FisioRehab

13/05/2025

💡 We conclude that each injection treatment (platelet-rich plasma, corticosteroid, hyaluronic acid) provides good long-term clinical outcomes, but not better than placebo. A corticosteroid injection might be regarded as a more effective treatment only within the first month post-injection.

👉🏻 This is from the new paper "Comparative Efficacy of Platelet-Rich Plasma, Corticosteroid, Hyaluronic Acid, and Placebo (Saline) Injections in Patients with Lateral Elbow Tendinopathy: A Randomized Controlled Trial" by Dejnek et al 2025

📚 Do you struggle to stay on top of new research?

😫 You're not alone!

✅ Physio Network’s Research Reviews make it easy for you to keep up to date and provide better care for your patients. Try it for free for 7 days now.

🔗 https://physio.network/7dayfreetrial

—---------

Disclaimer: Sharing a study is NOT an endorsement. You should read the original research yourself and be critical.

04/05/2025

Even with all the finest parameters.

11/02/2025

Die Pathophysiologie des radikulären Schmerzes 👉💥

Der radikuläre Schmerz ist eine Schmerzform, die durch eine Reizung der sensorischen Wurzel oder des Spinalganglions (DRG) eines Spinalnervs verursacht wird.

Radikuläre Schmerzen sind keine nozizeptiven Schmerzen, da die neurale Aktivität von der Hinterwurzel ausgeht und nicht von der Stimulation peripherer Nervenendigungen. Er ist daher nicht gleichbedeutend mit somatischen Schmerzen oder somatisch übertragenen Schmerzen und muss von diesen unterschieden werden.

Auch ist der radikuläre Schmerz nicht gleichbedeutend mit der Radikulopathie. Während der radikuläre Schmerz durch die Erzeugung von ektopischen Impulsen verursacht wird, wird die Radikulopathie durch die Blockierung der Reizleitung entlang der sensorischen und motorischen Axone verursacht und ist durch den Verlust der Nervenfunktion gekennzeichnet.

Dies untermauert die häufige klinische Beobachtung, dass trotz einer einzigen Pathologieebene mehrere Nervenwurzeln betroffen sind.

Obwohl die Ausbreitung des radikulären afferenten Signals ein komplexes Phänomen ist, ist eine bestimmte Abfolge in der Entzündungskaskade erkennbar.

Beginnend mit dem degenerierenden Bandscheibe werden proinflammatorische Zytokine am Ort der Läsion und in einiger Entfernung durch die Wallersche Degeneration (WD) freigesetzt. Während der Degeneration des distalen Axons durch WD wird das Zytokin TNF-α von Schwann-Zellen, Endothelzellen, Mastzellen und ansässigen Makrophagen an der Stelle der Nervenverletzung freigesetzt.

Dies führt zu ektopischen Impulsen im Hinterwurzelganglion (DRG), was zu einer erhöhten Freisetzung von Neurotrophinen und einer ektopischen Reizbildung im Hinterhorn und schließlich zu einer zentralen Sensibilisierung führt.

Den gesamten Artikel jetzt auf physiomeets.science 🤩🥸



Illustration: https://pubmed.ncbi.nlm.nih.gov/24553305/

01/02/2025

Auswirkungen von Dehnungs- und Kräftigungsübungen auf die Haltung 🧐🫵

Das Dehnen von Muskeln mit eingeschränktem Bewegungsumfang ist eine der beliebtesten Strategien, um muskuläre Dysbalancen und Beeinträchtigungen der Haltung zu beheben.

Bereits 1997 wurden sie von Spring et al. als Goldstandard der Behandlung von Haltungproblemen empfohlen. Überzeugende Beweise für diese Empfehlung fehlen bis heute.

Eine Meta-Analyse von Warneke und Kollegen untersuchte die Wirkung von Dehnungs- und Kräftigungsübungen auf die Haltung der Wirbelsäule und des Beckens (z. B. Beckenkippung, Lendenlordose, Brustwirbelsäulenkyphose, Kopfneigung) bei gesunden Personen.

Weder das akute (d = 0,01, p = 0,97) noch das chronische Dehnen (d = -0,19, p = 0,16) hatte einen Einfluss auf die Körperhaltung

Zusammenfassend lässt sich sagen, dass die gängige Empfehlung, verspannte oder verkürzte Skelettmuskeln zu dehnen, um das muskuläre Ungleichgewicht und die Körperhaltung zu verbessern, nicht wissenschaftlich belegt ist (mäßige Sicherheit).

