by ptfadmin | Mar 27, 2025 | Health Tips
Reviewed by Kirsten Hales, SPT
Introduction
Knee osteoarthritis (OA) is a prevalent musculoskeletal condition, commonly leading to pain, stiffness, and functional limitations, especially in older adults. While pharmacological treatments like pain relievers and anti-inflammatory medications are frequently used, non-pharmacological approaches such as physical therapy are essential for long-term management. The article “Well-Tolerated Strategies for Managing Knee Osteoarthritis: A Manual Physical Therapist Approach to Activity, Exercise, and Advice,” by Deyle and Gill (2012), explores manual physical therapy, exercise, and patient education as effective strategies for managing knee OA symptoms. This review aims to evaluate the article’s key findings and contributions to knee OA management.
Methods
The article provides a comprehensive overview of evidence-based strategies for managing knee OA. The authors reviewed multiple studies and clinical evidence to support the effectiveness of manual therapy, exercise, and patient education. These strategies were analyzed for their ability to alleviate pain, improve joint mobility, and enhance overall function in individuals with knee OA.The article highlights the best practices for physical therapists, covering exercise recommendations, manual therapy techniques, and behavioral changes.
Results
- Manual Therapy: The use of joint mobilizations and soft tissue techniques was shown to reduce pain and increase mobility in patients with knee OA. The authors emphasized that manual therapy could provide immediate symptomatic relief and improve range of motion when combined with other interventions.
- Exercise Therapy: A combination of strengthening exercises for the quadriceps and aerobic activities was identified as crucial for reducing pain and improving functional outcomes. The article mentioned that exercises should be customized to each patient’s needs, with a focus on gradual progression to prevent worsening symptoms.
- Patient Education: Teaching patients about the importance of staying active, modifying daily activities to minimize joint strain, and incorporating weight management strategies were key components of successful treatment.
- Progressive Load Management: The article discussed the importance of increasing exercise intensity over time, ensuring patients do not overload the joint but are progressively challenged to improve strength and function.
Discussion
The authors concluded that a combination of manual therapy, exercise, and patient education provides a well-rounded, effective approach to managing knee OA. Manual therapy helps reduce immediate pain and stiffness, while exercise promotes long-term improvements in joint function and strength. The authors also highlighted the critical role of patient education in helping individuals manage their condition, maintain physical activity, and prevent further joint degeneration.
However, the authors also noted some limitations. While the evidence supports the benefits of these interventions, they acknowledged that more research is needed to determine the most effective protocols for specific patient populations, including those with varying levels of severity in OA. The differences in exercise routines and manual therapy techniques across studies makes it challenging to create a standardized treatment protocol.
Conclusion
The article provided strong evidence for the efficacy of manual therapy, exercise, and patient education in managing knee OA. For clinicians, it serves as a valuable resource in developing treatment plans that emphasize non-invasive, well-tolerated interventions. Incorporating these strategies into rehabilitation programs can significantly improve outcomes for patients with knee OA. As a student physical therapist, I have observed the positive impact of combining these approaches in clinical practice. The focus on individualized care is particularly important, as knee OA affects patients in many different ways. However, like the authors, I believe more research is needed to determine optimal exercise protocols and to assess long-term outcomes. In the meantime, the comprehensive approach outlined in this article is an excellent foundation for treating knee OA in clinical settings.
Reference
Deyle, G. D., & Gill, N. W. (2012). Well-Tolerated Strategies for Managing Knee Osteoarthritis: A Manual Physical Therapist Approach to Activity, Exercise, and Advice. The Physician and Sportsmedicine, 40(3), 12–25. https://doi.org/10.3810/psm.2012.09.1976
by ptfadmin | Mar 20, 2025 | Health Tips
Reviewed by Kirsten Hales, SPT
Introduction
Rotator cuff tendonitis (RTC) is a common musculoskeletal condition, often associated with shoulder pain and dysfunction resulting from repetitive motion, aging, or poor posture. Conservative management strategies such as rest, physical therapy, and anti-inflammatory medications, are frequently used. However, the role of resistance exercise (RE) in alleviating pain and improving function in RTC tendonitis is still under investigation. The article “Effect of Resistance Exercise on Pain and Function in Rotator Cuff Tendonitis,” aims to provide insight into the effectiveness of resistance training in addressing pain and functional limitations in individuals with RTC tendonitis.
Methods
This systematic review and meta-analysis included data from 10 randomized controlled trials (RCTs) involving 552 patients diagnosed with RTC tendonitis. The different studies assessed the effects of RE programs on pain reduction, functional improvement, and overall quality of life in patients with chronic shoulder pain related to RTC injuries. Key outcomes analyzed were pain intensity (measured via the VAS) and functional improvement (assessed with the SPADI, and DASH).
