Somewhere, something incredible is waiting to be known.
— Carl Sagan

As a growing therapist, I believe it's crucial to take advantage of what the internet has to offer in terms of having access to knowledge of experts around the world. Here is a compiled list of the articles I've read in the month. Feel free to share with me articles that you found insightful and useful for your development as a person and as a clinician!


Modality Empires

  • Paul Ingraham explains how many courses available as continuing education are essentially the same packages wrapped in different boxes.

  • “Modality empires often revolve around an overly simplistic notion of how the body works and how it might be fixed. In particular, modality empires tend to be based on “structuralism,” which is the emotionally compelling idea that our problems are caused by being “crooked” in some way, and that all our problems will be solved when we are “straightened” by therapy."

 

An Introduction to Loading: Foundation & Principles

  • Scott Morrison dives into an important part of physical therapy that is surprisingly brushed over in most physical therapy programs, basic concepts of training.

  • “What this means is that changes in any of these three areas will potentially influence the way the individual moves. Strength training is an intervention directed at manipulating the constraints of the individual. With increased strength and/or capacity, the organism has more options available when faced with performing a task.”

 

The Power-Capacity Continuum

  • Jumping from Scott Morrison’s article above, I was lead to this article by Patrick Ward. He explains how athletes fall onto a continuum when it comes to specific demands the sport and position ask for, and how there metabolic needs are never black and white.

  • “All sports lie on a continuum between Power and Capacity. Power is the ability to do something for a shorter period of time but do it at a maximal or near maximal effort and then enjoy a complete or nearly complete recovery period. Capacity is the ability to either do something for a long period of time, such as run a marathon, or be able to express high, powerful efforts repeatedly with minimal or incomplete rest.”

 

Elite Level Placebos

  • Erik Meira shares his scoring system on how much your intervention of choice is a placebo. This is important article to understand and prevent yourself as a therapist from giving your patients misguided explanations.

  • “What exactly is your problem? Why are you so damn certain about something with so little evidence? Shame on you. You science bad.”

 

New England Journal of Medicine: R.I.P. Back and Neck Fusion Surgery

  • The title says it all, the New England Journal of Medicine cites evidence that spinal fusion surgery is no more effective that less invasive and cheaper interventions.

  • “In this new study, almost 300 patients with low back spinal stenosis (arthritis that’s putting pressure on nerves) were randomly assigned to undergo either a traditional laminectomy or that surgery plus a lumbar fusion. The result was not surprising—adding a fusion surgery didn’t improve outcomes at two or five years after surgery!”

 

The Influence of Pain on Shoulder Biomechanics

  • Mike Reinold keeps it simple in the article stating something that most clinicians should already know. Pain will alter movements of the shoulder and thus the therapist should see beyond the location of pain.

  • “As you can see, it is important to assess both shoulder and scapular movement together, and not in isolation, as movement impairments at one join likely influence the other.  The brain is exceptionally good at getting from point A to point B and finding the path of least resistance to get there.”

  • “I should note that in studies like this, it is impossible to tell if the pain caused the movement changes or the movement changes caused the pain.  So keep that in mind.  Regardless of causation, our treatment programs should be designed with these findings in mind.”

 

Informed Consent and the Cost of Residencies in Physical Therapy

  • Ryan Hamic discusses that actual financial cost of enrolling in a residency in physical therapy. The common “oh what is an extra $20k” thought is calculated out by Ryan to reveal that the financial impact is a lot more than expected.

  • “Let’s think about that, simply by taking the differential between an average starting PT salary and what a resident earns in their first year (minus the cost of residency) and investing it in a passive exchange traded fund and contributing nothing for the next 40 years the student would hit retirement age with 2.5 times the amount of retirement savings as the average American.”

 

When can I run? By Chris Johnson and Nathan Carlson

  • Chris Johnson and Nathan Carlson set some great return-to-run criteria in this blog on Tom Goom’s website. This is an essential article to consider when working with runners.

