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Physical Therapy Research, 66 Prescot Street, London (2025)

22/08/2022

🔬📚
Anatomical risk factors of lateral ankle sprain
ℹ️ℹ️
INTRO:
Lateral ankle sprains (LAS) are the most common musculoskeletal injuries, accounting for about 10%-30% of all athletic injuries.
ℹ️
LAS can have serious consequences for the injured athletes in terms of treatment costs and time lost from the sport.
ℹ️
Up to 70% of cases are persistent and can lead to post-traumatic ankle arthritis.
ℹ️
The highest rate of ankle sprain usually occurs in sports that involve running, cutting, and jumping.
ℹ️
Understanding what increases risk of ankle sprain could improve effective prevention and rehab measures.
ℹ️
Saki et al. (2021) determined the risk of non contact ankle sprains in athletes based on:
Previous ankle sprain history.
Q angle [A].
Knee recurvatum [B].
Navicular drop [C].
Tibia vara [D].
Tibia torsion [E].
Ankle ROM [F].
🔑🔑
METHODS:
152 adolescent male athletes assessed during preseason for 7 risk factors listed above.
🔑
LASs were prospectively recorded and diagnosed for two consecutive seasons (20 months).
📊📊
RESULTS:
34 LASs reported (22.37%).
📊
Logistic regression revealed 3 significant intrinsic predictors of LAS:
Previous ankle sprain history.
Navicular drop.
Knee recurvatum.
📊
None of the other variables were identified as significant risk factors.
📊
Receiver operating characteristic (ROC) analyses revealed predictive potentials:
Previous ankle sprain history [0.706]. Navicular drop [0.906].
Knee recurvatum [0.724].
✅✅
CONCLUSIONS:
Athletes with previous ankle sprain history, knee recurvatum, and especially navicular drop may have a greater risk of LAS injury.
📚📚📚
SOURCE:
Saki et al. 2021. Anatomical risk factors of lateral ankle sprain in adolescent athletes: Aprospective cohort study. PT in Sport. 48(2021), pp.26-34.

09/08/2022

🔬📚
SLAP Tears
💭
SLAP tear refers to a specific injury of the superior portion of the Glenoid labrum extending from anterior to posterior in a curved fashion. .
💭
These tears are common in overhead throwing athletes and laborers involved in overhead activities.
💭
SLAP tears are caused by forceful eccentric traction exerted on the biceps tendon
🗓🗓
HISTORY:
Symptoms typically include:
Anterior shoulder pain.
Episodic clicking, particularly in the cocking position of throwing.
Decline in function or throwing velocity.
🗓
Acute trauma cases may involve falling onto an outstretched arm or sudden traction of the arm, while lifting a heavy object with a sudden jerking motion.
🔍🔍
EXAM:
Motion, strength, and basic neurovascular function should be assessed. .
🔍
The proximal biceps tendon should be palpated; focal tenderness suggests tendon injury. .
🔍
Recommended tests for SLAP tears include:
Anterior glide test
Compression rotation test
Active compression (O’Brien’s) test
Crank test
Speeds test .
🔍
SLAP tears are frequently accompanied by other shoulder pathology.
💢💢
DIAGNOSIS:
Definitive diagnosis of a SLAP tear requires arthroscopy or MRA
💢
Clinical diagnosis is often adequate if:
Patient is not a good surgical candidate.

Other differential diagnoses ruled out by examination and ultrasound.
🚫🚫
DIFFERENTIAL DIAGNOSIS:
Rotator cuff tear.
tendinopathy.
Shoulder impingement.
Biceps tendon.
👐🏼👐🏼
MANAGEMENT:
Most cases require orthopedic referral.
👐🏼
Refraining from advanced imaging is important in patients unlikely to be suitable surgical candidates.
👐🏼
The management of SLAP tears depends upon patient age and activity, and the type of tear.
👐🏼
Nonoperative management is preferred given the 6-12 month recovery following surgical repair.

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SOURCE:
Up To Date article. 2017. Superior labrum anterior posterior (SLAP) tears.