Results
● Pain Reduction: Participants who engaged in RE programs demonstrated significant reductions in shoulder pain compared to control groups. Pain intensity scores improved by 35-45% after 6-12 weeks of resistance training.
● Functional Improvement: Functional outcomes, as measured by SPADI and DASH scores, showed that resistance exercise resulted in a 20-30% improvement in shoulder strength and ROM.
● Exercise Protocols: The studies varied in terms of the exercise duration (ranging from 6 to 12 weeks) and frequency (2-3 sessions per week). The most effective programs incorporated moderate to high-intensity exercises targeting both the rotator cuff muscles and scapular stabilizers.
● Long-Term Outcomes: While RE yielded immediate improvements in pain and function, the authors noted that the long-term benefits were less clear. Follow-up data at 3 to 6 months showed some sustained improvements in strength and function, but not all patients maintained pain relief after completing the exercise programs.
Discussion
The authors concluded that RE can be effective in short-term interventions for reducing pain and improving function in patients with RTC tendonitis. By strengthening the muscles around the shoulder joint, RE can help stabilize the joint, reduce strain on the tendons, and promote healing. Additionally, resistance training may enhance neuromuscular control and proprioception, which play a critical role in preventing re-injury and improving overall shoulder function. However, the review also highlighted several limitations. The diversification of the exercise protocols (such as variations in type, intensity, and duration) across studies makes it difficult to determine the most optimal approach for all patients. The absence of high-quality, long-term data leaves the question of long-term benefits unresolved.
Conclusion
The review concludes that RE is a promising intervention for managing pain and improving function in individuals with RTC tendonitis. Based on the article, clinicians are encouraged to incorporate RE into rehabilitation programs, particularly for patients with chronic shoulder pain. They are also encouraged to combine it with other conservative treatment strategies. In my clinical experience as a student PT, I have observed that incorporating RE into treatment plans for patients with RTC tendonitis can significantly improve pain and function in the short term and the long term. While I have witnessed the benefits of RE firsthand, the variability in protocols highlights the need for individualized and carefully tailored programs to meet each patient’s needs. This approach ensures that treatment is not only effective but also adaptable to the unique challenges and goals of each patient. However, similar to the authors’ conclusions, further research is necessary to establish standardized protocols and determine the long-term efficacy of RE in managing RTC tendonitis.
by ptfadmin | Mar 12, 2025 | Health Tips
Reviewed by Kirsten Hales, SPT
Dry needling (DN) has become a very relevant intervention in outpatient physical therapy, particularly for managing musculoskeletal (MSK) pain associated with myofascial trigger points (MTrPs). This review evaluates the efficacy of DN in reducing pain and improving function in patients with MSK conditions.
Methods
The authors conducted a comprehensive search across multiple databases, including PubMed, CINAHL, and the Cochrane Library, to identify randomized controlled trials (RCTs) assessing the effects of DN on MSK pain. The study included research that compared DN to sham treatments, placebo treatments, other interventions, or no treatment at all.The primary outcomes analyzed were “pain intensity and pressure pain threshold (PPT), with secondary outcomes including functional measures”. The researchers collected and analyzed data to assess how effective dry needling is in the short, medium, and long term.
Results
The review incorporated 12 RCTs involving a total of 484 participants. The findings suggested that DN provided a significant reduction in pain intensity immediately after treatment and at a 4-week follow-up compared to other placebo interventions. Additionally, improvements in PPT were observed, indicating a decrease in muscle sensitivity. However, the evidence for long-term benefits and functional improvements was limited and unclear because the studies varied in quality and used different DN techniques.
Discussion
The authors concluded that DN appears to be an effective short-term intervention for reducing pain associated with MTrPs in patients with MSK conditions. They emphasized the need for standardized DN protocols and high-quality RCTs with larger sample sizes to draw clear conclusions about its long-term effectiveness and impact on functional outcomes. The authors also highlighted the importance of considering patient-specific factors and integrating DN with other therapeutic modalities to optimize treatment outcomes.
Conclusion
In my clinical experience as a student PT, I have observed incorporating DN into treatment plans for patients with chronic neck and shoulder pain can lead to immediate pain relief and improved range of motion. While the article underscores the short-term benefits of DN, it also aligns with my observations that combining DN with other interventions, such as manual therapy and exercise, may enhance overall patient outcomes. Having personally experienced dry needling, I can attest to its immediate positive effects. Additionally, the consistent positive feedback from patients regarding pain relief and functional improvements highlights its value as a tool in PT practice. However, aligning with the authors’ recommendations, further research is crucial to develop standardized protocols and validate the long-term benefits of dry needling across diverse patient populations.
