Hump Day Hustling – Weekly Research Summary – April 5, 2023

Best exercise following lumbar surgery, a call to consider new “norms” for diastasis, exploring what happens when patients read their own MRIs, and more! Enjoy, and if you want to dive deeper with ICE Physio check out our Upcoming Course Dates and Locations.

Return to Play Criteria

We need a new game plan for ACL

The data is quite discouraging with both number of new ACL tears and re-tear rates climbing year over year. This is a nice concept paper from Dr. Kevin Wilk et al just published in IJSPT. Make sure to take a read of the open access full text, but the TLDR version is to integrate more neurocognitive reactive tests. Even simple stuff like changing your typical hop tests to a reactive test by having the athlete select which foot to land on, while in the air, at the last second is a really good idea.

Best Exercise Post Lumbar Surgery?

Finally some research in this area

The arena of exercise following lumbar surgery has historically been a bit of a “choose your own adventure” space with very little published evidence to use as a compass. Which is why it was so nice to see this randomized controlled trial comparing flexion to extension to walking (control group) in January’s Neurological Research journal.

Study run down:

N = 90 (30 per group) – Randomly assigned to flexion or extension based groups or no exercise control group. Exercising groups began 6 weeks post-op & performed for 8 weeks. ODI & pain scale used across all groups,
1) Flexion group – “Williams” group – Supine pelvic tilts, supine single knee-to-chest, supine knees to chest, supine crunch, longsitting static hamstring stretch, standing hip flexor stretch, air squat. Primary measurement here was Trunk Flexion Endurance Test (TFET)
2) Extension group – “McKenzie” group – Supine knees to chest, prone lying, prone on elbows, prone press-up, standing forward fold, standing lumbar extension, seated flexion. Primary measurement here was Biering-Sorensen test
3) Control group – Walking & modalities

Both “exercising” groups improved compared to the control group, with the extension based group improving the most on the ODI & pain scale, but not on a clinically significant scale. The group performing Williams’ exercises improved more on the TFET than the Biering-Sorensen and vice versa for those performing McKenzie exercises. Obviously a lot of limitations here in performing mostly supine (or prone) bodyweight exercises for 8 weeks into only one direction, but nice to see the evidence & advocation that some movement into some direction will be beneficial compared to walking & passive modalities.

Diastasis “Norms”

Is it time for an update?

We don’t have an agreed upon ‘pathological’ distance for diastasis rectus abdominus (DRA). And what is crazier: we didn’t even have the ‘symptomatic’ population comparison to an ‘asymptomatic’ population… until this study. Let’s break it down:This group decided to retrospectively look at CT images of individuals 18-90yo (n=329) who had the CT due to suspected kidney stones/appendicitis. They measured ALL of the inter-recti distances and compared their various details (gender, BMI, parity) to find out norms. (What a great idea!!) They measured at 6 locations along the linea alba in the CT images (so clean, from a data perspective).Here’s what they found:

  • 57% of people had an interrecti distance (IRD) >2cm (BTW, >2cm is what is commonly [arbitrarily] used in research for now). OVER HALF of ALL people.
  • Age, BMI, & parity were risk factors for increased IRD
  • There was NO association between genders. (<< This one gets us. It’s JUST AS COMMON in men 🤯 ….. and nobody’s freaking out about them doing toes to bar or sit-ups…………) Also no association with people who have umbilical hernias.

Conclusion: “The now reported prevalence of 57% in a standardized population aged between 18 and 90 years and in both genders is a new relevant finding. This finding should be taken into account when discussing future cutoff values of DRA, perhaps even a new definition of DRA is warranted.

When Patients Read MRIs

Cool study, ok conclusion, and a call for a higher target

In short here is what was investigated in this open access paper from Journal of Pain Research:

  1. Do patients think it is valuable for THEM to read imaging (Thoracolumbar MRI or CT) prior of medical consult
  2. Do patients and providers agree on what is relevant
  3. What is the psychological effect of patients reading these reports

What shook out: Patients believe the MRIs help them understand their symptoms better and communicate with physicians better, however the terms in the reports are concerning to the patients and this concern is correlated with an elevated Pain Catastrophizing Scale (PCS) score. They conclude that physicians should be aware of the risks associated with sharing these results.
Our Thoughts: Could we do one better and write the results differently? , Move away from “degenerative disc disease” and “moderate osteophyte formation with resultant foramina narrowing” to terms like “normal age related changes” and “finds do not indicate need for invasive or medical management”? Instead of shooting for a net 0 (protecting patients from the scary words) could we hand patients a radiology report that actually decreases PCS and improves sense of self efficacy and resilience??


Is it muscle specific?

It appears that way! Fresh off the Journal of Applied Physiology this open access comprehensive review paper on muscle specific atrophy claims the following:

“Comprehensive summary of the available information on age-related skeletal muscle atrophy in a muscle-specific manner, nearly half of which comes from the quadriceps. Decline in muscle-specific size over ~50yr of aging was determined from 47 cross-sectional studies…”

Check out this instagram post that serves as a great shareable visual!

PTonICE Rewind

Did you miss any of our ICE Physio podcasts last week? Well here you go!

Monday: “One powerful intervention for pregnancy related pelvic girdle pain” (Jessica Gingerich)
Tuesday: “Pain Performance and Connection: Part 2” (Lindsey Hughey)
Wednesday: “Let’s talk strength training intensity” (Christina Prevett)
Thursday: “New leader series Part 4: Amateurs talk tactics, experts talk logistics” (Alan Fredendall)
Friday: “Neck pain, cycling, and equipment” (Jason Lunden)

Thank You! – ICE Faculty

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📢 On Virtual ICE next week we’ll be chatting “Stress: Good or Bad?” with ICE faculty Justin Dunaway! Not in our virtual mentorship program? Find out how to enroll and learn more HERE