27/06/2022

📚🔬
Toe Strength and Balance in 60’s +
ℹ️ℹ️
INTRO:
The substantial role of large muscle groups in balance is recognized, such as:
Trunk.
Hips.
Knees.
Ankles.
ℹ️
However, significance of the toe flexor muscles is less well understood.
ℹ️
10 toe flexor muscles contribute to motion of the foot.
ℹ️
Extrinsics:
Flexor digitorum longus.
Flexor hallucis longus.
ℹ️
Intrinsics:
Abductor hallucis
Adductor hallucis
Flexor hallucis brevis.
Flexor digitorum brevis.
Flexor digiti minimi brevis.
Lumbricals.
Interossei.
Quadratus plantae.
ℹ️
Poor toe flexor muscle strength has been implicated in:
Poor postural balance.
Injury risk.
ℹ️
Quinlan et al. (2020), systematically reviewed the research to establish if toe flexor strength related to static and dynamic balance.
📊📊
RESULTS:
9 studies with over 2200 participants met inclusion criteria.
📊
In each study, participants were over sixty years of age, and over 73 % of them were female.
📊
All studies showed direct, proportional, and significant correlations between toe flexor strength and postural balance.
✅✅
CLINICAL SIGNIFICANCE:
Toe flexor strength contributes to improved postural balance for people over the age of 60.
✅
Including specific Toe Flexor Exercises into workouts can have a positive effect on balance
‼️
LIMITATIONS:
No study was found/included for a younger population group.
‼️
Primarily observational studies.
🧠🧠
Thoughts? Questions? Comments?
👇🏽
Write them below. .

📚📚📚
SOURCE:
Quinlan et al. 2020. The evidence for improving balance by strengthening the toe flexor muscles: A systematic review. Gait and Posture, 81, pp. 55-56.

22/06/2022

📚🔬
Traction Treatment for Carpal Tunnel Syndrome (CTS)
1️⃣1️⃣
INTRO:
CTS is a compressive disorder in which the nerves are compressed in the carpal tunnel.
1️⃣
This typically leads to numbness and pain, especially in the first three fingers, worsening at night.
1️⃣
Treatment options are either surgical or non-surgical.
1️⃣
Positive surgical outcomes range from 70-80%, however a promising non-surgical treatment for CTS is mechanical wrist traction.
1️⃣
Seems et al. (2017), evaluated the impact of mechanical traction in patients with CTS compared to usual care to avoid surgery.
1️⃣
The main clinical outcome of the study was surgery for carpal tunnel release during 6 months’ follow-up.
⏱⏱
METHODS:
⏱
181 Adults with confirmed CTS participated
All randomized to either:
Intervention group (12 treatments 2x/wk for 6wk; mechanical traction)
Care as usual.
🔑🔑
KEY FINDINGS:
Surgeries Required:
Intervention group (28%)
Care-as-usual group (43%)
🔑
At 6 months:
Symptom severity and functional status scores significantly improved in both groups.
Improvements did not differ between the two groups.
✅✅
MAIN TAKEAWAYS:
✅
Treatment of CTS by means of mechanical traction can possibly prevent progression of symptoms requiring surgery within 6 months in CTS patients.
✅
Because up to 30% of patients who received surgery report (new) CTS symptoms at longer follow-up (1 to 2 years), a longer period of observation is needed to compare the long-term effect of mechanical traction to care as usual (including surgery).
✅
Traction may improve blood microcirculation, reduces edema in the synovial tissue and, therefore, reduces pressure in the carpal tunnel
✅
This approach may result in a substantial reduction in the number of surgeries with similar patient-reported symptoms.
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SOURCE:
Seems et al. 2017. Mechanical wrist traction as a non-invasive treatment for carpal tunnel syndrome. Trials 18:464.

17/06/2022

🔬📚
Blood Flow Restriction Training Safety
1️⃣1️⃣
Background:
Blood flow restriction training (BFRT) is defined as the partial restriction of arterial blood flow into the muscle while venous outflow is occluded during a bout of exercise.
1️⃣
BFRT is used for physical training and performance in healthy individuals, as well as an adjunct to physical rehabilitation in injured individuals.
1️⃣
Current understanding of the physiological mechanisms of BFRT and related performance includes:
Acute muscle cell swelling.
Increased fiber-type recruitment
Decreased myostatin.
Decreased atrogenes.
Satellite cell proliferation.
1️⃣
With the increasing use of BFRT in clinical populations, Minniti et al. (2020) systematically reviewed the research to assess the potential adverse events associated with BFRT when used clinically in the treatment of patients with musculoskeletal disorders.
📊📊
RESULTS:
19 studies with 322 pooled participants.
📊
9 studies reported no adverse events.
📊
3 reported rare adverse events, including an upper extremity deep vein thrombosis and rhabdomyolysis.
📊
3 case studies reported common adverse events, including acute muscle pain and acute muscle fatigue.
📊
Individuals exposed to BFRT were not more likely to have an adverse event than individuals exposed to exercise alone.
📊
Adverse Events Overall:
Overall (14 of 322).
Rare Overall (3 of 322).
Rare BFRT (3 of 168).
Rare Control Group (0 of 154)
Any adverse BFRT (10 of 168).
Any adverse control (4 of 154).
✅✅
CONCLUSIONS:
BFRT appears to be a safe intervention and even more so when used according to evidence-based guidelines and in patients with knee-related musculoskeletal disorders.
✅
Further research is needed to make definitive conclusions about the absolute safety in all patient populations.
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SOURCE:
Minniti et al. 2020. AmJ Sprt Med 2020;48(7):1773–1785 DOI: 10.1177/0363546519882652

