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Will PT Help my Plantar Fasciitis? - themanualtherapist.com


Will PT Help my Plantar Fasciitis?


INTRO:
1 in 10 people in the United States experience persistent pain along the bottom of the foot. A condition commonly diagnosed as plantar fasciitis. In the US, outpatient clinics receive more than 1 million visits a year from people seeking help for this type of foot pain. In 2014, the Orthopaedic Section of the American Physical Therapy Association published updated clinical practice guidelines on the best treatments for patients with plantar fasciitis. The guidelines present evidence that strongly suggests a combination of manual therapy and rehabilitative exercises to help patients with this foot condition.

RESULTS:
The researchers studied a database of 819,963 patients diagnosed with plantar fasciitis. Only 7.1% of these patients were prescribed physical therapy.

Overall, patients sent to physical therapy received:
  • Manual therapy 87% of the time.
  • Supervised rehabilitative exercises 90% of the time.
The researchers found that patients who received manual therapy as part of their treatment averaged fewer visits and had a lower cost of care of $340.

PRACTICAL ADVICE:
This study shows that despite strong evidence on the benefits of physical therapy for plantar fasciitis, very few patients were given this treatment. If you have been diagnosed with plantar fasciitis, physical therapy offers evidence-based treatment options to help you recover from your pain.

COMMON EXERCISES GIVEN:
  • Calf Stretches
  • Foot Stretches
  • Toe Stretches
Play your big toe under a towel, pad, or @fasciafigher and lean your weight over until you feel a stretch in the bottom of your foot. Hold repeat 30x

Ankle Mobilization:

SOURCE:
J Orthop Sports Phys Ther 2017;47(2):56. doi:10.2519/jospt.2017.0501

WANT MORE RESEARCH? Check out @physicaltherapyresearch on Instagram!

SOURCE:
Pol et al. 2021. Structural and functional foot and ankle characteristics associated with falls in older people. Gait & Posture. (88), pp. 78-83.

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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Lumbar Spinal Stenosis — A Clinical Update and Approach to Patient Care With a Lumbar Spinal Stenosis Model - themanualtherapist.com



Goal of the Study?

Lumbar spinal stenosis affects approximately 11% of the population, primarily in the adult population.1 In this article, the authors worked to provide a clinical update giving practitioners a “what you need to know” perspective on the ins and outs of clinical practice.

 

Why are they doing this study?

Because of its prevalence and challenge to accurately diagnose, it is important to understand the clinical presentation of lumbar spinal stenosis from a symptomatology standpoint. This careful attention to a patient’s symptoms can help guide an appropriate care plan. The clinical challenge can be cloudy as other conditions like vascular claudication can lead even the best clinicians down the wrong diagnostic path.

 

What was done?

A review of the anatomy is important when understanding the clinical symptoms of lumbar spinal stenosis. In this clinical update, the authors revisit the degenerative changes of the spinal canal and the intervertebral foramen related to spacing and the nerves that travel through these spaces.

Spinal Canal Spacing, Lumbar Spinal Stenosis Education Model

Lumbar spinal stenosis model

 

What did they find?

As the discs lose height, the associated anatomical changes can lead to narrowing. Degenerative discs lose height over time, and in doing so, the facets approximate, leading to hypertrophy of the bony architecture. Facet arthropathy (as seen in the Lumbar Spinal Stenosis Dynamic Disc Model) can take up valuable spinal real estate for lateral recess and intervertebral foramen; furthermore, discs lose height, discs bulge. And with this bulging, just as a tire bulges when it loses air pressure, it can often take up spinal canal spacing. This can also lead to the ligamentum flavum bulging itself (also thought of as buckling or thickening), encroaching on the valuable room the vasculature around the cauda equina must have to function.

The classic presentation is the patient reporting of not being able to distance walk as they have previously. They also report that standing often generates lower leg symptoms or buttock/leg weakness and relief of these symptoms by sitting and/or using the upper extremities to offload and flex the spine, like that seen with the shopping cart posture.

The authors point out that lateral recess stenosis and foraminal stenosis can mimic radiculopathy as seen in sciatica related to a disc herniation and report that a combination of these symptoms and subtypes is common.

 

How is Lumbar Spinal Stenosis Diagnosed?

A careful history and examination are at the roots of a proper diagnosis. Imaging has been relatively unreliable and likely due to the static nature of MRI and CT. It is suggested that clinicians can ask suspected patients to walk or to have patients extend the lumbar spine for thirty seconds to recreate the symptoms.

