ampphysio-blog

[ampphysio-blog]

Popliteal Artery Entrapment Syndrome (PAES) 🚩 Only 1-3% of patient's will present with a RED FLAG to an orthopaedic physical therapist. Nonetheless, it is important to be aware of the various conditions that require medical management either immediately or in the near future. WHAT IS PAES? 🤔 PAES is a RED FLAG condition that requires immediate medical attention. Most commonly it is the compression of the popliteal artery, nerve or even vein by the medial head of the gastrocnemius secondary to hypertrophy or congenital anomaly. This compression can lead to lower limb ischemia. In many cases it will present as a compartment syndrome and is bilateral in many of the cases. DIAGNOSIS: 👩🏽‍⚕️ Patient demographics: usually young athletic male Symptoms: pain, numbness, tingling in the leg with exertion Clinical signs: changes in Ankle Brachial Pressure Index with plantar flexion (sign of arterial occlusion Investigations: lower limb angiography with and without patient plantar flexing #ampphysio #sportmedicine #physiotherapy #screening #redflags #physicaltherapy #physiotherapist #medicine

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Special Tests are not that special ... 🧐 There is loads of evidence suggesting our special tests are not so special meaning, there not tissue specific, they don't always lead a specific diagnosis, and it is debatable if it guides clinical decisions. However, this does mean we don't use them, just pick a few that have some good psychometric properties which will help you extract better information from your clinical examination. ... ➡️ Reflect on your physical exam tests that you commonly use and look into the diagnostic accuracy of them; that is their sensitivity and specificity. In quick summary, here is a familiar mnemonic below: Sensitive test and Negative rules OUT a condition = SNOUT Specific test and Positive test rules IN a condition = SPIN ➡️ Use special tests that help screen or rule in conditions to better inform your clinical decision making. Although Symptom Modification Procedure may likely be more salient for treatment. SMP could demonstrate to the patient that their symptoms are malleable and could lend opportunity to provide more targeted and meaningful exercises. ... ➡️ These tests are not specific to any one tissue. They aid in diagnosis and should not be used to determine a “medical label” for a patient. https://www.ampphysio.com/blog/2016/9/6/im-a-physiotherapist-not-a-statistician #ampphysio #physio #physiotherapy #physicaltherapy #dptstudent #orthopaedics #sportsmedicine #specialtests

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Co-morbidities and Pain ... #Metabolic conditions can effect tissue health. As part of a thorough history be sure to screen for conditions like Hypertension, Hypercholesterolemia and Diabetes Mellitus. ... https://www.ncbi.nlm.nih.gov/pubmed/28850330 #ampphysio #physio #dptstudent #painscience #diabetes #hypertension #physiotherapy #sportmedicine #shoulderpain

[ampphysio-blog]

Simple and Sensible Sleep Solutions for Physical Therapist 😴 https://www.ncbi.nlm.nih.gov/pubmed/28789471 #ampphysio #sleep #rehabilitation #physio #physiotherapy #physicaltherapist #pain #painscience

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Exercise Adherence - what is the key? 🔑 Exercise adherence can be challenging since were asking our patient's to change their normal day to day behaviours. There are few ways we can look to maximize the chance the exercise gets done. 🏃🏽 (1) Build self-efficacy: this is one's perceived ability to execute a set of behaviours. If one possesses self-efficacy, that is they know how to do their exercises and why they are being done, it will increase the chance sustaining short and long term behaviour change. That is what our job - ensure client's have the right tools, know why they have them, and how to use them. 🏋🏽 (2) Goal Setting: this is a must - there needs to be a tangible goal we can aim for. Many simply want to be pain-free while others want to run a race or return to sport. Have them write a goal down, get them to sign up for an event and get them to commit to something meaningful. ⛹🏾‍♂️ (3) Keep it Fun: as @adammeakins would say, "when s%!t is fun, s%!t gets". Find something they enjoy or don't mind doing, keep it very simple using as few exercises as possible and get them consistent. 🏌🏾‍♂️ (4) Booster Sessions: once your patient is on a roll, they have self-efficacy, they have a goal and are enjoying the ride, let them run with the exercise plan for a 4-6 weeks, but consider bringing them back in for a follow up. At this touch point, you can discuss how things are going, does anything need to be changed, and likely have the patient motivated to continue in preparation for your next session. Perhaps you are that support system and reinforcement that will hold them accountable. #ampphysio #physiotherapy #physio #exercise #adherence #makeaplan #motivation

