In a recent review of the highest quality of research available, exercise has been shown to diminish pain, increase mobility, and improve function for those that are experiencing subacromial shoulder pain. Other terms you may have heard for this type of pain include subacromial impingement syndrome, rotator cuff tendinopathy, or rotator cuff related shoulder pain.

Authors in the Journal of Orthopaedic and Sports Physical Therapy Journal recently reviewed 16 systematic reviews that concluded shoulder exercises supervised in a PT clinic and then performed at home as part of a home exercise program is the strongest recommendation to treat shoulder pain. These exercises include ones to strengthen the shoulder and shoulder blade muscles, as well as exercises to improve the mobility and quality of movement of the shoulder complex. It was also determined that for those with persistent shoulder pain, exercises are just as effective as corticosteroid injections in the short term management, and just as effective as shoulder decompression surgery in the long term management. Treating your shoulder pain with exercises decreases the risk of negative side effects, are less expensive, and promote general health benefits.

At Physical Therapy First, we will conduct a comprehensive evaluation of your shoulder, shoulder blade, and adjacent joints to determine the best exercises for you to manage your pain and improve function. We give individualized treatment for any person to help them achieve their specific goals. Whether you are a teacher having trouble writing on the board or an overhead athlete that’s unable to hit a volleyball, Physical Therapy First can help you get back to living your everyday lifestyle.

An Update of Systematic Reviews Examining the Effectiveness of Conservative Physical Therapy Interventions for Subacromial Shoulder Pain; Journal of Orthopaedic & Sports Physical Therapy, 2020

Volume: 50 Issue: 3 Pages: 131-141

Are you a runner looking to increase your miles? Or, are you rehabilitating a running injury and ready to return to running? Is it possible to safely increase running mileage with the least risk for injury? The Journal of Orthopaedic Sports Physical Therapy has published several findings to consider.

Researchers followed over 800 new runners for 1 year, where the runners tracked their weekly mileage and weekly increase in mileage. The runners classified their increase in mileage in one week as less than 10%, 10-30%, and more than 30%. Over the course of the study, 202 runners reported a running-related injury. Analysis of the 2 week period prior to the onset of injury showed that:
– Runners who increased their mileage by 30% or more over 2 weeks had the highest rates of injury
– Runners who increased their mileage by less than 10% over 2 weeks had the lowest rate of injury
– Runners who increased running speed and distance were at higher risk for
o IT band syndrome
o Shin splints
o Trochanteric bursitis
o Patellofemoral pain
o Patellar tendinopathy

An interesting finding was that some runners sustained injuries that were not associated with an increase in running mileage. These include:
– Hip flexor strains
– Achilles tendinopathy
– Plantar fasciitis
– Hamstring and calf strains
– Tibial stress fractures

This may suggest that these injuries which seem to occur unexpectedly are due to other errors in training. Also, symptoms of an injury may not appear until up to 2 weeks after increasing running mileage.

It is recommended to avoid a sudden increase in running mileage by 30% or more. If possible, the safest strategy is to increase mileage by less than 10% over 2 weeks. This enables your tissues to adapt to a small increase in load that is manageable without strain. The therapists at Physical Therapy First can help you recover from any of the above injuries and develop a plan to get you back to running.

J Orthop Sports Phys Ther 2014;44(10):748.

A record number of retractions are occurring in research due to falsified or fake research.
One lie that many Americans have heard over the years is that resveratrol in red wine is heart healthy. Dipak Das, PhD, a researcher from University of Connecticut Health Center, studied and published articles suggesting that 2 glasses of red wine a night is needed to maintain heart health. In 2012, the University of Connecticut announced that a review board found Dr. Das was guilty of 145 counts of fabrication or falsification of data and at least twenty of his research papers have been retracted.

A parallel study performed at Harvard University found that one would actually need to consume 2000 glasses of red wine a day to ingest enough resveratrol to have a health benefit. Furthermore, scientists at the Johns Hopkins University School of Medicine studied 800 men and women ages 65 and older whose diets were natural high in resveratrol and the study found there was no link between resveratrol levels and the rates of heart disease, cancer, and death (JAMA Internal Medicine).

