Centre de formation et physiothérapie de Lutry

21/11/2025

NEW IN

Our Hip Pain and Mobility Deficits - Hip Osteoarthritis has been updated

Access the update ➡️https://ow.ly/vMIu50Xnzs1

Orthopedics

21/11/2025

20/11/2025

Is it better to have one or multiple visits to for adults with or 🤔

Our latest tries to find out ➡️https://ow.ly/1eZJ50XumWe

The authors urge caution in interpreting the results *read beyond the abstract*

20/11/2025

Why Pain Science Still Matters: What's Changed in the Last 5 Years.

Pain science keeps moving forward, and the latest developments are genuinely exciting for anyone working with people in pain.
Join Professor Lorimer Moseley for an essential update on what's reshaping how we understand and treat pain.

Here's what's new:
Pain Science Education has evolved with richer learning strategies and broader content. The Fit-for-Purpose Model is opening fresh possibilities for chronic pain treatment. Community-wide education is amplifying what we can achieve with individual patients. And bioplasticity research is revealing how the whole body adapts and changes.

Wed, Dec 3rd | 9am London
Register now - places are limited.
https://us02web.zoom.us/webinar/register/2317470613503/WN__kqohcoLSuy4y0uIpCAJUQ

14/11/2025

Structural or functional instabiliy?!

09/11/2025

Just pubished 🔥

𝗔𝗲𝗿𝗼𝗯𝗶𝗰 𝗘𝘅𝗲𝗿𝗰𝗶𝘀𝗲 🚴‍♀️ 𝗮𝘀 𝗮 𝗧𝗵𝗲𝗿𝗮𝗽𝗲𝘂𝘁𝗶𝗰 𝗢𝗽𝘁𝗶𝗼𝗻 𝗳𝗼𝗿 𝗖𝗵𝗿𝗼𝗻𝗶𝗰 𝗟𝘂𝗺𝗯𝗮𝗿 𝗥𝗮𝗱𝗶𝗰𝘂𝗹𝗮𝗿 𝗣𝗮𝗶𝗻. 𝗔 𝗖𝗮𝘀𝗲 𝗦𝗲𝗿𝗶𝗲𝘀

Lumbar radicular pain (LRP), often termed sciatica, is a prevalent musculoskeletal condition with a lifetime incidence of up to 43% (https://pubmed.ncbi.nlm.nih.gov/18923325/). Patients with LRP typically experience more severe pain and disability compared to those with nonspecific low back pain (https://pubmed.ncbi.nlm.nih.gov/21358478/; https://pubmed.ncbi.nlm.nih.gov/23328336/). Conventional conservative management—including manual therapy, motor control training, or neurodynamic techniques—offers only modest benefits (https://pubmed.ncbi.nlm.nih.gov/36580149/).

🚴 Emerging preclinical evidence has highlighted the potential neuroprotective and analgesic benefits of aerobic exercise (AE) in animal models of sciatic nerve injury, showing reductions in hypersensitivity and neuroinflammation (https://pubmed.ncbi.nlm.nih.gov/36690283/; https://pubmed.ncbi.nlm.nih.gov/38137395/). Despite these promising findings, there is a substantial translational gap, as AE has been scarcely examined in clinical populations with radiculopathy (https://pubmed.ncbi.nlm.nih.gov/33490836/).

📘 In a brand-new study, Esposto, Arca, and Schmid (2025,👉 https://www.jospt.org/doi/10.2519/josptcases.2025.0171) conducted a case series to investigate whether aerobic exercise could be safely and feasibly integrated into a tele-rehabilitation program for patients with chronic lumbar radicular pain, and whether it may improve pain and functional outcomes.

✏️ This retrospective case series followed CARE guidelines (https://pubmed.ncbi.nlm.nih.gov/28529185/) and included five adult patients (aged 25–49 years) presenting with chronic lumbar radicular pain with or without radiculopathy treated in a telemedicine rehabilitation setting.

📋 The criteria for diagnosing lumbar radicular pain with or without radiculopathy followed published clinical recommendations: pins and needles or numbness in the involved lower limb; leg pain more severe than back pain; leg pain spreading below the knee; motor, sensory, or reflex deficits upon neurological examination; positive neurodynamic test (eg, straight-leg raise [SLR] or crossed SLR). The presence of a minimum sum score of 6 out of 10, representing 93% probability of sciatica according to Stynes et al. (https://pmc.ncbi.nlm.nih.gov/articles/PMC5886387/), was required for inclusion.

🚴 Intervention

Participants underwent a multicomponent tele-rehabilitation program combining:

💬 Patient education about pain mechanisms and active recovery. The aim was to help patients understand the difference between acute and persistent pain, the specifics of nerve pain, and the role of active recovery strategies such as AE.

💪 Graded strengthening to address strength deficits identified during the initial examination As patients’ tolerance and confidence improved, the program progressed to include more complex movements as well as specific activities that patients wanted to be able to perform again) and

💁‍♂️ neurodynamic exercises (eg, nerve sliders, performed daily within a pain-free range of motion).