Reference
https://pmc.ncbi.nlm.nih.gov/articles/PMC9917679/
by ptfadmin | Mar 6, 2025 | Health Tips
Reviewed by Kirsten Hales, SPT
Transcutaneous Electrical Nerve Stimulation (TENS) has long been used as a method of pain management, particularly in clinical settings for conditions like musculoskeletal pain and post-surgical discomfort. What many may not realize is that while TENS is commonly used for pain relief, the underlying mechanisms and its clinical efficacy remain complex and inconsistent. In the article “Using TENS for Pain Control: The State of the Evidence,” Vance et al. (2014) delve into the scientific evidence, reviewing the two primary theories behind its function and highlighting the need for further research to establish more conclusive results on its use and effectiveness in both acute and chronic pain management.
Methods
The authors conducted a systematic search of multiple databases, including PubMed, CINAHL, and Cochrane Library, for studies published up to 2013. The review included randomized controlled trials (RCTs), cohort studies, and case series that investigated the efficacy of TENS for a variety of pain conditions, including musculoskeletal, neuropathic, and postoperative pain. The focus was on evaluating the effectiveness of TENS in reducing pain intensity, improving functional outcomes, and providing long-term relief. The review aimed to assess both the clinical outcomes and the mechanisms underlying the effects of TENS.
Results
The review identified a total of 23 studies meeting the inclusion criteria, with results showing mixed outcomes for TENS use in pain control. The authors found moderate evidence supporting the use of TENS for musculoskeletal pain, particularly in conditions such as osteoarthritis and lower back pain. In contrast, the effectiveness of TENS for neuropathic pain was less consistent, with some studies showing positive effects while others found no significant benefit. For postoperative pain, the evidence was inconclusive, with studies reporting both positive and negative outcomes. The authors also noted that optimal TENS parameters (e.g., frequency, intensity, and duration) varied significantly across studies, which could account for the inconsistencies in the findings.
Discussion
The authors concluded that while TENS shows promise as a non-invasive and relatively safe option for pain management, the evidence is still inconclusive regarding its overall effectiveness. The authors highlight the need for further high-quality, large-scale RCTs to determine the most effective TENS protocols for specific pain conditions. They also emphasize that while TENS may be a valuable adjunct therapy, it should not be considered a standalone treatment for chronic pain. The review also addresses the potential mechanisms of action for TENS, such as the gate control theory and the release of endogenous opioids, although further research is needed to confirm these hypotheses. Finally, the authors note the importance of individualized treatment plans, as the response to TENS can vary significantly between patients.
Conclusion
Based on my experience in outpatient clinics during my first two rotations, I observed significant improvements in patients using TENS, particularly those with chronic back or neck pain. While the article highlights inconsistencies in the evidence for TENS efficacy, my clinical observations align with the moderate support for its use in musculoskeletal pain management. Whether TENS functions through mechanisms like gate control theory or endogenous opioid release, or even as a placebo, the reduction in pain levels was undeniable among the patients I treated. Although I have not used TENS for my own pain management, I believe it holds potential as a non-invasive, adjunct therapy that can enhance a patient’s overall pain management plan. My experience suggests that TENS, when applied thoughtfully and in conjunction with other therapies, can contribute meaningfully to improved functional outcomes and quality of life.
by ptfadmin | Feb 27, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Elbow stiffness secondary to trauma is multifactorial and may develop despite interventions to prevent its occurrence. While there is some evidence associating manipulation for elbow contraction with several risk factors and benefits, there is minimal evidence available on the benefit of manipulation under anesthesia for posttraumatic elbow stiffness.
Methods
The study includes 45 patients (average age of 45) who underwent a manipulation under anesthesia (MUA) procedure for stiff posttraumatic elbow due to moderate to severe elbow motion restrictions or lack of functional range of motion that showed no improvement. The procedure was performed under general anesthesia and consisted of the surgeon gently increasing the patient’s range of motion into flexion and extension. The study uses paired t-tests to compare ranges pre- and post-manipulation and considers a P value of 0.05 as significant.
Results
Range of motion at the elbow was recorded using a goniometer at follow-up visits. Most of the study participants followed through with formal physical therapy while some used a static or dynamic splint. The average length of follow up after the procedure was 565 days. Before manipulation, the average flexion arc was reported at 57.9 degrees. Intraoperatively, patients received an average of 17.8 degrees more in extension and 125.4 degrees flexion. On average at final follow up, patients showed a 25.8-degree improvement in the total flexion arc of motion; the study reported that finding as statistically significant. Following MUA and follow-up interventions, 3/17 patients in the late MUA (manipulation after 91 days) group achieved a functional arc of motion, while 6/10 patients in the early MUA (manipulation within 91 days) group achieved functional arc of motion; this difference was found to be statistically significant. Additionally, 14% of early manipulation and 18% of late manipulation achieved less than a 10-degree gain in motion. While 11% of early manipulation and 35% of late manipulation lost elbow motion.
