PT Inquest

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...

Injecting tendinopathies is a popular practice; everything from PRP to steroids to saline to even sugar. But is there any efficacy? What exactly do these things do? Could there actually be a mechanical effect or is it chemical or just good ol' placebo? When is a sham not really a sham and how do we know? We explore all these questions and more with special guest, Peter Malliaras! Effect of High-Volume Injection, Platelet-Rich Plasma, and Sham Treatment in Chronic Midportion Achilles...

Injuries to the hamstrings are more common than just about any other muscle injury in sport. And once you do it once, you are more likely to do it again. What is the problem here? Are some people just good at injuring that muscle and simple are destined to repeat it? Or are there deficits that just aren't fully rehabilitated prior to return to sport? Also, does anyone know how to pronounce Vodafone? THIS ARTICLE IS CURRENTLY OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Change in knee flexor...

When it comes to using treatments which have effects that may be nothing more than placebo, the question that is often asked is "What's the harm?" Well, according to these authors, it could be more than you realize. If it works, who cares? Does it matter that you are accidentally treating a psychosocial issue with something claiming to be treating something else? THIS ARTICLE IS CURRENTLY OPEN ACCESS SO FOLLOW THE LINK TO READ IT! 'Caution, this treatment is a placebo. It might work, but it...

We all know that "correlation does not equal causation" but it is still counterintuitive. There are many questions in healthcare that just cannot be approached by the randomized controlled trial (RCT) requiring us to depend on observational data which is extremely susceptible to this confounding correlation problem. Are there any visual tools that we can use to help keep our thinking honest and not fall for spurious correlations? YES! Join us on an exploration of directed acyclic graphs!!!...

Being positive in life is usually seen as a good thing. Try to identify the silver lining and highlight it. But when it comes to research, that "spin" can have detrimental results for developing clinical guidelines and the scientific process as a whole. This is the final episode of this season - we'll see you all in a few months! 'Spin' in published biomedical literature: A methodological systematic review. Chiu K, Grundy Q, Bero L. PLoS Biol. 2017 Sep 11;15(9):e2002173. doi:...

The double bundle ACL reconstruction is better! Kinda. Sorta. Maybe. But maybe it's not for you. Or maybe it is! Does this squirrel look fat? Does anyone read these descriptions? Does anyone else smell toast? I smell toast... Double-Bundle Versus Single-Bundle Anterior Cruciate Ligament Reconstruction: A Prospective Randomized Study With 10-Year Results. Järvelä S, Kiekara T, Suomalainen P, Järvelä T. Am J Sports Med. 2017 Sep;45(11):2578-2585. doi: 10.1177/0363546517712231. Epub 2017 Jun...

There is a lot that we can throw at musculoskeletal pain, but what actually has evidence behind it? We do we actually know and what directions should the research be headed? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence. Babatunde OO, Jordan JL, Van der Windt DA, Hill JC, Foster NE, Protheroe J. PLoS One. 2017 Jun 22;12(6):e0178621. doi:...

Medical research as a whole can be a mess of low quality studies. This has significant downstream effects of misinformation, confusion, and large variation of practice, not to mention the abundance of low value healthcare being provided. So how do we survive this mess? THIS ARTICLE IS OPEN ACCESS SO FOLLOW THE LINK TO READ IT! How to survive the medical misinformation mess. Ioannidis JPA, Stuart ME, Brownlee S, Strite SA. Eur J Clin Invest. 2017 Sep 7. doi: 10.1111/eci.12834. [Epub ahead...