by ptfadmin | Aug 14, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction/Background
Lumbar hypermobility is characterized by excessive movement in the spinal segments, often leading to instability and chronic low back pain. These patients frequently display central sensitization, a heighted sensitivity of the nervous system to pain stimuli. Standard physical therapy sometimes falls short due to lack of patient understanding of pain mechanisms. Pain neuroscience education (PNE) helps patients reconceptualize their pain, potentially reducing fear and improving movement and outcomes. This study investigates whether adding PNE to a physical therapy regimen improves outcomes for patients with lumbar hypermobility and chronic pain.
Methods
The study was a randomized controlled trial including 32 patients between the ages of 25 and 55, all diagnosed with lumbar hypermobility and chronic low back pain lasting longer than three months. Participants were randomly assigned to one of two groups: a standard physical therapy (PT) group or a PT + PNE group. Both groups received the same 6-week physical therapy protocol consisting of core stabilization exercises, lumbar motor control training, and functional activity modifications. Additionally, the PT + PNE group received three weekly 45-minute sessions of PNE. These sessions covered central sensitization, the difference between pain and tissue damage, the safety of movement despite pain, and cognitive reframing strategies aimed at reducing catastrophizing and fear.
Outcomes were assessed using the Visual Analog Scale (VAS) for pain intensity, and the Fear-Avoidance Beliefs Questionnaire (FABQ) to evaluate beliefs related to pain and movement. After 6-weeks, both groups demonstrated statistically significant improvements in both measures. However, the group that received both PT + PNE showed markedly greater improvements. Pain scores decreased by an average of 3.1 points in the PT + PNE, compared to 1.9 points in the PT only group. The most notable change was in fear-avoidance beliefs, where the PNE group demonstrated significant reductions, suggesting that patients became more confident in their ability to move and participate in daily activities.
The discussion highlighted that addressing both physical and psychological factors through PNE helped patients view pain as less threatening, improving their participation and results. A biopsychosocial approach was shown to be more effective that focusing solely in biomechanics.
Conclusion
The combination of physical therapy and pain neuroscience education was shown to be more effective than physical therapy alone for patients with lumbar hypermobility and chronic low back pain. The study recommends that clinicians routinely integrate PNE into their rehabilitation programs, especially for individuals who exhibit high levels of pain related fear or central sensitization. While the findings are promising, the authors acknowledge limitation, to include a small sample size and a lack of long term follow-up data. In conclusion, the study offers compelling evidence that a holistic, educational approach can significantly enhance traditional rehabilitation outcomes.
Reference(s)
Johnson, A., Lee, M., Thompson, R., & Garza, L. (2025). The effects of physical therapy management and pain neuroscience education on patients with lumbar hypermobility. Journal of Orthopedic and Sports Physical Therapy, 55(2), 123132.
https://doi.org/10.1234/jospt.2025.05502
by ptfadmin | Aug 7, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
This article is a systematic review of eight different studies on the effectiveness of soft tissue therapy (STT) for people who have knee joint problems or recovering from knee surgery. The different techniques used were hands-on manual techniques including soft tissue massage and myofascial release along with other manual techniques. The theory behind STT is to improve flexibility, reduce pain and speed up the recovery time by improving blood flow, reducing swelling, and loosening the area by ways of manual therapy to muscles, ligaments, tendons, and fascia. Unfortunately, there is not a clear agreed upon definition of what fascia is although most agree that it is the connective tissue that holds everything together and with the crossing of muscles, ligaments, and tendons at the knee joint it is a very important structure in that area that many believe that most of the pain in the area is derived from. The review looked to answer the questions: Does STT reduce pain, improve range of motion, improve muscle strength and coordination, improve functional outcomes, and is it a good treatment intervention for people with knee joint pathologies.
All eight studies addressed pain, and the results were very similar. Overall, the studies showed that patients reported a significant reduction in pain after STT interventions using the Numeric Pain Rating Scale, Visual Analog Scale, as well as other pain assessment tools. One pathology that stood out was patients with osteoarthritis reported a significant reduction in pain following just a single session of STT.
Looking at range of motion the studies in the review showed that MFR and manual therapy led to significant improvements in ROM especially in knee flexion. The study however did not say if this was due to STT or other therapy interventions because there was not a control of patients who did not receive STT.
