Friday, November 24, 2017

[3 DAYS LEFT TO SAVE] Black Friday Sales are Live!

3 Days Left to save! Part of being being mindful are practicing gratitudes. The MMT Team and I so grateful for your support, comments, and shares!

To give thanks, I am having a sale on all EDGE Mobility System products with the coupon code turkey20

This includes our popular and new EDGE Back SupportEDGE Suspension TrainerThe Occlusion Cuff for BFR, as well as our classics - The EDGE Mobility ToolMirror Box, and EDGE Mobility Bands!

Sale ends Nov 28, midnight EST. Click below to save!
Click here to apply the 20% off coupon to your cart! Ends Cyber Monday 11-28 midnight EST!

IASTM Technique 2.0 is 9.0 of training in IASTM, Compression Wrapping, and Functional Cupping! Eligible for CEUs and $50 off with the link below!

With our popular new MMT Webinars, full lectures from my MMT seminars, Q&A, live cases and hundreds of manual techniques, there hasn't been a better time to check out Modern Manual Therapy Premium! Save $20/year on yearly subscriptions and $2.00/month on monthly subscriptions by clicking on the links below.
MMT Sale Monthly
Thanks for all your support, comments, and questions! Keep them coming! I hope everyone in the USA has a safe and wonderful holiday and everywhere else, have an amazing week!
Keeping it Eclectic...

Thoracic manual therapy is not more effective than placebo therapy in shoulder dysfunction. Systematic review

Shoulder Pain

Manual treatments targeting different regions (shoulder, cervical spine, thoracic spine, ribs) have been studied to deal with patients complaining of shoulder pain. Thoracic manual treatments seem able to produce beneficial effects on this group of patients. However, it is not clear whether the patient improvement is a consequence of thoracic manual therapy or a placebo effect. The aim of this study was to compare the efficacy of thoracic manual therapy and placebo thoracic manual treatment for patients with shoulder dysfunction.

Electronic databases (MEDLINE, CENTRAL, PEDro, CINAHL, WoS, EMBASE, ERIC) were searched through November 2016. Randomized Controlled Trials assessing pain, mobility and function were selected. The Cochrane bias estimation tool was applied. Outcome results were either extracted or computed from raw data. Meta-analysis was performed for outcomes with low heterogeneity.

Four studies were included in the review. The methodology of the included studies was generally good except for one study that was rated as high risk of bias. Meta-analysis showed no significant effect for “pain at present” (SMD -0.02; 95% CI: -0.35, 0.32) and “pain during movement” (SMD -0.12; 95% CI: -0.45, 0.21). There is very low to low quality of evidence that a single session of thoracic manual therapy is not more effective than a single session of placebo thoracic manual therapy in patients with shoulder dysfunction at immediate post-treatment.

Wednesday, November 22, 2017

Is ‘plantar heel pain’ a more appropriate term than ‘plantar fasciitis’? Time to move on

Heel pain

During the last 300 years, a range of terms have been used to describe pain under the plantar aspect of the heel including gonorrhoeal heel, Policeman’s heel, heel spur syndrome, subcalcaneal pain, jogger’s heel, plantar fasciitis, plantar fasciopathy, plantar fasciosis and plantar heel pain. To facilitate effective communication between clinicians, improve patients’ understanding of their condition and allow for shared decision making, consistent and unambiguous terminology is required. Similar challenges with terminology have been recognised for other conditions, including groin pain experienced by athletes.

The aim of this article is to provide a stimulus for discussion about the terminology used to describe pain under the heel and propose an appropriate term based on current knowledge. By doing so, the authors hope that we will set the scene for a future consensus on appropriate nomenclature for the condition of pain under the heel and its associated diagnostic criteria.

Blogging is a Powerful Tool and We Need You!

Blogging, planning and writing

We want physiotherapists and physical therapists to share their unique opinions on issues that are shaping the global physiotherapy community.

By offering their perspective on the latest developments in clinical practice, Contributors to Physiospot’s Voices Column use their expertise to provide context to emerging trends and ask questions that challenge how we think about physiotherapy.

Our Contributors are students, clinicians and researchers from all around the world. They talk about the future of physiotherapy, their favourite mobility exercises and how virtual reality is changing how we treat patients. They discuss the real-world management of complex conditions and explore the cost of care. At their core, they’re motivated by improving global health through universal access to physiotherapy knowledge.

Take a look at this post by Darren Brown to see an example of the amazing work our contributors do.

HIV and Exercise – the Research and Reality

How do I become a contributor?

Submit a story to our Physiospot Editor and any photos or videos that complement your copy. We’re looking for clear and engaging writing on topics that physiotherapists will find intriguing. Tell us something that you think other physiotherapists should know about. Tell us stories that will surprise our readers.

Submit your story

Benefits of being a contributor

The benefits of being a Contributor — exposure and influence in our ever-growing community of peers — will help you build your brand while contributing to the profession. It’s a chance to increase your credibility and establish yourself as a trusted voice in the physiotherapy community. It’s also a great way to let current and future clients, business partners and collaborators see your ability to explain complex issues and promote the profession.

