Centre de formation et physiothérapie de Lutry

12/04/2026

𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀 𝗪𝗶𝘁𝗵 𝗖𝗵𝗿𝗼𝗻𝗶𝗰 𝗟𝗼𝘄 𝗕𝗮𝗰𝗸 𝗣𝗮𝗶𝗻 𝗪𝗶𝘁𝗵𝗼𝘂𝘁 𝗔𝗱𝘃𝗮𝗻𝗰𝗲𝗱 𝗗𝗶𝘀𝗸 𝗗𝗲𝗴𝗲𝗻𝗲𝗿𝗮𝘁𝗶𝗼𝗻 𝗘𝘅𝗵𝗶𝗯𝗶𝘁 𝗚𝘂𝘁 𝗠𝗶𝗰𝗿𝗼𝗯𝗶𝗼𝗺𝗲 𝗗𝘆𝘀𝗯𝗶𝗼𝘀𝗶𝘀

As physical therapist and clinical exercise physiologists, we are constantly looking for the "why" behind those persistent cases where a patient’s MRI doesn't match their level of pain and disability.

📘 A brand-new study by Sima et al. (2026, https://onlinelibrary.wiley.com/doi/10.1002/jsp2.70174) offers a compelling look at the "gut-disk axis" as a potential driver for chronic low back pain (LBP). Historically, we’ve relied on imaging to find structural culprits, but as Sima and Diwan (2025, https://pubmed.ncbi.nlm.nih.gov/39867670/) point out, many patients lack an easily identifiable surgical pathology. This research bridges that gap by investigating how our internal ecosystem might be fueling spinal inflammation from the inside out.

𝗧𝗵𝗲 𝗦𝗰𝗶𝗲𝗻𝗰𝗲 𝗼𝗳 𝘁𝗵𝗲 𝗚𝘂𝘁-𝗗𝗶𝘀𝗸 𝗔𝘅𝗶𝘀

The study compared 28 chronic LBP patients without advanced disk degeneration to 28 healthy, matched controls. The researchers built upon the work of Li et al. (2022, https://pubmed.ncbi.nlm.nih.gov/35286474/), who first proposed the "gut-disk axis"—a pathway where intestinal dysbiosis leads to systemic inflammation that eventually sensitizes the nerves around our spinal disks. This theory is supported by earlier findings from Shmagel et al. (2019), who found a significant association between dysbiosis and the presence and severity of musculoskeletal pain, particularly in the lower back.

📊 What Sima et al. (2026) discovered was a significant drop in alpha diversity (the richness of the microbiome) in LBP patients. This is a hallmark of dysbiosis also noted by Nitert et al. (2020, https://pmc.ncbi.nlm.nih.gov/articles/PMC7492308/) in overweight back pain cohorts. Specifically, the LBP group showed a depletion of Bacteroidota and Parabacteroides. These "good" bacteria produce short-chain fatty acids (SCFAs), which Agus et al. (2021, https://pubmed.ncbi.nlm.nih.gov/33272977/) and Ney et al. (2023, https://pubmed.ncbi.nlm.nih.gov/36977462/) have shown are vital for maintaining the gut barrier and suppressing pro-inflammatory cytokines like IL-17.

𝗪𝗵𝘆 𝗜𝘁 𝗠𝗮𝘁𝘁𝗲𝗿𝘀 𝗳𝗼𝗿 𝗢𝘂𝗿 𝗣𝗮𝘁𝗶𝗲𝗻𝘁𝘀?

When these protective bacteria are lost, "bad" players like Proteobacteria and Desulfobacterota take over. This shift increases intestinal permeability allowing endotoxins to enter the bloodstream. Once these toxins reach the intervertebral disk, they can trigger the infiltration of nociceptive fibers. This process, supported by research from Larsen (2017, https://pubmed.ncbi.nlm.nih.gov/28542929/) on Prevotella-induced inflammation and Cheng et al. (2013, https://pubmed.ncbi.nlm.nih.gov/23680281/) on Th17 cell frequency, might explain the pathogenesis and pain severity of IVD degeneration in part.

