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onthemove.physio, London (2025)

03/03/2022

Brain Foods - the role of diet in brain performance and health.

The performance of the human brain is based on an interplay between the inherited genotype and external environmental factors, including diet. Food and nutrition, essential in the maintenance of brain performance, also aid in the prevention and treatment of mental disorders. Both the overall composition of the human diet and specific dietary components have been shown to have an impact on brain function in various experimental models and epidemiological studies. This narrative review provides an overview of the role of diet in 5 key areas of brain function related to mental health and performance, including:⁠

🍎 Brain development

🍏 Signalling networks and neurotransmitters in the brain⁠

🍎 Cognition and memory⁠

🍏 The balance between protein formation and degradation⁠

🍎 Deteriorative effects due to chronic inflammatory processes⁠

🍏 The role of diet in epigenetic⁠
regulation of brain physiology

Refereces: Ekstrand et al 2020

03/03/2022

ADDUCTORS STRAIN⚽️🥅

About 60% of groin related injury in football happen with kicking and poor warm up.The Adductor Longus is most commonly injured.

There are 3 degrees of strain:

💥Grade 1- muscles are painful and tender and strength is normal. Recover within 1-2 weeks*.

💥Grade 2- pain is moderate to severe, reduced strength and potentially swelling and mild bruising. Recovery within 2-4 weeks*.

💥Grade 3- muscles fibers are strained to the point of tearing. There are obvious bruises and loss of function/strength. Recover within 4-6 weeks*.

Treatment is predominantly conservative. Criteria-based rehabilitation consists of three phases: return to participation, return to play, and return to performance. A rehab plan should include specific adductor exercises, non-adductor exercises, and progressive running and sports function drills.

03/03/2022

💥STAGE 3 and 4: Loading and Sport Specific Training

-Hip Thrust (aim to achieve your own body weight using barbell and weights in later stages)
-Copenhagen exercise for ADD strengthening
-Weighted SL 1/2 Dead Lifts
-Resisted Lunges

Start your return to sport training using drills and bosu ball exercises (check my previous posts 😉) focusing on speed, agility and balance training.

Hope this small serie on Hip FAI management will facilitate you planning patients rehab.

03/03/2022

💥 STAGE 2: COMPOUND MOVEMENTS

-Crab Walks With Loop Band On Ankles Or Feet
-Resisted Hip ABD
-Psoas March
-Side Plank On Knees With Hip ABD -Side Plank On Feet
-Front Side Plank with hip extension
-Static Lunges
-Step Downs

Progression to follow! 💪

03/03/2022

The goal of any rehabilitation is to restore function to the greatest degree in the shortest time, helping patients return to their function with minimal risk of re-injury. While absolute rest and offloading may relieve symptoms they are associated with negative potentials such as decreased tissue tollerance and increased tissue vulnerability in the future.

Understanding how tissues respond to physical stress and mechanical loading is helpful in achieving a balance between stabilising an injured tissue and avoiding detraining.

Therefore, is essential to go through diffent stages of rehab and progressive load.

This is what I do to work on my hip impingement:

STAGE 1 - LOCAL STABILITY

✔ Side lying hip abduction
✔ Bird Dog
✔ Bridge Variations
✔ Resisted ER in prone, sitting and kneeling
..Progression to follow! 😉

# health # private

03/03/2022

Lateral Hip Pain affects 1.8 out of 1000 patients annually.

The 3 most common differentials are:

💥Great Throated Pain Syndrome : typically presents with lateral hip pain that may radiate down the lateral thigh and buttons and occasionally to the lateral knee. It can be described as aching and intense at times of greater aggravation caused by passive, active and resisted abduction and external rotation. Positive FABER. It's also characterised by the "jump" sign where palpation of the greater trochanter causes the patient to nearly jump off the bed.

💥Hip OA:
Similar site of symptoms, commonly in groin/thigh radiating to buttock or knee. patients tends to present restricted range of motion, morning stiffness, locking and crepitus. Positive FADDIR test.

💥Lumbar Spine Referral:
Dermatome and sclerotome pain pattern will be present, rather than pain over the ITB specifically - L2-L5 segment in particular.

#💪

03/03/2022

OSTEOPOROTIC FRACTURES #💥

Osteoporosis is a characterized by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
It leads to nearly 9 million fractures annually worldwide, and over 300,000 patients present with fragility fractures to hospitals in the UK each year

An osteoporotic fracture is a fragility fracture occurring as a consequence of osteoporosis. Characteristically, fractures occur in the wrist, spine, and hip, but they can also occur in the arm, pelvis, ribs, and other bones.

Risk factors for osteoporosis include:
👩Female s*x.
👵Increasing age.
🩸Menopause.
💊Oral corticosteroids.
🚬Smoking.
🍸Alcohol.
🦴Previous fragility fractures
🔥Rheumatological conditions, such as rheumatoid arthritis and other inflammatory arthropathies.
👨‍👩‍👧‍👦Parental history of hip fracture.
⚖ Body mass index of less than 18.5 kg/m2.

Because of increased bone loss after the menopause in women, and age-related bone loss in both women and men, the prevalence of osteoporosis increases markedly with age, from 2% at 50 years to more than 25% at 80 years in women. As the longevity of the population increases, so will the incidence of osteoporosis and fragility fracture.

👵The patient with the above fracture is a 76yo female who developed sudden onset of mid back pain after standing up from a chair. She also had history of Breast Cancer therefore, she was sent for an MRI scan to rule out bone mets.

