Review the latest news:
Top undiagnosed causes of hip pain
High false positive carpal tunnel rate for NCV’s
Therapeutic tape for tennis elbow and shoulder dysfunction
Low vitamin D may contribute to scoliosis
Surprise: ultrasound works for ______ but not _______
Head & Spine
1. A small study of 31 patients with forward head posture found “The combination of upper cervical and upper thoracic spine mobilization indicated better overall short-term outcomes in craniovertebral angle, numeric pain rating scale, and respiratory function, compared with deep cervical flexion exercises.” Cho J et al. Upper cervical and upper thoracic spine mobilization versus deep cervical flexors exercise in individuals with forward head posture: A randomized clinical trial investigating their effectiveness. J Back Musculoskelet Rehabil. 2018 Dec 10. doi
2. Manual Therapy Wins Again!
A new JAMA randomized clinical trial of 259 lumbar spine stenosis (LSS) patients compared the effectiveness of three non-surgical options and concluded ”Manual therapy/individualized exercise had a greater proportion of responders in symptoms and physical function (20%) and walking capacity (65.3%) at 2 months compared with medical care (7.6% and 48.7%, respectively) or group exercise (3.0% and 46.2%, respectively). Although LSS is a chronic degenerative condition, patients with LSS can show improvement in walking capacity with nonsurgical approaches.”Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828
3. Short-term rigid and Kinesio taping may help improve scapular dyskinesis and pectoralis minor length in overhead athletes.” Ozer, S. T., Karabay, D., & Yesilyaprak, S. S. (2018). Taping to Improve Scapular Dyskinesis, Scapular Upward Rotation, and Pectoralis Minor Length in Overhead Athletes. Journal of Athletic Training (Allen Press), 53(11), 1063–1070.
4. Another study of 30 overhead athletes confirmed positive effects of therapeutic taping on scapular joint position sense and movement control. Shih, Y.-F., Lee, Y.-F., & Chen, W.-Y. (2018). Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study. Journal of Sport Rehabilitation, 27(6), 560–569.
5. A study of 23 minor league baseball players found: “Stretching the contralateral SI joint improved Glenohumeral Rotation Deficits (GIRD) more than the sleeper’s stretch.”
Left SI stretch for Right-sided GIRD – While lying supine, grab your left knee with your right hand and forcefully pull your knee toward your right shoulder while fully abducting your left arm and shoulder in the opposite direction. Hold this position for 30 seconds and repeat three times. Romano V, Romano J, Gilbert GE. Sacroiliac Stretching Improves Glenohumeral Internal Rotation Deficit of the Opposite Shoulder in Baseball Players in a Randomized Control Trial. J Am Acad Orthop Surg Glob Res Rev. 2018;2(10):e060. Published 2018 Oct 8. do
6. A study of 46 participants with shoulder impingement concluded: “The effect of high-intensity laser therapy plus exercise is not higher than exercise alone to reduce pain and improve functionality in patients with subacromial syndrome.” Aceituno-Gómez J, Avendaño-Coy J, Gómez-Soriano J, García-Madero VM, Ávila-Martín G, Serrano-Muñoz D, González-González J, Criado-Álvarez JJ. Efficacy of high-intensity laser therapy in subacromial impingement syndrome: a three-month follow-up controlled clinical trial. Clin Rehabil. 2019 Jan 23.
7. A study of 30 lateral epicondylopathy patients found: “Therapeutic taping in addition to exercises is more effective than sham taping and exercises only in improving pain in daily activities and arm disability.” Giray E, Bingul DK, Akyuz G. The effectiveness of kinesiotaping, sham taping or exercises only in treatment of lateral epicondylitis: A randomized controlled study. PM R. 2019 Jan 4.
8. In patients with acute tennis elbow symptoms: “A counterforce brace provides significant reduction in the frequency and severity of pain in the short term as well as overall elbow function.” Kroslak M, Pirapakaran K, Murrell Gac. Counterforce Bracing Of Lateral Epicondylitis: A Prospective, Randomized, Double-Blinded, Placebo-Controlled Clinical Trial. J Shoulder Elbow Surg. 2019 Feb;28(2):288-295. Doi: 10.1016/J.Jse.2018.10.002.
Did you know that radial tunnel syndrome mimics lateral epicondylopathy?
While a counterforce brace may help LE, it will likely aggravate RTS. Take our 7-question quiz to test your ability to differentiate.
