Brought to you by CSMi After acute hamstrings injury is it ok to push into pain during rehab? Would you actually get better results? If you didn't, why not? If you did, what would that mean? Join us as we look at loading up injured hamstrings with special guest Jack Hickey ! Pain-Free Versus Pain-Threshold Rehabilitation Following Acute Hamstring Strain Injury: A Randomized Controlled Trial. Hickey JT, Timmins RG, Maniar N, Rio E, Hickey PF, Pitcher CA, Williams MD, Opar DA. J Orthop Sports Phys...
Aug 06, 2019•1 hr 12 min
Brought to you by CSMi What is evidence without interpretation? For that matter, what exactly is evidence? Or interpretation? Can you make an evidence-based statement without a robust evidence base? Evidence vs Consensus in Clinical Practice Guidelines. Djulbegovic B, Guyatt G. JAMA . 2019 Jul 19. doi: 10.1001/jama.2019.9751. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post the PDF on the website for the world to download at will. That said, i...
Jul 30, 2019•1 hr
Brought to you by CSMi A study shows that those with FAI who get surgery earlier do better than those who get surgery later. Does that mean patients should rush to surgery? Or is the reality more nuanced? Early Hip Arthroscopy for Femoroacetabular Impingement Syndrome Provides Superior Outcomes When Compared With Delaying Surgical Treatment Beyond 6 Months. Kunze KN, Beck EC, Nwachukwu BU, Ahn J, Nho SJ. Am J Sports Med . 2019 Jul 15:2038-2044. doi: 10.1177/0363546519837192. [Epub ahead of print...
Jul 23, 2019•1 hr
Brought to you by CSMi "How do you feel now compared to how you felt before surgery?" is a common question asked of patients? But how well do they remember? Are they accurate or do they overestimate or do they underestimate? What effects can perception of pretreatment symptoms have on perception of progress? Patients Undergoing Shoulder Stabilization Procedures Do Not Accurately Recall Their Preoperative Symptoms at Short- to Midterm Follow-up. Hope D, French J, Pizzari T, Hoy G, Barwood S. Orth...
Jul 16, 2019•53 min
Brought to you by CSMi This episode is less about exercise programs after total hip arthroplasty and more about meticulous study design prior to data collection. We look at essentially having the paper written before the study begins - all you have left to do is plug in the data and run the calculations! Pragmatic Home-Based Exercise after Total Hip Arthroplasty - Silkeborg: Protocol for a prospective cohort study (PHETHAS-1) Mikkelsen LR, Madsen MN, Rathleff MS, Thorborg K, Rossen CB, Kallemose...
Jul 09, 2019•55 min
Brought to you by CSMi Patient reported outcome measures (PROM) are commonly used to assess function in patients. But is that what they are actually measuring? Can we alter those scores in a meaningful way just through practicing the tasks mentioned in the questionnaire? Can the QuickDASH PROM be Altered by First Completing the Tasks on the Instrument? Shapiro LM, Harris AHS, Eppler SL, Kamal RN. Clin Orthop Relat Res . 2019 Apr 27. doi: 10.1097/CORR.0000000000000731. [Epub ahead of print] Due t...
Jul 02, 2019•48 min
Brought to you by CSMi What do patients believe about knee osteoarthritis and nonsurgical interventions? Where do they get these beliefs? Can we change these beliefs? Even if we do will that make a difference? Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study. Bunzli S, O'Brien P, Ayton D, Dowsey M, Gunn J, Choong P, Manski-Nankervis JA. Clin Orthop Relat Res . 2019 Jun 10. doi: 10.1097/CORR.0000000000000784. [Epub ahead of...
Jun 25, 2019•47 min
Brought to you by CSMi Exercise works for pain..but why? Probably not for the reasons that we think. Does it matter? What a silly question... Musculoskeletal pain and exercise-challenging existing paradigms and introducing new. Smith BE, Hendrick P, Bateman M, Holden S, Littlewood C, Smith TO, Logan P. Br J Sports Med . 2018 Jun 20. pii: bjsports-2017-098983. doi: 10.1136/bjsports-2017-098983. [Epub ahead of print] Due to copyright laws, unless the article is open source we cannot legally post t...
Jun 18, 2019•1 hr 2 min
Brought to you by CSMi What happens when you go onto the interwebs and search for information from the websites of reputable organizations (government, hospital, university, professional associations, etc)? Is it accurate? Who defines accurate? What is the purpose of these websites? Credibility, Accuracy, and Comprehensiveness of Internet-Based Information About Low Back Pain: A Systematic Review. Ferreira G, Traeger AC, Machado G, O'Keeffe M, Maher CG. J Med Internet Res . 2019 May 7;21(5):e133...
Jun 11, 2019•57 min
Brought to you by CSMi . Following an algorithm in medicine (and other high consequence professions) is shown to result in better outcomes. But isn't that just like following a cookbook? Or is it more about making sure that we don't miss things? Evidence-based algorithm to treat patients with proximal humerus fractures-a prospective study with early clinical and overall performance results. Spross C, Meester J, Mazzucchelli RA, Puskás GJ, Zdravkovic V, Jost B. J Shoulder Elbow Surg . 2019 Jun;28...