11/06/2022

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22/05/2022

🔬📚
Ice for Ankle Sprains?
ℹ️ℹ️
INTRO:
Some documented treatment options after an acute ankle sprains include:
Cryotherapy.
Surgical treatment.
Joint mobilization.
Kinesiotherapy.
Bracing.
Acupuncture.
And many others.
ℹ️
Cryotherapy has often been recommended by clinical practice guidelines and used by health professionals in acute ankle sprain management because it has low cost, easy application, and is considered potentially effective in clinical practice settings.
ℹ️
However, current evidence supporting cryotherapy is still unclear.
ℹ️
Previous systematic reviews (1,2,3 sources below):
Included trials without appropriate comparators (i.e., placebo, sham, waiting list or no intervention).
Failed to investigate whether cryotherapy enhances effects of other treatments (i.e. cryo + exercise).
ℹ️
Thus, a new systematic review is necessary to investigate effectiveness of cryotherapy in the management of acute ankle sprains.
ℹ️
Miranda et al. (2021) investigated the effectiveness of cryotherapy for acute ankle sprains on:
Pain intensity.
Swelling.
Range of motion.
Function.
Recurrence.
📊📊
RESULTS:
377 articles were found.
134 duplicates were removed.
19 potential full texts were assessed.
👇🏽
2 RCTs with high risk of bias met inclusion criteria.
📊
Neither evaluated the effectiveness of cryotherapy compared with placebo, sham, waiting list or no intervention.
📊
Uncertain evidence showed cryotherapy does not enhance effects of other interventions on:
Swelling.
Pain intensity.
Range of motion.
✅✅
CONCLUSIONS:
Current literature lacks evidence supporting the use of cryotherapy on management of acute ankle sprain.
✅
High-quality RCTs are needed.

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SOURCE:
Miranda et al. 2021. Effectiveness of cryotherapy…Pt in Sport. (49), pp. 243-249.
📚
Noted Systematic Reviews
1: Bleakley, McDonough, & MacAuley, 2004
2:Van den Bekerom et al., 2012
3: Doherty et al., 2017

19/05/2022

🔬📚
Accuracy of Special Tests for Meniscus Tears
1️⃣1️⃣
INTRO:
Knee pain is a large and costly problem, and meniscal tears are one of the most common MSK diagnoses.
1️⃣
‘Special tests’ to diagnose torn menisci are often used in the physical examination of the knee joint, however, despite the wealth of research their diagnostic accuracy remains unclear.
1️⃣
In 2015 Smith et al. synthesized the most current literature on the diagnostic accuracy of special tests for meniscal tears of the knee in adults.
🔑🔑
METHODS:
Systematic Review & Meta Analysis
9 Studies were included (n=1234) and 3 special tests were included in the meta-analysis.
📊📊
RESULTS:
The methodological quality of the included studies was generally poor.
📊
McMurray’s:
Sensitivity 61%
Specificity 84%
📊
Joint line tenderness:
Sensitivity 83%
Specificity of 83%
📊
Thessaly 20°:
Sensitivity 75%
Specificity of 87%
✅✅
CONCLUSIONS:
The results of this systematic review indicate that the accuracy of McMurray’s, Apley’s, JLT and Thessaly to diagnose meniscal tears remains poor.
✅
This conclusion must be taken with caution since frequent methodological design flaws exist within the included studies.
✅
Most studies suffered from various biases, and between-study heterogeneity makes pooled data unreliable.
📚📚📚
SOURCE:
Smith et al. 2015. Special tests for assessing meniscal tears within the knee: a systematic review and meta-analysis. Evid Bas Med. 20(3).

