Physicians Fitness

11/06/2025

"It's hard to trust an individual, it's easier to trust an image"- patients with low back pain want imaging as a means of coping with uncertainty

Abstract

Background: Evidence-based guidelines for low back pain recommend against routine imaging. Despite these guidelines, many patients still seek imaging. We sought to understand why patients with low back pain may want imaging, using a qualitative approach grounded in the Common-Sense Self-Regulation Model (CSSRM), a model that frames how patients' beliefs and actions are shaped by their past experiences and understanding of an illness.

Methods: We interviewed 28 patients from a larger study in Ontario, Canada. Participants were recruited by family physicians (n = 8), chiropractors (n = 10), and physiotherapists (n = 10), and most (82.1%) had previous episodes of low back pain. Participants completed intake questionnaires and semi-structured interviews that explored their experiences with low back pain care and perspectives on imaging. We analyzed the interview transcripts using the CSSRM.

Results: The CSSRM domains were represented in patients' narratives: Stimuli and Illness Representations, Coping Procedures, and Appraisal of Outcomes. Within Stimuli and Representations, patients described perceptions of the causes of their pain, and they associated obtaining an image with gaining a sense of control over their diagnosis. Within Coping Procedures, Cognitive Reappraisal emerged as the construct with the most discourse, reflecting how patients interpreted and reassessed their low back pain over time. Many patients expressed the belief that imaging would resolve uncertainty, validate their experience, and confirm that nothing serious had been overlooked. Patients emphasized that imaging would "show what's going on," or help them "feel taken seriously". Within Appraisal of Outcomes, patients described the self-limiting nature of their LBP; the limited discourse about emotional outcomes was often linked to frustrations and fears. The beliefs expressed in interviews were not consistent with participants' questionnaire answers from months previously, suggesting that beliefs may shift over time.

Conclusions: Many patients believed imaging for low back pain was important to gain certainty in diagnosis and reassurance that treatment was appropriate. However, their beliefs about the value of imaging may not be stable over time, as they are influenced by ongoing experiences and reappraisals. To reduce unwarranted imaging, clinicians should consider providing consistent and contextualized messaging that meets the patient's ongoing illness experience.

Haslam-Larmer L, Norman KE, Patey AM, Thomas IM, Green ME, Grimshaw JM, Hayden JA, Hartvigsen J, Ivers NM, Jenkins H, French SD. "It's hard to trust an individual, it's easier to trust an image"-patients with low back pain want imaging as a means of coping with uncertainty. BMC Prim Care. 2025 Oct 31;26(1):332. doi: 10.1186/s12875-025-02998-5. PMID: 41174481; PMCID: PMC12576980.

10/30/2025

“... to move things is all that mankind can do, for such the sole executant is muscle, whether in whispering a syllable or felling a forest.”
Charles Sherrington, 1924

How are your muscles doing?

10/16/2025

"Abstract

Purpose:
The purpose of this study was to investigate differences in the associations between passive ankle dorsiflexion range of motion (ROM) and stiffness of the triceps surae, sciatic nerve, and deep fascia located in the posterior leg between young and older people.

Methods:
Twenty young and twenty older males were recruited and were placed in a prone position with their hip and knee fully extended. Passive ankle dorsiflexion ROM was determined based on the onset of pain during passive dorsiflexion at 1°·s using an isokinetic dynamometer. Shear wave speeds (as a stiffness index) of the triceps surae, the sciatic nerve, and the deep fascia in the posterior leg were evaluated by ultrasound shear wave elastography.

Results:
The shear wave speeds of the medial and lateral gastrocnemius measured at 15° dorsiflexion correlated negatively with passive ROM in young but not in older participants. The shear wave speed of the sciatic nerve measured at 15° dorsiflexion correlated negatively with passive ROM only in older participants. No association was observed between passive ROM and shear wave speed of the deep fascia in the posterior leg. For data measured at maximal dorsiflexion angle (as an index of stretch tolerance), shear wave speeds of the triceps surae and passive joint torque correlated positively with passive ROM in both groups.

Conclusion:
These results suggest that the tissues limiting passive ankle dorsiflexion ROM are muscle and nerve for young and older people, respectively, whereas stretch tolerance influences passive ROM for both groups. This implies that the relative contribution of nonmuscular tissues to joint flexibility become stronger than that of muscles with age."