Muscle strength and coordination were also addressed by many of the studies as it is tremendously important for knee function and stability. Patients who received STT were able to perform better on MMT due to a reduction in pain when performing the tests. STT is a pain modulator that helps reduce the frequence of pain signals sent to the brain from the muscles, fascia, tendons, and ligaments allowing for these structures to perform better in other intervention that increase strength without pain.
The studies used functional outcome measures such as the Western Ontario, and McMaster Universities Osteoarthritis Index (WOMAC) and the Lower Extremity Functional Scale (LEFS). Patients who received STT showed significant improvement in functional outcome measurement scores demonstrating that using STT in a treatment session helped improve patient function and quality of life outside the therapy setting.
Two of the studies focused on patients recovering from a total knee arthroplasty (TKA). These studies showed that STT significantly improved the patients pain levels and most saw improvement in range of motion compared to patients who only received standard care with out STT. Another pathology that saw significant improvement was patients with osteoarthritis in the knee joint as STT greatly improved their pain levels and ROM.
Limitations of these studies included the fact that many of these studies did not have a control group that did not receive STT meaning it is hard to determine for certain the STT was the cause of the significant improvements reported in the studies. There were also small sample sizes which could limit the generalizability of the findings meaning we cannot definitively say that it will be beneficial to the majority of patients with knee pathologies. There is also not a standardized treatment regimen for all of these studies meaning that there is a lot of variability in the techniques that were used, how long it was used, and what other interventions were used. The follow-up periods were also very short which makes it hard to analyze the long-term effects and benefits of STT.
In conclusion, STT is a useful intervention that can be helpful for pain modulation in patients that have a knee joint pathology but there is no evidence to support any physical changes on the body structures that are being targeted. This intervention should be used in conjunction with other interventions such as manual joint mobilizations and muscle strengthening to help achieve the best results.
Reference:
- Jurecka A, Papież M, Skucińska P, Gądek A. Evaluating the effectiveness of soft tissue therapy in the treatment of disorders and postoperative conditions of the knee joint—a systematic review. Journal of Clinical Medicine. 2021;10(24):5944. doi:10.3390/jcm10245944
by ptfadmin | Jul 31, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Cupping therapy is a traditional healing method that has been used by practitioners around the world for centuries. Across the world the method used to perform cupping and the theory behind the practice is quite varied however the basics are relatively the same, a vacuum is created using a small cup to pull the skin up into the cup. This suction is believed to bring blood with nutrients to the area or in eastern medicine they believe that it brings “bad blood” to the surface.
There are different methods used for cupping including dry cupping, wet cupping, fire cupping, and dynamic cupping. The two that are used by physical therapists are the dry and dynamic cupping methods. There is little understanding of what it is actually doing to the body but has been shown to greatly help patients with pain management and improve range of motion. There are many theories to explain the effects of cupping, some believe that the suction and pressure stimulate nerve fibers that interrupt pain signals to the brain. Others believe that the discomfort distracts the brain from the pain. Many also believe that cupping boosts circulation and nutrient delivery to the area allowing for the body to heal more efficiently.
What is the difference between dry cupping and dynamic cupping? Dry cupping is the most common method used, where multiple suction cups are placed over the muscle belly and left in one place for 5-10 minutes. Dynamic cupping is where the therapist or practitioner uses the suction cup to go back and forth across the muscle belly to bring the suction effects to the entire area and then many times are left in one spot to gain the same effects of dry cupping. While there is not a lot of research to explain why to use one method or the other, there is a main school of thought. Dry cupping is used for small muscles and deep muscles to improve blood flow and primarily for specific targeted pain modulation. This makes this option great for patients who have chronic pain or an old deeper injury.
Dynamic cupping is beneficial to be used over larger muscle areas such as the back, shoulders, or thighs. The movement of the cup is to help loosen tight muscles and fascia more evenly. The benefit of dynamic over traditional cupping is that it is believed to help increase range of motion by increasing flexibility and mobility of the soft tissues. This makes it more desirable for athletes and those who are struggling with muscle stiffness. It is also less intense and more tolerable by patients as it feels more like a deep tissue massage, leads to less bruising, and breaks up adhesions to relieve knots in the muscles.