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Is the Adductor Squeeze Test a useful screening tool for groin pain? 1 in every 2-3 male soccer athletes will experience groin pain in the competitive season and unfortunately a previous groin injury results in a 2.5 - 7 greater likelihood of reinjury. The more longstanding, the more pain, disability, and lost time from competition. 🏃🏽 This study looked at a few things: 1) Do athletes with past-season groin pain have lower preseason hip adductor squeeze strength compared with soccer athletes without past-season groin pain? ⚽️ 2) Do athletes with different durations of past-season groin pain have lower preseason hip adductor squeeze strength compared with soccer athletes without past-season groin pain. Yes and yes! Methods: 📊 n = 303 male soccer athletes Outcome = Hip adductor squeeze strength values were obtained using a handheld dynamometer using a long-lever and short-lever (hip flexion at 45 deg) test. Main finding: Male soccer athletes with past-season groin pain of longer than 6 weeks showed 12% and 15% lower preseason hip adductor strength on the short and long lever squeeze tests, respectively, compared with soccer athletes without past-season groin pain. . Clinical Implication: . Preseason screening is important! Ask soccer athletes if they are experiencing groin pain and test for adductor strength deficits using the long lever or short lever test. If there are impairments found, have the players work on exercises targeting the adductors to help reduce the risk of injury or reinjury and follow up to ensure they are getting stronger and their symptoms are improving. . http://vbn.aau.dk/ws/files/267847523/2325967117747275.pdf #ampphysio #physiotherapy #sportscience #sportmedicine #sport #soccer #adductors #groinpain #screening

[ampphysio-blog]

Are there potential societal implications of this study on the persistent pain epidemic? 🤷🏼‍♀️ Perhaps giving children a modern understanding of pain may be a future strategy to inoculate society from biomedical explanations of pain that can lead to future disability and persistent pain. ... Persistent pain affects millions across the world and the lifespan. This epidemic is multifactorial, but current beliefs and views of pain are likely playing a role. One highly studied and useful intervention is pain neuroscience education (PNE). PNE increases pain knowledge and helps people reconceptualize their symptoms to reduce fear, catastrophizing, disability, and movement dysfunction. . Can a 30-minute PNE session delivered to middle school children result in a increase in their pain knowledge and instil positive beliefs regarding pain? 👥 The Sample: ➡️ 145 grade 5 to 8 students attended a 30-minute PNE lecture. Primary outcomes were Pain knowledge (NPQ) and Beliefs regarding pain both measured before and immediately after the PNE lecture. 📊 Results: ➡️ 30% of students were currently experiencing pain and 93% of children had a close relative or friend with persistent pain ➡️ PNE lecture to middle school children resulted in a significant increase (30%) in their knowledge of pain as well various beliefs regarding pain (large effect size). ➡️ 5th graders demonstrated a smaller effect size: higher belief to agree that “pain means something is wrong with your tissues” after the PNE and “you control how much pain you feel” . http://www.tandfonline.com/doi/abs/10.1080/09593985.2017.1423142 . #ampphysio #physio #physiotherapy #pain #education #children #persistentpain #chronicpain

[ampphysio-blog]