The authors have created these points and to be mindful of patients over 50 present with these symptoms:

  • pain in lower extremities/buttocks while walking
  • flexion to relieve
  • relief if using the upper extremities to push down and generate lumbar flexion like that seen using a shopping cart or riding a bicycle
  • unsteady motor disturbance while walking
  • tingling or numbness in the legs while walking
  • pulses equal and bilateral in lower extremities
  • low back pain

 

How do Clinicians Talk about Lumbar Spinal Stenosis with their patients?

Lumbar Spinal Stenosis Model

What tools do you use to educate your patients?


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Feeling Reassured Does Not Help With Acute Low Back Pain – The Roles of Patient Education - themanualtherapist.com


Goal of the Study?

These researchers sought out to answer the question of does reassurance helps patients with acute low back pain? In this study 1, the authors looked at two hundred and two people with acute low back pain with a high risk of developing chronic low back pain. They were curious as to whether helping someone with supportive psychological language could help reduce disability outcomes.

Why are they doing this study?

The current zeitgeist and research push has emphasized reducing nocebic iatrogenic influences and steering away from the biomedical model. This has naturally led to alternative strategies like the use of emphasized reassurance tools.  However, does this strategy alone make a difference?


Bulging Disc Model

What was done?

Using a randomized sham-controlled clinical trial mediation analysis, these researchers compared patient education to sham patient education. Enrolled participants listened to either: 1. two 1-hour sessions explaining the benign aspects using a biopsychosocial framework. 2. two 1-hour sessions that included active listening only, as of the sham comparison.

What did they find?

Those that did receive patient education did express improved re-assurance(compared to the sham); however, this did not lead to improved disability scores or was associated with health care use frequency. All in all, the results demonstrated there was no association with participants feeling reassured and improved outcomes.

Limitations?

The main limitation was the length of patient education in this study. This is obviously much longer than what clinicians often employed in clinical practice. The authors also suggest that less time would unlikely result in a different outcome.

Why do these findings matter?

Clinicians have been encouraged to use reassurance in the case of many clinical conditions.  The authors suggest that although patient education can be effective, overemphasis does not lead to better outcomes. Clinicians with their clinical time restraints should be selective in the time allocated to specific topics. The authors suggested that perhaps more time listening and matching appropriate treatment strategies may be a better option with time management restrictions.



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Take It To Heart: Low Fat Versus Plant Based Diet - themanualtherapist.com


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

Since the 1980s many dietary guidelines promoted the notion of a low-fat diet in order to reduce cardiovascular disease (CVD) risk. Over the next 30 to 40 years healthcare providers and nutrition researchers found that simply lowering dietary fat alone is not the only answer to reducing heart disease. This is likely because those consuming a low-fat diet may still include junk foods, meat, and smoking -- which have all be directly correlated with higher risk of heart disease, comorbidities, and mortality. Data show that most plant-based oils and fats from sources like nuts, seeds, and some oils can actually be beneficial in lowering heart disease risk. Could a plant-based diet, which includes fats from plant-sources, be better than a low-fat diet? A recent publication provides physical therapists and other providers just the answer.

The new research, coined Coronary Artery Risk Development in Young Adults study (CARDIA), enrolled 5115 Black and white men and women in 1985-1986. During more than 30 years of follow up, there were 280 cases of cardiovascular disease, 135 cases of coronary heart disease, and 92 cases of stroke among the study participants.

To assess dietary patterns the researchers conducted three detailed diet history interviews over the follow-up period. These diet history questionnaires determined what participants ate. For example, participants who reported eating meat in the past 30 days would be asked what meat items and how much they consumed. This process was done for ~100 areas of the diet. Based on this information, the researchers calculated scores for all participants based on both the Keys Score of the A Priori Diet Quality Score (APDQS).

The researchers, after factoring for various factors including socioeconomic status, educational level, energy intake, history of cardiovascular disease, smoking and body mass index, found that having a more plant-based diet (higher APDQS Scores) and consuming less saturated fat (lower Keys Scores) were both associated with lower LDL levels. However, lower LDL levels did not necessarily correlate with lower future risk of stroke, but we know that lower LDL levels can correlate to lower heart disease risk. Higher APDQS scores, but not lower Keys Scores, were strongly associated with a lower risk for CVD, possibly due to the lower LDL.

