Cabinet Physionrj // Physiothérapie

22/01/2025

03/01/2025

🎊🌲Between the years, we traditionally announce our "Best-of series" of the most influential posts of 2024 on FB.

📣 today 🥇 7

C5‑T1 radicular pain without arm pain 💡

👉 Lower cervical levels (C4–C5, C5–C6, C6–C7, C7–T1) are the most common sites for disc herniations and spondylosis. Given that all the roots exiting at these levels form the brachial plexus, it is common to have radiating pain down the arm or numbness and weakness in the upper extremities. Patients with one of these painful radiculopathies might have neck pain, arm pain or both. When both are present, the identification of the pathologic level should be easier since they tend to follow dermatomal and myotomal distribution of symptoms.

🤷 In cases of isolated neck pain, the diagnosis becomes much more challenging because of the lack of a typical pain distribution. Neck pain is a vast entity and patients tend to label it “neck pain” even when the pain is located in-between the scapulae or near the shoulder and axilla.

📘 According to a recent publication by Redaelli and colleagues, there are typical pain locations which correlate with a specific root in the majority of cases (https://pubmed.ncbi.nlm.nih.gov/38191741/, s. original study of Tanaka et al. https://pubmed.ncbi.nlm.nih.gov/16924193/)

👉 C5 nerve root impingement causes pain on top of the shoulder radiating to the deltoid.

👉 C6 causes pain radiating to the supraspinous fossa.

👉 C7 causes pain medial to the spine of the scapula and can also cause pain in the axilla and the pectoral region, just below the clavicle.

👉 C8 causes pain along the medial border of the scapula, below the spine of the scapula and the pain can also radiate into the anterior chest but lower in the axilla than with C7 radiculopathy.

👉 Finally, T1 typically causes pain medial to the tip of the scapula, lower in the axilla than with C7 or 8 and into the lower anterior chest and is frequently described as a stabbing sensation . These pains, when present on the left side, can be mistaken for angina and have been called “cervical angina” (https://pubmed.ncbi.nlm.nih.gov/33108845/).

📸 Typical patterns of pain in (a) C5; (b) C6, (c) C7; (d) C8 and (e) T1 radiculopathies

22/12/2024

Hot off the press 🔥

Do physical or imaging changes explain the effectiveness of progressive tendon loading exercises? A causal mediation analysis of athletes with patellar tendinopathy

👉 Patellar tendinopathy (PT) is a highly prevalent injury in jumping athletes, (https://pubmed.ncbi.nlm.nih.gov/37347023/) leading to longstanding pain, decreased work productivity, and impaired sports performance (https://pubmed.ncbi.nlm.nih.gov/28391723/).

👉 Therapeutic exercises remain the cornerstone treatment for PT (https://pubmed.ncbi.nlm.nih.gov/37553459/, https://pubmed.ncbi.nlm.nih.gov/33414454/).However, it still needs to be determined whether the effects of exercise therapies are mediated by the improvement in physical properties (e.g., muscle strength). Additionally, from a clinical perspective, structural normalization, such as reduction in tendon thickening (https://pubmed.ncbi.nlm.nih.gov/19793213/) and intratendinous neovascularization (https://pubmed.ncbi.nlm.nih.gov/29952842/) is thought to be one of the main reasons for the effectiveness of exercise therapy. Nevertheless, evidence on this underlying mechanism by which the PTLE may exert its effects also remains scarce.

📘 A brand-new paper by Deng and colleagues (https://www.sciencedirect.com/science/article/pii/S1440244024005978) examines whether the effectiveness of progressive tendon loading exercises (PTLE) for treating patellar tendinopathy is mediated through changes in physical or imaging properties. A causal mediation analysis was conducted based on a randomized clinical trial comparing PTLE with eccentric exercise therapy (EET) by Breda et al. (https://pubmed.ncbi.nlm.nih.gov/33219115/). Causal mediation analyses can offer a robust methodological framework to elucidate how an intervention works by identifying potential targets or mediators for an intervention that could affect the outcome (https://pubmed.ncbi.nlm.nih.gov/37468141/, https://pubmed.ncbi.nlm.nih.gov/34546296/).