Im Gegensatz dazu unterstreicht diese Übersichtsarbeit die Rolle der Kräftigung schwacher Antagonisten, die jedoch nur in der Brust- und Halswirbelsäule, nicht aber in der Lendenwirbelsäule wirksam war (mäßige Sicherheit).

Den gesamten Artikel jetzt auf physiomeets.science 🤩🥸

11/01/2025

12/12/2024

Arc Sign 🦶🔍

Das Arc Sign ist ein klinischer Test zur Diagnose von Achillessehnentendinopathien.

Durchführung:

👉 In Bauchlage wird der Fuß so platziert, dass die Malleolen überhängend an der Bankkante liegen. Nun wird zunächst die Achillessehne palpiert und dabei untersucht, ob sie geschwollene Stellen aufweist.
👉 Wenn sich geschwollene Bereiche palpieren lassen, wird der Patient nun zusätzlich aufgefordert in Plantarflexion und Dorsalextension zu aktivieren.
👉 Wenn sich dabei der geschwollene Abschnitt mitbewegt, weist dies auf eine Achillessehnentendinopathie hin.
👉 Ein negativer Test liegt vor, wenn sich die Schwellung während der Bewegung mit der Achillessehne NICHT verschiebt.

Warum das Arc Sign wichtig ist:
✅ Spezifisch und präzise: Mit einer Spezifizität von 88 % 🩺 eignet sich das Arc Sign besonders gut, um eine Achillessehnentendinopathie zu bestätigen.
✅ Schnell und kosteneffizient: Der Test erfordert keine aufwändige Technik und kann direkt in der Praxis durchgeführt werden.
✅ Kombinierbar: In Kombination mit anderen Tests wie dem Royal London Hospital Test wird die diagnostische Genauigkeit noch erhöht.

Limitationen:
⚠️ Mit einer Sensitivität von 42 % sollte der Test nicht allein genutzt werden, um eine Achillessehnentendinopathie auszuschließen.
⚠️ Die Interrater-Reliabilität (0,77) zeigt gute Übereinstimmung zwischen Untersuchern, ist aber optimierbar.

Lerne jetzt mehr über die klinische Diagnostik der Achillessehne in unserer Web-App! 🏋️‍♂️

12/12/2024

Just published in NEJM 🔥

Degenerative Rotator-Cuff Disorders

📘 https://www.nejm.org/doi/full/10.1056/NEJMcp1909797

👉 Rotator-cuff disorder encompasses a spectrum of tendon degeneration, including (in order of increasing severity) rotator-cuff tendinopathy, partial-thickness tears, full-thickness tears, and rotator-cuff–tear arthropathy (a chronic rotator-cuff tear that leads to superior migration of the humeral head and arthritis over time). (https://pubmed.ncbi.nlm.nih.gov/39602631/, https://pubmed.ncbi.nlm.nih.gov/38332156/)

👉The rotator cuff comprises four tendons: supraspinatus (assists with abduction of the arm), infraspinatus (assists with external rotation of the arm), subscapularis (assists with internal rotation), and teres minor (assists with external rotation. (figure from https://pubmed.ncbi.nlm.nih.gov/39602631/)

👫 The incidence of surgery for rotator-cuff disorder, the most common cause of shoulder pain, across U.S. states ranges from 12 to 185 per 100,000 (https://pubmed.ncbi.nlm.nih.gov/31825507/).

🤕 Tears of the rotator cuff can result from substantial traumatic injury (e.g., a motor vehicle accident, assault, a blow from a fast-moving projectile, or a fall from greater than standing height, https://pubmed.ncbi.nlm.nih.gov/31397866/) or can occur insidiously (atraumatic or degenerative rotator-cuff tear).

👴 Age above 40 years is by far the strongest risk factor for degenerative tears (https://pubmed.ncbi.nlm.nih.gov/30335631/), with increasing prevalence with advancing age (https://pubmed.ncbi.nlm.nih.gov/25441568/): 1/5 in the 50s and 1/3 in the 80s. It is interesting to know that the prevalence of asymptomatic tear also increased with age: 1/2 in the 50s and 2/3 in those older than 60s, (https://pmc.ncbi.nlm.nih.gov/articles/PMC3768248/).