Contribute a minimum of one post per month and we’ll give you free access to Physiopedia Plus, our online learning portal which offers four-week courses and access to hundreds of online resources such as books and technique videos.

Do you teach a course on physiotherapy? We’ll promote that too! Your content, including links to your website, social media profiles, and textbooks that you’ve written will be promoted regularly on Physiopedia’s social media channels, email newsletters and website.

Submit your story

Review of diabetic frozen shoulder.

xray image show right shoulder and frozen shoulder

Frozen shoulder is a painful debilitating condition which can be diagnosed clinically. It is a condition of chronic inflammation and proliferative fibrosis resulting in painful limitation of shoulder movements with classical clinical signs. Diabetic patients are more likely to develop the disease and more likely to require operative management. Diabetic frozen shoulder is a difficult condition to manage, and the clinician must strike a balance between improving range of movement and treating pain, but not over-treating what is an essentially self-resolving condition. Treatment options principally include physiotherapy and intra-articular injections, and progression to hydrodilatation, manipulation under anaesthetic, or arthroscopic capsular release as required.

In this article, the authors review the available literature to assess best management, and correlate with practice at the authors unit, proposing a management strategy for treating patients with diabetic frozen shoulder. Management decisions should be agreed upon jointly with the patient and be based upon comorbidities, severity and the natural history of the condition.

Tuesday, November 21, 2017

Effect of vitamin D supplementation on non-skeletal disorders: a systematic review

Vitamin D

Randomised trials reported up to Dec 31, 2012, did not confirm that vitamin D supplementation could protect from non-skeletal health conditions affecting adults, as was expected on the basis of data from observational studies. To examine whether the more recently published meta-analyses and trials would change past conclusions, the authors systematically reviewed meta-analyses of vitamin D supplementation and non-skeletal disorders published between Jan 1, 2013, and May 31, 2017, that included study participants of all ages, including pregnant women. They also searched for randomised trials not included in meta-analyses.

From the search they identified 87 meta-analyses, of which 52 were excluded because they contained less recent literature or were of suboptimal quality. They retrieved 202 articles on trials that were not included in meta-analyses. Recent meta-analyses reinforce the finding that 10-20 μg per day of vitamin D can reduce all-cause mortality and cancer mortality in middle-aged and older people. Although vitamin D doses were greater than those assessed in the past, the team found no new evidence that supplementation could have an effect on most non-skeletal conditions, including cardiovascular disease, adiposity, glucose metabolism, mood disorders, muscular function, tuberculosis, and colorectal adenomas, or on maternal and perinatal conditions. New data on cancer outcomes were scarce.

The compilation of results from 83 trials showed that vitamin D supplementation had no significant effect on biomarkers of systemic inflammation. The main new finding highlighted by this systematic review is that vitamin D supplementation might help to prevent common upper respiratory tract infections and asthma exacerbations. There remains little evidence to suggest that vitamin D supplementation has an effect on most conditions, including chronic inflammation, despite use of increased doses of vitamin D, strengthening the hypothesis that low vitamin D status is a consequence of ill health, rather than its cause. The authors further hypothesise that vitamin D supplementation could exert immunomodulatory effects that strengthen resistance to acute infections, which would reduce the risk of death in debilitated individuals. They identified many meta-analyses of suboptimal quality, which is of concern. Future systematic reviews on vitamin D should be based on data sharing so that data for participants with the same outcomes measured in the same way can be pooled to generate stronger evidence.

Does taping in addition to physiotherapy improve the outcomes in subacromial impingement? Systematic review.

Person Applying Physio Tape To Man

Taping is used with or without other interventions for many purposes, especially to manage pain and improve functional activity in patients with shoulder pain. The aim of this review was to determine whether any taping technique in addition to physiotherapy care is more effective than physiotherapy care alone in patients with shoulder impingement syndrome.

A systematic search of Cochrane Database of Systematic Review, MEDLINE (EBSCO), Physiotherapy Evidence Database (PEDro), CINAHL (EBSCO), PUBMED, AMED, EMBASE (OVID), The Kinesio Kinesio® Taping Method, Kinesio® Tex Tape UK and International websites ( ; ) was conducted to June 2015. The outcome measures were pain, disability, range of motion and muscle strength. As data were not suitable for meta-analysis, narrative synthesis were applied.

Three randomized controlled trials and one controlled trial (135 patients) were included. The results were conflicting and weak on the effectiveness of taping as an adjunct therapy for improvement of pain, disability, range of motion and muscle strength.

Clinical taping in addition to physiotherapy interventions (e.g. exercise, electrotherapy, and manual therapy) might be an optional modality for managing patients with shoulder impingement syndrome, especially for the initial stage of the treatment; however, we need further robust, placebo controlled and consistent studies to prove whether it is more effective than physiotherapy interventions without taping.