9. A study of 50 patients found that “extracorporeal shock wave therapy (ESWT) and therapeutic ultrasound are equally effective in the treatment of lateral epicondylosis.” Yalvaç B, Mesci N, Geler Külcü D, Volkan Yurdakul O. Comparison of ultrasound and extracorporeal shock wave therapy in lateral epicondylosis. Acta Orthop Traumatol Turc. 2018;52(5):357-362.
10. A study of 40 asymptomatic hands found that nerve conduction studies had a high false positive rate (43%) for carpal tunnel syndrome; while the false positive rate for diagnostic ultrasound was lower (23%).
Fowler JR et al. False-Positive Rates for Nerve Conduction Studies and Ultrasound in Patients Without Clinical Signs and Symptoms of Carpal Tunnel Syndrome. J Hand Surg Am. 2019 Jan 8. pii: S0363-5023(18)30599-9. doi: 10.1016/j.jhsa.2018.11.010. [Epub ahe
11. In patients with mild carpal tunnel syndrome, use of a splint is an appropriate and sufficient treatment.
Hesami O, Haghighatzadeh M, Lima BS, Emadi N, Salehi S. The effectiveness of gabapentin and exercises in the treatment of carpal tunnel syndrome: a randomized clinical trial. J Exerc Rehabil. 2018;14(6):1067-1073. Published 2018 Dec 27. doi:10.12965/jer.1
SI & Hip
12. In patients younger than 50, greater than 85% of hip pain that is undiagnosed or misdiagnosed by primary physicians falls into one of the four following diagnoses:
13. The A study of 36 patients with patellofemoral pain found “altered gluteus medius, vastus medialis oblique (VMO), and vastus lateralis (VL) muscle activity during single leg stance and single leg squat compared to healthy subjects.”
Mirzaie GH et al. Electromyographic activity of the hip and knee muscles during functional tasks in males with and without patellofemoral pain. J Bodyw Mov Ther. 2019 Jan;23(1):54-58. doi: 10.1016/j.jbmt.2018.11.001. Epub 2018 Nov 9.
Hip Abductor Weakness & Knee PainTo learn more about hip abductor weakness and knee pain, check out this ChiroUp 15 minutes to excellence webinar.
14. “The addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis. Therefore, the authors recommend excluding therapeutic ultrasound from the treatment of plantar fasciitis and agree with results of previous studies that stretching may be an effective treatment for healing plantar fasciitis.”
Wagner, Eric R.; Solberg, Muriel J.; Higgins, Laurence D. The Utilization Of Formal Physical Therapy After Shoulder Arthroplasty. Journal Of Orthopaedic & Sports Physical Therapy Nov2018, Vol. 48 Issue 11, P856
15. A systematic review found that “low-level laser therapy (LLLT) in patients with plantar fasciitis significantly relieves the heel pain and the excellent efficacy lasts for 3 months after treatment.”
Wang W et al. Clinical efficacy of low-level laser therapy in plantar fasciitis: A systematic review and meta-analysis. Medicine (Baltimore). 2019 Jan;98(3):e14088. doi: 10.1097/MD.0000000000014088.
16. Consider testing scoliosis patients for vitamin D deficiency: “We postulate that vitamin D deficiency and/or insufficiency (negatively) affects Adolescent Idiopathic Scoliosis development by its effect on the regulation of fibrosis, postural control, and bone mineral density.”
Ng SY, Bettany-Saltikov J, Cheung IYK, Chan KKY. The Role of Vitamin D in the Pathogenesis of Adolescent Idiopathic Scoliosis. Asian Spine J. 2018;12(6):1127-1145.
17. A systematic review of 22 studies found: “strength training is beneficial and can be used to treat fibromyalgia. The main results included reduction in pain, fatigue, number of tender points, depression, and anxiety, with increased functional capacity and quality of life.”
Andrade A et al. A systematic review of the effects of strength training in patients with fibromyalgia: clinical outcomes and design considerations. Adv Rheumatol. 2018 Oct 22;58(1):36. doi: 10.1186/s42358-018-0033-9.
18. “A single session of chiropractic manipulative therapy was shown to have an immediate effect of reducing the time required for asymptomatic special operations forces personnel to complete a complex whole-body motor response task.”
DeVocht JW et al. Effect of chiropractic manipulative therapy on reaction time in special operations forces military personnel: a randomized controlled trial. Trials. 2019 Jan 3;20(1):5. doi: 10.1186/s13063-018-3133-2.
Cliff Atwell, B.S., D.C.