Discussion
While both groups showed statistically significant intraoperative improvements in range of motion, only the early manipulation group retained significant improvement at follow-up. Researchers have concluded that MUA within 3 months of initial injury is most beneficial for improving range of motion. They reported that this conclusion agrees with other literature pertaining to different joints. They also suggest that physical therapy along with dynamic and static splinting may have resulted in more static and permanent improvements in total arc of motion, however many patients are limited by compliance and financial implications. Researchers included the following limitations: use of retrospective data, patient loss to follow up, lack of postmanipulation rehab protocols. Based on their study, they saw a low complication rate among their patients but still suggest caution when opting for MUA as surgeons.
Conclusion
In their opinion, MUA of the elbow is safe and effective for improving range of motion at the elbow if initiated within 3 months following initial injury resulting in posttraumatic stiffness.
Reference
Spitler, C.A., Doty, D.H., Johnson, M.D., Nowotarski, P.J., Kiner, D.W., Swafford, R.E., & Jemison, D.M. (2018). Manipulation Under Anesthesia as a Treatment of Posttraumatic Elbow Stiffness. Journal of Orthopedic Trauma, 32(8), e304-e308. DOI: 10.1097/BOT.0000000000001222
by ptfadmin | Feb 21, 2025 | Health Tips
Reviewed by Tyler Tice, PT, DPT, OCS, ATC
Introduction
Overuse injuries are traditionally thought to develop gradually over time due to repetitive microtrauma from activities such as running. These injuries differ from acute overload injuries, which are caused by a single traumatic event. However, the Garmin-RUNSAFE study challenges this conventional understanding by exploring the onset patterns of overuse injuries. It highlights the possibility that many overuse injuries occur suddenly during high-intensity training sessions rather than developing over weeks or months. The study aims to classify running-related injuries into three categories: acute overload injuries, sudden-onset repetitive overuse injuries, and gradually developing overuse injuries. This paradigm shift has significant implications for injury prevention, training protocols, and clinical practice.
Methods
The study used data from the Garmin-RUNSAFE Running Health Study, a global cohort of runners aged 18 and older who used Garmin devices to track their running activities. Participants completed weekly questionnaires for 18 months, reporting any musculoskeletal injuries or problems caused by running. Injuries were categorized into three groups: (1) overload injuries from an acute mechanism with sudden onset, (2) sudden-onset repetitive overuse injuries with a preceding issue reported 7–28 days before the injury, and (3) gradual-onset overuse injuries without prior issues. Statistical analyses determined the proportion of injuries in each category and explored patterns in anatomical location and training loads.
Results
Out of 1,666 injuries recorded, 467 (28%) were classified as acute overload injuries, while 1,199 (72%) were overuse injuries. Among the overuse injuries, 1,065 (64%) occurred suddenly, and only 134 (8%) had a gradual onset. Interestingly, just 11.1% of runners reported problems in the same anatomical location within 28 days of the injury, and only 6.9% reported issues within 7 days. These findings suggest that most overuse injuries occur without warning signs and challenge the gradual-onset hypothesis. The results also emphasize the role of single-session training spikes in triggering injuries, underscoring the need for refined training load management strategies.
Discussion
The study’s findings call for a reevaluation of traditional theories surrounding overuse injuries. Instead of a gradual progression, many overuse injuries arise suddenly due to rapid increases in training intensity or volume. This has significant implications for clinicians, coaches, and runners, who must consider acute workload spikes as a primary risk factor. Training load management tools, such as acute-to-chronic workload ratios, may help identify and mitigate these risks. However, the study also acknowledges limitations, including reliance on self-reported data and a specific population of Garmin users, which may affect generalizability.
Conclusion
The Garmin-RUNSAFE study provides strong evidence that most overuse injuries occur suddenly rather than gradually, challenging existing injury prevention frameworks. This finding emphasizes the need for better monitoring of training loads and early detection of risk factors to reduce injury incidence. Future research should explore the underlying mechanisms and validate these findings across diverse athletic populations.
Contributions to Physical Therapy
This study offers valuable insights for physical therapists working with runners and athletes. The sudden-onset nature of many overuse injuries highlights the importance of assessing recent training loads when diagnosing and treating injuries. Therapists can use these findings to educate patients on the risks of sudden increases in training intensity and to develop individualized programs that gradually progress workloads. Additionally, early intervention strategies, such as addressing biomechanical inefficiencies and implementing recovery protocols, can help prevent injuries. By incorporating these principles into practice, physical therapists can play a crucial role in reducing overuse injuries and improving athletic performance.
Reference
1.Frandsen JSB, Simonsen NS, Hulme A, Jacobsen JS, Nielsen RØ. A Paradigm Shift in Understanding Overuse Running-Related Injuries: Findings From the Garmin-RUNSAFE Study Point to a Sudden Not Gradual Onset. JOSPT Open. 2025;3(1):85-92. doi:10.2519/josptopen.2024.0075
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