The Freshman Physio

NEW PODCAST EP 🎙

LINK IN BIO

When treating runners it’s important to understand how Gradien can impact with ology. Changes in load with respect to gradient (like changes to hill running) can alter loading through the hips and knees. As well as cadence, contact time and foot strike postures.

How do you alter or introduce hill work with your injured runners?

We had the pleasure of talking to and about the importance of understanding hill running and how to best proceed when faced with hip and knee pathologies.

You can watch or listen to the podcast - Link In Bio!

↗️UPHILL vs. DOWNHILL ↘️

In this episode, Adrian is joined by and to talk about Uphill and Downhill running and the nuances associated with the diagnosis and treatment of pathologies linked to changes in gradient. The outline of the episode is:

✅Impact of uphill and downhill running on joints.
✅How changes in gradient can influence cadence.
✅Understanding how changes in gradient can impact diagnosis.
✅How to factor in gradient when prescribing a return to run program.

LINK IN BIO 🎥

‼️Strength training: What most runners don't do or do well 🏃🏼 ‼️

Understanding how to incorporate strength training for your runners is crucial. The type of running (distance, road vs. trail, etc) and running loads will determine the frequency and style of resistance training.

This recent study by Blagrove and colleagues (2018) provides good insight into how you can prescribe exercise to your runners.

The main take home points:
1️⃣ Strength training increases running economy by 2-8%.
2️⃣ Strength training increases time trial performance by 2-5%.
3️⃣ 18 out of 24 studies found NO change in body mass (from baseline). Whilst control groups has slight decreases in body mass.
4️⃣ Maximal oxygen uptake, blood lactate and body composition appear to be unaffected.

The types of training studied were:
1️⃣ Heavy resistance training: barbell squats, deadlifts etc.
2️⃣ Plyometrics: jumping, hopping and bounding.
3️⃣ Explosive resistance training: Olympic lifts and squat jumps.
✅ The review recommended a combination of heavy resistance and plyometric training, performed 2-3 times per week as having a positive affect on performance.

The limitations:
1️⃣ The studies in the review predominantly selected male runners (352:96).
2️⃣ Studies in the review had an interval validity between 4-6 based on the PEDro rating system.
3️⃣ Lack of detail regarding the runners history of strength training and their running loads.

While there is still a lack of high quality evidence, the general consensus from this review is suggestive of what we believe to be true in clinic and hence these recommendations should be loosely used as a guide along side the specific requirements of an individual runner (goals, running loads, Etc).

🔥Normal Aging Changes in Runners🔥
A great summary by on the normal changes in the master runner.

Physiological changes are normal! Let’s break down common myths around how running can be bad for someone older! Instead, let’s find solutions to help attenuate these changes that are normal!

Yes, there are inevitable changes, but don’t let these changes stop someone from running! It’s normal and not something to fear!💪

Leave a comment and let us know what the wildest thing your patients tell you with respect to running and aging!🙌

📚The Physiology and Biomechanics of the Master Runner. W***y and Paquette (2019)

WILL THEY TEAR⁉️

Protocol:

👉SLS: Scores as follows:

0️⃣= “good control”- displayed proper alignment with a straight line from knees to the mid toes, no obvious valgus motion of either knee and, no knee mediolateral oscillation during the performance.

1️⃣= “reduced control” – improper alignment with 1 or both knees moving into a slight valgus position and some knee oscillation during the performance.

2️⃣=” poor control” – alignment of the knees was poor, at least 1 of the knees clearly m oved into substantial amount of valgus, or there was substantial mediolateral oscillation during performance.

👉VDJ: The athletes’ ability to control their knees in the frontal plane during landing phase was assessed using a graded scale from 0 to 2. (Same as SLS)

👉Observer – Five physical therapist or sport physical therapist with at least 3 years of clinical experience served as raters over the 7-year study period.

👀Results: Visual assessment of the VDJ and SLS cannot predict who will sustain a future noncontact ACL injury.

💡Clinical Implication:
Some may look at this study and conclude that SLS and VDJ are ineffective screening tools to predict future ACL injuries. Although, there is an argument to be made based on this study, there are many limitations to consider.

Some may even infer from this study that “knee valgus” or “knee control” is not an important factor (Hopefully none of you draw such a conclusion with this study!)

I challenge you to think what this study adds to your knowledge with ACL rehab. Things to consider:
1) Is a VDJ from a 30 cm box high enough to mimic your patient’s sport?
2) Is a SLS in a controlled environment to 90 degs of knee flexion realistic to your patient’s sport?
3) Can we still use these tests to help us with screening?

We currently do not have a gold standard screening tool that is validated to predict future ACL injuries despite knowing some factors that contribute to an increased risk. These tests MAY still be valuable as part of a complete screening tool but may need to be more specific to your patient’s sport.