Hamstring Injury Reduction Strategies in Sport Hamstring injury (HSI) in sport is a common injury often resulting in lost time from competition and tends to recur. Fortunately, there are a number of risk reduction and management strategies at our disposal. One of the best is the Nordic Hamstring (NH) program. This partner-assisted eccentric hamstring exercise isn’t a “magic bullet”, but there is some solid evidence to support its use. 🏃🏻‍♂️ A classic RCT conducted by Petersen and colleagues, assigned amateur and elite-level soccer teams to one of two groups: 1) Control (n=27) 2) Eccentric Hamstring Program (n=23) 🎯 The NH group was given a progressive 10-week eccentric hamstring exercise program in mid-season. At one-year follow-up, there were 67 HSIs in the control group (44 new, 23 recurrent) and 15 HSIs in the NH group (12 new and 3 recurrent). Wow 😯 This shows that the intervention group experienced 60% fewer HSIs! And even more impressive, recurrent HSIs were reduced by 85%! For the nerds out there, there was a number needed to treat (NNT) of 3; which means, that for every 3 high-risk athletes (athletes who have a history of HSI) participating in the NH program, one hamstring injury will be prevented. 🤝 Nordics have become apart of the FIFA11+ program and are being integrated into strength and conditioning programs. With considerations given to load management, fatigue, nutrition, sleep, we can continue to keep players in the game. #ampphysio #physiotherapy #physio #sportmedicine #sport #hamstringinjury #strengthandconditioning

[ampphysio-blog]

Sleep Deprivation and Pain 🛌 Evidence suggests that when we initially undergo sleep deprivation, there is habituation, meaning the body adjusts and can tolerate noxious input as per usual. However, as changes to sleep continued, subjects became less tolerant to noxious input and felt uncomfortable more quickly to the same given stimulus from the week prior. This could mean that poor sleep subjects less tolerant to the stressor. 💤 3 Big Take Homes from chronic sleep deprivation... ➡️ Increases sensitivity to pain; capacity to inhibit pain is reduced ➡️ Chronicity of exposure to sleep loss may require an extended recovery period to normalize. ➡️ Ask about sleep especially in those with chronic conditions: LBP, OA, Fibromyalgia #ampphysio #physiotherapy #physio #sleep #sleeping #osteoarthritis #lowbackpain #fibromyalgia #rehabilitation ... https://journals.lww.com/pain/Abstract/2018/01000/Chronic_exposure_to_insufficient_sleep_alters.7.aspx

[ampphysio-blog]

Physical Activity Guidelines 🤷🏼‍♀️ Current Canadian Physical Activity guidelines suggest getting: ▶️ 150 minutes moderate to vigorous PA ⛹🏾‍♂️ ▶️ 2 days of resistance training 🏋🏽 Why try and attain this goal? Reaching the minimum or exceeding the current minimum recommendations for weekly exercise can significantly reduce the risk for serious disease. We see a dose-dependent response with most exercise - do more, reduce the risk. Beyond this, people who are more regularly active live happier, healthier and longer lives. ... Citation: Kyu H et al. Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. BMJ 2016. ... Simple Solutions to get more Physical Activity: ➡️ Climbing stairs x 10 minutes, vacuuming x 15 minutes, gardening x 20 minutes ➡️ Running x 20 minutes, walking or cycling for transportation x 25 minutes ... How to find consistency: (inspired by Dr. Derek Griffin ) ➡️ Find activities you enjoy ➡️ Have goals, make a plan, build slowly and sensibly ➡️ Interact with people, communities and nature ➡️ Balance with sleep, stress and nutrition ... #ampphysio #exercise #exerciseismedicine #canada #physicalactivity #physiotherapy #physio #DPTstudent #healthiswealth

[ampphysio-blog]

PHYSICAL ACTIVITY - Key to a longer life 🔑 Here are the basics from this study: 🏃🏽 13 studies => n = 1 million ☠️ 2-18 year follow up => 85,000 deaths counted 😱 8 or more hours of sitting = 59% ⬆️ risk of mortality ➡️ RISK ATTENUATED if active for 1 hour per day ... This is good background information ‏ for those working to get people more active. I wouldn’t use this study as a scare tactic, especially for those whose occupation requires them to sit. This wouldn’t motivate most to start moving more in a similar way it may not change smokers to ‘butt out’. However it wouldn’t be unreasonable to think that if you sat all day at work then sat all day at home and went to sleep, the risk of developing a health problem would increase. ... Considering the entirety of the evidence base, there is appears to be a dose-dependent response to exercise meaning, the more you do the more health benefits (of course there is a ceiling effect at some point). So for those who sit most days, encourage them to make small changes in the day so they experience small wins along the way. Some exercise is better than none. If people achieve small wins and reach short term goals, this will drive more long term goal setting and increase the probability of behaviour change. And remember this takes time, ‘change is a process not an event.’ ... What is the long term goal? Current Canadian Physical Activity guidelines recommend getting 150 minutes of moderate to vigorous PA per week plus 2 days of resistance training. Is there a one size fits all? Likely not, but at least we have something in place and a target 🎯 for many to aim for. #ampphysio #physio #physiotherapy #exercise #exerciseismedicine #physicalactivity #vancouver #britishcolumbia

