Issue 23 Blue Crab Edition - Can You Learn Knee Tests from YouTube? And Dry Needling for Migraines

This week, we’re looking into what YouTube can teach you about Knee tests and going into a great RCT about dry needling for migraines.

Now that we’re officially into the last month of 2020 (way to go!) note that PT Crab can be a great gift, and an easy one. Just share it with friends and colleagues and they’ll get free research in their inboxes forever. I’ll even make a cute printable for you to give out next week. And if you’re the selfish type who wants to get something for giving (like me), use our referral program. It’s all set up for you at Grow.Surf/esvria. It’ll pop out your special link automatically. Tweet, share, or email it to earn swag (like gonis, beer mugs, free King Crab, and more) and share PT Crab.

Alright, I’m done self-promoting and PT Crab promoting. Except to say that I and the Crab are on twitter @LukeHollomon and rarely have anything interesting to say. But sometimes I post graphs and whatnot made from the studies. Now I’m done.

Enjoy the articles!

Can You Learn Knee Special Tests From YouTube? Maybe…. Actually Probably Not.

The Gist - A group of researchers from South Korea got together to see if YouTube is actually a good place to go when you need a refresher about special tests for the knee. They search for the anterior drawer test, the Lachman test, posterior drawer test, and valves and various stress tests, then watched the first 20 videos that popped up (5 pages of results). 85% of people don’t go deeper than three pages when searching for material, so they chose to go just a bit deeper than that. Two reviewers then analyzed each video according to a fixed set of criteria to determine if the video and information were actually any good. They assessed comprehensiveness and reliability using a checklist down in the Tell Me More section.

The results? Not great. 126 of the 218 videos (58%) were suitable for education. The other 42% were usually thrown out because they had insufficient information about posture or technique, but 10% of the lot had misleading or inaccurate information altogether. 71% were produced and distributed by a professional group of some sort, but these were no more dependable than the non-professional videos. Of all 218, only 47 (22%) contained information about limitations or precautions for the tests. Not good news at all. YouTube might be a good place to learn to sew, but be cautious when trying to use it to learn how to perform PT, eh?

Tell Me More - They used an 11 question scoring system in their research, with varying amounts of points given to each question based on its importance. Here’s a brief list divided into two sections, comprehensiveness and reliability.

• Comprehensiveness
  – Is the purpose explained?– Patient posture explained?– Examiner posture explained?– How to perform the test explained?– How to interpret test results explained?– Limits or precautions mentioned?
• Reliability
  – Are the aims clear and achieved?– Are valid sources cited?– Is the information balanced and unbiased?– Are additional sources listed?– Are areas of uncertainty mentioned?

Digging a bit deeper into the stats shows a couple more unfortunate elements. Videos scored as unsuitable had more view overall and views per day since their posting. They also had more likes and were shorter. YouTube uses a secret algorithm to rank their search results, but part of it is based on engagement and the amount of people who watch entire videos. With the unsuitable videos being shorter and getting more engagement, it’s quite possible that they rank higher in search. The researchers did not comment on this phenomenon, but it would be an interesting follow-up. There’s a theory in the semi-libertarian environment of the internet that good information wins against bad. Clearly, in many ways, that’s not the case.

What should you do about it? Most of you, probably nothing except stop using random YouTube searches to find information about how to perform PT. There are good sources out there, but your chance of finding one in the first five pages of search is little better than a coin flip. I’ll bet one reader out there has the skills and environment to make PT training videos that aren’t crap. I might even start that YouTube channel myself. If I do, you’ll hear about it on the Crab, and I’ll pump out PT Videos That Aren’t Crap on the regular. Until then, be careful with your information sources, even if they look like they know what they’re doing.

Can I Read the Full Paper? I really wish the authors had made a YouTube video about the paper but, sadly, they have not. So here’s a link to it instead.

Hit Dat SCM Trigger Point to Stop Dat Migraine

The Gist - This pretty little paper from the Journal of PM&R looks into how the treatment of SCM trigger points could stop migraine headaches and, wouldn’t ya know it, they can! They grabbed 40 patients diagnosed with migraine headaches, evaluated them for SCM trigger points, then split them into two groups, a placebo and a dry needling group. The DN group got three sessions of SCM dry needling 48 hours apart while the placebo got sham needling, using blunt needles that didn’t penetrate the skin. They checked outcome measures just before, just after, and 1 month later. Here’s what they found:

The treatment group had significantly fewer, less intense, and shorter headaches one month later than the placebo group. The SCM pain pressure threshold when up significantly in the treatment group with a decrease in the placebo group, CROM measurements all improved significantly in the treatment group with a decrease in the placebo, and the treatment group’s SCM thickness increased while placebo’s decreased. Winner all round!

Tell Me More - This is just the latest in a string of dry needling success stories that has some speculating that it’s all a big fad that will blow over. Therapists older than me insist that this happened in the 80s and we all forgot about it again, so the same will happen here. I’d reply: fat chance. DN definitely made a difference with these patient in this RCT, makes a difference in many other uses (though not all) and has survived a few systematic reviews as well. It’s here to stay. But you’re not here to hear me talk about some rando on twitter, so let’s move on a bit.

Why did this work? Well, we don’t really know for sure (as usual), but it’s speculated that some migraines could be caused by referred SCM pain. Specifically, SCM pain that refers in a headache pattern. There are multiple reasons why DN works, and the paper does a good job of summarizing those, so pop over for more details. This study is limited by its applicability to all patients with migraines, since it specifically grabbed patients with migraines originating from trigger points in SCM, but you realized that, right?

Paper?Right here my good man. Woman. Etc. Enjoy!

That’s our week! Please remember to share PT Crab, it’s how we can stay alive. Cheers!

Oh, one more thing! If you’re going to make eggnog this winter (and you should!) make it now, add the alcohol, and age it gently for a couple of weeks. It will be much better for it. Here’s Alton Brown’s recipe. And now I go.