Should we start using OKC early in ACL rehab? What are international PF strength norms? Get answers to these questions and more in this hump day hustling episode, and if you want to dive deeper with ICE Physio content make sure to check out our Upcoming Course Dates and Locations!
Post-Op ACL
Open or closed chain for the win?
The historical narrative has been clear: Avoid open kinetic chain early post-op ACL for safety reasons. This open access paper in June’s Orthopaedic Journal of Sports Medicine challenges this narrative a bit as they evaluate the addition of OKC quad and hamstring training to standard closed kinetic chain work.
Conclusion: “Early use of OKC exercise for both the quadriceps and the hamstring, in addition to conventional CKC exercise, resulted in better correction of quadriceps and hamstring strength deficits without increasing graft laxity.”
It seems early open kinetic chain work can maximize key muscle gains without resulting graft laxity and may well be worth considering for our ACL patients.
Ankle Plantar Flexion Strength
What should we be considering “normal”?
A lack of quality normative data is a constant battle in the rehabilitation world as it makes it challenging to identify when a patient is deviating far enough from expected to be concerning. That’s why when we find it we share it. This 2022 publication in Journal of Physical Therapy and Science is a helpful scoping review on PF normative values representing world wide data, variety in testing procedure, and norms according to age (40 to >60 year olds) for the heel raise test.
Take homes:
- Mean heel raise test for adults under 40: 28.7
- Mean heel raise test for adults over 60: 11.8
Where do your patients stack up? For that matter where do you stack up?
Free Weight vs Body Mass Exercise
Comparing strength and intramuscular fat changes
Interesting question explored in this paper in July’s Experimental Physiology: “How do free weight resistance training (RT) and body mass-based RT for 8 weeks compare for isometric muscular strength, muscle size and intramuscular fat (IMF) content in the quadriceps femoris?”
Primary finding of importance: “Free weight and body mass-based RTs could induce muscle hypertrophy; however, decreased IMF content was observed following the body mass-based RT alone”
Some additional thoughts from our faculty: The keys to muscle tissue change are volume, time under tension, and level of effort & focus… both groups weren’t exactly equal here considering there was more exercises in the one group and level of effort was different: max reps vs 8-12 reps at 70% 1RM (which is equivocal to somewhat hard effort on an RPE) Rest was not accounted for here.
#Biascheck
Dry needling fails to improve strength
“Our main findings showed reduction of latent TrP in the quadriceps, gluteus, and gastrocnemius muscles when DN was performed, and DN was not observed to have any effect on lower-limb muscle power or maximal isometric quadriceps strength”
So much to consider in this open access randomized pilot trial. Is this another demonstration of the limited efficacy of trigger point “pick and stick” approach (no e-stim was utilized)? Would we have seen something different if athletes were symptomatic versus healthy individuals with latent trigger points? Lots of food for thought!
Support ICE Faculty at CF Games
Last week to get your 64 Army swag!
As most of you know ICE Faculty member Kelly Benfey and her team 64 Army are headed to the CrossFit Games next month. If you want to be repping their brand in Madison you only have a couple more days to snag your tee shirt here. Proceeds will help get the crew over here to the states from New Zealand and support their stay and training. Tee-shirt or no tee-shirt, make sure you check the schedule either in person or on youtube so you can root Kelly and friends on!
PTonICE Rewind
Did you miss any of our ICE Physio podcasts last week? Well here you go!
Monday: “Lessons from lasso” (Rachel Moore)
Tuesday: “Hip and knee OA: The unspoken battle” (Lindsey Hughey)
Wednesday: “Trizepatide and the older adult” (Julie Brauer)
Thursday: “Stop giving your audience what they want” (Jeff Moore)
Friday: “Chill out: Why cold plunges may not be as effective as you think” (Alan Fredendall)
Upcoming ICE Physio Courses
In-Person Courses
- July 14-16: Dry Needling: Lower Body (Matawan, NJ)
- July 15-16: Older Adult LIVE (Watertown, CT)
- July 15-16: Extremity Management (Holmes Beach, FL)
- July 22-23: Cervical Spine Management (Milwaukee, WI)
- July 22-23: Extremity Management (Simi Valley, CA)
- July 29-30: Older Adult LIVE (Watkinsville, GA)
- July 29-30: Extremity Management (Madison, WI)
- July 29-30: Older Adult LIVE (Boise, ID)
- July 29-30: Dry Needling: Upper Body (Fort Worth, TX)
- July 29-30: Pregnancy and Postpartum LIVE (Denver, CO)
Online Courses
- July 10th: Fitness Athlete: Pregnancy & Postpartum
- July 11th: Rehab of the Injured Runner
- August 9th: Older Adult: Essential Foundations
- August 14th: Persistent Pain Comprehensive Management
- August 14th: Primary Care PT
- September 11th: Fitness Athlete: Essential Foundations
- September 12th: Brick by Brick: Launching Your Practice
- September 17th: Fitness Athlete: Advanced Concepts
- October 12th: Older Adult: Advanced Concepts
📢 On Virtual ICE next week we’ll be chatting “The older adult runner” with ICE faculty Jason Lunden! Not in our virtual mentorship program? Find out how to enroll and learn more HERE