Obviously more research is needed and some limitations exist for this current study. First, it was a questionnaire-based study which can often be riddled with errors. Subjects can forget what they've eaten, exaggerate or under-report certain dietary patterns, or simply fabricate data. Second, the lower LDL levels didn't actually translate into lower stroke prevalence within the group; such a finding seems dubious but may suggest that other factors such as exercise, stress management, or smoking, which were controlled for, may be stronger predictors of stroke than what was measured. 

While the study has some limitations the findings are important as it shows that there may be other factors contributing to heart disease than simply fat. Saturated fat does increase LDL and promotes CVD. As such, guidelines were onced focused on simply reducing fat consumption as big priority, without much concern on the source of the fat. As this data show, plant-sources of fat (e.g. from nuts, seeds, and some fish) may be beneficial -- but also the removal of animal products seems to strengthen the CVD risk reduction. Data show that meat contains heme iron, TMAO, and may negatively impact the gut microbiome. Dairy is chock full of naturally occurring bovine hormones and growth factors. Could these factors be the other driving forces for CVD risk? Possibly, but more studies are needed to clearly extract factors for their risk modification.

The study's findings are relevant to doctors of physical therapy (DPTs) and physical therapy practice in several ways. PTs working in cardiac rehabilitation often engage their clients several times per week in order to improve their endurance, strength, and recover from cardiac interventions (like bypass). During such sessions an emphasis on dietary and lifestyle changes is critical, as many who have heart disease will often have a recurrence of that disease again later. For physios working in the general population, prevention ought to be a major aspect of care as it relates to reduce the burden of disease and other conditions. In other words, if you can improve a person's general health and lifestyle you likely will see improvements across many realms and systems (e.g. better health = less pain and better movement). Cardiovascular disease is not just about the heart: it can affect tissue healing peripherally, cognition, sexual function, and muscle performance. Moreover, most of cardiac disease starts in childhood with fatty streaks and foams cells found in teenagers' coronary arteries! Much of this early disease prevalence can be related to poor dietary patterns at school and home. As such, pediatric PTs need to be armed with good nutritional knowledge on how diet can prevent future heart disease for our citizens. In the end, PTs need to work with dieticians, physicians, and nurses to optimize our patients' health through diet, and it seems that choosing a predominantly plant-based diet may just be that mechanism.

Earn your CNPT



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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TMJ Clinical Pearls - themanualtherapist.com


In this episode, Erson goes over newer drivers (triggers) of TMJ dysfunction and pain. Andrew gives his take on the findings and they also go over some clinical pearls for TMD Patients


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Foot & Ankle Characteristics Associated with Falls in Older People - themanualtherapist.com



Foot & Ankle Characteristics Associated with Falls in Older People


BACKGROUND:
Falls affect approximately 1 out of 3 Older Adults. Foot problems are amongst the potential modifiable risk factors. Pol et al. (2021) investigated the associations between foot and ankle functional and structural characteristics with falls in community-dwelling older adults.

METHODS:
  • 187 community-dwelling older adults aged 62–90 years were studied.
  • Foot & ankle structure and function (including foot posture, range of motion, muscle strength, deformity, pain and plantar loading patterns during walking) were measured.
  • Fall history was documented in the preceding year.
RESULTS:
74 Participants experienced a fall (~40%).

Factors significantly and independently associated with these falls:
  • Less first metatarsophalangeal joint extension.
  • Less plantarflexor muscle strength.
  • Greater pressure-time integral in the medial forefoot.
  • Greater center of pressure velocity in the forefoot.
  • Greater foot pain.

CONCLUSIONS:
Several structural and functional foot and ankle characteristics were associated with falling in older people. Future development of interventions to help prevent or treat these potentially modifiable risk factors may help decrease the risk of falling in this population.

WANT MORE RESEARCH? Check out @physicaltherapyresearch on Instagram!

SOURCE:
Pol et al. 2021. Structural and functional foot and ankle characteristics associated with falls in older people. Gait & Posture. (88), pp. 78-83.

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...

4 Full Body Combo Exercises - themanualtherapist.com


⚡️Full-Body Combo Exercises⚡️


When it comes to loading in order to achieve a desired adaptation, there are many ways to “skin the cat” in a training program for your athletes.
Untold Physio Stories - Intermittent and Recurrent Leg Weakness - themanualtherapist.com


In this episode, Andrew goes over a recent case of intermittent leg weakness. All things being equal, if pain, balance, stability and function are improving, patients shouldn't regress for no reason. Especially with a previous history of Cancer.



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...