Data Nerds is a new series that we are introducing which will be alternating weeks with our usual journal club podcast. In this series, we share cases from our clinical practice where we utilize objective testing to inform our decision making, with most attention paid to the results of the tests and interpretation of the information. Therefore, this works best when you can see the numbers. Luckily, these are uploaded to our YouTube channel! Check us out at https://www.youtube.com/@ReadingRehab.

This week, Mike shares a recent case of a runner presenting with a left posteromedial tibial bone stress injury, but he is also 8 months post-op ACLR! Listen to hear how his poor quad strength impacted his running gait!

This week we discuss multi-ligament knee injuries. These are uncommon, but devastating injuries. In athletes, return to sport rates are as high as 53%, but in higher competitive levels it could be more like 23%. The authors note there is a lack of evidence describing return to sport testing in this population, which they attempt to rectify with this article. They describe different phases of rehab, expected timelines for various activities (walking, running, cutting, etc), and objective markers to look to achieve at different time periods (ex. >65% quad strength LSI at 4 months). Tables 1 and 2 are very helpful to summarize this information quickly and give actionable methods.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/35141534/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss isokinetic testing for shoulder internal and external rotation strength! This scoping review had a lot of promise, but unfortunately it did not live up to the hype for us. We learned there is a lot of heterogenity in testing set ups, but the seated 90/90 position is the most common, with 60 and 180 degrees per second being the most common speeds tested. The most common objective measures from these tests are peak torque and ER:IR ratio, but there are a lot of variations of ER:IR ratio looking at differences in concentric and eccentric force outputs. The information we wished this article gave was the average values for peak torque and ER:IR ratio from each of the studies so clinicians would be able to have a general idea of benchmark scores their patients should be hitting. We feel this is a big missed opportunity which could have made this paper a 10/10!

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39628773/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss considerations when treating posterior medial meniscus root tears. Each meniscus has an anterior and posterior root, and a root tear is a radial tear within 1 cm of the attachment. Radial tears cut across the fibers of the meniscus disrupting the hoop stress mechanism: how the meniscus disperses load by expanding with axial load. Possibly due to this disruption, meniscal root tears are associated with accelerated osteoarthritis progression. Therefore, surgical repair, rather than meniscectomy, is typically advised, especially in younger patients with previously healthy knees since menisectomy has also recently been linked to more rapid OA progression. There are many post-operative considerations, including: minimizing joint load via a conservative progression from non-weight bearing for 6 weeks to a 4 week progression to full weight bearing, limiting knee flexion range of motion to 90 degrees for the first 2 weeks while aiming to achieve full extension as soon as possible, minimizing arthrogenic muscle inhibition, using caution with repetitive hamstring pulling into flexion, and waiting 9-10 weeks until initiating shallow squatting due to increases in posterior horn meniscal pressure, joint compressive forces, and joint shear from squatting.

The abstract can be found here: https://ijspt.org/posterior-medial-meniscus-root-tears-clinical-implications-surgical-management-and-post-operative-rehabilitation-considerations/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss a proposed testing battery for baseball pitchers. The authors discuss the importance of a comprehensive testing battery to both minimize injury risk and identify areas for performance improvement. We feel Table 1 does a good job detailing the main points of the article. There are many key physical qualities for baseball pitchers, including: trunk rotation mobility, trunk rotation peak force, hip extension mobility, shoulder external and internal rotation mobility, shoulder flexion mobility, lower body power, shoulder internal rotation peak force, shoulder horizontal adduction peak force, posterior shoulder endurance, hip internal rotation mobility. These qualities should all have associated tests, these are: lumbar locked rotation test, isometric trunk rotation test, modified Thomas test, shoulder rotation total range of motion, shoulder to wall test, countermovement jump, ASH T test, Landmine throw, posterior shoulder endurance test, hip internal rotation range of motion. This is obviously a lot of tests and qualities to consider. Understand that you do not have to do all the tests if you do not have time, but kowing all priority areas is helpful for deciding which qualities are most important to you at this time. Table 1 also gives benchmark points and clinicmetric properties of these tests, which is very helpful. However, there is a poor description of some of these tests in the body of the article, and the YouTube links do not appear to be working.

The abstract can be found here: https://www.researchgate.net/publication/380283244_Test-Training_Integration_to_Optimize_Performance_and_Health_in_Baseball_Pitchers_An_Outcome_Driven_Approach

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss cervical examination for vascular pathology prior to cervical manipulation. In general, our biases are against cervical manipulation. However, if you choose to perform cervical manipulations, this could be a useful paper to understand to limit the risk of adverse event from the technique. The authors primarily advocate for thorough history taking, multiple clinical tests including blood pressure and cranial nerve exam, and utilizing clinical reasoning and prior knowledge of neurovascular pathology presentation and risk factors to appropriately determine safety of cervical manipulation. While we agree this is crucial to ensuring safety performing the technique, we wonder if clinicians are able/willing to spend the amount of time required to perform all the appropriate screening prior to performing a cervical manipulation?

The abstract can be found here: https://www.jospt.org/doi/epdf/10.2519/jospt.2022.11147

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss the training of marathon runners! Most PT's likely won't need to know about marathon training in the detail provided by this article, so we try to also distill down the main concepts. These are: more easy volume is associated with improvements in performance, therefore if you are working with marathoners you want to really push them to make sure their body can withstand the stresses they are going to be placing on them. Since most runners do not do much, or any, strength training, this is a big bucket that can be maximized. For the recreational runner that wants to improve their marathon performance, but does not have the time to do more volume, they may want to emphasize time doing zone 2 and 3 running. Since this is a higher stress to the body, it is vital to educate on proper recovery (sleep, nutrition, stress management) to ensure their body can appropriately tolerate the demands of running. Again, emphasizing strength training will help to build the body's capacity to training.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39616560/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!

This week we discuss a recent article from the Journal of Athletic Training which asserts transdisciplinary collaboration is required for high performing medical teams in elite sport. They introduce two "largely competing" models for athletics organizations: the high performance model and medical models. The high performance model places a performance director at the center of a team of ATs, PTs, physician, strength and conditioning coaches, dieticians, and sports psychologists. These high performance directors synthesize the information from the sport performance team and directly communicate with sport coaches and management. In contrast, the medical model has more siloing of medical staff and emphasizes autonomy of medical dicisions. This is "designed to minimize potential conflicts of interest that could adversely affect athlete health". The authors believe this distinction is relatively arbitrary: “We argue that the medical model is theoretically consistent with the high performance model only if we reject the notion that the ‘performance director’ is an administrative person and instead conceptualize this as a ‘health and performance information hub’ that facilitates transdisciplinary collaboration”. Instead, organizations should strive for a transdisciplinary approach to the sport performance staff where the team uses their experience and expertise to solve a problem through a shared conceptual framework. There is standardization to information and data flow, and although there may be different documentation systems, they all feed into a central system that allows for synthesis of the parts. The authors say it best: “Injury prevention is a team effort, requiring structured and trusted data sharing.”

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/38477160/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!