[ampphysio-blog]

Exercising with and into pain - Sore today and strong tomorrow 🏋🏽 To exercise into pain or not to? There is not a 'one size fits all' approach to many things in life, but under the framework of "hurt does not equal harm" we can ask patient's to do so. The evidence base suggests getting patient's to push into some discomfort creates a transient increase in symptoms, but is often followed by a reduction in symptoms. Now this increase in symptoms is not associated with tissue damage and overtime we will likely see improvements in function. ... How does pain reduction occur? Pain is complex and it likely happens through several mechanisms. Pain reduction may occur through a decrease in fear and catastrophizing, exercise induced hypoalgesia, and other inhibitory spinal and supraspinal changes. Like many things in life, we want to respectfully confront challenging situations with pain being no different. And many times, once we start to challenge things we often wish we would have done so sooner only to realize progress could be made. Lets create learning opportunities for our patient's. REASSURE them its okay to push into some symptoms, that HURT DOES NOT ALWAYS EQUAL HARM, and things will desensitize over time. Ask them to LEARN about their symptoms, work near the edges and get them comfortable with a bit of discomfort. Be a movement optimist. “Sore today, but stronger tomorrow." 💪🏻 Should exercises be painful in the management of chronic musculoskeletal pain? A systematic review and meta-analysis: ⬇️ http://bjsm.bmj.com/content/early/2017/07/12/bjsports-2016-097383 #ampphysio #painscience #exercise #physiotherapy #physio #rehabilitation #pain

[ampphysio-blog]

Conducting the history - Looking for Sensitizing Agents ... The human mind likes to work as such: A + B = C or in the realm of physiotherapy, this could mean muscle weakness + too much load = injury. Certainly there are cases when this is true, but there could also be a few other factors at play leading to an injury. ... In order to assist in teasing out potential agents that could add fuel to a low burning amber in a fire, be sure to ask about the following that place physical demands on the body: ... 1) Aggravating and easing factors. This will assist in initial advice - what may need to be temporarily avoided then added back in for a later date and perhaps do more of what already is known to feel good. 2) Changes in normal physical activity or occupational workloads. This goes without saying, but if there is a rapid change in physical demands over a short period of time or if there is a sustained physical load that could exceed ones capacity, we need to know about this. Load management is the cornerstone in the management of several injuries and injury reduction strategies. 3) Co-morbidities: diabetes mellitus, thyroid conditions, cardiovascular disease risk factors, systemic conditions. These conditions and many others place physical demands on the body and can affect tissue health. For example, can we name one tissue that diabetes does not effect? ... Having a thorough understanding of our patient's injury obtained through good questions and lots of listening, gives both you and the patient a better idea on whats wrong and how to get it better. ... #ampphysio #physiotherapy #physio #physiodetective #historytaking

[ampphysio-blog]

