PT Inquest

Here we go again, hating on physical therapy (the theme song does say "I'm my own worst enemy"...) There have been some recent pushes in the physical therapy world to promote what we do, but has this been the most honest, evidence-based approach? What is the difference between "non-evidence-based" and "evidence-based" marketing? Can we do better? Special guest Joshua Zadro from the University of Sydney School of Public Health and the Institute for Musculoskeletal Health is here to help us...

Pew! Pew! Pew! Lasers!!! What could be more high tech than that? Hold on a second...what exactly IS a laser? And how is it different than other sources of light? Knowing that, why would you use it? And can you have very high quality research on very low plausibility hypothesis? You bet you can! Incorporation of photobiomodulation therapy into a therapeutic exercise program for knee osteoarthritis: A placebo-controlled, randomized, clinical trial. de Paula Gomes CAF, Leal-Junior ECP,...

Thinking your ACLR patients are using compensatory strategies when they are squatting? Simple! Just watch them do a squat and you'll see it with your own eyes...OR WILL YOU?! This week our super-special guest is study lead-author Susan Sigward, Associate Professor of Clinical Physical Therapy at the University of Southern California. Compensatory Strategies That Reduce Knee Extensor Demand During a Bilateral Squat Change From 3 to 5 Months Following Anterior Cruciate Ligament...

A topic we have discussed before, early activity after rotator cuff repair, but this is a different study design. What is meant by non-inferiority? Is this the same as saying equal? What if it was better? Would such a paper tell us? No Functional Difference Between Three and Six Weeks of Immobilization After Arthroscopic Rotator Cuff Repair: A Prospective Randomized Controlled Non-Inferiority Trial. Jenssen KK, Lundgreen K, Madsen JE, Kvakestad R, Pripp AH, Dimmen S. Arthroscopy. 2018...

Anterior Cruciate Ligament Reconstruction (ACLR) is a procedure that has a lot published on it yet there are still second injury rates as high as 40% in some populations. There seems to be some consensus in the literature as to how these patients should be managed, but do physical therapists actually manage them this way? Embarrassingly the answer is no. Rehabilitation Practice Patterns Following Anterior Cruciate Ligament Reconstruction: A Survey of Physical Therapists. Greenberg EM,...

There is a lot of talk amongst medical professionals and the media about sitting being the new smoking. Is that true? How would we compare that? Even if that is not EXACTLY true, what's the harm if it scares people into moving more? This article is open access at the time this episode was released so click the link below to download! Evaluating the Evidence on Sitting, Smoking, and Health: Is Sitting Really the New Smoking? Vallance JK, Gardiner PA, Lynch BM, D'Silva A, Boyle T, Taylor...

A lot of people out there, including medical providers, believe that our understanding of chronic traumatic encephalopathy (CTE) or even concussions is complete and conclusive. As with many things, our understanding is very much just emerging. Everything from management to definitions of terms are constantly changing. Is the horse still chasing the cart here? In this episode we take a little tour of what we know and don't know with special guest Jason Hugentobler, the director of the sports...

Can psychosocial factors predict pain after rotator cuff surgery? Or could they be predictive of a poor outcome in general? Does this mean surgery shouldn't be done in these cases? Also, does hunger have an effect on the quality of a PT Inquest episode? A prospective evaluation of predictors of pain after arthroscopic rotator cuff repair: psychosocial factors have a stronger association than structural factors. Ravindra A, Barlow JD, Jones GL, Bishop JY. J Shoulder Elbow Surg. 2018...

Sometimes it seems like ACL injury can be linked to all kinds of future problems. In this example there is a correlation to future myocardial infarction, although not statistically significant. We all know that showing a correlation doesn't mean causation, but what exactly does it mean? More importantly, just how many people are murdered by steam related weapons?! Relation of Anterior Cruciate Ligament Tears to Potential Chronic Cardiovascular diseases. Meehan WP, Weisskopf MG, et...

This week we are discussing an editorial from Physical Therapy Journal. We get into how much we really enjoy editorials, especially from specific editors, but we also discuss the role of scientific journals. Many clinicians confuse the broad and varied missions of a professional organization and the goals of that organization's scientific journal. What is the right platform for advocacy of a profession and what role does science play? Scientific Journals Are Not Advocacy...

