Matt Does Physio

Everyone watching Squid Game…
Mattdoesphysio still watching Simpsons reruns

Your two favourite kinesiology professors are back at it for their first day of the 2021/22 school year!!!

It’s all business in this class no bones about it 😂 😂

or is it ??

Haven’t seen a registered physio in a minute.. can CAPR get our residents registered this time around??
.

The look I shoot when they say you :
1️⃣ you need to find your “why”
2️⃣ you need to work on your therapeutic alliance

But then tell you:
1️⃣ we’re going to judge you as a therapist by your PVA (patient visit average) or better yet “mentor” you how to improve your PVA

2️⃣ never really explain how to improve therapeutic alliance except for increasing your PVA

We’re an industry who looks at direct outcome measures right??

So what the f**k does training PVA have to do with therapeutic alliance??

Want to learn to be a better therapist for your patients??

Find mentors and clinical partners who help you grow as an individual, teach you not how to ask “better” questions but more emotionally intelligent questions to help you and your clients find solutions together.

Remember you’re not a sales agent maximizing PVA. You’re here to help people find health related solutions.

And business owners who’ve been taught to fixate in PVA.. I used to be there too. It’s a quick easy measure - but doesn’t tell you if your patients love the care they get, will refer friends or family, etc etc

*It’s also the face I make when the Raptors passed over Suggs in the draft at the party.. although I’m quickly falling in love with Scottie Barnes 🤷🏽‍♂️

📸

2021 mattdoesphysio & education

Not how I thought I’d have to dress for my first day as a lead instructor but happy to be working & teaching PTA/OTA at Humber this term!

New year, New challenges; LFG! @ Humber College

running 5 minutes late... again

@ Foundation Physiotherapy & Wellness

This years #1 overall draft pick Joe Burrows sustained a hyperextension knee injury Sunday resulting in a torn ACL & MCL. We’ve covered the mechanism and rehab extensively in older posts.. so today we look at what this means for Burrows and the Bengals moving forward..

A 2014 study looked at return to play in NFL QB’s; what they found was*:

-92% of QBs returned to the NFL
-the average age of the QB was 27 +/- 2.4 years old
-the mean career length following the surgery was 4.85 +/- 2.7 years in the NFL
-performance was not significantly different from pre-injury

With 9 months until the start of the 2021 NFL season, the timeline for Burrows to start the season is a little tight; but there should be no reason that he shouldn’t be back starting games for the Bengals within the first few weeks of the 2021 season. And based on the statistics from the previously mentioned study, Bengals and fantasy football fans should feel confident that it won’t impact the rest of his career.






*Performance and Return-to-Sport After ACL Reconstruction in NFL Quarterbacks
Brandon J. Erickson, MD; Joshua D. Harris, MD; Jacob R. Heninger, BS; Rachel Frank, MD; Charles A. Bush-Joseph, MD; Nikhil N. Verma, MD; Brian J. Cole, MD, MBA; Bernard R. Bach, MD @ Foundation Physiotherapy & Wellness

You already know the news

All-World Guard Klay Thompson who had just recovered from an ACL tear in last years NBA finals tore his Achilles tendon yesterday during training.

has a good post summarizing the injury if you want to take a look.. but I wanted to dig into the risk of Achilles tears post ACL injury/reconstruction.

And although the current literature on the topic of injury/re-injury is scarce, there are a few high quality studies and meta-analyses.*

Maybe not surprising, the research suggests that ACL injuries are linked not only to further ACL injury but also other injuries in the lower body (for example an achilles tear), and furthermore that in general injuries such as ACL tear, achilles tear, and hamstring tears are associated to increased risk of other injuries in the lower body.

This suggests changes in the mechanics of how we move post injury, and very noteworthy for therapists and trainers to consider when creating treatment plans for return to sport regardless of the level of competitiveness of our clients.

This is unfortunately reminiscent of Boogie Cousins; but fingers crossed that Klay will return next season to close to the same player we’ve come to know.

thoughts on this? drop them in the comments!

*Fulton, J., Wright, K., Kelly, M., Zebrosky, B., Zanis, M., Drvol, C., & Butler, R. (2014). Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. International journal of sports physical therapy, 9(5), 583–595.

**Toohey LA, Drew MK, Cook JL, et al Is subsequent lower limb injury associated with previous injury? A systematic review and meta-analysis British Journal of Sports Medicine 2017;51:1670-1678.
@ Toronto, Ontario

pain in the 🍑

One of the most accurate PK in the NFL, Josh Lambo returned this week from a Gluteus Medius (GM) injury only to hit a record tying 59-yard field goal.. and then to re-injure his left GM on a squib kick and be placed back on the IR list.

His initial injury kept him out of the lineup for 5 weeks and his newest injury is being called “worse than the initial” injury. Because it’s his second stint this season on the IR list his season is over.