Jun 04, 2019•47 min
Brought to you by CSMi Doing a manipulation on the thoracic spine may help people with cervical radiculopathy but there are a lot of questions to answer here. This paper has an odd presentation of the data and generates concerns when looking at the pretrial registration ( https://clinicaltrials.gov/ct2/show/NCT01495728?term=NCT01495728&rank=1 ). Immediate and Short-term Effects of Thoracic Spine Manipulation in Patients With Cervical Radiculopathy: A Randomized Controlled Trial. Young IA, Po...
May 27, 2019•51 min
Brought to you by CSMi Is there a lack of diversity in orthopedics? Is improving diversity around gender the same challenge as improving diversity around race? Why are some areas of medicine improving while others are still having issues? In this episode we look at the specific issues around orthopedics and see if there are lessons that can be learned in the physical therapy profession. The Orthopaedic Workforce Is Not as Diverse as the Population It Serves: Where Are the Minorities and the Wome...
May 21, 2019•1 hr 14 min
Brought to you by CSMi Does the weight of an athlete matter when considering how much force they can handle? Is obesity the cause of disease or just something else that was caused by the cause of disease; whatever that actually is? Here we take a look at understanding predictors versus understanding causation and how this affects interventions for public health. Why causality, and not prediction, should guide obesity prevention policy. Chiolero A. Lancet Public Health . 2018 Oct;3(10):e461-e462....
May 14, 2019•53 min
Brought to you by CSMi In previous episodes we have talked about many issues around biologics research. This article takes an honest look at PRP for patellar tendinopathy by including two different preparations AND a placebo group. How did it turn out? Not so well for PRP... Platelet-Rich Plasma for Patellar Tendinopathy: A Randomized Controlled Trial of Leukocyte-Rich PRP or Leukocyte-Poor PRP Versus Saline. Scott A, LaPrade RF, Harmon KG, Filardo G, Kon E, Della Villa S, Bahr R, Moksnes H, Tor...
May 07, 2019•1 hr
Brought to you by CSMi There is a lot of health misinformation out there from simple "wellness" advice to anti-vaccination zealots, but what do we as medical providers do about it? Is it time to wage war? How high are the stakes? How do we make a difference? Do medical journals play a role? Counteracting Health Misinformation: A Role for Medical Journals? Armstrong, PW, Naylor CD. JAMA . Published online April 22, 2019. doi:10.1001/jama.2019.5168 Due to copyright laws, unless the article is open...
Apr 30, 2019•1 hr
There are studies that show that a hip focused exercise program helps for PFP; there are others that show that a knee focused exercise program also works. Is one better than the other? What about just doing ANY kind of exercise? This study takes a look at answering those questions...kind of. Effectiveness of Isolated Hip Exercise, Knee Exercise, or Free Physical Activity for Patellofemoral Pain: A Randomized Controlled Trial. Hott A, Brox JI, Pripp AH, Juel NG, Paulsen G, Liavaag S. Am J Sports ...
Apr 23, 2019•59 min
"You hate on everything! What do you even do with your patients? Why so negative?" We've heard it all before, and so have the authors of this paper. This open source article explores and defends the position of being skeptic within the medical world. The Case for Being a Medical Conservative. Mandrola J, Cifu A, Prasad V, Foy A. Am J Med . 2019 Mar 6. pii: S0002-9343(19)30167-6. doi: 10.1016/j.amjmed.2019.02.005. [Epub ahead of print] Open Source! Due to copyright laws, unless the article is ope...
Apr 16, 2019•53 min
Brought to you by CSMi Historically is has been typical to expect to return from an ACL reconstruction around 6 months after surgery. We know know that such suggestions are not very well founded. What can a study with over 3500 subjects tell us about how these athletes typically look at this time point? Only one patient out of five achieves symmetrical knee function 6 months after primary anterior cruciate ligament reconstruction. Cristiani R, Mikkelsen C, Forssblad M, Engström B, Stålman A. Kne...
Apr 09, 2019•45 min
Brought to you by CSMi When we say that a patient is "strong", what does that mean exactly? Can a single muscle do well on one strength test but poorly on another? Are some tests more "functional"? Sometimes it is less about IF they are strong and more about WHEN they are strong... Deficits in rate of torque development are accompanied by activation failure in patients with knee osteoarthritis. Ventura A, Muendle B, Friesenbichler B, Casartelli NC, Kramers I, Maffiuletti NA. J Electromyogr Kines...