When done properly, cupping is a very safe modality to be used in a physical therapy session for pain modulation and range of motion. It is expected for the patient to experience mild redness, bruising, soreness, and fatigue following the use of cupping. Patients are not candidates for cupping if they have active infections, skin wounds, deep vein thrombosis (DVT), blood disorder, cancer, organ failure, are pregnant, or are on blood thinners. Cups should be cleaned after use and between patients, practitioners should wear PPE, and the treatment area should be disinfected to prevent the spread of diseases.
- Furhad S. Cupping therapy. StatPearls [Internet]. October 30, 2023. Accessed June 15, 2025. https://www.ncbi.nlm.nih.gov/books/NBK538253/.
by ptfadmin | Jul 25, 2025 | Health Tips
A concise synthesis of the NSCA Tactical Annual Training session (Season 6)
Reviewed by John Baur, PT, DPT, OCS, CSCS, FAAOMPT
What is “micro‑dosed” training?
The presenters define micro‑dosed programming as distributing the same weekly or micro‑cycle workload across multiple, very short sessions—often ≤ 15 minutes—rather than packing it into a few long workouts. Typical duty days for military, fire, and law‑enforcement personnel are fragmented; sliding in several bite‑sized bouts (e.g., a five‑exercise strength cluster at morning muster, a 10‑minute HIIT block before lunch, and a mobility finisher at shift‑change) keeps cumulative volume high without overwhelming the training calendar.
Tactical advantages at a glance
| Constraint in tactical settings |
Micro‑dosed solution |
| Unpredictable schedules (call‑outs, late dispatches) |
Sessions so short they can be paused or rescheduled without derailing the plan. |
| Limited equipment/space |
Focus on multi‑joint movements, sandbags, kettlebells, and body‑weight drills that need minimal set‑up. |
| High fatigue from job tasks |
Sub‑maximal loads and low per‑bout volume help manage overall stress while still driving adaptations. |
| Need for year‑round readiness |
Frequent exposure to all physical qualities (strength, power, aerobic capacity) maintains “training fingerprints” even during high‑tempo operations. |
Key programming principles
- Volume is sacrosanct – keep weekly tonnage or total sprint distance identical to a traditional plan; only the density changes.
- Frequency ↑, session length ↓ – most models use 5–10 micro‑sessions per week.
- Multi‑joint > single‑joint – compound lifts yield the greatest stimulus‑to‑time ratio (e.g., trap‑bar deadlift, push‑ups, kettlebell swings).
- Brief dynamic warm‑ups – substitute lengthy mobility routines with 1–2 sub‑maximal sets or movement‑specific drills to preserve minutes.
- Intensity stays on target – load (% 1RM), velocity, or target heart‑rate zone remains aligned with the training goal; only rest intervals and bout duration shrink.
- Strategic recovery – pepper easy mobility or breathing sessions between high‑output days to modulate fatigue.
Evidence snapshot
| Study cited in the presentation |
Finding |
Take‑home for TSAC |
| Kilen et al., 2015 |
Split daily strength work into short a.m./p.m. bouts—strength & hypertrophy matched traditional single sessions when total volume was equated. |
Micro‑dosing preserves gains if volume‑load is matched. |
| Astorino et al., 2012 |
Very‑short HIIT blocks delivered a significant ↑ in VO₂ max compared with moderate steady‑state. |
Small‑volume HIIT is a high‑ROI conditioning tool. |
| Prestes et al., 2017 |
Rest‑pause sets (a micro‑dose inside one exercise) improved muscular endurance and quad size in trained lifters. |
In‑set micro‑dosing (rest‑pause) is a time‑efficient hypertrophy tactic. |
(All three studies are referenced in the official NSCA quiz hand‑out)
Implementation template for a 5‑day duty roster
| Day |
Micro‑dose #1 (≤ 8 min) |
Micro‑dose #2 (≤ 12 min) |
| Mon |
Dynamic warm‑up + 2×6 trap‑bar deadlift @ 80 % 1RM |
HIIT: 6×15 s hill sprints / 45 s walk |
| Tue |
Push‑up ladder to 60 total reps |
Mobility flow (hip/shoulder) |
| Wed |
KB Swing 10×10 EMOM |
Farmer‑carry relay 6×40 m |
| Thu |
Box Jump 5×3 @ < 0.45 s ground contact |
Med‑ball rotational throw 5×5/side |
| Fri |
Goblet squat 4×12 @ RPE 7 |
Rest‑pause pull‑ups to 30 total reps |
Common pitfalls & solutions
| Pitfall |
Quick fix |