✅ Study Objectives

The primary goal was to determine if the beneficial effects of PTLE on pain-related disability and pain intensity were mediated by:

1. Physical changes (e.g., quadriceps muscle strength, ankle dorsiflexion range, jumping performance).

2.Imaging properties (e.g., tendon thickness, degree of neovascularization).

✅ Methodology

• Participants: Athletes aged 18–35 years diagnosed with patellar tendinopathy.

• Study Design: A secondary analysis of data from a previous randomized controlled trial (JUMPER study), conducted over 24 weeks.

• Outcome Measures:

o Victorian Institute of Sports Assessment–Patella (VISA-P) score.
o Pain intensity measured by Visual Analogue Scale during single-leg decline squat (VAS-SLDS).

• Mediators Examined: Maximal isometric quadriceps muscle strength, ankle dorsiflexion range, jumping performance, ultrasonographic tendon thickness (mm) and tendon neovascularization (low / high) using power Doppler.

🏋️‍♂️ Intervention Programs (s. picture below)

1. Progressive Tendon Loading Exercises (PTLE):

o Stages: Included isometric, isotonic, energy storage, and sport-specific exercises.

o Isometric Phase: Daily exercises with a 60° knee flexion and 70% maximal voluntary contraction (5 repetitions of a 45-second hold).

o Isotonic Phase: Performed every second day, starting with a limited range of motion (10–60° knee flexion) and progressing to full extension with increasing resistance (15RM to 6RM).

o Energy Storage and Sport-Specific Phase: Focused on jump and landing tasks, tailored to the athlete’s sport.

o Monitoring: Pain response was tracked using VAS-SLDS to ensure tolerable loading.

2. Eccentric Exercise Therapy (EET):

o Stage 1: Pain-provoking single-leg squats on a decline board (VAS ≥ 5/10).

o Stage 2: Transition to sport-specific exercises.
Both programs were unsupervised and spanned 24 weeks.

🔑 Key Findings

1. The beneficial effects of PTLE on improving VISA-P scores and reducing pain (VAS-SLDS) were significant compared to EET.

2. However, these improvements were not mediated by the selected physical or imaging factors.

o The indirect effects of all mediators were negligible, and 95% confidence intervals included zero.

o Factors like muscle strength, ankle dorsiflexion, jumping performance, tendon thickness, and neovascularization did not explain the improvements.

💡 Conclusions and Recommendations

• The study highlights that the mechanisms behind PTLE’s effectiveness are not explained by changes in the selected physical or imaging properties. It underscores the need for broader exploration into the mechanisms of exercise therapy beyond conventional physical and imaging factors.

• Implications for Practice: Healthcare providers should explore alternative mechanisms, possibly psychological (i.e. pain catastrophizing, and pain self-efficacy, https://pubmed.ncbi.nlm.nih.gov/36306175/) or neuromuscular adaptations, i.e. reduction in cortical inhibition (https://pubmed.ncbi.nlm.nih.gov/25979840/), for optimizing exercise interventions in patellar tendinopathy.

05/11/2024

Discours à l’UCI Aigle par Antoine et Bjørn concernant la santé des cyclistes, avec la perspective de la physiothérapie pour les coachs mondiaux dans le cyclisme 🙌

Nous avons parlé des blessures dans le cyclisme, qu’elles soient aiguës ou chroniques. Nous avons partagé nos perspectives sur le renforcement musculaire et ses effets sur la prévention, la performance et la santé générale, y compris les aspects hormonaux comme le « female and male athlete triad ».

Ensuite, nous avons abordé le sujet des commotions dans le cyclisme, puis enfin la biomécanique et l’évolution du bike fitting (étude posturale pour le vélo) avec un point de vue physiothérapeutique.

Les trois heures sont passées très vite en excellente compagnie, en collaboration avec les coachs mondiaux venus suivre leur « Certificate of Advanced Studies » (CAS) en cyclisme, organisé par l’Université de Lausanne.

Un grand merci à Raphaël Faiss et l’université de Lausanne pour l’invitation et le temps de donner notre point de vue physiothérapeutique 🙏