Tag Archive for: acl knee

The Week in Research Review, etc 12-17-18

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Not a lot this week…sorry folks. Focusing a bit more on other projects. The Week in Research Review, etc 12-10-18 included only 3 posts but they definitely made some waves. Especially my latest Instagram post on burn-out in the PT field. Check it out and chime in…it’s never too late to like a post and comment on SoMe.

When is it Safe to Drive after Orthopaedic Surgery?

💥OPEN ACCESS! 💥⠀

This study looked to comb the research to see the available data regarding when patients are safe to resume driving after common orthopedic surgeries and injuries affecting the ability to drive.


This is always the age old question as a PT or ATC (amongst the other disciplines) and this study may help to shed light and give a bit more concrete evidence.

Often times, our answer is ‘it depends’ and that is definitely true. Or we pass the ball to the doctor who did the surgery and try to buy time by waiting until that 1st post-op visit.

Or we just say you can’t drive because you’re still on pain meds…and that is definitely true! All of these factors may play a role but it seems as if the literature can help guide our answers a little better so I invite you to take a look to this OPEN ACCESS paper and keep it in your patient database.

It may help to guide a future patient’s independence after an injury.

Posterior Shoulder Stretching after a Surgery

The efficacy of stretching exercises to reduce posterior shoulder tightness acutely in the postoperative population: a single-blinded randomized controlled trial. Salamh et al Physiother Theory Pract. 2018.


This paper looked at acutely post-op shoulder patients (no repairs, just debridements) and followed their ROM horizontal adduction and internal rotation after the surgery.


Group 1 was assigned the supine sleeper stretch and shoulder pendulum exercises. Group 2 was assigned the standing horizontal adduction (cross-body) stretch and shoulder pendulum exercises. Group 3 (control group) was assigned and performed shoulder pendulum exercises only and asked to perform 10 clockwise or counter-clockwise pendulum exercises twice a day.

The study noted that ‘the horizontal adduction stretch is more effective 
at reducing acute posterior shoulder tightness in the postoperative shoulder population when compared to the supine sleeper stretch and no stretch at all.

Not surprised but wanted to share the information and maybe help someone use this for their clinical practice.
Not sure why they chose supine sleeper stretch versus sidelying sleeper stretch but most likely because of pain tolerance.

Traditionally, the sleeper stretch is performed in supine. It’s modified by having the patient rollback to potentially put the shoulder in a more comfortable position. We wrote a paper about this in JOSPT 2013 with @wilk_kevin and @toddrhooks

I’m still more of a fan of the horizontal adduction stretch and use it clinically every day for my shoulder patients.

Burn Out in Physical Therapy

Just said yesterday that I don’t post my tweets to IG but get like this one should be posted here too.

Not going to say much more than I already have.. maybe a future blog post or something.

Curious to hear the comments below too. Throw it all at me and I’ll try to write something up in the future.

The Week in Research Review, etc 12-10-18

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This week we’re still playing with formats and learning these Instagram changes. With that, in the week in research review 12-10-18, we discussed many topics that I wanted to share!

Surgery vs Physical Therapy for Carpal Tunnel Syndrome

Cost-Effectiveness Evaluation of Manual Physical Therapy Versus Surgery for Carpal Tunnel Syndrome: Evidence From a Randomized Clinical Trial Fernández-de-las-Peñas et al JOSPT 2018.

This Level 1b study looked to evaluate cost-effectiveness differences of manual physical therapy versus surgery in women with carpal tunnel syndrome (CTS).

Performed in Spain, 120 women with a clinical and electromyographic diagnosis of CTS were randomized through concealed allocation to either manual physical therapy or surgery.

They concluded that manual PT including desensitization maneuvers of the central nervous system has found to be equally effective but less costly, i.e., more cost-effective than surgery for women with CTS.

From a cost-benefit perspective, the proposed manual PT intervention of CTS can be considered.

Interesting results but 2 obvious limitations to this study:
1️⃣No control group. What if the symptoms could spontaneously improve over time
2️⃣ They only looked at 1-year improvement and not short-term improvements. I would’ve liked to have seen 3 months and 6 months results as well to see the acute effects.

Not sure what to make of this study but it does seem as if a population of Spanish women may respond to Rx of CTS without surgical intervention.

This could be a huge cost/time saver for society!

Return to Sport Criteria and Reinjury Rates

The Association Between Passing Return-to-Sport Criteria and Second ACL Injury Risk: A Systematic Review With Meta-Analysis  Losciale et al JOSPT 2018.

Not going to lie, this study caught my attention because the results match my confirmation bias.⠀

I’ve been saying for years that hop tests, even combined with other tests, just don’t cut it.⠀

I wrote a blog post about this too for @mikereinold. This study, although with its limitations, did show that passing RTS criteria did not show a statistically significant association with risk of a second ACL injury. 

This review also determined that 12% of those who failed RTS testing suffered a graft injury, compared to 5.9% of patients who passed. 