Finding Sensitizers - Internal or Cognitive Loads The most recent definition of PAIN from the International Association for the Study of Pain is “an unpleasant sensory and EMOTIONAL experience associated with actual or POTENTIAL tissue damage, or described in terms of such damage.” There are several things to draw from this definition, but one is that emotions or cognitive load can lead to symptoms or amplify them. 😰 I really like Greg Lehman's Cup analogy. Suffice it to say that the more water we have in the cup, the closer we get to a threshold where we might get something spilling over the top. Now within the context of our patient's, the capacity of the cup can be taken up by several things, and if there is too much at one time, we may get symptoms (i.e. pain, stiffness, paraesthesias, etc.) 😱 What can fill the cup? ➡️ Thoughts and beliefs about one's condition ➡️ Acute or sustained spikes in weekly stress levels ➡️ Poor sleep habits ➡️ Early adverse life events, previous experiences ➡️ Depression, Anxiety, PTSD, Bipolar ➡️ Lack of social support or withdrawal from social engagement ... There are many things to that could contribute to someone's clinical picture or fill the cup, and its our job to try identify what that COULD be. All of the aforementioned have been studied and are linked to pain but again, CORRELATION does not mean CAUSATION. ... So what to do? Appreciate the complexity of pain and help your patient understand some of the complexity as well. See what they think could be contributing and attempt to modify the 'modifiables'. If you are unable or is outside your scope refer onwards to complete their clinical care pathway. #ampphysio #painscience #physiotherapy #physio #massagetherapy #chiropractic #psychology

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Spontaneity of Movement 🏃🏻‍♂️ Movement variability is hot topic right now. There are many debates, likely occurring daily, suggesting there is an optimal way to move when participating in our activities of daily living. Furthermore, it has also been said the consequence of not moving 'optimally' could be putting ourselves at risk for a pain problem. We can teach people different strategies to move differently when they are in pain, but they should be temporary. If we suggest there is a perfect way to move, in all likelihood, they will revert back to their normal after pain is gone. There are several studies showing this phenomenon as well; for example, measurement of head forward angle or dynamic knee valgus does NOT change once pain is gone after a course of treatment or even with time. Encourage movement freedom - nothing should be off limits forever. There may be a time where we need to reduce the amount of some particular activity, but after, we gradually expose that individual to that movement again in way that they habituate and adapt to it. Create freedom and opportunity for implicit learning, not fear. 😀 #ampphysio #movement #exercise#physio #physiotherapy #louisgifford

[ampphysio-blog]

Pain and Fatigue in Sport - these are two similar bodily sensations: both cause discomfort, can be perceived as dangerous, and can lead to reductions in training load. It is up to medical staff (#doctor, #physio, #sportscientist, #strengthcoach etc.) and the #coach to determine whether these signals are meaningful (i.e. could lead to overtraining or injury) or are they necessary to drive further adaptation to reach the athlete and team goals?👨🏻‍⚕️ ... Being an #athlete is not easy. Certainly, it should be expected that hard work spent on the pitch, field, ice, court, and in the gym will produce the subjective experiences of pain and fatigue. Both sensations are modulated by the CNS which can be influenced by many things (i.e. sleep and stress). Therefore, it is important to get to know your athletes so you know what sensations they should push through, so you can educate them in confidence that their hard work is going to pay off and not to lead injury. 🏃🏻‍♀️ ... Again, COMMUNICATION IS KEY! Get to know your athletes and help them reconceptualise their symptoms in order to keep them on track to reach their goals, keep them feeling confident and keep them physically and psychologically resilient. ... #ampphysio #physiotherapy #sportmedicine #trainharderandsmarter #sportscience

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Language Matters - Happy New Year everyone! Why not start the year on the right foot thinking about the language we use and how we can be sure to make people feel good leaving the clinic? 🗣 Language and communication are powerful in any life setting, with physiotherapy being no different. The words that are sometimes used can be harmful, however, if being mindful, they can be healing. 🤔 Try putting yourself in your patient's shoes and then being told this: your weak, your back is unstable, your hips are tight and rotated, etc. Now how does this make you feel? If you have an injury, will this help in your recovery? 😢 What if we turn this around and say the following: good news, your in the right place we see this everyday; this gets better with time and I am going to show you a few exercises to keep this moving in the right direction. 😃👍🏻 Its clear that language matters - being mindful of language will only help your patient recover faster ensuring were are not instilling fear, enhancing body confidence and encouraging them to move more. #ampphysio #language #wordsthatheal #physiotherapy #physio #painscience #vancouver #victoriabc