💡 Ultimately, this suggests that our role in the clinic might extend beyond biomechanics. Emerging evidence hints that therapies we already use, like exercise and psychologically informed practice, might actually help by enhancing microbial diversity. This study reinforces that we need a holistic, biopsychosocial approach to back pain that considers systemic inflammation and perhaps even microbiome-targeted interventions to get our patients moving better.

04/04/2026

Hot off the Press 🔥

𝗥𝗲𝗰𝗲𝗻𝘁 𝗵𝗶𝗴𝗵𝗹𝗶𝗴𝗵𝘁𝘀 𝗶𝗻 𝗹𝗼𝘄 𝗯𝗮𝗰𝗸 𝗽𝗮𝗶𝗻 𝗿𝗲𝘀𝗲𝗮𝗿𝗰𝗵, 𝗣𝗮𝗿𝘁 𝗜𝗜: 𝗣𝗿𝗲𝘃𝗲𝗻𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗺𝗮𝗻𝗮𝗴𝗲𝗺𝗲𝗻𝘁

A brand-new narrative review by Saragiotto and colleagues (https://www.sciencedirect.com/science/article/pii/S1836955326000172) synthesised five key themes in contemporary LBP management.

Theme 1️⃣ (Prevention) demonstrated consistent evidence that exercise-based programs, particularly when combined with education, reduce the risk and impact of recurrent LBP.

Theme 2️⃣ (Non-pharmacological management) showed that education, exercise, manual therapy, acupuncture and psychologically informed approaches generally produce small to moderate effects on average, with the strongest and most sustained benefits observed for exercise and psychologically informed approaches.

In Theme 3️⃣ (Pharmacological management), it was found that commonly used medicines provide at best small benefits while carrying meaningful risks, reinforcing their limited and time-restricted role in care.

Theme 4️⃣ (Invasive and surgical interventions) highlighted that most invasive procedures offer little to no meaningful benefit for LBP and expose patients to substantial harm and cost.

Finally, Theme 5️⃣ (Special populations) showed that older adults, children, adolescents, and Indigenous and underserved communities remain under-represented in clinical trials and are more likely to receive non-guideline concordant care, emphasising the need for tailored, equity-oriented approaches.

‼️Conclusion‼️

LBP care is most effective when it is active and person‑centred. Education, exercise and psychologically informed approaches should be prioritised, while medicines and invasive procedures offer little benefit and carry risk; care should be tailored to reduce persistent inequities across populations.

04/04/2026

The Suspected Cauda Equina Syndrome Score (SuCESS) 📋

▶️Despite a wealth of published data on the subject, diagnosing cauda equina syndrome (CES) remains challenging. The clinical presentation is often non-specific, with red flag symptoms such as bilateral sciatica, saddle anaesthesia, and urinary dysfunction lacking the sensitivity or predictive value needed for reliable triage and prioritization. Yet the consequences of a missed or delayed diagnosis are profound, ranging from irreversible sphincter dysfunction to a marked reduction in health-related quality of life (https://pubmed.ncbi.nlm.nih.gov/34862914/).

📘 To address this problem, Najjar and colleagues (https://pubmed.ncbi.nlm.nih.gov/41763246/) conducted a multivariable diagnostic model derivation and external validation study, using real-world data from four temporally distinct cohorts of patients referred with suspected CES to a UK tertiary spinal unit (259 patients in the derivation study and 444 patients in the validation study). Their objective was to develop and validate a simplified clinical risk score, th e Suspected Cauda Equina Syndrome Score (SuCCESS), based on interpretable and routinely collected variables, with the primary aim of optimizing the use of emergency MRI without compromising diagnostic safety or delaying surgical intervention.

