January Research Roundup

The research is in! Check out our collection of 15 new studies that will optimize your practice each day—5 treatments that work, 5 that don’t, and 5 that are simply intriguing.

Review the latest news:

✔  Avoiding surgery for rotator cuff tears

✔  Transverse friction massage is superior for lateral epicondylopathy

✔  Muscle energy tops mobilization for restoring shoulder ROM

✔  Chiropractic care excels for lumbar stenosis

✔  Ultrasound and TENS may not work for….

5 Treatments That Work

1. Journal of Shoulder & Elbow Surgery: “Nonoperative treatment is an effective and lasting option for many patients with a chronic, full-thickness rotator cuff tear. The operative and nonoperative outcomes at 5-year follow-up were not significantly different. 75% of patients remained successfully treated with nonoperative treatment at 5 years.”

2. A study comparing the effectiveness of three common strategies for lateral epicondylitis (splinting/ stretching, cortisone injection, and transverse friction massage) concluded: “At 6-month follow-up, only patients in the deep friction massage group demonstrated a significant improvement in all outcome measures, including VAS pain score, DASH score, and grip strength.”

3. JMPT: “Patients with mild to moderate carpal tunnel syndrome benefit from manual therapy, including neurodynamic techniques.”

4. “Posterior shoulder tightness, defined as limited glenohumeral horizontal adduction and internal rotation motion, is a common occurrence in overhead athletes.  (This study found) the application of muscle energy techniques to the horizontal abductors provides acute improvements to glenohumeral horizontal adduction, while joint mobilizations provide no improvements.”

5. A JAMA randomized clinical trial of 259 lumbar spine stenosis patients compared the effectiveness of three non-surgical options:

• Medical care consisted of medications and/or epidural injections provided by a physiatrist.

• Group exercise classes were supervised by fitness instructors in senior community centers.

• Manual therapy/individualized exercise consisted of spinal mobilization, stretches, and strength training provided by chiropractors and physical therapists.

The results: “Manual therapy/individualized exercise had greater improvement of symptoms and physical function compared with medical care or group exercise.”

5 Less Promising Interventions

6. A Cochrane Database systematic review concluded: “Acupuncture and laser acupuncture may have little or no effect in the short term on symptoms of carpal tunnel syndrome in comparison with placebo or sham acupuncture.”

7. A study of 54 patients concluded that “the addition of therapeutic ultrasound did not improve the efficacy of conservative treatment for plantar fasciitis.”

8. A clinical trial of 97 patients: “This study does not support the use of TENS in the treatment of patients with chronic LBP.”

9. An RCT of 61 TMD patients concluded: “The efficacy of manipulation seems to be limited, in contrast to our expectations. The advantage of manipulation was observed only during the first treatment session.”

10. “Imaging is overused in the management of low back pain (LBP). Interventions designed to decrease non-indicated imaging have predominantly targeted practitioner education alone; however, these are typically ineffective.”

5 Thought-Provoking Studies

11. The fascial system includes solid and liquid fascia, closely inter-linked, without interruption. Each cell communicates with neighboring cells by sending and receiving signals. Therapeutic touch at the skin triggers cell deformation which sends electromagnetic and mechanometabolic messages throughout the entire body–like electricity in water. This concept is known as quantum entanglement.

*Our friend and mentor, Dr. Tom Hyde, commented on this research and reminded us of the incredible “Strolling under the skin” video from Dr. Jean-Claude Guimberteau that provides a fascinating look into the fascial system. You can check out the full 28 minute version or this brief clip.

12. A new study mapped carpal tunnel pain vs. paresthesia: “Painful symptoms were clearly centered over the carpal tunnel and were reported much less frequently in the digits. Non-painful sensory disturbances (e.g. numbness, paresthesias) were found to have a much more peripheral and lateral distribution.”

13. Following an ankle sprain, the supporting muscle (peroneus longus) undergoes fatty degeneration, with a resultant loss of strength. This process “increases with increasing frequency of ankle sprain”—with obvious implications for chronic ankle instability. 

14. Q: How thick is an average healthy disc?

A: Generally less than 9mm

An imaging analysis of 240 healthy spines measured the height of the intervertebral disc and compared those measurements against age and gender: “Variation in disc height is determined much more by sex rather than age. The maximum height of the interbody space in the adult lumbar spine was at the L4/5 level (8.9±1.7 mm males, 8.6±1.8 mm females).”

15. A new JAMA article discussed the link between dementia and chronic pain: “Compared with pain-free controls, those with chronic pain showed a more rapid decline in memory and increased probability of dementia.” (Whitlock et al) “These findings are especially relevant for patients with low back pain given that current pharmacotherapy has the potential to cause central nervous system depression and further compromise cognition.“ (Bailey et al)

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