Hirata K, Yamadera R, Akagi R. Associations between Range of Motion and Tissue Stiffness in Young and Older People. Med Sci Sports Exerc. 2020 Oct;52(10):2179-2188. doi: 10.1249/MSS.0000000000002360. PMID: 32348099; PMCID: PMC7497479.

10/02/2025

The musculoskeletal syndrome of menopause

"ABSTRACT

Fifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes inmidlife and ultimately stops, it is estimated that more than 47 million women worldwide enter themenopause transition annually. More than 70% will experience musculoskeletal symptoms and 25% willbe disabled by them through the transition from perimenopause to postmenopause. This often-unrecognizedcollective of musculoskeletal symptoms, largely influenced by estrogen flux, includes arthralgia, loss ofmuscle mass, loss of bone density and progression of osteoarthritis, among others. In isolation, it canbe difficult for clinicians and patients to adequately appreciate the substantial role of decreasingestrogen, anticipate the onset of related symptoms and actively treat to mitigate future detrimentalprocesses. Thus, in this review we introduce a new term, the musculoskeletal syndrome of menopause,to describe the collective musculoskeletal signs and symptoms associated with the loss of estrogen.Given the significant effects of these processes on quality of life and the associated personal andfinancial costs, it is important for clinicians and the women they care for to be aware of this terminologyand the constellation of musculoskeletal processes for which proper risk assessment and prophylacticmanagement are of consequence."

Vonda J. Wright, Jonathan D. Schwartzman, Rafael Itinoche & JocelynWittstein (2024) The musculoskeletal syndrome of menopause, Climacteric, 27:5, 466-472, DOI:10.1080/13697137.2024.2380363To link to this article:

Fifty-one percent of humans are born with ovaries. As the ovarian production of estrogen diminishes in midlife and ultimately stops, it is estimated that more than 47 million women worldwide enter ...

09/26/2025

If you're heading for a total knee joint replacement, it appears that strength and conditioning is the way to go...

One-year results of voluntary-based supervised exercise or treatment at orthopedic clinic for radiographic severe knee osteoarthritis..

Abstract

[Purpose]
In this study, we investigated the efficacy of supervised physical exercise or conventional treatment on symptomatic knee osteoarthritis with severe morphological degeneration.

[Subjects] Sixty-six patients with severe radiographic knee osteoarthritis were enrolled. [Methods] Participants were separated into two groups: in one group patients conducted physical exercise under supervision; while in the other group they were treated by conventional clinical methods for one year. Participants filled out two types of questionnaires; the Japanese Knee Osteoarthritis Measure and the Pain Disability Assessment Scale at baseline and one year following enrollment in the study. Two-way repeated measures analysis of variance was used to examine the effects over time and by group for a total of 43 participants; consisting of an exercise group (n=20) and a clinical group (n=23) excluding 23 dropouts.

[Results]
Analysis did not show a significant time-course effect or interaction between time-course and the groups in both questionnaires. On the other hand, there were significant group effects in both questionnaires with an advantage in the exercise group.

[Conclusion] These results indicate that patients with knee osteoarthritis under supervised exercise conditions are more likely to maintain a better clinical outcome at one-year follow-up, despite the severe morphological degeneration in their knees.

J Phys Ther Sci. 2016 Mar;28(3):906-10. doi: 10.1589/jpts.28.906. Epub 2016 Mar 31.

Our specialist can help you assess, implement, monitor, and progress a tailored process.

Call for a free consultation at (614) 442-8100.

09/18/2025

Your teeth are hooked up to your brain!

09/04/2025

Research: Olfactory function and motor function relationship?

Apparently so…

“Abstract

Background: Among older adults, both olfaction and motor function predict future cognitive decline and dementia, suggesting potential shared causal pathways. However, it is not known whether olfactory and motor function are independently related in late life.

Methods: We assessed cross-sectional associations of olfaction with motor and cognitive function, using concurrent data on olfactory function, mobility, balance, fine motor function, manual dexterity, and cognition in 163 Baltimore Longitudinal Study of Aging participants aged 60 and older without common neurological diseases (n = 114 with available cognitive data). Using multiple linear regression, we adjusted for age, s*x, race, smoking history, height, and weight for mobility and balance, and education for cognition. We used multiple linear regression to test whether olfaction-motor associations were independent of cognition and depressive symptoms.

