Hump Day Hustling – Weekly Research Summary – March 20, 2024

This episode is PACKED! Enjoy, and if you want to dive deeper with ICE content make sure to check out our Upcoming Course Dates and Locations.

Knee OA

Does football (soccer) increase risk?

Let’s provide the findings of this systematic review and meta-analysis first, then have ourselves a quick but important chat

Does playing football (soccer) really increase risk of knee OA? Yes, in general, BUT only in those who have suffered a MAJOR knee injury while playing. For those who have not had such an injury, risk of knee OA is equal to controls. Direct quote from paper: “This suggests that knee injuries may primarily contribute to the increased risk of knee OA among football players, and not cumulative workload or mechanical joint overuse, when practicing football.”

OK fair enough, and perhaps good to know, but is it? Or does this type of study perpetuate the too often assumed link between radiographic findings and symptoms? This review focused entirely on radiographic findings, with zero mention of symptoms, functional capacity, disability, or forced time off sport etc. Publications like this, while interesting perhaps, may be doing a fair bit of harm suggesting that radiographic changes alone are relevant. Do you think any of these players who have radiographic changes care if they don’t have symptoms because of a healthy systemic profile and ecosystem? We sure don’t.

Just food for thought!

BFR

Does it improve performance??

The research on BFR for injury is mixed, but what we don’t have a lot of is research on using BFR for performance in non-injured populations.

Design – 11 elite world champion-class rowers were recruited for this controlled intervention trial. Rowers completed 5 weeks of their normal training (10-12 sessions of rowing/week) without BFR, and then 5 weeks with 3 of their training sessions being replaced with low-intensity, BFR rowing sessions with the goal of achieving 1 hour/week of BFR training (5 hours total across the intervention period). BFR was placed on the superior thigh to occlude the lower limbs by 75%, using Doppler ultrasound to confirm the degree of occlusion through the arteries (hardcore). VO2max and 2,000 m time trial tests were used to measure change during each 5 week period.

Results – Subjects increased their VO2 max by ~2L/min across the 5 week period with no corresponding improvement in 2,000 m time trial.

Takeaways – Low-intensity, low-volume BFR cardiovascular exercise can maintain or improve VO2max levels in individuals in place of normal, higher-intensity and/or higher-volume training. This can be a great recommendations for individuals looking to deload, taper, or even go into a full off-season.

Limitations – no randomized control, however the authors made a great point that you’ll never be able to use world champion test subjects in a study where they can’t perform 100% or close to 100% of their normal training.

Chronic Pain

A role for health coaching

We LOVE the research question from this recent open access systematic review: “What is the effect of health coaching on physical activity, disability, pain and quality of life compared with a non-active control in adults with chronic non-cancer pain?”

It’s due time we stop trying to fix non mechanical pain with mechanical interventions and start addressing the health of the human stuck in a chronic pain state! That enthusiasm aside, we have to admit the outcomes showed just a small effect in regards to improvements in pain. BUT small effects are a big deal in the chronic pain population AND you gotta think about the wonderful “side effects” of getting these folks more active on the health of all their other systems!

Maybe not a home run, but you wouldn’t expect one in this population, so quite encouraging!

Grip Strength

Is there anything it CAN’T predict?

Hand Grip Strength & Hip Fractures…yet another data point for Hand Grip Strength as a screening tool.

This open access study measured hand grip strength & followed around 10,000 folks (Age = 58.6 +/- 9 years) for 4 years looking at 1) Reported Falls & 2) Hip Fx’s. This was a part of the China Health & retirement longitudinal study.

2.2% had a Hip Fx over that period of time18% had a REPORTED Fall (likely artificially low when you consider the true definition of a fall)

There was a significant inverse relationship between Hand grip strength and risk of hip fracture and falls. The folks that fractured a hip had hand grip strength of 29.3 kg +/- 10.4.I found these stats pretty wild…”In men, each kilogram increase in grip strength was associated with a 4% lower risk of hip fracture (OR: 0.96, 95% CI: 0.94–0.99, p < 0.05). Similarly, women experienced a 3% decrease in hip fracture risk for every kilogram increase in grip strength (OR: 0.97, 95% CI: 0.94–0.99, p < 0.05). In the age group of 60–80 years, each kilogram increase in grip strength showed a 4% lower risk of hip fracture (OR: 0.96, 95% CI: 0.94–0.98, p < 0.05).”

Stronger people are harder to kill…and to break a hip.

Manual Therapy

Examining reproducibility in literature

Lots of chatter on the interwebs regarding this review paper hot off the JOSPT press. Here are a few thoughts we’d like to contribute to the conversation:

  1. Folks often push back about manual therapy not working (seen commonly in social media circles). It’s pretty difficult to argue one way or the other with this point when you consider that most of the trials lack enough description of MT interventions to be replicated. You’re painting with a broad brush if you make an argument that the science has formed a strong conclusion considering one of the tenants of science is repeatability, and a lot of articles in print on the subject aren’t repeatable.
  2. “Clinical practice guidelines for managing LBP suggest a multimodal approach for treating LBP, and our finding suggests that a large percentage of the included trials adhered to current best practice.” Seems like the CPG authors are selective of which studies they include in the CPG’s, and those publications make recommendations to include MT in the treatment of LBP. One off articles to support an argument that “MT doesn’t work” are not a strong argument.
  3. “Research in physical therapy is often conducted by researchers whose primary focus may not be on clinical practice, which may impair how research is translated to clinical practice” – (This is why at ICE we prioritize clinicians doing the teaching. Both worlds are important, but when academia and practice don’t line up we end up confusing a ton of our profession.)

PTonICE Rewind

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

Monday: “Menopausal women deserve better” (Rachel Moore)
Tuesday: “Barbell isometrics for the power lifter” (Brian Melrose)
Wednesday: “Why older adults NEED to lift heavy” (Christina Prevett)
Thursday: “Gapping mobilizations to improve knee flexion” (Lindsey Hughey)
Friday: “Gait retraining for injury prevention” (Megan Peach)

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