Physio Research Quests | By Research Raconteur

How can you prevent patients from getting stress fractures? A 2021 study uses the tactic of training around your bone physiology. A 2021 study by Kardouni and colleagues looked at the bone damage that occurs in new runners over the first 12 weeks after starting a new program. We took a Research Quest to reveal the exact steps of this weekly plan. Let’s dive in.  Reference: Joseph R. Kardouni, PhD; Craig J. McKinnon, PhD; Kathryn M. Taylor, ScD; Julie M. Hughes, PhD. Timing of Stress Fractures in Soldiers During the First 6 Career Months: A Retrospective Cohort Study. J Athl Train (2021) 56 (12): 1278–1284.

What is the link between hypermobility, ACL injuries and doughnuts? Is there a way to tailor rehab specifically for these patients? Hypermobile patients were 14% more likely to get a second ACL injury. Put another way, this is 1 out of every 7 hypermobile ACL patients. They are also 5 and a half times more likely to get a second ACL injury within 12 months of their first one. We went on a Research Quest to discover a 6-step system for protecting hypermobile patients from ACL injury. Let’s dive in. Reference: Zsidai B, Piussi R, Thomeé R, Sundemo D, Musahl V, Samuelsson K, Hamrin Senorski E. Generalised joint hypermobility leads to increased odds of sustaining a second ACL injury within 12 months of return to sport after ACL reconstruction. Br J Sports Med. 2023 Aug;57(15):972-978. doi: 10.1136/bjsports-2022-106183. Epub 2023 May 16. PMID: 37192830; PMCID: PMC10423474.

Have you ever heard of micro-stretching? The theory is that most stretching is a complete waste of time. In 2009, Wyon and colleagues conducted a study comparing two stretching protocols over six weeks. We went on a Research Quest to uncover whether this micro form of stretching could get better results. Let’s dive in. Reference: Wyon M, Felton L, Galloway S. A comparison of two stretching modalities on lower-limb range of motion measurements in recreational dancers. J Strength Cond Res. 2009 Oct;23(7):2144-8. doi: 10.1519/JSC.0b013e3181b3e198. PMID: 19855344.

Does blood flow restriction work for elderly patients? A 2019 systematic review examined 11 studies and found a surprising answer.  We went on a Research Quest to uncover the truth.  Let’s dive in. Reference: Centner C, Wiegel P, Gollhofer A, König D. Effects of Blood Flow Restriction Training on Muscular Strength and Hypertrophy in Older Individuals: A Systematic Review and Meta-Analysis. Sports Med. 2019 Jan;49(1):95-108. doi: 10.1007/s40279-018-0994-1. Erratum in: Sports Med. 2018 Nov 9;: PMID: 30306467; PMCID: PMC6349784.

A 2009 meta-analysis found that improving this one thing can improve patient compliance and program adherence by 162%. That means better patient outcomes, more follow-up sessions booked, and faster growth for your practice. We went on a Research Quest to uncover a three-part framework of how we can apply this research in our practice. Let’s dive in. Reference: Zolnierek KB, Dimatteo MR. Physician communication and patient adherence to treatment: a meta-analysis. Med Care. 2009 Aug;47(8):826-34. doi: 10.1097/MLR.0b013e31819a5acc. PMID: 19584762; PMCID: PMC2728700.

Is there an isometric protocol that could get your patients 3 times the results of normal rehab? What would this protocol look like, and is there any scientific evidence behind it? Wright and colleagues might have cracked the code in their 2019 study. We went on a Research Quest to find out. Let’s dive in. Reference: Wright AR, Richardson AB, Kikuchi CK, Goldberg DB, Marumoto JM, Kan DM. Effectiveness of Accelerated Recovery Performance for Post-ACL Reconstruction Rehabilitation. Hawaii J Health Soc Welf. 2019 Nov;78(11 Suppl 2):41-46. PMID: 31773110; PMCID: PMC6874690.

