JOSPT Insights

In part 2 of this series, we continue chatting about designing and implementing a rehabilitation program after cervical discectomy with Drs Justin Lantz, Jessica Evaristo and Joseph Derian. Today we work through phases 3 and 4 in the rehabilitation program: re-modeling and maturation occurring around 12-weeks after surgery. We cover nerve glides and how to dose them, the goals and areas of focus for manual therapy and therapeutic exercise, incorporating proprioception training, and important clinical milestones to consider along the way. The patient’s goal was to return to manual labor, and we talk about how healing timelines impact on clinical decisions in the later stages of rehabilitation. ------------------------------ RESOURCES Read more about the case: https://www.jospt.org/doi/10.2519/josptcases.2023.11608 Catch part 1 here: https://podcasts.apple.com/us/podcast/ep-158-planning-a-rehabilitation-program-after/id1522929437?i=1000637409917 or https://open.spotify.com/episode/0Ci1ya1CHXB8FgYYBO4Q3q?si=94b548f8e3bd4b4e

Join a group of experienced orthopaedic clinicians as they review the background of anterior cervical discectomy and fusion surgery in a 2-part podcast series. In part 1, we cover who does well with surgery, the indications and surgical procedure, plus a deep dive into evidence-based pre- and post-operative rehabilitation. There's not much hard research evidence to guide your decisions on how to structure and deliver, so tune into hear how expert clinicians approach things. You'll learn about the phases of rehabilitation (we tackle the first two in today's episode), what’s normal, what’s not, strategies for collaborating with surgeons, and suggested interventions. ------------------------------ RESOURCES Read more about the case: https://www.jospt.org/doi/10.2519/josptcases.2023.11608

Dr Jeremy Graber joins us to help answer the question: how often should patients with total knee arthroplasty come to rehabilitation? To answer this and more, we dive into the 2023 JOSPT article, “Expert Consensus for the Use of Outpatient Rehabilitation Visits After Total Knee Arthroplasty: A Delphi Study.” ------------------------------ RESOURCES Dr Graber and his colleagues led a expert consensus process to establish recommendations for how often and for how long you might consider scheduing rehabilitation visits. The group also discussed discharge planning, how to implement telerehabilitation, and monitoring the patient's progress to guide clinical decisions Check out the JOSPT article: https://www.jospt.org/doi/10.2519/jospt.2023.11840 For more on predicting outcomes after total knee replacement: https://www.medrxiv.org/content/10.1101/2023.10.23.23297404v1 (preprint)

Florian Teichert and Dr Daniel Belavy discuss exercise interventions for preventing neck pain, emphasizing the importance of individual engagement and tailoring programs to individual preferences. They also explore the relationship between exercise dose and its impact on pain and disability. The podcast highlights the effectiveness of different exercises in preventing and managing chronic back and neck pain, emphasizing individualized routines and compassionate care. Additionally, the importance of healthcare professionals understanding diagnosis development and effective communication with patients is discussed.

How do you help someone manage cancer-related fatigue or get back to exercise after their treatment? Is it safe for someone with bone metastases to exercise? PhD candidate and recent Master of Physical Therapy graduate, Kendra Zadravec, and Professor Kristin Campbell (Department of Physical Therapy at the University of British Columbia, Canada) share their research and clinical expertise in developing physiotherapy interventions for people with cancer to help answers to these questions and more. ------------------------------ RESOURCES Canadian Physiotherapy Association Oncology Division: https://www.oncologycpa.ca/ American PT Association Oncology: https://oncologypt.org/ Australian Physiotherapy Association - Cancer, Palliative Care and Lymphodema: https://australian.physio/membership/national-groups/cancer-palliative-care-and-lymphoedema Macmillan UK: https://www.macmillan.org.uk/healthcare-professionals ACSM guidelines for exercise and cancer: https://www.acsm.org/news-detail/2019/10/16/expert-panel-cancer-treatment-plans-should-include-tailored-exercise-prescriptions One stop shop for cancer and exercise information: www.cancerexercise.ca (direct link to resources for health care providers: https://cancerexercise.med.ubc.ca/resources-hcp/ Recommendations for exercise with bone metastases (open access): https://pubmed.ncbi.nlm.nih.gov/34990293/ Systematic review on exercise for people with bone metastases: https://pubmed.ncbi.nlm.nih.gov/34358650/ Physical activity recommendations for cancer survivors living with bony metastases: https://pubmed.ncbi.nlm.nih.gov/33604871/

Val Jones, Clinical Lead Physiotherapist, shares practical advice on managing elbow pain, including assessing common pathologies, the role of manual therapy, contextually relevant exercises, and appreciating the elbow's role in the upper limb.

Dr Casey Humbyrd—orthopaedic surgeon and Chief of foot & ankle orthopedics at the University of Pennsylvania—shares her expertise and insights on treating ankle sprains that are not responding to non-surgical treatment. Dr Humbyrd reviews ankle anatomy and her rationale for recommending surgery, how she performs a Broström repair, and explains how she works in close partnership with physical therapists and patients to achieve quality rehabilitation and return to sport outcomes. For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

Do you work with young people with ACL injury? Well, you're in the right place! Today, Drs Chris Kuenze and Adam Weaver walk through the story behind creating a comprehensive normative dataset for knee function and strength outcomes. You'll learn how the project got started, and how you can use the information to help make even more informed clinical decisions. ------------------------------ RESOURCES Find the paper "Age-, Sex-, and Graft-specific Reference Values From 783 Adolescent Patients At 5-7 months After ACL Reconstruction: IKDC, PEDI-IKDC, KOOS, ACL-RSI, Single-leg Hop, and Thigh Strength" on the JOSPT website: https://www.jospt.org/doi/abs/10.2519/jospt.2023.11389 To access the normative database: https://dataverse.lib.virginia.edu/dataset.xhtml?persistentId=doi:10.18130/V3/JNPHUB For more on the Virtual Sports PT Conference (3-4 November, 2023), including the full program and to purchase tickets, head to https://www.eventbrite.com/e/aaspt-and-jospt-virtual-sports-pt-conference-tickets-694110913427.

Dr Lynn McKinnis, an expert in neck trauma, discusses the Canadian C-Spine Rule, vertebral artery injuries, and tips for diagnosing and treating acute neck trauma. The podcast explores a case of an unstable fracture, the importance of Canadian C-Spine Rules in assessing trauma patients, and evaluating high-risk factors for cervical spine injuries.

Dr Annina Schmid, physiotherapist and neuroscientist, shares valuable tips for conducting a thorough neurological assessment. Topics covered include the importance of the assessment, quantifying neurological changes, neurodynamic testing, and three essential tips for a successful assessment.