🫀Several disease conditions have been postulated to have a role in the development and progression of rotator cuff disease, and subsequently, may influence healing rates following surgical repair. These conditions include type 2 diabetes mellitus, hyperlipidaemia, s*x hormone deficiency, obesity, smoking, hypertension, gout, connective tissue diseases and depression (https://pubmed.ncbi.nlm.nih.gov/34660827/, https://pubmed.ncbi.nlm.nih.gov/34424222/, https://pubmed.ncbi.nlm.nih.gov/30808669/, https://pubmed.ncbi.nlm.nih.gov/27600100/, https://pubmed.ncbi.nlm.nih.gov/28486089/, https://pubmed.ncbi.nlm.nih.gov/36252786/)

🫀 In natural-history studies of degenerative rotator-cuff tears, at 5 years of follow-up, the tears were enlarged in half the persons with full-thickness tears (https://pubmed.ncbi.nlm.nih.gov/31627964/) and the tears had progressed to full thickness in approximately one third of those with partial-thickness tears (https://pubmed.ncbi.nlm.nih.gov/26589385/). But there is a lack of correlation between patient symptoms and the size and thickness of the tear on imaging (https://pubmed.ncbi.nlm.nih.gov/24875019/).

📶Full-thickness tears are classified according to Codman classification (https://pubmed.ncbi.nlm.nih.gov/34012769/, tear size in anterior to posterior direction) as:

• Small: 0–1 cm
• Medium: 1–3 cm
• Large: 3–5 cm
• Massive: >5 cm

Although there is expert consensus that traumatic rotator-cuff tears should be treated operatively timely soon after the diagnosis is made to avoid long-term consequences such as rotator-cuff muscle degradation and tendon retraction (https://pubmed.ncbi.nlm.nih.gov/24292934/), most patients with symptomatic degenerative rotator cuff disorders can be treated nonoperatively.

🏋️‍♂️ Nonoperative treatment using an exercise based protocol is effective for treating atraumatic full-thickness rotator cuff tears in approximately 75% of patients followed up for 2 years (https://pubmed.ncbi.nlm.nih.gov/23540577/), 5 years (https://www.jshoulderelbow.org/article/S1058-2746(18)30852-8/abstract) and even 10 years (https://www.sciencedirect.com/science/article/pii/S2666638324004778). Compared with natural history, patients who performed physical therapy within the first 3 months had statistically significant improvements in pain and function as measured by the SPADI score at 3 months (https://pubmed.ncbi.nlm.nih.gov/30553798/).

😷 Consensus is lacking regarding indications for surgical intervention. Observational data support that surgery is associated with better function and reduced pain in patients who are younger (e.g.,

28/11/2024

Pubblicato sulla rivista Archives of Physiotherapy l’editoriale a cura di Marco Barbero, Responsabile del 2rLab, dal titolo “A Decade of Growth: Preserving the Original Purpose of Physiotherapy Research”. L'articolo sottolinea l'importanza di mantenere elevati standard qualitativi nella ricerca scientifica, per promuovere una pratica clinica sempre più efficace ed efficiente.

Per maggiori informazioni: https://www.supsi.ch/it/archives-of-physiotherapy-nuovo-articolo-a-cura-di-marco-barbero

25/10/2024

https://www.tutti.ch/go/vi/70192218

Nel contesto di uno studio di riabilitazione affittiamo sala di trattamento, finestrata, indipendente. Lo studio, al primopiano, ubicato presso ...

03/10/2024

https://www.facebook.com/share/p/qJPhs7eFwh5qQFdX/?mibextid=WC7FNe

19/07/2024

Tendon structure in health and disease 🦶

💡 Summary based on Scott (2015, https://pubmed.ncbi.nlm.nih.gov/26390273/)

👉 The classic description of the tensile load-bearing region of tendon includes 3 main components:

1️⃣ type I collagen fibers (70–80% of the dry weight of the tendon and represents almost 95% of the total collagen. Other collagens include collagen types II, III, IV, V, VI, IX, X, XII, and XIV) longitudinally oriented;
2️⃣ a well-hydrated, noncollagenous extracellular matrix (rich in glycosaminoglycans); and

3️⃣ cells. The predominant cell population in healthy tendon is traditionally categorized as collagen-producing fibroblasts, responsible for the synthesis of the collagen fibers and extracellular matrix. (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2505234/ https://pubmed.ncbi.nlm.nih.gov/26390273/)

👉 Prominent features of chronic tendinopathy histopathology (FIGURE 1) include the following:

