Hump Day Hustling – Weekly Research Summary – April 10, 2024

All featured articles are open access this week, enjoy the full text reads! If you want to dive deeper with ICE content make sure to check out our Upcoming Courses, we now regularly have ten or more IN-PERSON courses running each weekend and new ONLINE cohorts launching every couple weeks, plenty of options to choose from! Have an amazing Hump Day everyone!

ACL Reconstruction

Do hip and calf strength deficits persist?

Interesting open access systematic review from BJSM looking at hip/calf strength at least 1 year post ACL reconstruction. We know that quadriceps and hamstring weakness persists after 1 year and beyond post surgery from an ACL injury but does that same weakness show up below and above the knee? These 23 studies didn’t find any major strength deficit when comparing the surgical leg to the contralateral or uninjured controls.

Lots of limitations, the testing is both isometric and concentric dynamometry, so you can’t extrapolate this to other variables like power or eccentric control. You also have to wonder about isometric testing because your limited to strength results in just that test position.

The key takeaway is really just to keep hammering quad/hamstring strength long term as well as the entire kinetic chain, but its possible that the proximal and distal deficits don’t persist as long.

Bone Stress Injury

Does education on nutrition intake help?

Bit of a #biascheck for recommending nutrition interventions for bone stress injuries (BSI) but with some promising results. The authors of this open access 7 year prospective study implemented a 4-year education-based nutrition intervention preceded by a 3-year pilot study for NCAA D1 endurance runners at two different universities in an effort to improve energy availability (EA) and reduce the incidence of BSI.

Unfortunately, no significant reduction in BSI occurred after the intervention as compared to data collected in a previous phase of the study. However, when results were further stratified into cortical and trabecular BSI, trabecular BSI rates declined with nutrition intervention while cortical BSI rates did not. This is meaningful because trabecular bone is more metabolically active than cortical bone, more sensitive to low energy availability and subsequent hormonal changes, and therefore may also have an increased response to changes in nutrition.

While this study does not fully support the notion that improved EA reduces BSI, the authors acknowledge that results may have been influenced by institutional differences in nutrition programs and team culture

Subacromial Shoulder Pain

Manual therapy + exercise still the way

Open access RCT published Jan 2024: Michener et al

Basic design: Individuals with subacromial pain syndrome (N = 93) randomized to exercise (EX; n = 41) or exercise plus spine and shoulder manual therapy (EX+MT; n = 52)

Outcomes: DASH and satisfaction with secondary analysis of GROC and whether or not additional health care utilized…evaluated these measures at: baseline, 2, 4, 6, 26, and 52 week (we love all those time point check-ins)

Conclusion: “Manual therapy added to a resistance exercise program improved long-term shoulder disability, satisfaction, and perceived benefit in patients with subacromial pain. Both groups had improved outcomes over time, with greater effects for the EX+MT group at 26 and 52 weeks.”

Important to note: There was no difference in the short term , so patient’s may need to stick to the regimen a bit longer before satisfaction results! #TrustTheProcess

Rotator Cuff Related Shoulder Pain

Is exercise the “right” treatment?

Hot off the press and open access from Jared Powell (leader in all things shoulder care) is this inclusive review of our current state of affairs full of solid literature points to ponder when caring for our folks with RCRSP.

Powell highlights that we need to recognize that while RCRSP has shown benefit from exercise, we cannot equate it to improvement of subacromial space, scapular mechanics, PT supervision, or even increasing strength. Rather, we can be honest and say how folks respond to treatment is a complex multifactorial biopyschosocial issue and strength may help influence improvement if that patient is game for it.

On a systematic review level we still know exercise is THE BEST medicine for this RCRSP and manual therapy is a great modulator and influencer of outcomes, but with the state of the evidence as a whole we can do it best through shared decision making and a human first approach.

*Note: This paper is lower level on the literature hierarchy being a review, but is really FULL of so many clinical pearls; recommend a dive for all of those in the trenches treating shoulder pain!

Hump Day Hustling - Weekly Research Summary - March 6, 2024

ICE has partnered with Mayhem Athlete & CrossFit Mayhem to provide clinicians, patients, and athletes with a free month of Everyday Athlete programming by using the coupon code ICEPT when registering!

PTonICE Rewind

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

Monday: “Kipping during pregnancy” (Jess Gingerich)
Tuesday: “Manual therapy misconceptions” (Zac Morgan)
Wednesday: “Group fitness with acute arthritis” (Jeff Musgrave)
Thursday: “Technique Thursday: Lateral shift variations” (Jordan Berry)
Friday: “Getting back on the road: Transitioning from the trainer” (Jason Lunden)

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