🚴 Aerobic exercise (AE) was performed 3–5 times per week (cycling, walking, or interval running) with a duration of 20 to 30 minutes per session. AE was prescribed at 60–70% of maximum heart rate (HRmax), estimated by Fox’s formula (HRmax = 220 – age, https://pmc.ncbi.nlm.nih.gov/articles/PMC7523886/). Exercise intensity and duration were progressively adjusted based on tolerance. The specific modality was chosen based on the patient’s preference and symptoms tolerance, utilizing either a stationary bike, walking, or a combination of walking and running. For patients who chose running, a graded interval-based approach was used, starting with short running intervals (eg, 1 minute) alternating with longer walking periods (eg, 3 minutes).

📊 Outcome Measures

Primary outcomes were:

▶️ Pain intensity, measured by the Numeric Pain Rating Scale (NPRS)
▶️ Function, assessed by the Patient-Specific Functional Scale (PSFS)

Outcomes were measured monthly for 3–6 months. Adherence and adverse events were recorded at each session.

📊 Results

All five patients showed large, clinically meaningful improvements in both pain and disability:

✅ Mean leg pain decreased by 4–8 points on the NPRS.

✅ Functional scores on the PSFS improved by 3–6 points, surpassing minimal clinically important differences (https://pubmed.ncbi.nlm.nih.gov/24828475/).

✅ Average adherence was 87.6% for the full program and 86.2% for AE specifically.

✅ No major adverse events occurred; there were four minor and two moderate self-limiting flare-ups.

✅Notably, four patients reported immediate post-exercise hypoalgesia, consistent with the phenomenon of exercise-induced hypoalgesia described in pain research (https://pubmed.ncbi.nlm.nih.gov/30904519/; https://pubmed.ncbi.nlm.nih.gov/33062901/).

💡 Discussion

Aerobic exercise might be a feasible, safe, and potentially effective adjunct for patients with chronic lumbar radicular pain. These results provide preliminary clinical support for preclinical findings showing AE’s role in modulating neuroinflammation and promoting neural recovery (https://pubmed.ncbi.nlm.nih.gov/36690283/; https://pubmed.ncbi.nlm.nih.gov/38137395/).

While the multimodal design precludes causal attribution to AE alone, consistent improvement across all cases strengthens the hypothesis that AE contributes meaningfully to symptom relief and functional recovery. Moreover, the tele-rehabilitation approach demonstrated strong feasibility and adherence.

⭕ Key limitations include:

☑️ Small sample size (n=5) and lack of a control group
☑️ Retrospective design and absence of long-term follow-up
☑️ Possible inaccuracy in AE intensity estimation via HRmax formula

Illustration of SLR: https://www.magonlinelibrary.com/doi/abs/10.12968/pnur.2023.34.11.400?journalCode=pnur

01/11/2025

𝗛𝗼𝘄 𝗺𝘂𝗰𝗵 𝗮𝗲𝗿𝗼𝗯𝗶𝗰 𝗲𝘅𝗲𝗿𝗰𝗶𝘀𝗲 𝗶𝘀 𝗻𝗲𝗲𝗱𝗲𝗱 𝘁𝗼 𝗿𝗲𝗱𝘂𝗰𝗲 𝗺𝗶𝗴𝗿𝗮𝗶𝗻𝗲?

🤕 Migraine, a leading cause of disability affecting over 1.16 billion people worldwide (GBD Collaborators, 2024; Woldeamanuel & Cowan, 2017), contributes to an estimated $1.9 trillion economic burden in 2025 (Woldeamanuel et al., 2025). Given the limitations of pharmacologic therapy and access disparities in headache care (Bentivegna et al., 2023; Lanteri-Minet et al., 2024), scalable interventions like exercise are urgently needed.

📘 A brand-new dose-response meta-analysis by Ogrezeanu et al. (2025, https://pubmed.ncbi.nlm.nih.gov/41085000/) quantified, for the first time, a therapeutic dose of aerobic exercise for migraine and revealed a U-shaped dose–response curve.

🏃‍♀️Aerobic training significantly reduced both:

⬇️ Migraine pain intensity (SMD = –1.10),

⬇️ Attack frequency (SMD = –0.79),

✅ with optimal benefits achieved at 900–950 cumulative minutes of moderate-intensity aerobic exercise delivered over 10–11 weeks (equivalent to ~30 minutes, three sessions per week at 50–70% VO₂peak, infographic below).

👉 These findings build on earlier reviews supporting exercise efficacy (La Touche et al., 2020; Varangot-Reille et al., 2022; Reina-Varona et al., 2024) but are the first to define specific exercise dosing guidelines.