16/05/2022

📚🔬
Balance & Strength Training to Improve Chronic Ankle Instability
1️⃣1️⃣
INTRO:
Lateral ankle sprains most prevalent musculoskeletal injuries in sport.
1️⃣
Without appropriate rehab, risk increases for chronic ankle instability (CAI), and osteoarthritis (OA).
1️⃣
Prolonged symptoms of CAI include pain, weakness, or instability, which can lead to range-of-motion (ROM), strength, balance, and functional performance deficits.
1️⃣
Hall et al. (2018) determined if balance- and strength-training protocols would improve the strength, balance, and functional performance deficits associated with CAI.
📊📊
METHODS:
39 volunteers with CAI, 3 groups, all completed 20-minute sessions, 3x/week, for 6 weeks:
Balance-training protocol
Strength-training protocol
Control
🔑🔑
KEY FINDINGS:
🔑
Time-by-group interactions were found in:
Concentric & eccentric inversion
Eccentric eversion
Concentric & eccentric plantar flexion
Balance Error Scoring System (BESS)
Star Excusrion Balance Test (SEBT)
Side hops
🔑
Improvements in the balance- and strength-training protocol groups in concentric and eccentric inversion and concentric and eccentric plantar flexion and the BESS, SEBT, and side hop.
🔑
Only the strength-training protocol group improved in eccentric eversion.
🔑
The control group did not improve in any dependent variable
✅✅
MAIN TAKEAWAYS:
✅
The balance- and strength-training groups improved their strength, balance, and functional performance.
✅
The control group did not improve, suggesting that bicycling alone or increasing passive motion did not improve strength, balance, and functional performance.
✅
Combining resistance-band and proprioceptive neuromuscular facilitation strength training was an effective intervention.
✅
More clinicians should incorporate hop-to-stabilization exercises into their rehabilitation protocols to improve the deficits associated with chronic ankle instability.
📚📚📚
SOURCE:
Hall et al. 2018. Balance- and Strength-Training Protocols to Improve CAI. Journal of Athletic Training 2018;53(6):568–577.

06/05/2022

🔬📚
Accuracy of 3 ACL Diagnostic Tests
1️⃣1️⃣
INTRO:
The anterior cruciate ligament (ACL) is one of the most commonly injured ligaments of the knee.
1️⃣
In America, estimates of ACL injury cases range from 80,000 to 250,000 per year, with approximately 100,000 of these patients undergoing ACL reconstruction surgery.
1️⃣
The 3 primary diagnostic assessments of these manual tests are:
Anterior drawer test.
Lachman test.
Pivot shift test.
1️⃣
Hunag et al. (2016), performed a meta-analysis, looking at diagnostic sensitivity and specificity of the 3 assessments to evaluate the diagnostic accuracy of the anterior drawer, Lachman, and pivot shift tests.
📊📊
RESULTS:
16 studies assessed the accuracy of the 3 tests for diagnosing ACL ruptures & met the inclusion criteria.
📊
Lachman test; most sensitive test to determine ACL tears (87.1%).
📊
Pivot shift test; most specific test (97.5%) & has the highest positive likelihood ratios (LR+) of 16.00.
📊
Lachman test has the lowest negative likelihood ratios (LR−) of 0.17.
✅✅
CONCLUSIONS:
In cases of suspected ACL injury:
Perform the pivot shift test, as it is very specific and has greater likelihood ratios in diagnosing ACL rupture.
✅
The Lachman test has favorable efficacy in ruling out a diagnosis of ACL rupture.
✅
The anterior drawer test is the least proven of the 3 approaches in diagnosing ACL rupture.
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SOURCE:
Huang et al. 2016. Clinical examination of anterior cruciate ligament rupture: a systematic review and meta-analysis. Acta Orthop Traumatol Turc 2016;50(1):22–31 doi: 10.3944/AOTT.2016.14.0283.

02/05/2022

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25/04/2022

📚🔬
Exercise Rehab Protocol
Femoroacetabular Impingement Syndrome (FAI)
[SERIES] 5/5
ℹ️ℹ️
FLEXIBILITY & MOBILITY
ℹ️
Flexibility and mobility exercises should not elicit pain and should be performed at least 1 to 2 times per day.
ℹ️
Static stretches should be held for 15 to 30 seconds.
ℹ️
Static stretching, myofascial release using lacrosse balls and foam rollers, and self-mobilization techniques can improve flexibility and mobility in all of the hip and lower extremity muscles.
❗️
Dynamic drills should be performed within a painfree ROM with proper posture, such as:
Internal and external hip rotation.
Pendulum swings.
Kickers.
Traveling lunges.
❗️
Flexibility of the lower extremity muscles can be evaluated using:
Thomas test.
Ober test.
Hamstring Flexibility test.
Hip External Rotation test.
❗️
Patients who pursue nonoperative approaches often have the same goals as patients who choose surgery: to return to the preinjury or sport-performance level.
❗️
In 6 weeks, some successful outcomes could include:
Pain levels at 0 - 2/10 with repetitive transitions from supine to sitting and sitting to standing.
Able to walk on varied terrain.
Jog for at least 30 minutes.
Complete sport-specific tasks that involve cutting, jumping, and pivoting.
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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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