It seems as if quadriceps strength measured via isokinetic testing or isometric testing may be an important factor to consider for RTS decision making.


Also, hamstring-quadriceps strength ratio symmetry should also be considered.

So with this review demonstrating that current objective criteria-based RTS decisions did not show an association with the risk of a second ACLI, how does this affect your practice?

Physical Therapy vs Knee Scope for Meniscus Tears

💥PT vs Scope for Meniscus Tear 💥
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Effect of Early Surgery vs Physical Therapy on Knee Function Among Patients With Non-obstructive Meniscal Tears: The ESCAPE Randomized Clinical Trial. van de Graaf VA et al JAMA Oct. 2018

Among patients with non-obstructive meniscal tears, PT was equal to arthroscopy for improving patient-reported knee function over a 24-month follow-up period. 

They went on to say that “Based on these results, PT may be considered an alternative to surgery for patients with non-obstructive meniscal tears.”

So basically, if there’s no bucket handle tear present that may be blocking joint range of motion, then it is highly encouraged that the patient #GetPT1st and not do surgery.

Without going out on a limb, I’d say this is a much more cheaper treatment option as well and would save society many costs associated with the surgery and lost time from work.

I do note a couple limitations: the surgical group did not get PT after surgery if they did ‘as expected’ but they could get PT to help improve their symptoms.

The PT group did pretty basic exercises although leg press, lunges, and balance type exercises were included.

Have you read this paper? It was a multi-center, randomized controlled trial performed in 9 hospitals in the Netherlands.

So, are we encouraged or surprised? Let me know by commenting below…thanks!

Shoulder Health Accessory Exercises

by @kieferlammi

Want strong and healthy shoulders!?

Shoulder strength is about more than pushing big lifts like strict pressing, push pressing, etc.

If you want a robust, healthy, well moving shoulder you should be including lower level drills that more specifically address scapular and RTC strength and control. –

I will always be a fan of traditional exercises like side like ERs, Prone Ys, Ts, etc.

Lately, I’ve thrown in more band work because it’s easy for me to do for higher volumes on a frequent basis and I enjoy the constant tension that the band provides. 

Give these two exercises a try:

✅ Band Front Raise Pull-Apart

✅ Band Overhead Y Raise

I find that these two do a great job of targeting my mid back and posterior shoulder without much compensation through a big range of motion.

Give them a try either in a warm-up for 1-3 sets of 10-15 reps or at the end of a training session for 2-4 sets of 10-25 reps depending on the difficulty of your band and your capacity. 

Should we Brace after an ACL Surgery?

  
 
 
 
 
 
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 [NEW BLOG POST]⠀ 💥Knee Bracing Immediately After an ACL Reconstruction 💥⠀ In this post, I review some recent Twitter, Facebook and Instagram discussions about the usage of a hinged knee brace after an ACL surgery.⠀ .⠀ You'd be surprised what I found in the literature and the differences that exist throughout the US and the world.⠀ .⠀ Go to my website <LINK in my BIO> and read/share with your friends/colleagues.⠀ .⠀ It was a bit eye-opening and I'm curious to hear what others have to say.⠀ .⠀ I still like to recommend a brace for my clients because it seems to give them an added security after a pretty painful surgery.⠀ .⠀ I typically keep them braced 4-6 weeks, depending on their quadriceps activity and if they can do an active straight leg raise without a lag.⠀ .⠀ Many others don't even bother bracing at anytime post-op, which was surprising.⠀ .⠀ What do you think? Read the blog post and let me know. Let's try to educate and come to a better consensus...thanks!⠀ .⠀ #kneerehab #knee #kneepain #kneesurgery #acl #aclsurgery #ROM #physio #physiotherapist #crossfit #exercise #deadlift #physiotherapy #physicaltherapy #physicaltherapist #athletictraining #athletictrainer #ATC #PT #teamchampion #dptstudent #lenmacpt #instagram
 
A post shared by  Lenny Macrina MSPT, SCS, CSCS (@lenmacpt) on

You can also get to the blog post by clicking this link

Let me know what you think about this new blog post or any of my social media posts…thanks!

The Week in Research Review, etc 8-26-18

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Predictors of Pain and Functional Outcomes After the Nonoperative Treatment of Rotator Cuff Tears Jain et al OJSM 2018

Who should have RTC surgery and who may not need RTC surgery? That’s a big question but this study tries to give us a better understanding.

70 patients with rotator cuff tears were diagnosed based on the clinical impression of a sports/shoulder fellowship–trained attending physician and evidence of structural deficits on MRI (when available). In cases where an MRI scan was available, both of these conditions had to be met for a patient to be diagnosed with a rotator cuff tear. If an MRI scan was unavailable (because it was not clinically indicated; n = 14), the diagnosis was based on the clinician’s impression.

The Shoulder Pain and Disability Index (SPADI) was used to determine the level of disability at 3, 6, 12, and 18 months.