📊 Six clinical variables – saddle anaesthesia, bilateral sciatica, and clinical signs (motor weakness < grade 4, decreased perianal (PR) sensation (assessed clinically using a pin-prick test), bladder scan post void residual urine PVR ≥ 200 ml, and presence of urinary catheter (when bladder scan unavailable). – were identified and combined into an eight-point scoring system. A diagnostic threshold of ≥ 3.0 was selected based on ROC curves and Youden’s Index. This threshold maximized sensitivity and negative predictive value (NPV) with a perfect rule-out capacity while potentially reducing unnecessary MRI referrals. So, a score below 3.0 effectively "rules out" CES, as no confirmed cases in the study presented with a score lower than this threshold.

💡 In a clinical scenario where bladder data are unavailable, a nuanced approach is essential. If the patient already scores ≥ 3.0 based on other criteria, urgent MRI is still strongly indicated. If the score falls just below threshold, however, the absence of PVR or catheter status should be recognized as missing information that may underestimate risk. In this context, objective bladder assessment may reveal early cauda equina syndrome and should prompt urgent referral. Documented urinary retention, catheter insertion, or loss of bladder awareness should therefore be treated as high-risk features and explicitly considered during preoperative counselling and decision-making. This reinforces the clinical observation that CES is a multi-symptom diagnosis.

⭕Limitations: Data derived from a single tertiary UK spinal unit, unclear inter- and intraoberserver variability in the six clinical variables, possible variability in documentation and examination techniques.

01/04/2026

Just published 🔥

𝗣𝗥𝗜𝗖𝗘 (𝗣𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝗼𝗻, 𝗥𝗲𝘀𝘁, 𝗜𝗰𝗲, 𝗖𝗼𝗺𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻, 𝗘𝗹𝗲𝘃𝗮𝘁𝗶𝗼𝗻) 𝘃𝘀 𝗣𝗘𝗔𝗖𝗘 𝗮𝗻𝗱 𝗟𝗢𝗩𝗘 (𝗣𝗿𝗼𝘁𝗲𝗰𝘁𝗶𝗼𝗻, 𝗘𝗹𝗲𝘃𝗮𝘁𝗶𝗼𝗻, 𝗔𝘃𝗼𝗶𝗱 𝗮𝗻𝘁𝗶-𝗶𝗻𝗳𝗹𝗮𝗺𝗺𝗮𝘁𝗼𝗿𝗶𝗲𝘀, 𝗖𝗼𝗺𝗽𝗿𝗲𝘀𝘀𝗶𝗼𝗻, 𝗘𝗱𝘂𝗰𝗮𝘁𝗶𝗼𝗻 𝗮𝗻𝗱 𝗟𝗼𝗮𝗱, 𝗢𝗽𝘁𝗶𝗺𝗶𝘀𝗺, 𝗩𝗮𝘀𝗰𝘂𝗹𝗮𝗿𝗶𝘇𝗮𝘁𝗶𝗼𝗻, 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲) 𝗶𝗻 𝗮𝗱𝗼𝗹𝗲𝘀𝗰𝗲𝗻𝘁 𝗹𝗮𝘁𝗲𝗿𝗮𝗹 𝗮𝗻𝗸𝗹𝗲 𝘀𝗽𝗿𝗮𝗶𝗻 𝗿𝗲𝗵𝗮𝗯𝗶𝗹𝗶𝘁𝗮𝘁𝗶𝗼𝗻: 𝗮 𝗿𝗮𝗻𝗱𝗼𝗺𝗶𝘇𝗲𝗱 𝗽𝗿𝗼𝘀𝗽𝗲𝗰𝘁𝗶𝘃𝗲 𝗰𝗼𝗺𝗽𝗮𝗿𝗮𝘁𝗶𝘃𝗲 𝘀𝘁𝘂𝗱𝘆 𝗼𝗳 𝗺𝘂𝘀𝗰𝗹𝗲 𝘀𝘁𝗿𝗲𝗻𝗴𝘁𝗵 𝗮𝗻𝗱 𝗱𝘆𝗻𝗮𝗺𝗶𝗰 𝗯𝗮𝗹𝗮𝗻𝗰𝗲

🦶 Lateral ankle sprain (LAS) is one of the most frequent musculoskeletal injuries in active adolescents, yet wide variability persists in diagnostic methods and treatment pathways (https://pubmed.ncbi.nlm.nih.gov/29514819/, https://pubmed.ncbi.nlm.nih.gov/29886432/).

