The Institute of Clinical Excellence
Upcoming Courses

Hump Day Hustling – Weekly Research Summary – June 21, 2023

by | Jun 21, 2023 | Hump Day Hustling

New NICE guidelines, new concussion guidelines, new ACL bracing concepts, all the new things coming at you this week! Enjoy this hump day hustling episode, and if you want to dive deeper with ICE Physio content check out our Upcoming Course Dates and Locations

Concussion

New consensus statement released

Lot’s of important updates in this open access paper hot off the BJSM press! Our favorite of course is the shift to allow folks to RESISTANCE train when symptomatic as long as symptoms don’t bump up more than 2 points on a 10-point likert scale.

If you want more comprehensive highlights on this paper check out this 20 tweet thread from concussion expert Dr. Jess Schwartz. While we’re talking about Jess Schwartz for those looking to level up their concussion management you need to look into her incredible course offerings over at Concussion Corner Academy!

Osteoarthritis

Updated NICE guidance released and we’re giddy about it!

We realize it’s mid summer, but all we want for Christmas is for this new infographic from BMJ to wind up on every PTs social media and therefore every patient’s phone nationwide! Just listen to this framing in the title paragraph: “Adds a new emphasis on non-pharmacological management, reserving pharmacologic management for short term management and increasing the ability of patients to engage in therapeutic exercise” FINALLY, pharmaceuticals taking their rightful place: As a short term option to make the ACTUAL solution of movement and loading more accessible!

Stretching and ROM

How much static stretching required for mobility gains?

Simply put: More than your patient has time for.

​In this study published in May’s JSCR subjects had maximal voluntary contraction, flexibility, and muscle thickness of the plantarflexors assessed pre & post test. They stretched 6 x 10 min per day (1 hour/day) for 6 weeks (7 hours/week or 42 total hours of stretching). Stretching was performed using an ankle stretching orthosis. The mean improvement in ankle dorsiflexion (measured with the half kneeling knee-to-wall assessment) was 0.25-0.5 cm. This may be a functional improvement for someone with a mildly stiff ankle, but for someone >=4 cm from the wall, it won’t change their functional mobility.

Study limitations: Ankle dorsiflexion was measured with the knee-to-wall test which biases the soleus muscle while stretching interventions biased the gastroc as the calf was stretched with an extended knee in supine. Would be cool to see this study repeated using an intervention that targets the soleus more specifically.

Obviously the practical application of this study is limited as it is highly unlikely that our patients will dedicate 7 hours a week to stretching, even if chunked up in 10 minute segments

Women’s Health

Great resource for athletes and coaches

Thanks to our friends down under for this wonderful resource!! You name the area of interest: Bone health, body image, REDS, pelvic health, and you’ll find quality information geared towards the end consumer. Because the information is presented at a level that is understandable without a medical or specialty background, this site is a terrific resource to share directly with all of the active ladies in your community!

ACL Healing

Brace them at 90 degrees??

N=80 people with acute ACL tear,, and yes they were braced at 90 degrees! The idea here is that it maximizes approximation of the torn ends at that flexed position and then they just progress the range slowly over 10 weeks and then take the brace off at week 12.

Fairly typical ACL program other than that, but the results were pretty good with impressive healing rates with 90% of them showing some sign of healing. They had 14% re-tear and admittedly not everyone had a great outcome, but this is very novel and could end up being a seminal study for ACL management in the future.

​Link to open access article

PTonICE Rewind

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

Monday: “Healthcare worker / Teacher’s bladder syndrome” (April Dominick)
Tuesday: “Momma wrist” (Lindsey Hughey)
Wednesday: “Become the expert: Workshops” (Dustin Jones)
Thursday: “You are who you hire” (Jeff Moore)
Friday: “Bilateral vs unilateral training: The ultimate debate” (Alan Fredendall)

Thank You! – ICE Faculty

Upcoming In-Person Courses

Upcoming Online Courses

​View All Upcoming Courses

📢 On Virtual ICE next week we’ll be chatting “Enhancing physical therapy outcomes: The resource dealer” with ICE faculty Zac Morgan! Not in our virtual mentorship program? Find out how to enroll and learn more HERE