So what happened??

the job of the GM is to maintain stability of the pelvic region when on one leg and helps to maintain normal movement patterns of the pelvis and lower extremities.* one study found that the external torque increases as the contralateral leg leaves the ground, especially when the stance leg is in neutral or in a slight amount of adduction as would happen during a kickoff. **

Another study found (maybe not surprisingly) that the EMG of the GM increased as the load was increased on the contralateral side of the body.* Although the study was conducted in a controlled manner, we can hypothesize that during a kick off attempt; the GM activation would probably increase as well.

so even though it’s not the most common injury, it’s likely that due to the repeated stress of being a PK and torque of producing the strength to perform a squib kick- he has sustained a tear of his left GM.

*Lee JW, Kim YJ, Koo HM. Activation of the gluteus medius according to load during horizontal hip abduction in a one-leg stance. J Phys Ther Sci. 2015;27(8):2601-2603. doi:10.1589/jpts.27.2601

**Hu, X., Zheng, N., Hsu, W. et al. Adverse effects of total hip arthroplasty on the hip abductor and adductor muscle lengths and moment arms during gait. J Orthop Surg Res 15, 315 (2020). https://doi.org/10.1186/s13018-020-01832-1 @ Foundation Physiotherapy & Wellness

⚽️Liverpool star Van Dijk was injured over the weekend, sustaining the injury from a vicious tackle from Everton keeper.🥅

The common joke on social media seems to be “what are ACLs even good for”; they are essential in stability of the knee joint and the control of pivoting and cutting movements.

Football is a high risk sport for ACL injuries. The FIFA 11+ program focusing on fitness, strength, balance, and jumping has demonstrated a significant benefit to reducing ACL and lower body injuries in athletes.

however, you can’t train for dangerous tackles.

Swipe left to see the screen shots of Van Dijk’s knee injury. We can see his knee end up in hyperextension for a strong lateral blow with his foot planted. Although the diagnosis of an ACL tear seems to well-known, recent news suggests the injury is worse than initially thought and he still hasn’t scheduled surgery to repair the tear. It’s likely that Van Dijk has suffer the “unhappy triad” of injury to the ACL, MCL, and medial meniscus… and perhaps a fracture as well.

Bad news for Van Dijk, Liverpool fans, and EPL fantasy players as he’ll be out for at least 9 months.
@ Toronto, Ontario

⚡️🏈Chargers QB Tyrod Taylor was a surprisingly missing from Sundays game.. and it turns out it was due to sustaining a punctured lung or a pneumothorax when he was receiving an injection of pain killers for a “cracked rib” sustained in week 1.🏈⚡️

A pneumothorax is classified as either spontaneous or traumatic. Taylor’s injury was obviously an accidental traumatic injury and…
1- anytime you are inserting a needle around the ribs.. you are also inserting a needle around the lungs, so there is a known risk on the part of the practitioner and the patient

2- we really have no idea of how often NFL doctors are injecting pain relief medication around the ribs and chest.. but my guess is more than we think .. that is to say they’re probably fairly good at it.

This injury is an emergency as it can be life threatening .. because you need your lungs to breathe!

Generally the recommendation is 4-6 weeks without exercise, so if you’re in a fantasy football league.. I’d go ahead and drop him as he probably won’t be ready to start until after their bye week in week 10.

If you’re a cardio-respiratory physio I’d love to get your thoughts in the comments!

@ Foundation Physiotherapy & Wellness

🎺Saints Fantasy Injury Update🎺

Fantasy darling Michael Thomas suffered a “mild” high ankle sprain late in their game against the Bucs Sunday so...

🎺What is a high ankle sprain
It is also known as a syndesmotic ankle sprain, where the anterior inferior tibio-fibular ligament,posterior inferior tibio-fibular ligament, or the interosseous ligament is at fault as opposed to the talocrural ligaments or the ankle

🎺Injury Mechanism
Forced dorsiflexion and external rotation of the ankle.
This creates a forceful widening of the mortise joint and leads to tearing of the ligaments which hold the tibia and fibula together

🎺Clinical Diagnosis
▪️the 'squeeze' (compressing the tibia and fibula above the midpoint of the calf), ▪️dorsiflexion with compression' (patient dorsiflexes the foot while the examiner compresses the medial and lateral malleolus)
▪️Kleiger’s external rotation stress test (patient sits with leg dangling and ankle at 90° and external rotation then applied to the foot)
▪️the palpation or “point” test (applying direct pressure to the anterior inferior tibio-fibular ligament)
▪️the “thump” test (the clinician applies a blow to the heel of the patient in an attempt to create a splaying of the joint)

🎺Typical recovery
Median recovery time is reported at 7-8 weeks.

🎺It’s not unusual for NFL players to come back quicker than expected. Based on news reports expect him to be out 3-4 weeks - so you’ll need to find a new WR1 for your fantasy teams

*Cheng-Feng Lin, MS1 Michael T. Gross, PT, PhD2 Paul Weinhold, PhD3. (2006). JOSPT. Ankle Syndesmosis Injuries: Anatomy, Biomechanics, Mechanism of Injury, and Clinical Guidelines for Diagnosis and Intervention @ Leslieville