03/03/2022

👣Proprioception helps with the planing of movements, sport performance and ultimately helping us avoid an injury.

Proprioception can be affected by the following factors:
🍷Temporary impairment from a compromised state (for example the consumption of alcohol).
👵Age-related changes also affect proprioception. The risk of proprioception loss increases as we age due to a combination of natural age-related changes to the nerves, joints, and muscles.
🧠Injuries or medical conditions that affect the neuromuscular system which can cause long-term or permanent proprioception impairment.

Proprioception impairments have been noted among the following conditions:
🧠Brain injuries; multiple sclerosis (MS);stroke; Parkinson’s disease; Huntington’s disease; ALS (amyotrophic lateral sclerosis)
🫀Health conditions: herniated disc; arthritis; autism spectrum disorder (ASD); diabetes; peripheral neuropathy.
🦿Post-surgery: joint replacement surgery, such as hip replacement or knee replacement
🦴 MSK conditions: ankle sprains, ACL injuries, shoulder dislocations and tendinopathies, whiplash associated disorders

No matter the underlying cause of a proprioceptive deficit, clinicians can rehabilitate patients with tasks and activities to improve motor skills, strength,balance and coordination.
Retraining of a somatosensory function includes any interventions that addresses the remediation of the somatosensory modalities. Intervention methods include:

📚 Education
🔄 Repetitive practice and feedback in detecting, localising, discriminating, or recognising different sensory stimuli, pressure, or objects; PRACTICE, PRACTICE, PRACTICE!
🤸‍♀️Proprioceptive training
🤸Balance training (unstable surfaces, unpredictable situations with an external stimuli)
🤹‍♂️Dual task training (in the absence of visual feedback for example)
👐 Somatosensory stimulation

A 2019 review on sensory retraining of the leg following a stroke, concluded that interventions used for retraining leg somatosensory impairment significantly improved somatosensory function and balance, but not gait suggesting a specificity of training effect.

Fenny FS Chia et al 2019

03/03/2022

Ultrasonography (US) is an inexpensive, convenient, and effective tool that can be used to evaluate different conditions. It does not expose the patient to harmful radiatio to evaluate the musculoskeletal system dynamically. Additionally, US is not subject to metal artifacts when evaluating patients with previously placed hardware. Over the years, US has been found to be reliable and accurate for diagnosing rotator cuff tears.

In 2008, Fotiadou et al. evaluated the accuracy of US in detecting full-thickness RCTs in 96 patients with clinically suspected rotator cuff pathology. The authors found that in 57 patients with arthroscopically confirmed full-thickness RCTs, US was 98% accurate in identifying the tears.

Similarly, Moosmayer et al. 2009 reported that US correctly identified full-thickness RCTs, confirmed by intraoperative findings. The accuracy of US in diagnosing RCTs has also been found to be similar to that of MRI.

In 2010, Rutten et al. demonstrated US and MRI to be comparably accurate in diagnosing full-thickness RCTs (94% and 94%, respectively).

However, The sensitivity and specificity of US for diagnosing partial-thickness RCTs has been found to be lower than for full-thickness RCTs.

For evaluating the characteristics of RCTs, US may be less accurate than MRI. Although US has shown good accuracy in determining whether a tear is present, MRI may be more suitable for determining tear size, tendon retraction, muscle atrophy, and the degree of fatty infiltration. In evaluating patients with recurrent shoulder pain after a rotator cuff repair, US has been found to be an accurate tool in diagnosing re-tears, while limiting interference from orthopedic hardware.

Kelechi R. Okoroha et al 2019

Here with and looking at my Rotator cuff. So far, so good. 💪😉

03/03/2022

Patellofemoral Pain Syndrome.

PFPS is a common condition causing knee pain in both athletes and non-athletes, which can affect both men and women of all ages. PFPS occurs due to overloading of the front of the knee, behind the kneecap. It is more common in people who take part in sport, particularly those whose sports involve running or jumping, such as tennis, football or badminton. Historically it has been referred to as anterior knee pain but this is misleading, pain can be felt in all aspects of the knee (including the popliteal fossa). The differential diagnosis of PFPS include Chondromalacia Patellae and Patellar Tendinopathy. Both are not considered to be under the umbrella term of PFPS though patients will complain of similar symptoms.

🔹️Causes: PFPS most often occurs without an injury to the knee, but can
sometimes be a result of an injury, such as a fall onto the knee. If you have not injured your knee, it may be difficult to find one specific cause of your PFPS, as it usually occurs due to a combination of factors. It is often associated with the start of a new activity, an increase in the intensity and/or frequency of an existing activity, or following a period of reduced activity that leads to weakening of the muscles.

🔹️Symptoms: Pain is the main symptom of PFPS. It can be felt anywhere around the kneecap and even at the back of the knee. It can
affect one or both knees.There are a variety of other symptoms that people with PFPS experience, including:
• clicking or clunking
• mild swelling
• a feeling of instability (like your knee might give way)
• pain when squatting or coming downstairs
• discomfort or pain when sitting for long periods

🔹️Treatment: A structured exercise programme is the best treatment for your PFPS. Research shows this to be the best therapy
• Strengthening of the Quadriceps is a key in the rehabilitation program.
•Closed kinetic chain (CKC) and Open kinetic chain (OKC) exercises
•Vastus Medialis Obliquus (VMO)
•Hip abductors and lateral rotators training
•Prioceptive training
As well as Manual Therapy, Patellar taping, Orthotics and Education.

#💪

onthemove.physio

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