Figuring out what to charge patients can be a struggle. How do you put a price point on the value of your rehabilitation?  Is there research that could help us figure out if we’re priced too low or too high? A 2022 paper from Cornell University describes a phenomenon called Heuristic Price Theory. It all boils down to a nifty mental shortcut our brains use. Instead of walking around all day trying to figure out the true worth of everything we see, our subconscious brain uses the mental shortcut that price equals value. We went on a Research Quest to learn more. Let’s dive in. Reference: Thomas, M. 2022. Heuristic Price Theory: A Model of Pluralistic Price Evaluations. Consumer Psychology Review, 1– 17, 2022 https://doi.org/10.1002/arcp.1087

Is there any research showing that a simple massage chair could replace manual therapists? Turns out, some researchers in Korea had the same question back in 2020. They decided to compare massage chairs to physio treatment for patients with chronic lower back pain. 56 participants were enrolled to receive either physiotherapy or mechanical massage using the massage chair. We took a Research Quest to uncover the truth. Let’s dive in. Kim SK, Min A, Jeon C, Kim T, Cho S, Lee SC, Lee CK. Clinical outcomes and cost-effectiveness of massage chair therapy versus basic physiotherapy in lower back pain patients: A randomized controlled trial. Medicine (Baltimore). 2020 Mar;99(12):e19514. doi: 10.1097/MD.0000000000019514. PMID: 32195952; PMCID: PMC7220115.

A 2022 study shows only 17% of ACL patients pass their return-to-play testing nine months post-op. One in every four ACL patients gets re-injured, and more than half never return to sport. We went on a Research Quest to discover what on earth is going on in Anterior Cruciate Ligament rehabilitation. Let's dive into helping physiotherapists and physical therapists conquer clinically. References: Ronden AE, Koc BB, van Rooij L, Schotanus MGM, Jansen EJP. Low percentage of patients passed the 'Back in Action' test battery 9 months after bone-patellar tendon-bone anterior cruciate ligament reconstruction. J Clin Orthop Trauma. 2022 Sep 11;34:102025. doi: 10.1016/j.jcot.2022.102025. PMID: 36147380; PMCID: PMC9486609. Joreitz R, Lynch A, Popchak A, Irrgang J. CRITERION-BASED REHABILITATION PROGRAM WITH RETURN TO SPORT TESTING FOLLOWING ACL RECONSTRUCTION: A CASE SERIES. Int J Sports Phys Ther. 2020 Dec;15(6):1151-1173. doi: 10.26603/ijspt20201151. PMID: 33344032; PMCID: PMC7727433. Filbay SR, Grindem H. Evidence-based recommendations for the management of anterior cruciate ligament (ACL) rupture. Best Pract Res Clin Rheumatol. 2019 Feb;33(1):33-47. doi: 10.1016/j.berh.2019.01.018. Epub 2019 Feb 21. PMID: 31431274; PMCID: PMC6723618. van Melick N, van Cingel RE, Brooijmans F, Neeter C, van Tienen T, Hullegie W, Nijhuis-van der Sanden MW. Evidence-based clinical practice update: practice guidelines for anterior cruciate ligament rehabilitation based on a systematic review and multidisciplinary consensus. Br J Sports Med. 2016 Dec;50(24):1506-1515. doi: 10.1136/bjsports-2015-095898. Epub 2016 Aug 18. PMID: 27539507. Buckthorpe M. Optimising the Late-Stage Rehabilitation and Return-to-Sport Training and Testing Process After ACL Reconstruction. Sports Med. 2019 Jul;49(7):1043-1058. doi: 10.1007/s40279-019-01102-z. PMID: 31004279.

We know that limb symmetry is a huge deal in ACL rehabilitation. But how do you get your patient there? You’re not going to reach 95% LSI through hip bridges and elastic bands. We went on a Research Quest to discover an evidence-based plan to bulletproof our rehab.  Let’s dive in. References: Randall Cooper & Mick Hughes: Melbourne ACL Rehabilitation Guide. melbourneaclguide.com/brief Crossley et al., 2011 Culvenor et al., 2016 & Thorstensson et al., 2004 Campanholi Neto, José, et al., 2015