This week we discuss cervical examination for vascular pathology prior to cervical manipulation. In general, our biases are against cervical manipulation. However, if you choose to perform cervical manipulations, this could be a useful paper to understand to limit the risk of adverse event from the technique. The authors primarily advocate for thorough history taking, multiple clinical tests including blood pressure and cranial nerve exam, and utilizing clinical reasoning and prior knowledge of neurovascular pathology presentation and risk factors to appropriately determine safety of cervical manipulation. While we agree this is crucial to ensuring safety performing the technique, we wonder if clinicians are able/willing to spend the amount of time required to perform all the appropriate screening prior to performing a cervical manipulation?

The abstract can be found here: https://www.jospt.org/doi/epdf/10.2519/jospt.2022.11147

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This week we discuss the training of marathon runners! Most PT's likely won't need to know about marathon training in the detail provided by this article, so we try to also distill down the main concepts. These are: more easy volume is associated with improvements in performance, therefore if you are working with marathoners you want to really push them to make sure their body can withstand the stresses they are going to be placing on them. Since most runners do not do much, or any, strength training, this is a big bucket that can be maximized. For the recreational runner that wants to improve their marathon performance, but does not have the time to do more volume, they may want to emphasize time doing zone 2 and 3 running. Since this is a higher stress to the body, it is vital to educate on proper recovery (sleep, nutrition, stress management) to ensure their body can appropriately tolerate the demands of running. Again, emphasizing strength training will help to build the body's capacity to training.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39616560/

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This week we discuss a recent article from the Journal of Athletic Training which asserts transdisciplinary collaboration is required for high performing medical teams in elite sport. They introduce two "largely competing" models for athletics organizations: the high performance model and medical models. The high performance model places a performance director at the center of a team of ATs, PTs, physician, strength and conditioning coaches, dieticians, and sports psychologists. These high performance directors synthesize the information from the sport performance team and directly communicate with sport coaches and management. In contrast, the medical model has more siloing of medical staff and emphasizes autonomy of medical dicisions. This is "designed to minimize potential conflicts of interest that could adversely affect athlete health". The authors believe this distinction is relatively arbitrary: “We argue that the medical model is theoretically consistent with the high performance model only if we reject the notion that the ‘performance director’ is an administrative person and instead conceptualize this as a ‘health and performance information hub’ that facilitates transdisciplinary collaboration”. Instead, organizations should strive for a transdisciplinary approach to the sport performance staff where the team uses their experience and expertise to solve a problem through a shared conceptual framework. There is standardization to information and data flow, and although there may be different documentation systems, they all feed into a central system that allows for synthesis of the parts. The authors say it best: “Injury prevention is a team effort, requiring structured and trusted data sharing.”

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/38477160/

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This week we discuss appropriate responses to mechanical loading since it is likely that an appropriate amount of stimulus to drive adaptation in one tissue could be maladaptive, or at least ineffective, for other tissues. This article explores acute vs chronic adaptations to stress, endurance vs strength/power training, and muscle, tendon, cartilage, and bone response to loading. There is a breadth of information in this narrative review, so be sure to listen to the episode and/or read the article for yourself!

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39527327/#:~:text=Optimal%20loading%20involves%20the%20prescription,improving%20performance%20in%20healthy%20athletes.

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This week we discuss wearable technology! This systematic review of systematic reviews is unique in that the authors plan to continue updating it every 6 months as more new research comes out on the validity and accuracy of consumer wearable technology. The most common consumer wearable technology are watches and rings which measure things like heart rate, sleep, and step count, among many other possible variables. The authors identified 310 different devices, and to appropriately validate the devices would require a separate validation study for each biometric on each device. This would require 1500+ validation studies! Most consumer wearables underestimate biometrics (like heart rate, oxygen saturation, and step count), however VO2max and total sleep time appear to be overestimated. Some wearables are able to track cardiac arrythmias, and data shows they are 97% accurate. This could be helpful to remotely monitor at-risk populations. One of our biggest takeaways from this is to not place too much stock into the data from the wearables, and try to correlate how you are feeling subjectively with the numbers that the device is giving you. This is how you can get the most out of your wearable technology without letting it rule your life.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39080098/