Let us know your thoughts

[ACL REHAB and RETURN TO SPORT]

Grindem et al (2016), demonstrates the importance of strength and time. Not seperate you but together.

Achieving quad symmetry (greater than 90%) as well as waiting for 9 months has a significant reduction in the risk of re-injury.

Clearly there is something to do with natural healing of the graft and tunneled bone. However, allowing time without strengthening adequately also has its implications.

We’d love to hear your thoughts and let’s create a community engaged in positive discussion and a high standard of care.

📚 Grindem et al (2016). Simple decision rules can reduce reinjury risk by 84% after ACL reconstruction: the Delaware-Oslo ACL cohort study. BJSM.

THE RUNNER’S CORNER 🏃‍♂️

🎥 YOUTUBE - LINK IN BIO 🎥

In this episode, Adrian is joined by Benoy Mathews and Aidan O'Flaherty to talk about Medial Tibial Stress Syndrome (MTSS) and the nuances associated with the diagnosis of this pathology. The outline of the episode is:

- What is Medial Tibial Stress Syndrome (MTSS).
- Presentation of MTSS.
- Common errors made by therapists.
- Differential diagnosis of Tibial Stress Fractures.
- When to request a scan (MRI)?

You can find Benoy

MTSS 🏃‍♀️

Medial Tibial Stress Syndrome accounts for a good chunk of running related injuries that we are in clinic.

The Runners Corner is a concept we are exploring with and featuring 🎥

In this weeks episode we take about the diagnosis of MTSS and clinical valley you need to navigate through to make an accurate diagnosis.

The Episode will be released tonight UK time across YouTube and Podcast.

WE’RE BACK

Hey Instagram. For those of you who don’t know us. We are Freshman! A collective of like-minded growth mindset clinicians here to improve clinical standards across the globe. Especially bridging the gap between finishing university and working in clinic.

COVID has been a tough time for us here at Freshman. Personal and Professional circumstances changed our priorities and hence we decided to pause our work here.

We are back! And getting back to what we do best! Which is reviewing research and clinical concepts to help clinicians be the best versions of themselves.

We’ll look to be transparent and vulnerable with our clinical opinions. And in turn ask that you challenge our thought in the hope that we all can learn from each other.

LETS GOOO!

‼️RUNNING WEBINAR ‼️

Link in Bio - This Friday at 7PM GMT 🏃‍♂️

This paper is quite fascinating. Out of 201 papers, only 20 studies (10%) reported using clinical criteria and 30 studies (15%) reported using a strength criteria.

This Wednesday I’ll be sharing how running after an ACLR is altered and why we need to be equally as engaged in improving this element of rehab as we are with RTP.

After all, most individuals returning to play will be engaging in a running related sport. So re-training the fundamentals in movement patterns will have an impact on their recovery and RTP.

Leave your thoughts in comments and let’s seek to be better!

¿TO SCAN OR NOT TO SCAN - THAT IS THE QUESTION ?

This paper might not add anything new from the trends we are observing in the literature. More and more we are recognising a pattern where Asymptomatic Participants are presenting with what the orthopeadic and Physio world has traditionally weighted heavily to form a diagnosis.

Subsequently, we’ve come to know and live by quotes like treat the person NOT the scan. And I completely agree with that. But the more important question we need to ask ourselves is when should we ask for a scan?

Negative perceptions and cultures on scans are largely based on biomedical models. But in a BPS models understanding when scans can/are helpful should not be mistaken and undervalued. After all, the development of scans are designed to improve diagnosis and treatment. We as clinical need to develop better filters to understand how to utilise them.

How do you approach a patient insistent on a scan? How do you clinically Rationale the need for a scan? And more importantly how do you educate your patients on the findings on what is typically a jargon jungle not designed to reassure patients and merely to report.

There’s NO one size fits all. And solutions will have to be individualised and factor in all the necessary variables.

Follow to help build your clinical reasoning and become a better clinician.

Clinical Relevance:
This study has provided a glimpse of what we should include when designing a rehab program. The main take-aways from the study may include:
1️⃣Quads strength is important!
2️⃣Sagittal movements should be assessed and trained to add “variance”.
3️⃣Possible test(s) could include double leg drop jump + single leg drop jump.
4️⃣You may want to assess and add movements to train your patient to have multiple landing strategies, especially ones that target areas found in the study.

For example, the study showed patients have longer ground contact times and increased flexion at the hip, knee, ankle and thorax. You may decide to include more “power” & speed type movements into your training program.

This study does not specifically state that having an increased hip, knee, ankle and thorax landing strategy increases the risk of a contralateral ACL injury but rather that was what was observed prospectively. However, we can add and train landing strategies that does the opposite to add “variance” which may give another learned strategy for the patient when landing.