Another fake and fraudulent article published in 1998 in the Lancet Journal showed an association between Autism and vaccination. This article was eventually retracted, however, currently in some states approximately 4% of children are not vaccinated due to fear of autism.

Vioxx, an anti-inflammatory medication thought to replace the need of people suffering from osteoarthritis from taking large doses of Ibuprofen, is another example of research being falsified. Researchers in the study of Vioxx were well aware of the cardiac challenges associated with taking Vioxx. They decided to selectively remove individuals’ cardiac abnormalities from their data and selectively  hired FDA employees as consultants to prevent negative information from being released to the public.

Duke University’s pharmacokinetics and cancer researcher Anil Potti, MD published that he had found a connection between a person’s genes and a pharmacokinetics cocktail. He built research around his reported findings and received 4 grants (2 of them Federal grants) for his research. However, parallel research conducted at MD Anderson Cancer Center showed that Dr. Potti’s work was all falsified. In 2015 Dr. Potti was found guilty, by U.S. Health and Human Services Department investigators, of engaging in misconduct while researching treatments in human cancer patients. Ultimately Duke University reached a settlement agreement with the federal health agency, patients, and the estates of patients who participated in those medical trials. Dr. Potti was allowed to continue research work, under supervision, until 2020, and Duke University currently has to go through additional steps since being caught for falsifying research on this occasion, and with other researchers.

These research retractions, from falsified and fraudulent studies, are never fully reported to the public or the medical community, and the long-term impact on society is significant.
Most published research findings have little pertinence whatsoever to clinical practice. With over 3 million biomedical publications occurring every year we are now in a race to identify who has a grasp of the best research and who doesn’t.

At Physical Therapy First we work hard as a practice to keep pace with the greatest and latest research, including retracted falsified studies, in order to glide our patients to optimal health and physical therapy outcomes. We also work hard to disseminate the best available medical information to our patients, residents, fellows and students.

Optimal Sleep Position

• What position is best for sleep?
• What kind of pillow should I be using?
• I wake up with neck/back/hip pain or headaches.

These are questions and concerns that a physical therapist will discuss with nearly every type of patient. Although most common in spinal patients, sleep can be an issue with shoulder, hip, headache, and post-operative patients due to difficulty finding a position of comfort. When recovering from an injury, sleep is a crucial time of restoration and healing of injured tissues. If a patient is tossing and turning all night or waking up with pain, then they may be placing excessive strain on the affected body region during their sleep.

SLEEP POSITION: SIDE-SLEEPERS

Most of the following information is related to optimal positioning in the side-lying position, as the majority of people are side sleepers (for at least a portion of the night).

Starting at the neck, it is crucial for side sleepers to have a pillow that is high enough to span the distance between the shoulder and head. This will maintain a neutral cervical spine curve and prevent excessive forward shoulder positioning. Often, for those with broad shoulders, 2 pillows will be necessary or you may use the higher side of a contour pillow (as shown above). The chin should be slightly tucked down to prevent strain at the base of the head.

In the trunk, consider adding a small towel roll or bolster pillow to prop up your waist. The bolster will fit just below the ribs and above the hip bone, creating a neutral lumbar curve. This is especially helpful if you wake with mid or low back pain or have pain when turning in bed.

The above photo also shows a pillow between the knees, which keeps the pelvis from rotating.

Consider this option if you have lateral hip pain that limits how long you can sleep on your side.

BACK AND STOMACH SLEEPERS

Back sleepers make up the next most common position. A very small pillow under the knees can be helpful in those with acute back pain. However, this is not recommended as a long term solution as it can lead to hamstring muscle tightness.

Stomach sleepers make up the smallest percentage, and it is a position to avoid especially in lumbar and cervical spine patients diagnosed with stenosis or spondylolisthesis. A pillow under the trunk from hips to ribs is necessary to achieve a neutral spine. To avoid extreme neck rotation when on your stomach, consider placing your temple region on the end of the pillow and having your face angled towards the bed.

If you struggle with pain while trying to sleep or pain upon waking, discuss your concerns with your physical therapist. At Physical Therapy First, our thorough examination and evaluation allow the therapist to develop a customized treatment plan to improve your quality of life – including when you’re asleep.