Results: Olfactory scores were significantly associated with mobility (usual gait speed, rapid gait speed, 400-m walk time, and Health ABC Physical Performance Battery score), balance, fine motor function, and manual dexterity (all p < .05). In those with available cognitive data, additional adjustment for depressive symptoms, verbal memory, or visuoperceptual speed demonstrated especially strong independent relationships with challenging motor tasks such as 400-m walk and nondominant hand manual dexterity (p < .005)

Conclusions: This study demonstrates for the first time that, in older adults, olfactory function is associated with mobility, balance, fine motor function, and manual dexterity, and independent of cognitive function, with challenging upper and lower extremity motor function tasks. Longitudinal studies are needed to determine if olfactory performance predicts future mobility and functional decline.”

Tian Q, Resnick SM, Studenski SA. Olfaction Is Related to Motor Function in Older Adults. J Gerontol A Biol Sci Med Sci. 2017 Aug 1;72(8):1067-1071. doi: 10.1093/gerona/glw222. PMID: 27811155; PMCID: PMC5861968.

08/28/2025

Surgery can solve some challenging problems, but also create some...

"Adhesions and Scar Tissue

Approximately 1 in 14 hospital readmissions following abdominal surgery are due to adhesion-related problems (Parker et al., 2001). Every time tissue undergoes trauma, as in the case of abdominal surgery and laparoscopic adhesiolysis to remove adhesions, scar tissue forms. Adhesive scar tissue develops when the layers of tissue do not heal separately but ‘stick’ together causing decreased tissue elasticity, protective postural patterns, changes in proprioceptive input, altered neurovascular activity and complications including pain syndromes (Kobesova et al., 2007)."

Ryan C. Kelly, Michelle Armstrong, Alyssa Bensky, Abigail Foti, Jennifer B. Wasserman, Soft tissue mobilization techniques in treating chronic abdominal scar tissue: A quasi-experimental single subject design, Journal of Bodywork and Movement Therapies, Volume 23, Issue 4, 2019, Pages 805-814,
ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2019.04.010.
(https://www.sciencedirect.com/science/article/pii/S1360859219301238)

08/27/2025

Does our ability to smell affect our motor function?

Apparently so...

"Abstract

Background:
Among older adults, both olfaction and motor function predict future cognitive decline and dementia, suggesting potential shared causal pathways. However, it is not known whether olfactory and motor function are independently related in late life.

Methods:
We assessed cross-sectional associations of olfaction with motor and cognitive function, using concurrent data on olfactory function, mobility, balance, fine motor function, manual dexterity, and cognition in 163 Baltimore Longitudinal Study of Aging participants aged 60 and older without common neurological diseases (n = 114 with available cognitive data). Using multiple linear regression, we adjusted for age, s*x, race, smoking history, height, and weight for mobility and balance, and education for cognition. We used multiple linear regression to test whether olfaction-motor associations were independent of cognition and depressive symptoms.

Results:
Olfactory scores were significantly associated with mobility (usual gait speed, rapid gait speed, 400-m walk time, and Health ABC Physical Performance Battery score), balance, fine motor function, and manual dexterity (all p < .05). In those with available cognitive data, additional adjustment for depressive symptoms, verbal memory, or visuoperceptual speed demonstrated especially strong independent relationships with challenging motor tasks such as 400-m walk and nondominant hand manual dexterity (p < .005)

Conclusions:
This study demonstrates for the first time that, in older adults, olfactory function is associated with mobility, balance, fine motor function, and manual dexterity, and independent of cognitive function, with challenging upper and lower extremity motor function tasks. Longitudinal studies are needed to determine if olfactory performance predicts future mobility and functional decline."

Tian Q, Resnick SM, Studenski SA. Olfaction Is Related to Motor Function in Older Adults. J Gerontol A Biol Sci Med Sci. 2017 Aug 1;72(8):1067-1071. doi: 10.1093/gerona/glw222. PMID: 27811155; PMCID: PMC5861968.

