Hump Day Hustling – Weekly Research Summary – October 25, 2023

1 Rep Max Living, how provider choice influences course of care, and much more in this episode of Hump Day Hustling! Enjoy, and if you want to dive deeper with ICE content make sure to check out Upcoming Course Dates and Locations!

One Rep Max Living

“How to Identify and Destroy”

ICE faculty Dustin Jones recently dropped this editorial in the fall issue of Topics in Geriatric Rehabilitation as a call to action for our entire system to put “1 Rep Max Living” in the crosshairs. Defined as “When demands of life are near or exceeding one’s capacity” 1 RM Living is a dangerous reality for people of all ages, but is particularly prevalent in our older adult clients. We’re here to change lives, not just pain, and that means creating some margin for folks to challenge their bodies without constantly being at high risk of re-injury, to do so we must seek out and destroy 1 RM Living everywhere it’s hiding.

Target: Strength Gains

What is best practice to achieve them??

This ongoing question is answered here in this narrative review from JSCR (no surprise that Schoenfeld is in on this). Two main themes shake out for criteria to get after that functional competence and performance dominance for our patients:

Effort: “giving maximal mental effort, leading to maximal neural activation of muscle to produce forceful contractions, involving lifting and lowering movements, training through a full range of motion, and (potentially) inducing muscular metabolic stress.”

Dose & recovery optimization: “Optimizing the dose of RE within a session, beginning each set of RE in a minimally fatigued state, optimizing recovery between training sessions, and (potentially) periodizing the training stimulus over time”

Other cool takeaways from this review are that when no load is possible, low load is the way to maintain strength gains (think when injury or equipment accessibility is an issue, think motor imagery, contralateral limb training, or BFR)

Foot Intrinsics

Functional or specific for the win?

When it comes to rehabbing plantar intrinsic foot muscles, do functional or isolated exercises provide greater ROI? This publication from a few months back used surface EMG (not optimal) to assess the activation of three plantar surface foot muscles during Functional exercises (heel raise variations) versus local foot exercises.

Authors conclusion: “Functional exercises provoked comparable or even more activation of the PIFMs than isolated foot exercises. Given that functional exercises are easier to perform, this finding indicates the need to further investigate the effectiveness of functional exercises in physical therapy to improve muscle function and functional task performance in populations that suffer from PIFM weakness or dysfunction.

Our thoughts: While an #AndNotOr argument could always be made for cases of high fear or high irritability, this paper fits our bias nicely that in most cases it’s functional for the win.

Provider Choice & Healthcare

Where you start dictates much of your journey

Nearly thirty thousand patients with a new episode of low back pain were retrospectively analyzed in this open access piece just published in PTJ to determine if initial choice of provider effects costs and medical utilization. Here are some very interesting takeaways:

Most popular points of entry:

  • Primary Care (51%)
  • Chiropractic (17%)
  • Emergency Department (10%)
  • Surgery (8%)
  • Physical Therapy (4%)

Overall Conclusion: “Chiropractic care and physical therapy provide nonpharmacologic and nonsurgical, guideline-based interventions. The use of physical therapists and chiropractors as entry points into the health system appears related to a decrease in immediate and long-term use of health resources.

Check out this link for an interview with the author to get some great behind the scenes info and speculation about causes and ideas on how to best move forward.

Calf Gains

Why we do BOAF

What is firing up and getting SWOLE when we do knee straight vs knee bent via hypertrophic/rehab dose loading (~4 sets of 20 , reps to failure)?

This small study comprised of 17 ‘recreationally active adult females’ looked at acute effects (so measured right after loading bout) of calf loading in knee straight and knee bent positions on muscle thickness of the medial gastrocnemius, lateral gastrocnemius and soleus as measured by ultra sound imaging.

FINDINGS? Soleus (and lateral gastroc) muscle change/swelling was elicited more in knee bent position compared to knee straight position which elicited lateral gastroc and medial gastroc thickness change more. Knee straight position was the only position that fired up all 3 muscles-lateral & medial gastroc & soleus.

Clinic takeaway: If short on time send the knee straight position, but combining is best practice when able.

PTonICE Rewind

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

Monday: “Valsalva: What does it even mean?” (Rachel Moore)
Tuesday: “Catastrophize rest” (Zac Morgan)
Wednesday: “Cluster approach to dementia care” (Jeff Musgraves)
Thursday: “Technique Thursday: Alternative dry needling approach for lumbar multifidus” (Elli Melrose)
Friday: “Does form matter?” (Alan Fredendall)

Upcoming ICE Physio Courses

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📢 On Virtual ICE next week we’ll be chatting “Get SCARY food with deadlifts” with ICE faculty Guillermo Contreras! Not in our virtual mentorship program? Find out how to enroll and learn more HERE