Pt Inquest

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 physical therapy residency program at Cincinnati Children's Hospital. Chronic Traumatic Encephalopathy: The Horse Is Still Chasing the Cart. Asken BM, Bauer RM. J Orthop Sports Phys Ther. 2018 Sep;48(9):672-675. doi: 10.2519/jospt.2018.0612. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Tha

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 Oct;27(10):1824-1829. doi: 10.1016/j.jse.2018.06.019. Epub 2018 Aug 16. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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 al. American Journal of Cardiology. 2018. doi: 10.1016/j.amjcard.2018.08.030. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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 Organizations. Jette AM. Phys Ther. 2018 Sep 1;98(9):731-732. doi: 10.1093/ptj/pzy073. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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, Morrissey D, Scott I, Munteanu S, Malliaras P. Clin J Sport Med. 2018 Aug 8. doi: 10.1097/JSM.0000000000000625. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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 on global outcome and pain from gluteal tendinopathy: prospective, single blinded, randomised clinical trial. Mellor R, Bennell K, Grimaldi A, Nicolson P, Kasza J, Hodges P, Wajswelner H, Vicenzino B. BMJ. 2018 May 2;361:k1662. doi: 10.1136/bmj.k1662. Here is the pre-trial protocol: BMC Musculoskeletal Disorders Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Musi

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 rehabilitation: a systematic review and meta-analysis. Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Br J Sports Med. 2017 Jul;51(13):1003-1011. doi: 10.1136/bjsports-2016-097071. Epub 2017 Mar 4. Here is the pre-review registration: ReviewRegistry91 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Sho

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 intervention! (Here you can find Kenny's blog and his Twitter profile) Effect of Pain Neuroscience Education Combined With Cognition-Targeted Motor Control Training on Chronic Spinal PainA Randomized Clinical Trial. Malfliet A, Kregel J, Coppieters I, et al. JAMA Neurol. Published online April 16, 2018. doi:10.1001/jamaneurol.2018.0492. Here is the pretrial registration: ClinicalTrials.gov Here is the article that they cited that describes the exercise interventions: https://doi.org/10.1016/j.bjpt.2017.06.019 Due to copyright laws,

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 BG. Am J Sports Med. 2018 May;46(6):1306-1314. doi: 10.1177/0363546517751912. Epub 2018 Feb 14. Here is the pretrial registration: ClinicalTrials.gov Here is the article that they cited that describes the physical therapy interventions: https://doi.org/10.1186/s12891-016-0914-1 Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of S

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 referring to: https://psychcentral.com/quizzes/autism-test/ Influences of Mental Illness, Current Psychological State, and Concussion History on Baseline Concussion Assessment Performance. Weber ML, Dean JL, Hoffman NL, et al. Am J Sports Med. 2018 Apr 1:363546518765145. doi: 10.1177/0363546518765145. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us.

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, Golden NH, Fredericson M. Am J Sports Med. 2017 Feb;45(2):302-310. doi: 10.1177/0363546516676262. Epub 2016 Dec 30. We also discussed one of Mitch's many article on the topic from several years ago that happens to be open access: Associations between the female athlete triad and injury among high school runners. Rauh MJ, Barrack M, Nichols JF. Int J Sports Phys Ther. 2014 Dec;9(7):948-58. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That

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 article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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 Reconstruction: How Many Actually Meet Recommended Return-to-Sport Criterion Cutoffs? Toole AR, Ithurburn MP, Rauh MJ, Hewett TE, Paterno MV, Schmitt LC. J Orthop Sports Phys Ther. 2017 Nov;47(11):825-833. doi: 10.2519/jospt.2017.7227. Epub 2017 Oct 7. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than

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 in Contemporary Science (and How to Fix Them). Wicherts JM. Animals (Basel). 2017 Nov 27;7(12). pii: E90. doi: 10.3390/ani7120090. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. In the episode we also reference this wonderful overview of "replication crisis" and p-hacking from Veritasium. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than

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 Tendinopathy: A Randomized Double-Blinded Prospective Study. Boesen AP, Hansen R, Boesen MI, Malliaras P, Langberg H. Am J Sports Med. 2017 Jul;45(9):2034-2043. doi: 10.1177/0363546517702862. Epub 2017 May 22. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Check out Peter's blog which includes his online tendinopathy course at TendinopathyRehab.com In the episode we re

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 torque after fatiguing exercise identifies previous hamstring injury in football players. Lord C, Ma'ayah F, Blazevich AJ. Scand J Med Sci Sports. 2018 Mar;28(3):1235-1243. doi: 10.1111/sms.13007. Epub 2018 Jan 8. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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 might not': why emerging mechanistic evidence for placebo effects does not legitimise complementary and alternative medicines in sport. Rohrer JM. Br J Sports Med. 2017 Jul 19. pii: bjsports-2017-097747. doi: 10.1136/bjsports-2017-097747. [Epub ahead of print] The two blog posts Erik refers to in the episode can be found here: Placebo-Fu Elite Level Placebos Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having

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!!! THIS ARTICLE IS CURRENTLY OPEN ACCESS SO FOLLOW THE LINK TO READ IT! Thinking Clearly About Correlations and Causation: Graphical Causal Models for Observational Data. Rohrer JM. Advances in Methods and Practices in Psychological Science. First Published January 29, 2018. Here is the Amazon link to the book Erik was talking about, Anathem by Neal Stephenson. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having

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: 10.1371/journal.pbio.2002173. eCollection 2017 Sep. Recommendations are made in the absence of any good treatments. Colquhoun D. BMJ. 2017 Aug 30;358:j3975. doi: 10.1136/bmj.j3975. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission

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 29. Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, if you are having difficulty obtaining an article, contact us. Music for PT Inquest: "The Science of Selling Yourself Short" by Less Than Jake Used by Permission