08/21/2025

Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease

“Age is a primary risk factor for a number of chronic diseases including mobility disability, cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer. Most physical activity guidelines emphasize the performance of 150 min of moderate-to-vigorous or 75 min of vigorous aerobic exercise training (AET) weekly for reduction of chronic disease risk. Nonetheless, there is an emerging body of evidence showing that resistance exercise training (RET) appears to be as effective as AET in reducing risk of several chronic diseases. It may also be that RET is more effective than AET in some regards; the converse is likely also true. We posit that the perceived divergent exercise mode-dependent health benefits of AET and RET are likely small in most cases. In this short review, our aim is to examine evidence of associations between the performance of RET and chronic health disease risk (mobility disability, T2D, CVD, cancer). We also postulate on how RET may be influencing chronic disease risk and how it is a critical component for healthy aging. Accumulating evidence points to RET as a potent and robust preventive strategy against a number of chronic diseases traditionally associated with the performance of AET, but evidence favors RET as a potent countermeasure against declines in mobility. On the basis of this review we propose that the promotion of RET should assume a more prominent position in exercise guidelines particularly for older persons.”

Mcleod JC, Stokes T and Phillips SM, (2019) Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease. Front. Physiol. 10:645. doi: 10.3389/fphys.2019.00645

08/14/2025

Resistance Exercise Training as a Primary Countermeasure to Age-Related Chronic Disease

“Age is a primary risk factor for a number of chronic diseases including mobility disability, cardiovascular disease (CVD), type 2 diabetes (T2D), and cancer. Most physical activity
guidelines emphasize the performance of 150 min of moderate-to-vigorous or 75 min of vigorous aerobic exercise training (AET) weekly for reduction of chronic disease risk. Nonetheless, there is an emerging body of evidence showing that resistance exercise training (RET) appears to be as effective as AET in reducing risk of several chronic diseases. It may also be that RET is more effective than AET in some regards; the converse is likely also true. We posit that the perceived divergent exercise mode-dependent health benefits of AET and RET are likely small in most cases. In this short review, our aim is to examine evidence of associations between the performance of RET and chronic health disease risk (mobility disability, T2D, CVD, cancer). We also postulate on how RET may be influencing chronic disease risk and how it is a critical component for healthy aging. Accumulating evidence points to RET as a potent and robust preventive strategy against a number of chronic diseases traditionally associated with the performance of AET, but evidence favors RET as a potent countermeasure against declines in mobility. On the basis of this review we propose that the promotion of RET should assume a more prominent position in exercise guidelines particularly for older persons.”

Mcleod JC, Stokes T and Phillips SM
(2019) Resistance Exercise Training
as a Primary Countermeasure to
Age-Related Chronic Disease.
Front. Physiol. 10:645.
doi: 10.3389/fphys.2019.00645

08/07/2025

For those computing their target heart rate training zones, there is a New Maximum Heart Rate formula - 211 - 0.64 x Age

"Abstract
Maximal heart rate (HRmax ) declines substantially with age, but the magnitude and possible modifying effect of gender, body composition, and physical activity are not fully established. The present study examined the relationship between HRmax and age in 3320 healthy men and women within a wide age range using data from the HUNT Fitness Study (2007-2008). Subjects were included if a maximal effort could be verified during a maximal exercise test. General linear modeling was used to determine the effect of age on HRmax . Subsequently, the effects of gender, body mass index (BMI), physical activity status, and maximal oxygen uptake were examined. Mean predicted HRmax by three former prediction formulas were compared with measured HRmax within 10-year age groups. HRmax was univariately explained by the formula 211 - 0.64·age (SEE, 10.8), and we found no evidence of interaction with gender, physical activity, VO2max level, or BMI groups. There were only minor age-adjusted differences in HRmax between these groups. Previously suggested prediction equations underestimated measured HRmax in subjects older than 30 years. HRmax predicted by age alone may be practically convenient for various groups, although a standard error of 10.8 beats/min must be taken into account. HRmax in healthy, older subjects and women were higher than previously reported."

Nes BM, Janszky I, Wisløff U, Støylen A, Karlsen T. Age-predicted maximal heart rate in healthy subjects: The HUNT fitness study. Scand J Med Sci Sports. 2013 Dec;23(6):697-704. doi: 10.1111/j.1600-0838.2012.01445.x. Epub 2012 Feb 29. PMID: 22376273.