  • “The goal of a proper rehab program is not only to help runners build the necessary capacity to get through their daily routine, but to also withstand the performance demands of running; a repetitive plyometric activity that involves bounding from one leg to the next in a balanced manner. This is best accomplished through a “considered, gradual overload by progressing the intensity and complexity of movements specific for that tissue and region” before finally restoring capacity in the entire kinetic chain”

 

Models Of Pain And Movement

  • Todd Hardgrove discusses the variety of models on pain currently in circulation and how to not choose a single side, and instead take the salient points from multiple GOOD models as foundations to your clinical choices.

  • “The way I look at it, all models are necessarily wrong, at least to some extent. But some models are still useful. We need to be aware of how a particular model might lead us astray, but we also need to appreciate how it can provide insight.”

 

Do quarter squats transfer best to sprinting?

  • The S&C Research team highlights current research on partial squats and how, depending on your performance goals, may be a smart choice for training your client or patient.

  • “Based on this study, there may be benefits of training using partial squats for improving vertical jump height in collegiate athletes. In fact, it indicates that quarter squats may even be better than either half squats or full squats.”

  • “This study indicates that there may be benefits of training using partial squats for improving sprinting. In fact, it indicates that quarter squats may even be better than either half squats or full squats”

 

Hunting for Pain

  • Erik Meira shares his explanation to athletes about how progressive load works for tendon pain management during rehabilitation.

  • “Should you drop the light and run away from the new shadow in fear? NO! You hunt that fucker! You change positions to redirect the light to the new shadow. That new shadow also disappears. By confronting it, you show your nervous system that nothing is hiding back there. There is no danger. Your nervous system then calms down.”

 

Hip Hinge

  • Aaron Swanson goes through almost everything you need to know about the hip hinge and how it is a key basic movement pattern that is essential for optimal performance and injury prevention.

  • “Isolated isometrics and basic isotonic strengthening exercises are necessary.  But to take our profession to the next level (and your patients) we need to “bridge the gap”.  Try adding some movement training into your plan of care.  Your patients will appreciate it.”

 

Health before performance

  • Andrew Read discusses the importance of addressing a client’s or patient’s health before performance. Commonly overlooked, athletes of all types are so focused on doing what it takes to get back onto their training regiment that their clinicians/trainers forget to address the possible faulty movement patterns that may need priority.

  • “Before we can be a specialized human, like an athlete, we must first be a human being. That means we should be able to twist, bend, squat, move pain free, and be in good general health. Human being, before human doing.”

 

Physiotherapists’ confidence implementing a biopsychosocial approach to managing CLBP

  • The team at Paid Ed shares their study on Cognitive Functional Therapy and how it helped increase the confidence of clinicians to implement a biopsychosocial approach for chronic low back pain. The article highlights how there needs to be an increase in understanding of pain and how to educate the patient in order to properly address chronic low back pain.

  • “Physiotherapists reported feeling neither equipped by their initial training, nor currently available professional development courses, to successfully deal with these factors in practice. The Physiotherapists emphasised a need for training on integrating these factors into patient management.”

 

How our diaphragm can run our lives

  • Michael Mullin talks about the importance of the diaphragm from multiple perspectives and really reveals how it can play a significant role in multiple pathologies and limitations.

  • “Important to remember that the diaphragm can influence, and is influenced by, dysfunction to and from many different areas.  It is a messenger, and while it may be a large part of any dysfunction, it should be perceived as merely following orders.”

 

What You Need to Know About GIRD: What It Is and What it Isn’t

  • Mike Reinold talks about the commonly mistaken diagnosis of Glenohumeral Internal Rotation Deficit (GIRD), and how to take into consideration of proven anatomical changes of the throwing athletes humerus when treating them for possible GIRD.

  • “The major flaw of the posterior capsule tightness theory is that it does not take into consideration the very specific increase in ER that is also seen in overhead athletes, let alone the fact that total rotational motion is still the same side-to-side.  If the posterior capsule was the cause of the loss of IR, would we then assume that the anterior capsule has loosened precisely the exact same amount to allow the exact same increase in ER as the posterior capsule does to restrict IR?”

 

Manual therapy: process or product?

