-Sanz J et al 2018
In conclusion, the Smartphone applications “Clinometer” and “Compass” have been proved of an excellent validity, by using CROM as gold standard in the lower cervical spine and upper cervical spine ROM measurements in subjects with 441 chronic cervical pain.
Based off of this study alone, I would feel confident as a clinician to use these applications to measure cervical AROM of the upper and lower cervical spine and knowing it will have solid validity and reliability against our gold standard, the CROM device.
Granted, the patients in this study were considered to have “chronic cervical pain”— which meant over the age of 18 and pain in cervical region for > 3 months.   This hasn’t been studied specifically with patients with Cervicogenic Dizziness, but could be highly relevant as these patients have limitations in cervical ROM, especially cervical extension and rotation.
Now rock on smart phones!
Rock on more to save $400 for purchasing a CROM device in your clinic!

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.
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

In this episode of Untold Physio Stories podcast, Erson reunites with super friend and former podcast host Jason Shane from Shane Physiotherapy. Erson recounts how his knee has been very stiff, painful and clicking recently and what he tried to "fix" it.

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Untold Physio Stories is sponsored by the EDGE Mobility System, featuring the EDGE Mobility Tool for IASTM, EDGE Mobility Bands, webinars, ebooks, Pain Science Education products and more! Check it out at edgemobilitysystem.com .  Be sure to also connect with Dr. Erson Religioso at Modern Manual Therapy and Andrew Rothschild at Modern Patient Education.

Keeping it Eclectic...


This post and infographic was first found on Brad Beer's Instagram.

How often do you address sleep? Quality AND quantity? This is important not only for athletic performance, but also recovery. It is also important for those with chronic pain and overall central sensitization.

This post was first found on @physicaltherapyresearch on instagram.