👉 Subgroup analyses suggest s*x differences and migraine chronicity modify treatment response:

▶️ Greater effects in episodic migraine than in chronic migraine (Ogrezeanu et al., 2025),

▶️ Larger reductions in attack frequency among women, consistent with s*x-based pain sensitivity and hormonal influences (Amin et al., 2018).

🏃‍♂️‍➡️ In an editorial, Woldeamanuel emphasizes a precision medicine approach, advocating graded exercise pacing to prevent overexertion cycles common in migraine patients (Andrews et al., 2012; Nielson et al., 2014). For sedentary individuals or those with kinesiophobia (fear of movement) (Benatto et al., 2019), exercise initiation at low intensity (40–50% VO₂peak) using time-contingent progression strategies is recommended (La Touche et al., 2023).

Importantly, exercise efficacy may be enhanced by addressing sleep and circadian regulation, as morning light exposure combined with exercise improves migraine stability (Youngstedt et al., 2016; Ong et al., 2018; Woldeamanuel et al., 2023).

💡 Practical tips:

☀️ Circadian Alignment: Encourage morning exercise with outdoor light exposure to stabilize sleep wake cycles.

😴 Lifestyle Integration: Advise consistent sleep (7-8 hoursnightly), strict meals at fixed daytimes, and hydration tracking.

⬆️ For complex cases with comorbid disorders—such as vestibular migraine, postural orthostatic tachycardia syndrome (POTS), or exercise intolerance—modifications including recumbent cycling, hydration strategies, compression garments, vestibular rehabilitation (gaze stabilization or balance training), and neck strengthening (Sun et al., 2022; Benatto et al., 2022) may improve tolerance.

🏋️‍♀️ Although promising, the review evidence is rated low to very low certainty due to heterogeneity and small sample sizes. In future studies, a comparison of aerobic vs. strength training is mandatory, as resistance training may be equally or more effective (Woldeamanuel & Oliveira, 2022; Wang et al., 2025; Sari Aslani et al., 2022).

✅ Conclusion

Exercise is positioned as a first-line behavioral intervention for migraine prevention. A personalized prescription of 900–950 cumulative minutes of moderate-intensity aerobic exercise over 10–11 weeks is supported by current evidence. Pharmacologic therapies should be used as bridge therapies to enable long-term lifestyle interventions that improve self-efficacy and disease control (Irby et al., 2016).

📚 References

Amin FM, Aristeidou S, Baraldi C, et al. (2018). J Headache Pain, 19:83.

Andrews NE, Strong J, Meredith PJ. (2012). Arch Phys Med Rehabil, 93:2109–2121.

Benatto MT, Bevilaqua-Grossi D, Carvalho GF, et al. (2019). Pain Med, 20:846–851.

Benatto MT, Florencio LL, Bragatto MM, et al. (2022). BMC Neurol, 22:126.

Bentivegna E, Onan D, Martelletti P. (2023). Neurol Ther, 12:337–342.

GBD 2021 Diseases and Injuries Collaborators. (2024). Lancet, 403:2133–2161.

Irby MB, Bond DS, Lipton RB, et al. (2016). Headache, 56:357–369.

La Touche R, Fernández Pérez JJ, Proy Acosta A, et al. (2020). Scand J Med Sci Sports, 30:965–982.

La Touche R, Fierro-Marrero J, Sánchez-Ruiz I, et al. (2023). J Headache Pain, 24:68.

Lanteri-Minet M, Leroux E, Katsarava Z, et al. (2024). J Headache Pain, 25:134.

Nielson WR, Jensen MP, Karsdorp PA, Vlaeyen JWS. (2014). Clin J Pain, 30:639–645.

Ogrezeanu DC, Núñez-Cortés R, Salazar-Méndez J, et al. (2025). Headache.

Ong JC, Taylor HL, Park M, et al. (2018). Headache, 58:1040–1051.

Reina-Varona Á, Madroñero-Miguel B, Fierro-Marrero J, et al. (2024). Headache, 64:873–900.

Sari Aslani P, Hassanpour M, Razi O, et al. (2022). Sport Sci Health, 18:433–443.

Sun L, Li G, Liu F, et al. (2022). Rev Neurol (Paris), 178:370–376.

Varangot-Reille C, Suso-Martí L, Romero-Palau M, et al. (2022). J Pain, 23:1099–1122.

Wang Y, Zhu X, Liang Y. (2025). Am J Lifestyle Med.

Woldeamanuel YW, Cowan RP. (2017). J Neurol Sci, 372:307–315.

Woldeamanuel YW, Oliveira ABD. (2022). J Headache Pain, 23:134.

Woldeamanuel YW, Palesh O, Cowan RP. (2023). Ann Neurol, 94:S152.

Woldeamanuel YW, Fani M, Javaheri E, et al. (2025). Ann Neurol, 98:S205.

Woldeamanuel YW. (2025). Headache, 00:1–4.

Youngstedt SD, Kline CE, Elliott JA, et al. (2016). J Circadian Rhythms, 14:2.

26/10/2025