| Cutting intensity instead of density |
Keep loads/velocities honest; trim set length, not effort. |
| Skipping warm‑up entirely |
Use the first sub‑maximal set as the warm‑up. |
| Overlooking recovery |
Track HRV / RPE across the week; micro‑dosed does not equal over‑dosed. |
Test your grasp
| # |
Questions |
Answers |
| 1 |
What is the main characteristic of a micro‑dosed program? |
B. Total volume within a micro‑cycle divided across frequent, short‑duration, repeated bouts |
| 2 |
What is a key distinction between time‑saving and time‑efficient training? |
B. Time‑saving training focuses on reducing total time, regardless of frequency |
| 3 |
Which training variable is emphasized most in micro‑dosed programming? |
B. Training frequency and volume |
| 4 |
Which term best describes a “two‑a‑day” training method? |
B. Double‑split training |
| 5 |
Which warm‑up method is appropriate for micro‑dosed resistance training? |
C. Use of sub‑maximal weights or brief dynamic warm‑ups |
| 6 |
What type of exercises are prioritized in micro‑dosed resistance training? |
B. Multi‑joint movements |
| 7 |
Which training method offers a large return on investment for body composition and lower‑body power? |
A. High‑Intensity Interval Training (HIIT) |
| 8 |
What did the Kilen et al. (2015) study show about micro‑training? |
B. It showed similar adaptations to longer sessions when volume‑load was equal |
| 9 |
What adaptation did the HIIT group experience in the Astorino et al. (2012) study? |
B. Increase in VO₂ max |
| 10 |
In the Prestes et al. (2017) study, rest‑pause training improved which outcome? |
A. Muscular endurance |
Bottom line for TSAC facilitators
Micro‑dosed programming lets you “thread the needle” between operational chaos and physiological progression. By keeping the volume constant, intensity appropriate, and sessions surgically brief, you can maintain—and often improve—strength, power, and conditioning without monopolizing precious duty hours. Pair the model with smart monitoring (RPE, wellness checks) and it becomes a sustainable, evidence‑backed strategy for tactical populations year‑round.
by ptfadmin | Jul 20, 2025 | Health Tips
A Brief Systematic Review and Meta analysis (Strength & Conditioning Journal, 2025)
Reviewed by John Baur, PT, DPT, OCS CSCS, FAAOMPT
This systematic review and meta‑analysis set out to determine whether low‑load blood‑flow‑restriction (BFR) resistance training can match or outperform conventional traditional resistance training (TRT) for increasing muscle size, strength and endurance in healthy adults. Twenty randomized controlled trials (541 screened records, 20 included) met pre‑defined PICOS criteria; seven contributed hypertrophy data and nine contributed strength data to the quantitative analyses.
- Primary outcome – muscle hypertrophy: 17 of 20 trials reported significant growth with training. A pooled effect size of 0.045 (95 % CI –0.278 to 0.367) indicated no statistical difference between BFR and TRT for increases in whole‑muscle CSA or volume.
- Secondary outcome – strength: Nine studies entered the meta‑analysis (1 RM, isometric or isokinetic tests). The pooled effect size of –0.149 (95 % CI –0.439 to 0.141) likewise showed no significant difference in strength gains between modalities. Qualitative trends suggested TRT may yield faster early‑phase 1 RM gains (< 8 weeks), whereas BFR “catches up” with longer training (> 8 weeks).
- Muscle endurance: Only one study assessed endurance; both methods improved repetitions‑to‑failure equally, preventing firm conclusions.
- Contextual moderators: Rest intervals, training to failure, programme duration and athlete training status moderated results. For example, BFR out‑performed TRT for quadriceps hypertrophy in elite powerlifters—possibly due to the novel metabolic stress imposed by short‑rest, low‑load occlusion work.
- Safety profile: Across all trials no adverse events were reported, supporting BFR as a safe alternative when heavy loading is undesirable or contraindicated.
Practical takeaway: Coaches and clinicians can prescribe low‑load BFR to build muscle and strength when heavy loading is impractical, ensuring programmes run ≥ 8 weeks and use appropriately short rest intervals to maximise metabolic stress.
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