Monday, March 19, 2018

Maximize the Bridge

In the Eval, Reset, and Stabilize paradigm, you can use extension in standing and SFMA like breakouts to see which hip may be lacking in extension mobility. 

After restoring hip extension via a manual technique (like the pain free psoas inhibition). loading the new pattern is a good way to keep it. One of my favorite progressions is cueing a double leg bridge to a single leg bridge. 

This video demonstrate my cues to maximize hip extension versus lumbar extension to load the newly restored hip extension pattern. The full 11 min mini case is on MMT Premium, click below to learn more!

Maximize the Bridge

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...

The Reliability & Validity of a Modified Squat Test to Predict Cardiopulmonary Fitness in Healthy Older Men.

Elderly man exercising

Shortcomings are noted in currently available cardiopulmonary field tests for the older adult and thus relevant research is still ongoing. The purpose of this study was to investigate the reliability and validity of a modified squat test and to establish a regression model for predicting aerobic fitness in the older adult.

Twenty-five healthy men aged 60 to 75 years completed this study. Each subject performed two modified squat tests with a prototype testing equipment and a maximal exercise test to determine maximal oxygen consumption. Recovery heart rates (HR) (0~30, 60~90, and 120~150 seconds) were measured following the modified squat tests. The fitness indexes included the sum of recovery HR, recovery HR index, age-adjusted recovery HR index, and immediate HR.

The results revealed that the age-adjusted recovery HR index fitness had the highest intraclass correlation coefficients (ICC) of 0.9 and Pearson’s correlation coefficients of 0.71, which suggested the modified squat test can reasonably assess cardiopulmonary fitness for the older adult. The regression equation for estimating aerobic power was [Formula: see text] = 16.781 + 16.732 × (age-adjusted recovery HR index) + 0.02467 × (physical activity level).

The modified squat test is a valid and reliable field test and thus can be an option to assess the cardiopulmonary fitness level of healthy older men in clinics or communities.

Sunday, March 18, 2018

Importance of physical capacity and the effects of exercise in heart transplant recipients

Heart Transplant

One of the most important prognostic factors in heart failure patients is physical capacity. Patients with very poor physical performance and otherwise eligible, may be listed as candidates for heart transplantation (HTx). After such surgery, life-long immunosuppression therapy is needed to prevent rejection of the new heart. The dark side of immunosuppression is the increased risk of infections, kidney failure, cancer and advanced atherosclerosis (cardiac allograft vasculopathy), with the two latter conditions as the main causes of later mortality. In a worldwide perspective, 50% of the HTx patients survive past 10 years. Poor aerobic capacity prior to graft deterioration is not only limited to the failing heart, but also caused by peripheral factors, such as limited function in the skeletal muscles and in the blood vessels walls.

Exercise rehabilitation after HTx is of major importance in order to improve physical capacity and prognosis. Effects of high-intensity interval training (HIT) in HTx recipients is a growing field of research attracting worldwide focus and interest. Accumulating evidence has shown that HIT is safe and efficient in maintenance HTx recipients; with superior effects on physical capacity compared to conventional moderate exercise.

This article generates further evidence to the field by summarizing results from a decade of research performed at our center supported by a broad, but not strict formal, literature review. In short, this article demonstrates a strong association between physical capacity measured after HTx and long-term survival. It describes the possible “HIT-effect” with increased levels of inflammatory mediators of angiogenesis. It also describes long-term effects of HIT; showing a positive effect in development of anxiety symptoms despite that the improved physical capacity was not sustained, due to downregulation of exercise and intensity. Finally, the results are linked to the ongoing HITTS study, which investigates safety and efficiency of HIT in de novo HTx recipients.

Together with previous results, this study may have the potential to change existing guidelines and contribute to a better prognosis for the HTx population as a whole.

Friday, March 16, 2018

Top 5 Fridays! 5 New Dynamic Plank Variations

Airway clearance techniques in neuromuscular disorders: A state of the art review.

Healthy Lungs

This is a unique state of the art review written by a group of 21 international recognized experts in the field that gathered during a meeting organized by the European Neuromuscular Centre (ENMC) in Naarden, March 2017. It systematically reports the entire evidence base for airway clearance techniques (ACTs) in both adults and children with neuromuscular disorders (NMD). The authors not only report randomised controlled trials, which in other systematic reviews conclude that there is a lack of evidence base to give an opinion, but also include case series and retrospective reviews of practice.

For this review, the team has classified ACTs as either proximal (cough augmentation) or peripheral (secretion mobilization). The review presents descriptions; standard definitions; the supporting evidence for and limitations of proximal and peripheral ACTs that are used in patients with NMD; as well as providing recommendations for objective measurements of efficacy, specifically for proximal ACTs. This state of the art review also highlights how ACTs may be adapted or modified for specific contexts (e.g. in people with bulbar insufficiency; children and infants) and recommends when and how each technique should be applied.

Thursday, March 15, 2018

The WCPT Congress Programme is Coming Together Nicely

The WCPT Congress Programme Committee has met in London to start to shape the scientific programme for Geneva.

A committee of a diverse group of 10 physical therapists, met face to face in London for the first time last month. Time was taken to reflect on previous lessons learned from other Congress’ with the aim of making Geneva 2019 the most successful on yet.