Apr 02, 2019•46 min
In this episode we swap podcast feeds in order to confuse the crap out of you and see if anyone reads the show notes. Hint: Take a look at the release date. For real, listen to the episode though. More info at https://www.ptpintcast.com/
Apr 01, 2019•17 min
Brought to you by CSMi This episode explores the application of exercises starting 2 months after total knee replacement. Is working with a PT better than just joining a community program? If there are performance improvements, is there much of an effect on perceived function? How difficult is it to answer these questions? Effectiveness of Later-Stage Exercise Programs vs Usual Medical Care on Physical Function and Activity After Total Knee Replacement: A Randomized Clinical Trial. Piva SR, Schn...
Mar 26, 2019•56 min
Brought to you by CSMi This episode explores the nature of fixating an injury in a place that normally allows a little movement. Should the fixation also allow some movement? Would this allow faster return to function? Can breaking a screw actually lead to better outcomes? We also explore the need for services like PRISMA. Suture Button Versus Syndesmotic Screw for Syndesmosis Injuries: A Meta-analysis of Randomized Controlled Trials. Shimozono Y, Hurley ET, Myerson CL, Murawski CD, Kennedy JG. ...
Mar 19, 2019•45 min
Brought to you by CSMi This article ruffled some PT feathers. In a head to head match up, many interpreted this RCT to show that surgery beats physical therapy, but is there more to it? Would Erik and JW have been able to put together a better rehab program than what was studied in this paper? Perhaps...perhaps not. This article gives a great opportunity to contrast the quality of research in the surgical and rehabilitation worlds. Arthroscopic hip surgery compared with physiotherapy and activit...
Mar 12, 2019•1 hr 2 min
Brought to you by CSMi Epidemiology studies are a fascinating snapshot of injuries in a population, but they also provide insight on how we interpret data. How common are lumbar spine injuries amongst elite athletes? How are they defined? How limiting are they? Is there a group we should address and another group we should leave alone? Lumbar Spine Injuries in National Collegiate Athletic Association Athletes: A 6-Season Epidemiological Study. Hassebrock JD, Patel KA, Makovicka JL, Chung AS, Tum...
Mar 05, 2019•51 min
Brought to you by CSMi Low value healthcare (like ordering imaging for patients with nonspecific low back pain) is a known issue for healthcare providers. But how big of an issue is it? Are the best providers doing that much better than the worst offenders? Why do they do this? Is there anything we can do about medical overuse and all the problems that come with it? Analysis of Physician Variation in Provision of Low-Value Services. Schwartz AL, Jena AB, Zaslavsky AM, McWilliams JM. JAMA Intern ...
Feb 26, 2019•1 hr 3 min
Brought to you by CSMi Pain catastrophizing has been shown to have an affect on outcomes specifically after total knee arthroplasty. This article took a good look at the problem and many people interpreted the findings to say that cognitive behavioral therapy (CBT) wasn't effective. Turns out it's much more interesting than that... Pain Coping Skills Training for Patients Who Catastrophize About Pain Prior to Knee Arthroplasty: A Multisite Randomized Clinical Trial. Riddle DL, Keefe FJ, Ang DC, ...
Feb 19, 2019•1 hr 1 min
Brought to you by CSMi Returning to sport after ACL reconstruction is kind of a complex mess. Strength issues, coordination, soreness, not to mention the psychological factors. How do these things interact? What matters? What should we measure and how? Join us with special guest Ryan Zarzycki from Arcadia University ! Psychological Readiness to Return to Sport Is Associated With Knee Kinematic Asymmetry During Gait Following Anterior Cruciate Ligament Reconstruction. Zarzycki R, Failla M, Capin ...
Feb 12, 2019•55 min
Therapeutic ultrasound has been relegated to the physical therapy trash heap as "ultraplacebo". But is there an application where it might work? What can we learn about other physical therapy interventions from research on ultrasound? Effect of low-intensity long-duration ultrasound on the symptomatic relief of knee osteoarthritis: a randomized, placebo-controlled double-blind study. Draper DO, Klyve D, Ortiz R, Best TM. J Orthop Surg Res . 2018 Oct 16;13(1):257. doi: 10.1186/s13018-018-0965-0. ...
Feb 05, 2019•52 min
It would be great if we could provide regular, personal follow up communications with our patients but the time commitment becomes huge. But what if you just had a bot send generic patient education text messages? Would that give a sense of connection? Will that improve patient compliance? A Novel, Automated Text-Messaging System Is Effective in Patients Undergoing Total Joint Arthroplasty. Campbell KJ, Louie PK, Bohl DD, et al. JBJS . 2019;101:145-51. doi: 10.2106/JBJS.17.01505. [Epub ahead of ...
Jan 29, 2019•49 min
Some people have cams in their hips, some don't. Some cams are a problem, some aren't. What effects can a cam have on a hip joint? Are these good or bad? What happens after a cam is surgically removed? Hip Joint Torsional Loading Before and After Cam Femoroacetabular Impingement Surgery. Ng KCG, El Daou H, Bankes MJK, Rodriguez Y Baena F, Jeffers JRT. Am J Sports Med . 2018 Dec 31:363546518815159. doi: 10.1177/0363546518815159. [Epub ahead of print] Due to copyright laws, unless the article is o...
Jan 22, 2019•38 min