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This week we discuss outcomes with femoroacetabular impingement syndrome FAIS), defined as "as a clinical triad of symptoms, signs, and imaging findings related to the underlying hip pathology." There are three bony morphologies associated with FAIS: cam, pincer, and mixed. Cam morpohlogy is a bony growth on the femoral head/neck, while a pincer morphology is bony growth of the acetabulum. Mixed morphology is the presence of both cam and pincer changes. Symptoms of FAIS include hip/groin pain, pain worse with motion or certain positions, clicking/locking/stiffness, decreased hip strength/ROM, and impaired balance. The FADDIR test, commonly associated with a clinical diagnosis of FAIS, actually has poor sensitivity and specificity (41% and 47%). Early activity modifications may be necessary to manage symptoms, which involves generally avoiding repetitive hip flexion and internal rotation and limiting end-range stretching of the hip, especially in the presence of pain. Studies also demonstrate hip muscle weakness in the presence of FAIS symptoms, which could be a focus of rehab interventions. Conservative management of FAIS for a minimum of 3 months has shown to be successful in 39-82% of FAIS cases, and it is likely successful conservative management is related to the radiographic severity of morphology. Most reviews demonstrate that surgery has improved short term outcomes (<1 year) compared to physical therapy in young, active populations. Although, the return to play rate after hip arthroscopy was 85.4%, which took an average of 6.6 months. One article found that 1 in 4 athletes don’t return to previous level of sport participation after hip arthroscopy for FAIS.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/37650998/

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This week we discuss considerations when utilizing the limb symmetry index (LSI) as a metric for return to sport testing following ACL reconstruction. Limb symmetry index is a popular metric which compares the performance of the involved limb to the uninvolved limb during a test. Commonly, a 90% threshold is used to determine if there is acceptable levels of asymmetry. However, there are a few points to consider when utilizing this metric. First, after an ACL rupture the contralateral side also loses strength and functional capacity. Therefore, comparing to the post-surgical performance of the uninvolved side can give an artificially inflated LSI, so it is important to ground the test outcomes in normative data or benchmark data. Second, variability in movement is a "hallmark of normal function" and understand humnas, and sport, are not always symmetrical. Although, an argument can be made that the test is to see if you have the capacity to be symmetrical, which does not mean you have to be symmetrical all the time, especially at submaximal efforts. Is your maximal effort symmetric on each side? If not, then you may be more likely to be hurt. Third, biomechanical asymmetries can persist past 9 months post ACLR, so don't just look at the numbers: look at the movement strategy. Finally, assess the functional capacity across a load continuum via testing considering the end goal as the sport.

The abstract can be found here: https://journals.lww.com/nsca-scj/abstract/2024/08000/testing_limb_symmetry_and_asymmetry_after_anterior.3.aspx

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This week we discuss microscopic changes to muscle architecture following eccentric hamstring exercise. Twelve recreationally active participants in their mid-20s performed 9 weeks of eccentric hamstring training via Nordics: 3 session per week, progressively building from 4x6 to 5x8 at the end. After the 9 weeks of training, they had a 3 week detraining period. Eccentric hamstring strength during Nordics, passive fascicle length, and sarcomere length were measured at baseline, end of training, and end of detraining. Serial sarcomere number was calculated using fascicle length and sarcomere length. After the training block, there was significantly increased biceps femoris fascicle length, serial sarcomere number, volume, and knee flexion torque. There was a large effect for all of these metrics. There was a significant regional effect for fascicle length and serial sarcomere number: increased fascicle length at distal region compared to central, but increased serial sarcomeres centrally versus distally. During detraining, fascicle length decreased but remained logner than pre-training lengths. Muscle volume stayed the same and there was a decrease in strength but it was higher than pre-training. Takeaways from this article include evidence for a long-term adaptation of eccentric training being addition of sarcomeres in series which could be protective against hamstring strain injuries, and muscle architectural responses to detraining happen quickly! It would be interesting to investigate if addition of sarcomeres in series is an effect specific to eccentric training, or any specific hamstring muscle training would create this effect.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39461588/

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!