It looks like there is a good chance that will happen. There was a record 103 focused symposium submissions submitted to the committee, and with the the call for abstracts opening in May, it looks like this will beat records too.

Don’t forget to keep you eyes peeled for contributions to Congress by the Physiopedia team. Congress gives us a chance to get together with the global physio community, we can’t wait to see you out there.

Key Dates

  • 23rd Feb 2018 – Call for focused symposia closes
  • May 2018 Call for abstracts launched
  • July 2018 – Registration opens
  • September 2018 – Deadline for abstract submission
  • October 2018 – Deadline for early bird registration
  • April 2019 – Deadline for advanced registration
  • 10th-13th May 2019 – Congress takes place

We will let you know about any significant updates but for the full details please go to the WCPT Congress Site.

It wouldn’t be right if I don’t mention that regular Physiospot Contributor Darren Brown is a member of the committee! Congrats Darren, we look forwards to seeing you in Geneva.

The Toll of Persistent Injury

The Toll of Persistent Injury
Rugby player Dave Attwood talked about the toll of persistent injury in The Guardian today. This is likely to be one of the greatest fears of any sports person, particularly for professionals with a career at stake, and who identify with their game.
The physical nature of the training and the sport itself, particularly considering the extent of contact in rugby, both present a risk of injury. This would be accepted by players, with pain being part of the deal. It is expected and perhaps even revered as a demonstration of commitment. No pain, no gain continues as a philosophy.
Then we have pain that persists, which gradually begins to intrude into the player’s attention at inappropriate times. Thinking about pain rather than the game will inevitably affect performance and outcome. Beyond the white lines, the pain seeping into day to day life takes the suffering to a new level. This is a typical story for chronic pain. A sequence of priming events akin to a kindling fire, building and building along a timeline.
Not only does the player need to deal with the pain itself and the day to day rehabilitation, he or she also has to cope with a shift in their role. All of the above are ample causes of suffering, which can take its toll on anyone. We are all vulnerable to a greater or lesser degree. And this is why the modern understanding of pain and injury is so important across society, including professional sport. The biomedical model does not provide any long-term solutions to persistent pain, yet it continues to predominate in both arenas. This must change.
In sport, acute care is usually very good. However, identifying players who could be at higher risk of developing chronic symptoms should be a routine part of screening. Medical teams in sport need to be armed with knowledge allowing them to identify the factors the pre-exist but also be aware of characteristics of the acute injury that may heighten the risks; early, uncontrolled pain for example.

Dave Attwood: ‘Compulsory counselling for long-term injuries will stop stigma’ 

Attwood suggests that counselling should be compulsory. He acknowledges that not everyone will persist with this kind of input, however relevant it might be for that person. The opportunity to talk about the effects of an on-going injury would offer a non-judgmental arena of safety for players to express fears and worries. If players were also educated about persistent pain and injury, they would realise that a change in emotional state and thinking is typical, thereby reducing the stigma. Of course, the stigma arises from the existing culture that is misinformed when it comes to pain. Much of the education enabling pain to be understood would be very similar in content to that of a modern pain management programme.
To see a high profile player speaking out about the issue of persistent injury will hopefully encourage others to seek the right kind of help. Dealing effectively with on-going pain is a specialist area that requires a comprehensive approach that addresses all aspects of the experience. Medical teams may need to call upon external specialists to work with them for particular players. This is something that I have done and it works very well, particularly because professional clubs typically have great facilities and staff who you work with to cover all angles: strength and conditioning, diet, sports doctors, physios, massage therapists etc. But, it all starts with understanding pain.

‘Pain and injury are not the same and they are not well related’

To understand pain means that you know what you must focus upon, without fear, to achieve results. In managing painful moments and seeking to overall overcome the pain problem, it takes dedicated practice, encouraged by positive coaching. The content of the practice varies according to the nature of the problem and the necessary approach. That is for the specialist to decide and communicate with the player and medical team.  The Pain Coach Programme that I designed is commonly a blend of sensorimotor training, mobilisations of different types, skills of being well, and practices that bolster resilience, focus and hence performance. This sits in with input from other fields, very much embracing teamwork with the player’s best interests at the heart. A typical aim is to achieve greater than pre-injury performance.
The coverage of on-going injuries is typically negative from the press, fans, the team and the club. Instead there must be understanding, compassion and encouragement. The right conditions for recovery must be created, easing the pressure off the player so that he or she can truly focus on their job of the moment, getting better. So, well done Dave Attwood and The Guardian for raising the issue, another example of chronic pain in society. It is time for change.

  • Pain Coach Programme — for players suffering persistent or recurring injuries and pain
  • Pain Coach Mentoring & Workshops for clinicians and therapists who want to build their skills and knowledge in chronic pain
  • Pain Coach Workshops for medical teams
t. 07518 445493 or e.
Blended with my clinical work and workshops is the Understand Pain social enterprise that has the purpose of driving social change with regards pain, the number one global health burden.

Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school. Live cases, webinars, lectures, Q&A, hundreds of techniques and more! Check out Modern Manual Therapy!

Keeping it Eclectic...