✅Being married as compared with being single/divorced/widowed

✅Shorter duration of symptoms

✅Daily shoulder use at work that included light or no manual labor versus moderate or heavy manual labor

✅alcohol use of 1 to 2 times per week or more as compared with 2 to 3 times per month or less

✅Absence of fatty infiltration

✅ College level of education or higher

✅ Partial-thickness tear versus full-thickness tear

Interesting results, especially the alcohol use and being married (kinda surprising but intriguing). Does this help you to guide your future patients if they ask about RTC repair surgery? Tag a friend or colleague who may benefit from this information…thanks!

 

 

Playing video games for more than 3 hours a day is associated with shoulder and elbow pain in elite young male baseball players. Sekiguchi et al JSES 2018

[HOT OFF THE PRESS] in Sept 2018 issue showing the potential effects of playing video games on injury rates in youth baseball players.
200 Japanese ‘elite level’ male baseball players ages 9-12 years old were included in the analysis.

Playing video games for ≥3 hours/day was significantly associated with an elbow or shoulder pain vs. spending <1 hour/day playing video games.

The amount of time spent watching television was not significantly associated with the prevalence of elbow or shoulder pain.

Originally saw this study on Twitter by Dan Lorenz and thought it was interesting, considering @redsox pitcher @davidprice14had a recent injury and attributed it to playing video games.

Not sure how valid the results are but I just wanted to share with my friends and get your opinions. Tag a friend or colleague that may be interested in these results…thanks!⠀

 

 

 

Shoulder Stabilization Drills

More closed chain rhythmic stabilization drills that we like to utilize at @championptp for our upper extremity patients.

A recent study in 2014 Kang et al showed “The EMG activity of the infraspinatus and the ratio of the infraspinatus to the posterior deltoid activities were significantly increased, whereas the posterior deltoid activity was significantly decreased under the CKC condition compared to the OKC condition.”

I prefer to position the patient with an open palm to make it a less stable surface on the ball. Cue them by telling them ‘don’t let me move you’ as I give manual perturbations along the forearm.

To advanced the drill, we can have them perform it with their eyes closed or in a single-legged stance position with their push-off leg on the ground (if they are a pitcher).

You can also advance them in a time-based manner by extending the duration of the exercise to focus on more of the endurance aspect of the rotator cuff.

This is a great drill for those patients with hyperlaxity that need a relatively stable position to perform their exercises in a relatively pain-free fashion.

Do you utilize these drills or know someone that may benefit from them? tag them below so we can discuss them further…thanks!

Credit to @shift_movementscience for the ER wall stabilization drill that he showed us recently. We always performed them IR Wall Stab drill but a quick 180-degree shift and we got a great posterior RTC exercise!⠀

 

 

Lachmans Test for an ACL Tear

Video showing an obviously positive Lachman’s test in a recent @NFLpreseason game.

Check out the anterior translation of the tibia on the femur while the knee is flexed to about 25 degrees.

This is the best way to diagnose an ACL injury and should be the 1st ACL test that you do in your clinical exam.

Remember to rule out the PCL or you may get a false positive if you see excessive anterior translation because the tibia is sitting too far posteriorly.

According to Benjaminse et al 2006, The Lachman test is the most valid test to determine ACL tears, showing a pooled sensitivity of 85% and a specificity of 94%. There are numerous other studies that conclude this as well.

They even discuss the pivot shift as a test to consider but I think the Lachman’s test will be the most valid overall.

Do you agree? What do you think? Tag a friend or colleague who may benefit from this post…thanks!

 

 

Shoulder Drills

[REPOST] from @tony.comellatalking bodyweight drills that you can use as a warm up or even as part of a shoulder rehab program. Take a look below and applaud these movements by Tony! 👏🏼⠀
⠀
BODYWEIGHT SHOULDER DRILLS⠀
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🙋🏻‍♂️The shoulder can get overly complex, but the goal of this post is to keep it simple. There are a ton of exercises we can perform, utilizing a variety of equipment (bands, weights, barbells, cable, etc), but here are a few drills I like to perform using only bodyweight:

1️⃣ Prone swimmers. This drill can be deceivingly challenging, as we fight against gravity to keep our arms above the ground. Try and keep your arms as high above the ground as you can and elbows straight (think about reaching fingertips away from you). If you have trouble on the ground you can do this on a bench, or if this is too easy, hold some light weights <5lbs. No need to go too heavy here, as your ability to move a lot of weight won’t impress anybody.

2️⃣ Downdog toe tap. We get the shoulder into full flexion overhead (working on serratus) and some thoracic spine movement too. AdAn additionalonus is showing some love to the posterior chain (hamstrings, calves).

3️⃣ Bear roll. You can’t work on overall shoulder health and not include thoracic spine drills. This beautiful dance move targets the thoracic spine and closed chain shoulder stability at the same time.

😎These are 3 great bodyweight exercises to mix into your warm-up or exercise routine for overall shoulder health. Which one is your favorite?