  • One of the most impacting articles I’ve read is written here by Jason Silvernail. He replies to a statement on the uselessness manual therapy is. He explains that manual therapy is more than just a specific maneuver and that it overall ties into a hands on, clinical reasoned, and patient centered system for rehabilitation.

  • “A manipulative procedure is not the same as a manual therapy approach, just as extension exercises do not represent the MDT approach. The manual therapy approach is a ‘process’ of care centred on a reasoning model, not a ‘product’ consisting of one or more manipulative techniques.”

 

Understanding Pain

  • Rey Allen lays down everything you need to know about how pain works, citing great pieces of evidence throughout his article.

  • “Our experience of pain is a top-down process—always. In fact, there is no such thing as myofascial pain, bone pain, organ pain, or even the existence of nerve pain. There’s just pain. This means damaged and pinched nerves do not have to hurt. Even in the presence of actual tissue damage—given pain is an output of the brain—it is our brain that concludes whether our tissues are in danger.”

 

SITTING POSTURE & BACK PAIN: WHERE BELIEFS MEET SCIENCE

  • Derek Griffin combats the current notion that poor posture is crippling everyone in pain. Providing the evidence, he argues that these bad posture beliefs need to be received in a different light.

  • “Healthcare professionals need to avoid invoking fear by coaching "ideal" or "optimal" postures as such a practice has little scientific support.”

 

9 tendinopathy truths that you MUST know

  • Peter Malliaras provides points on tendinopathy and what are the most effective interventions backed by evidence.

  • "Tendinopathy rarely improves long term with only passive treatments such as massage, therapeutic ultrasound, injections, shock-wave therapy etc. Exercise is often the vital ingredient and passive treatments are adjuncts.”

 

PNF for Lumbar Flexion in Quadruped: Restore Toe Touch and Lumbar Dissociation

  • Erson Religioso shares a Proprioceptive Neuromuscular Facilitation technique to help increase lumbar flexion mobility as an early intervention for improving standing toe touch flexibility.

  • "When hip hinges are practiced too much, you often lose the ability to actually flex at the lumbar spine. Every joint needs to move to remain healthy as long as it's non threatening or done in excess to the point of injury."

 

Effects of exercise on immune function and risk of infection

  • Michael Gleeson explains the relation of exercise and your immune system function, citing evidence that exercise categorized as overtraining can significantly make you more vulnerable to illness.

  • “After strenuous exercise, athletes enter a brief period of time in which they experience weakened immune resistance and are more susceptible to viral and bacterial infections, in particular URTIs. Post-exercise immune function depression is most pronounced when the exercise is continuous, prolonged (>90 minutes), of moderate to high intensity (55-75% of aerobic capacity), and performed without food intake (Gleeson et al. 2013).”

 

Mismatch in muscle and tendon development: risk factor for patellar tendon pain?

  • Peter Malliaras explains the possible risk of injury due to different rates of growth of tendons to muscles. He reviews an article on tendon adaptation during adolescence in this article.

  • “the marked fluctuations in muscle development in the athletic group were not matched by tendon development, exposing the tendon to very high strains at times that may have relevance to patellar tendon injury."

 

Don’t stand on the shoulders of giants

  • This article by Giorgio Aracara makes a bold statement about how research should be viewed by academics. Specifically criticizing psychology and neuroscience literature, he explains that the credibility of current research is poor. From repeated debunked old theories to current grad students forced to produce almost meaningless research for their degree, he pleads for a change in academia to revitalize research and its quality. I feel this article really ties in with the poor body of research that is currently out there in the physical therapy world.

  • “All these discussions point  to a clear conclusion. Science is facing a crisis because its results are proved to be much weaker and less solid than we are prone to think. The consequence is that we should be careful in trusting existing and published results, or, put in other terms, we should be careful to “stands on the shoulder of giants” (read this interesting post here on the issue and on some solutions). The only way to solve the crisis is to be more skeptic on the results existing studies and to examine critically the literature.”

  • “If you do research when you are not really ready (and you are forced to do so), it is highly likely that your research will be one of the thousands of studies that won’t be replicated, or that won’t add anything of really relevant to the field. This is basically the view (from inside) of what’s not working in science, and that can explain (at least in part) the crisis we are facing.”

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