This week we discuss tendon stress and strain. This article was a review written by one author which was published in 2022. We found the definitions provided in the article to be particularly helpful. Strain is the change in tendon length relative to normal length, while stress is the amount of force relative to the tendon (force/CSA). These describe what is happening to a tendon. Stiffness and Young's modulus are physiologic properties of a tendon. Stiffness is a change in tendon length relative to the force applied which is dependent on cross sectional area (CSA). Young's modulus is the relationship between stress and strain, which is independent of CSA (stress/strain). This review discusses a few different articles, but one of the key points we took from this is that you can increase strain on a tendon by using heavier loads or by working at a stretched position of the joint. While this review focuses on healthy populations, this could be applied to injured populations when treating patients with tendinopathy. If the goal is to try to induce tendon strain, you could explore a variety of loading options.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/36135039/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

Data Nerds is a new series that we are introducing which will be alternating weeks with our usual journal club podcast. In this series, we share cases from our clinical practice where we utilize objective testing to inform our decision making, with most attention paid to the results of the tests and interpretation of the information. Therefore, this works best when you can see the numbers. Luckily, these are uploaded to our YouTube channel! Check us out at https://www.youtube.com/@ReadingRehab.

This is a continuation of the case from Episode 1: Isometric testing. You can find that episode on our YouTube channel.

Since IE, Pat has been utilizing CPM mode for eccentric training of knee extension to both qualitatively and quantitatively improve his patients torque production capabilities throughout challenging ranges of motion.

The graphs demonstrate the progression his patient has made across 4 treatment sessions. We do not attribute this success to this sole intervention, but believe it is a great adjunct to track qualitative force production and provides a good stimulus along the way.

Pat discusses his rationale for modifying the exercise procotol and answers questions provided by Mike and Bryan.

This week we discuss knee and shoulder isokinetic torque strength targets among healthy athletes. This study had a sample of 233 athletes from 27 different sports! This is a little worrisome in that there is not a large sample for any one sport. They even grouped sports up into six different categoies, but there was still not enough data per category. Lumping sports could also be problematic because basketball and baseball are both team sports, but they have very different kinetic and strength requirements. The large standard deviations for knee torque are likely due to the variety of sports tested. So what can we take away from this? Across a variety of sports, it is standard to have above 3.0 Nm/kg knee extension torque, and at least 1.8 Nm/kg knee flexion torque. There is a strong correlation between peak torque and rate of force development. Shoulder external rotation and internal rotation peak torques are similar across two different speeds.

The abstract can be found here: https://www.jospt.org/doi/10.2519/josptopen.2025.0095

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

Data Nerds is a new series that we are introducing which will be alternating weeks with our usual journal club podcast. In this series, we share cases from our clinical practice where we utilize objective testing to inform our decision making, with most attention paid to the results of the tests and interpretation of the information. Therefore, this works best when you can see the numbers. Luckily, these are uploaded to our YouTube channel! Check us out at https://www.youtube.com/@ReadingRehab.

This week, Mike shares a recent case of a runner presenting with a left posteromedial tibial bone stress injury, but he is also 8 months post-op ACLR! Listen to hear how his poor quad strength impacted his running gait!

This week we discuss multi-ligament knee injuries. These are uncommon, but devastating injuries. In athletes, return to sport rates are as high as 53%, but in higher competitive levels it could be more like 23%. The authors note there is a lack of evidence describing return to sport testing in this population, which they attempt to rectify with this article. They describe different phases of rehab, expected timelines for various activities (walking, running, cutting, etc), and objective markers to look to achieve at different time periods (ex. >65% quad strength LSI at 4 months). Tables 1 and 2 are very helpful to summarize this information quickly and give actionable methods.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/35141534/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss isokinetic testing for shoulder internal and external rotation strength! This scoping review had a lot of promise, but unfortunately it did not live up to the hype for us. We learned there is a lot of heterogenity in testing set ups, but the seated 90/90 position is the most common, with 60 and 180 degrees per second being the most common speeds tested. The most common objective measures from these tests are peak torque and ER:IR ratio, but there are a lot of variations of ER:IR ratio looking at differences in concentric and eccentric force outputs. The information we wished this article gave was the average values for peak torque and ER:IR ratio from each of the studies so clinicians would be able to have a general idea of benchmark scores their patients should be hitting. We feel this is a big missed opportunity which could have made this paper a 10/10!

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39628773/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss considerations when treating posterior medial meniscus root tears. Each meniscus has an anterior and posterior root, and a root tear is a radial tear within 1 cm of the attachment. Radial tears cut across the fibers of the meniscus disrupting the hoop stress mechanism: how the meniscus disperses load by expanding with axial load. Possibly due to this disruption, meniscal root tears are associated with accelerated osteoarthritis progression. Therefore, surgical repair, rather than meniscectomy, is typically advised, especially in younger patients with previously healthy knees since menisectomy has also recently been linked to more rapid OA progression. There are many post-operative considerations, including: minimizing joint load via a conservative progression from non-weight bearing for 6 weeks to a 4 week progression to full weight bearing, limiting knee flexion range of motion to 90 degrees for the first 2 weeks while aiming to achieve full extension as soon as possible, minimizing arthrogenic muscle inhibition, using caution with repetitive hamstring pulling into flexion, and waiting 9-10 weeks until initiating shallow squatting due to increases in posterior horn meniscal pressure, joint compressive forces, and joint shear from squatting.

The abstract can be found here: https://ijspt.org/posterior-medial-meniscus-root-tears-clinical-implications-surgical-management-and-post-operative-rehabilitation-considerations/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss a proposed testing battery for baseball pitchers. The authors discuss the importance of a comprehensive testing battery to both minimize injury risk and identify areas for performance improvement. We feel Table 1 does a good job detailing the main points of the article. There are many key physical qualities for baseball pitchers, including: trunk rotation mobility, trunk rotation peak force, hip extension mobility, shoulder external and internal rotation mobility, shoulder flexion mobility, lower body power, shoulder internal rotation peak force, shoulder horizontal adduction peak force, posterior shoulder endurance, hip internal rotation mobility. These qualities should all have associated tests, these are: lumbar locked rotation test, isometric trunk rotation test, modified Thomas test, shoulder rotation total range of motion, shoulder to wall test, countermovement jump, ASH T test, Landmine throw, posterior shoulder endurance test, hip internal rotation range of motion. This is obviously a lot of tests and qualities to consider. Understand that you do not have to do all the tests if you do not have time, but kowing all priority areas is helpful for deciding which qualities are most important to you at this time. Table 1 also gives benchmark points and clinicmetric properties of these tests, which is very helpful. However, there is a poor description of some of these tests in the body of the article, and the YouTube links do not appear to be working.

The abstract can be found here: https://www.researchgate.net/publication/380283244_Test-Training_Integration_to_Optimize_Performance_and_Health_in_Baseball_Pitchers_An_Outcome_Driven_Approach

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!