🦀 Issue 48 - Flex and Stab
Welcome to the long, hot summer everyone! This email was originally supposed to send before the equinox, when it wasn't technically summer yet, but apparently my email system protested that prematurity and so you receive it as intended, just after the true summer begins. Here's your summer tip, especially for those in small and mid-size towns: check out minor league baseball! It's cheap (the Richmond Flying Squirrels are just $6/game and the beer's cheap too), outside so it's virus safe, and a good time. Check out your local team this week.
In other news, King Crab supporters received 2 more articles this week, one on MSK injuries associated with cell phone use (there are a lot) and a second about treadmill vs. overground walking for stroke rehab (and the results will surprise you). Subscribe to the full edition by becoming at PT Crab supporter at PTCrab.org/subscribe
Let’s dive in!
Stabilization? Flexion? Either? Neither?
The Gist - In degenerative spondy, what works better, stabilization or flexion exercises? Well, according to this study from Mexico, either will do ya. The researchers took 92 patients over 50 who had degenerative spondy and randomized them to flexion or stabilization exercise groups. They met with a PT once per month for 6 months and were given exercises to do at home. To test outcomes, researchers used pain intensity and the Oswestry disability index. They also checked out flexibility and the Roland-Morris as secondaries. Overall, between group differences were not significant. Everyone got better, no one got better better. Stabilization and flexion exercises were samesies. Flexion exercises are simpler, so consider that in your prescription.
Tell Me More - The paper didn’t have too much detail on the exact exercises used, so we can’t dig deeper there. I will answer your burning question: one visit per month? Yea, I know. Idk too much about Mexico’s healthcare system, but these authors said they chose this because it replicates the PT availability of less well-off Mexican residents. All of their patients did improve, so that’s great news overall. They had follow-up for 84 of their 92 person cohort for 48 months and only 4 sought surgical intervention in that timeframe. This is great! Since apparently there’s not too much data about conservative interventions for degenerative spondy. This intervention worked well enough that the patient’s involved didn’t feel like they had to get more aggressive. How cool!
Paper it up. Ummmmm sure. Free for APTA members.
DN = Win-win for OA
The Gist - DN for hip OA, what? Yea, apparently so. This RCT from the Archives of PM&R showed that DN improved short-term (48hr) pain, hip strength, TUG, WOMAC, and the 40-meter walk-test more than control or sham DN. Noice! They went after trigger points in the rec fem, TFL, glute min, or iliopsoas over the course of 1 session per week for 3 weeks. Sham DN received the same amount of treatment, but with a blunt needle that didn’t penetrate the skin and control got nothin’. Before treatment, scores were similar across all three groups, but afterward the DN group improved more than MCID in pain, TUG, isometric strength, and 40-meter walking and more than standard error of measurement for the WOMAC. Why? Read on for what the researchers said about that.
Tell Me More - The researchers hypothesize that the dry needling reduced peripheral and central sensitization and increased endogenous opioid production in their patients, removing some central barriers to strength. They don’t argue that DN actually made these patients stronger. Instead, they say, it reduced their pain and reset their brain enough to allow them to work a bit harder across the tasks they were given. Because of this, they recommend that DN be paired with other therapies to take advantage of these temporary strength increases. These researchers didn’t combine DN therapy with any other interventions, so we don’t actually know that yet, but it’s a hopeful sign.
I wanna read this one! You should, it’s good and short (only 6 pages!)
That’s our week!
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Hey, if you’re at a clinical right now (and I know some of you are) maybe tell your CI about PT Crab? Cuz I’d really appreciate it and I bet they’d think it was awesome that you’re reading so much research. Either talk to them about it or just forward this to them. Thanks!
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