Metro Physical Therapy

01/07/2025

01/07/2025

01/05/2025

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

📣 today 🥇 4

tool: How lesions to peripheral nerves or spinal nerve roots present with sensory and/or motor deficits in the lower limb 💡

📘 Lyon, S. (2022). Pictorial review of lesion localization for patients with stroke, upper limb and lower limb pathology. Neurology Education, 1(1), e200012. https://doi.org/10.1212/NE9.0000000000200012

📌 References

1. Desai SS, Cohen-Levy WB. Anatomy, bony pelvis and lower limb, tibial nerve [updated 2021 Aug 11]. In: StatPearls [Internet]. StatPearls Publishing, 2022. ncbi.nlm.nih.gov/books/NBK537028/.

2. Lung K, Lui F. Anatomy, abdomen and pelvis, superior gluteal nerve [updated 2021 Aug 11]. In: StatPearls [Internet]. StatPearls Publishing, 2022. ncbi.nlm.nih.gov/books/NBK535408/.

05/31/2024

05/29/2024

Water massage. Relax, relax and relax.

04/22/2024

Students have left Flint Community Schools in droves while more buildings sit vacant - But school officials say they have a plan for turnaround,.

03/04/2024

Different approach to core training

02/17/2024

02/16/2024

A Diagnostic Scoring System for Sacroiliac Joint (SIJ) Pain Originating from the Posterior Ligament 💡

👉 According to the a brand-new german study summarizing the recommendations from a new clinical guideline published by the German Spine Society, there is conflicting evidence as to whether the combination of multiple clinical provocation tests (≥3 tests) can predict outcome of intra-articular SI joint injection. (Quality of evidence: very low). (https://journals.sagepub.com/doi/10.1177/21925682241230922)

🤷One - among other -reasons for this low diagnostic accuracy might be the non-consideration of pain arising from the ligamentous apparatus surrounding the SI joint (https://pubmed.ncbi.nlm.nih.gov/19101212/, https://pubmed.ncbi.nlm.nih.gov/18259783/)

👉 In 2016, Kurosawa and colleagues developed a diagnostic scoring system to differentiate sacroiliac joint (SIJ) pain originating from the posterior ligament (criteria: Pain improved by 70% after a periarticular SIJ injection. Other types of injections were not effective) from lumbar disorders (lumbar disc herniation and lumbar spinal canal stenosis, criteria: only surgical cases, physical and MRI findings; significant improvement 3 months after surgery). (https://pubmed.ncbi.nlm.nih.gov/28204687/)

The biggest differentiators between lumbar spine disorders and SIJ pain originating from the posterior ligament were six items as follows:
1️⃣ the posterior superior iliac spine (PSIS) area indicated using the one-finger test,
2️⃣ groin pain,
3️⃣ pain while sitting on a chair with-out back rest,
4️⃣ SIJ positive shear test,
5️⃣ PSIS tenderness, and
6️⃣ sacrotuberous ligament (STL) tenderness (s. figure).

👉These six items are used as the SIJ scoring system. The sum of the risk scores for each patient ranged from 0 to 9. It has a sensitivity of 90.3% and specificity of 86.4% for a positivity cutoff point of 4 or higher.

⭕ But CAVE: Additional studies are needed to determine if this scoring system can distinguish SIJ related pain from non-specific lower back and buttocks pain and from systemic pain syndrome, such as fibromyalgia.

📸 Illustration: https://link.springer.com/chapter/10.1007/978-981-33-6204-8_6

01/17/2024

Phases of Tendon Healing 🦶

https://link.springer.com/chapter/10.1007/978-3-662-54184-5_4?fbclid=IwAR29o-3gz5NQoG9mUK_YrN7zFf_jPJsjRbcer8XAj25jbBuscyp9jMaAN1w

🦶 The biologic cascade that modulates tendon healing is divided in overlapping phases, each governed by different cell types (https://pubmed.ncbi.nlm.nih.gov/15634833/, https://pubmed.ncbi.nlm.nih.gov/24057354/.

1⃣ The inflammatory phase (a) is initiated by the traumatic event surrounding tendon injury, precipitating the hematoma and the agglomeration of platelets, releasing a slew of chemotaxic molecules, cytokines, and growth factors.

👉 The phagocytic cells, monocytes, neutrophils, and microphages, migrate to the site of injury via dilated vessels and begin the process of breaking down the blood clot and extracellular matrix. The process of angiogenesis is introduced by macrophages where a new network of vasculature matures in the healing tissue (https://pubmed.ncbi.nlm.nih.gov/1383229/).

👉 The ECM is notably stabilized by the increasing amount of collagen type III, which are not yet aligned in parallel. The inflammatory stage lasts between 3 to 7 days following tendon injury. The amount of collagen will steadily increase during the first 5 days where the tendon callus will reach its largest size (https://pubmed.ncbi.nlm.nih.gov/21822105/)

2⃣ The proliferative phase (b) follows with an increasing amount of intrinsic fibroblast in the ECM. These cells emerge from the endotenon and epitenon and play a role in resorbing and producing new collagen (https://pubmed.ncbi.nlm.nih.gov/24057354/). At this stage, the immature healing ECM is still stabilized by a soaring amount of type III collagen, and this phase lasts for about 6 weeks.

3⃣ During the remodeling phase (b), the biomechanical strength of the tendon is at its greatest. The collagen is reorganized in a longitudinal, parallel fashion, while the collagen type III is replaced by collagen type I. The ECM will continue to mature for the next year with a rising amount of longitu-dinal and cross-linked collagen, while the callus volume of the tendon will decrease and the tendon biomechanical strength will continue to improve (https://pubmed.ncbi.nlm.nih.gov/21368094/).

📌 The healed tendon is biomechanically weaker than the uninjured tendon, with less cross-linking and smaller diameter collagen, and is more susceptible to reinjury. (https://pubmed.ncbi.nlm.nih.gov/10810761/). In a mice model, Dyment et al. (https://pubmed.ncbi.nlm.nih.gov/21698662/) demonstrated that the healed tendon regains 63% of its original strength after an 8-week time.

Illustration: https://link.springer.com/chapter/10.1007/978-3-662-54184-5_4?fbclid=IwAR29o-3gz5NQoG9mUK_YrN7zFf_jPJsjRbcer8XAj25jbBuscyp9jMaAN1w