We are back for another season of PT Inquest with more tendinopathy talk! There are a couple studies that have shown that high load, long duration isometrics reduce pain, but would short duration be just as effective as long as time under tension was held constant? And are the effects only on pain or is there something more specific going on? Immediate and Short-Term Effects of Short- and Long-Duration Isometric Contractions in Patellar Tendinopathy. Pearson SJ, Stadler S, Menz H,...

Exercise and education is better than steroid injection for gluteal tendinopathy! Hooray for physical therapy! Or is it? What are the options and how great are they? We end this season with another example of an article and an intervention that we use and love, but we may want to pump the brakes a little. See you all next season!!! THIS ARTICLE IS CURRENTLY OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Education plus exercise versus corticosteroid injection use versus a wait and see approach...

Blow Flow Restriction (BFR) training is a topic that is often requested for us to cover, but the research has not been very impressive to us regarding rehab application. That said, we aim to please! (No we don't.) So in this episode, we are joined by Scot Morrison to discuss what we know and what we don't know around BFR and the potential rehab applications. THIS ARTICLE IS CURRENTLY OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Blood flow restriction training in clinical musculoskeletal...

We love us some pain neuroscience and exercise for the treatment of chronic pain as a very plausible approach, but there is not very much research out there that truly tests it. This article compared that approach to a more "old style" approach to physical therapy management of chronic spine pain. The conclusions were promoted as promising, but the findings may not be as impressive as advertised. Special guest Kenny Venere joins us to take an exploration of pain neuroscience as an...

Finally a randomized controlled trial comparing physical therapy management to surgery for femoroacetabular impingement syndrome (FAIS)!!! And what were the findings? Well, not impressive on either end. Of course this generates more questions than answers but that's what good research does. Arthroscopic Surgery or Physical Therapy for Patients With Femoroacetabular Impingement Syndrome: A Randomized Controlled Trial With 2-Year Follow-up. Mansell NS, Rhon DI, Meyer J, Slevin JM, Marchant...

Determining when to return to play after concussion requires the use of testing to make sure that the athlete has returned to baseline. But what if you don't have a baseline measurement? Can having a history of common mental illnesses like anxiety and depression have an impact in the true baseline for an individual athlete? What about other cognitive peculiarities? Erik also discusses what it is like to be on the autism spectrum. Here is the test for Autism/Asperger's that Erik was...

Female Athlete Triad may be more common than you think, and it turns out many male athletes can have it too! We take a deep exploration of the condition, how it works, and how to screen for it with special guest, San Diego State University PT School Program Director Mitch Rauh! Association of the Female Athlete Triad Risk Assessment Stratification to the Development of Bone Stress Injuries in Collegiate Athletes. Tenforde AS, Carlson JL, Chang A, Sainani KL, Shultz R, Kim JH, Cutti P,...

Do older runners run differently than younger runners? If they do, is it A GOOD THING OR A BAD THING?! Can this actually be used as a tool for training or useful information for return after injury? Join us with study co-author Blaise Williams from Nike! Biomechanical Implications of Training Volume and Intensity in Aging Runners. Paquette MR, Devita P, Williams DSB 3rd. Med Sci Sports Exerc. 2018 Mar;50(3):510-515. doi: 10.1249/MSS.0000000000001452. Due to copyright laws, unless the...

Many clinicians wonder is tests such as the quad index are good enough for returning an athlete to sport after ACLR. Turns out, clinicians aren't even doing that! In the episode we have special guests Allison Toole and Matt Ithurburn discussing their recent paper that looked at how athletes tested after they had already been cleared to return to play after ACLR. Spoiler - they didn't look very good. Young Athletes Cleared for Sports Participation After Anterior Cruciate Ligament...

The scientific community has made some mistakes over the past couple decades, leading people to think many effects were much larger than they actually are, if they even existed at all! So what is the reason for this? How has the current process incentivized the publication of studies that may not be the best reflection of the truth? And what can we do about it? Turns out, there is a lot we can do about it! THIS ARTICLE IS CURRENTLY OPEN ACCESS SO FOLLOW THE LINK TO READ IT! The Weak Spots...