▶︎ a disorganization of collagen fibers,
▶︎ an increase in the number of vessels and sensory nerves, (https://pubmed.ncbi.nlm.nih.gov/17604979/, https://pubmed.ncbi.nlm.nih.gov/23609815/, https://pubmed.ncbi.nlm.nih.gov/15958764/)
▶︎ an increase in the hydrated components of the extracellular matrix, (https://research.monash.edu/en/publications/human-tendon-overuse-pathology-histopathologic-and-biochemical-fi)
▶︎ a breakdown of tissue (tendon/endotendon/paratendon) organization, (https://search.worldcat.org/de/title/human-tendons-anatomy-physiology-and-pathology/oclc/35103208) and
▶︎ haphazardly arranged proliferation of smaller, type III collagen fibers. (https://pubmed.ncbi.nlm.nih.gov/24571576/, https://pubmed.ncbi.nlm.nih.gov/12867575/)

👉There are frequently areas of cell death (eg, hypocellularity, https://pubmed.ncbi.nlm.nih.gov/16567784/) or, alternatively, of fibroblast reaction (eg, hypercellularity with rounded tenocytes and adhesions, https://pubmed.ncbi.nlm.nih.gov/3071152/).

📌 Indeed, it is typical to find both degenerative and reactive changes within the same biopsy, even in very severe, long-standing cases. It is also postulated that there is a resident population of fibroblast-like cells within tendons that, after injury, can differentiate into several lineages (osteoblast, chondrocyte, adipocyte, tenocyte), leading to metaplasia (eg, bony, cartilaginous, or adipocyte transformation, https://pubmed.ncbi.nlm.nih.gov/12837285/). Metaplasia is not usually discernible on imaging, unless the ossification is advanced, but is frequently encountered in biopsy specimens (reviewed in Lui, https://pubmed.ncbi.nlm.nih.gov/23671126/).

👉 The implication is that patients with chronic symptoms and evidence of structural change on imaging typically have profound underlying abnormalities that will not be quickly resolved, and that are associated with the loss of tendon function.

✅ At the cellular level, several authors have reported increased numbers of leukocytes (especially macrophages and mast cells) in chronically painful tendons (rotator cuff, patellar and Achilles tendons, https://pubmed.ncbi.nlm.nih.gov/24096896/, https://pubmed.ncbi.nlm.nih.gov/25081311/, https://pubmed.ncbi.nlm.nih.gov/20595553/, https://pubmed.ncbi.nlm.nih.gov/15958764/) as well as increased numbers of vascular cells (endothelial and smooth muscle, https://pubmed.ncbi.nlm.nih.gov/18067512/).

🔥 However, compared to the more immune-driven pathologies, such as rheumatoid arthritis, with measurable systemic inflammation, the number of leukocytes is small. In other words, there is indeed an inflammatory reaction within chronically painful tendinopathy, but to a lesser extent than that of immune-driven rheumatological disorders.

✅ Macrophages with accumulations of hemosiderin in their cytoplasm are more prevalent in tendinopathic than in normal tendon (https://pubmed.ncbi.nlm.nih.gov/9174456/); hemosiderin is an indicator of prior injury that resulted in an activation of the innate immune response. At a biochemical level, the cells in painful tendons produce increased levels of glycosaminoglycan and inflammatory mediators such as substance P and prostaglandin E2 (PGE2, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5714045/, https://pubmed.ncbi.nlm.nih.gov/24563019/, https://pubmed.ncbi.nlm.nih.gov/12072760/, https://pubmed.ncbi.nlm.nih.gov/9820287/).

✅ Substance P is released by peripheral sensory nerves (https://pubmed.ncbi.nlm.nih.gov/21678472/) and repetitively stretched tendon fibroblasts (https://pubmed.ncbi.nlm.nih.gov/21625050/, https://pubmed.ncbi.nlm.nih.gov/22069500/), and activates local mast cells that may contribute to pain and fibrosis (https://pubmed.ncbi.nlm.nih.gov/22343473/). Tendon cells derived from tendinopathic tendon produce more PGE2 than cells from healthy individuals, indicating a chronic upregulation (https://pubmed.ncbi.nlm.nih.gov/12072760/).

📣 Taken together, the evidence suggests that during the rehabilitation process, any worsening of edema, morning stiffness, or delayed-onset pain should be closely monitored and controlled, as inflammation could drive the tendon further down the pathological path. An early return to sport before adequate tendon load-bearing capacity is a significant risk factor for recurrence of Achilles tendinopathy (https://pubmed.ncbi.nlm.nih.gov/23770660/).

📷 Illustration:
https://link.springer.com/chapter/10.1007/978-3-031-33537-2_5