📋 For more than 20 years, acute care has relied on the PRICE (Protection, Rest, Ice, Compression, Elevation) approach, combined with non-steroidal anti-inflammatory drugs (NSAIDs). However, guideline authors note a lack of high-quality evidence supporting PRICE as a universal strategy and warn that excessive rest and prolonged NSAID use may impair optimal tissue repair (https://pubmed.ncbi.nlm.nih.gov/29514819/). On the contrary, contemporary rehabilitation enhances early loading, progressive exercise, and patient education. A 2019 systematic review and meta-analysis reported that exercise-based rehabilitation reduces recurrent sprains risk compared with usual care, though optimal content and dosage remain unclear (https://pubmed.ncbi.nlm.nih.gov/30612980/).

In order to avoid drawbacks of traditional treatment algorithm, PEACE and LOVE was suggested as a two-phase protocol covering immediate care (Protection, Elevation, Avoid anti-inflammatories, Compression, Education) and subacute recovery (Load, Optimism, Vascularization, Exercise), paying attention to education, early optimal loading, and graded activity (https://pubmed.ncbi.nlm.nih.gov/31377722/).

❤️ ☮️ Traditional PRICE + NSAIDs and the PEACE and LOVE frameworks differ not only in clinical management but also in underlying physiological basis. PRICE concentrates primarily on early symptom control by reducing pain and swelling; however, prolonged rest and routine use of anti-inflammatory strategies may impair beneficial inflammatory cascades, macrophage activation, angiogenesis, and collagen remodeling required for optimal tissue healing (https://pubmed.ncbi.nlm.nih.gov/22889660/).

Conversely, PEACE and LOVE supports early, gradual mechanical loading and patient education to stimulate mechanotransduction, maintain neuromuscular function, and support collagen fiber alignment. This protocol aims to optimize tissue regeneration and functional recovery rather than simply controlling symptoms (https://pubmed.ncbi.nlm.nih.gov/31377722/).

📘 In a brand-new randomized prospective comparative study, Meškauskas and colleagues (https://pubmed.ncbi.nlm.nih.gov/41840451/) enrolled 76 adolescents (12–17 years) with first-time LAS, allocated to PRICE + NSAIDs or PEACE and LOVE treatment group (s. comments). Functional performance was assessed at 1–2, 5–7, and 12–15 weeks using Biodex isokinetic dynamometry and the Y-Balance Test composite score (YBT-CS).

📊 Significant improvements over time were observed for strength, range of motion, and dynamic balance in both groups. However, no statistically significant group effects or Group × Time interactions were detected, indicating similar recovery trajectories between rehabilitation approaches during the 12–15-week follow-up period.

💡Clinical relevance

The PEACE and LOVE framework may represent a biologically informed and patient-friendly approach to LAS management in adolescents, emphasizing education, early optimal loading, and functional rehabilitation. Despite being a more recently proposed rehabilitation framework, PEACE and LOVE demonstrated short-term functional outcomes comparable to those observed with the traditional PRICE + NSAIDs approach. In the present study, both rehabilitation protocols were associated with comparable short-term improvements in strength, ROM, and dynamic balance. No statistically significant between-group differences were detected.

⭕The magnitude of these changes was modest, and their clinical relevance should be interpreted cautiously. Future studies incorporating minimal clinically important difference thresholds, patient-reported outcomes, and longer follow-up are needed to determine practical impact. Given the single-center design, application of these findings should be considered in the context of local clinical resources and expertise

Infographic: https://pubmed.ncbi.nlm.nih.gov/31377722/

24/03/2026

21/03/2026