Hump Day Hustling – Weekly Research Summary – July 12, 2023

Creatine revisited, STarT Back screening tool scrutiny continues, and much more in this hump day hustling episode! Enjoy, and if you want to dive deeper with ICE Physio content make sure to check out our Upcoming Course Dates and Locations!

Kettlebells & Cocktails

New podcast episode with ICE faculty!

Our very own Christina Prevett was on the Kettlebells and Cocktails podcast talking all things geriatrics and pelvic health with John Wooley and Niki Brazier. Such a fun episode and very cool that Christina got to educate the audience on both older adults AND pelvic health!

Palm Cooling

Another notch in the L column

We want it to work, unfortunately this recent paper in JSCR is additional evidence that suggests it isn’t shaking out that way.

Very nice methodology: subjects performed 4 sets of bench press to failure at 80% 1RM with 3 minutes of rest between sets. Experimental groups used 50° F or 60° F palm cooling for the first 60 seconds of each reset compared to control. No difference found between groups for body temperature, heart rate, blood lactate, or RPE.

Limitations: small sample size (11)

STart Back

Time to start over?

It is a great idea: Characteristics are identified upon evaluation using an evidence based tool that stratifies disability risk and guides physicians or other direct access providers on how much and what type of care is required for both optimal outcomes and most efficient utilization of resources. The problem? It doesn’t seem to work. This open access RCT from JAMA is only the most recent paper to illustrate that fact.

Across 270 patients in a single payer military system the conclusion is pretty straight forward: “In this randomized clinical trial, using risk stratification to categorize and provide tailored treatment for patients with LBP did not result in better outcomes at 1 year compared with usual care.”

The quest to simplify low back pain management unfortunately marches on.


Are the right people taking it?

A systematic review with meta-analysis published last month sought to answer the question “How well does creatine supplementation work?” Creatine is one of only two recommended supplements by the International Society of Sports Nutrition each year (the other being caffeine), so we have a lot of high quality evidence that it works, but now a better question is: who does it seem to work for and how well does it work? Furthermore, beyond muscle hypertrophy, is there an effect on brain health & cognitive function?

Inclusion criteria here was great: only studies that compared resistance training supplementing with creatine to resistance training without creatine supplementation were included. Studies needed to evaluate for at least 6 weeks, assess only adults, utilize studies only published in English with peer review, and report on direct changes in muscle hypertrophy (using MRI, CT, or musculoskeletal ultrasound).

10 studies were included (4 on adults aged 21-26, 6 on adults aged 21-72). Only 1 study used a loading phase (20g/day for 5 days before reducing to 6g/day). The other 9 studies used a flat dose at 2-4x/week (3 studies) or 5-7x/week (7 studies). 1 study used CT scan to evaluate muscle growth and 9 used ultrasound.

Overall, creatine appears to provide a small boost to muscular hypertrophy mainly in novice lifters, those underconsuming calories, and those who do not report eating mammal flesh (beef/pork/bison/deer or elk/rabbit). It seems to have a smaller effect in trained lifters and those who regularly consume “meat.” Likewise, cognitive benefits appear minimal in younger subjects and greater in older subjects, especially those already at-risk or already diagnosed with cognitive deficits.

TLDR – As creatine is already found stored inside mammalian muscle tissue, those regularly eating “meat” are likely to notice a small benefit (or zero benefit) from creatine supplementation. Muscular hypertrophy appears to be more tied to training experience and overall nutrition profile. Creatine is still extremely beneficial to those who do not regularly (or ever) consume “meat” such as those who eat mainly chicken/eggs or fish, vegetarians, or vegans. It also appears very beneficial to older adults, especially those at risk or already diagnosed with cognitive deficits.


Troubling biases revealed in healthcare

This is a really fascinating qualitative study about how obesity bias impacts healthcare providers. It shows that providers tend to spend less time, give less information and assume individuals are less intelligent when they are obese. In the geriatric PT space, obesity can be a compounding factor to the ageism bias that already exists.

Really fascinating to reflect on the fact that they did a seminar to see if they could change beliefs and it moved… marginally. This suggests that behavior change is more than a one-off intervention and we’ve all got to keep doing the work to reign in our biases!

PTonICE Rewind

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

Monday: “Pain in the a$$ Part 1: Tailbone assessment and treatment” (April Dominick)
Tuesday: “Let freedom reign in patients with osteoarthritis” (Lindsey Hughey)
Wednesday: “Exercise that improves cognition” (Jeff Musgraves)
Thursday: “Artificial intelligence & PT: Skynet or Skynot?” (Alan Fredendall)

Upcoming ICE Physio Courses

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📢 On Virtual ICE next week we’ll be chatting “Obesity management and the role of PT” with ICE faculty Ellen Csepe! Not in our virtual mentorship program? Find out how to enroll and learn more HERE