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The research is in! Check out our collection of 15 new studies that will optimize the way you practice each day- 5 treatments that work, 5 that don’t, and 5 studies 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.”

Boorman RS, More KD, Hollinshead RM, et al. What happens to patients when we do not repair their cuff tears? Five-year rotator cuff quality-of-life index outcomes following nonoperative treatment of patients with full-thickness rotator cuff tears. J Shoulder Elbow Surg. 2018;27(3):444-448.

 

Want to review the current evidence-based management for rotator cuff pathology?

Check out our Mastering the Rotator Cuff Guide detailing every essential test, treatment and exercise.

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.”

Yi R, Bratchenko WW, Tan V. Deep Friction Massage Versus Steroid Injection in the Treatment of Lateral Epicondylitis. Hand (N Y). 2018 Jan;13(1):56-59. doi: 10.1177/1558944717692088. Epub 2017 Feb 1.

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

Wolny T et al. The Effect of Manual Therapy Including Neurodynamic Techniques on the Overall Health Status of People With Carpal Tunnel Syndrome: A Randomized Controlled Trial. J Manipulative Physiol Ther. 2018 Dec 26. pii: S0161-4754(18)30334-8. doi: 10.

Here are two neurodynamic techniques that may be useful for carpal tunnel syndrome:

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.”

Reed, ML et al. Acute effects of muscle energy technique and joint mobilization on shoulder tightness in youth throwing athletes: a randomized controlled trial. Int J Sports Phys Ther. 2018 Dec; 13(6): 1024–1031.

PIR and contract/relax stretching are examples of muscle energy techniques. Check out this option.

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.”

Schneider MJ, Ammendolia C, Murphy DR, et al. Comparative Clinical Effectiveness of Nonsurgical Treatment Methods in Patients With Lumbar Spinal Stenosis: A Randomized Clinical Trial. JAMA Netw Open.2019;2(1):e186828. doi:10.1001/jamanetworkopen.2018.6828

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.”

Choi GH. Et al. Acupuncture and related interventions for the treatment of symptoms associated with carpal tunnel syndrome. Cochrane Database Syst Rev. 2018 Dec 2;12:CD011215. doi: 10.1002/14651858.CD011215.pub2. [Epub ahead of print]

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.”

Nagata K et al. Efficacy of mandibular manipulation technique for temporomandibular disorders patients with mouth opening limitation: a randomized controlled trial for comparison with improved multimodal therapy. J Prosthodont Res. 2018 Dec 15. pii: S1883

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.”

Jenkins HJ, Moloney NA, French SD, et al. Using behaviour change theory and preliminary testing to develop an implementation intervention to reduce imaging for low back pain. BMC Health Serv Res. 2018;18(1):734. Published 2018 Sep 24. doi:10.1186/s12913-0

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.

Bordoni B, Simonelli M. The Awareness of the Fascial System. Cureus. 2018;10(10):e3397. Published 2018 Oct 1. doi:10.7759/cureus.3397

*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.”

Nelson JT et al. Patient Reported Symptom-Mapping in Carpal Tunnel Syndrome. Muscle Nerve. 2018 Dec 14. doi: 10.1002/mus.26398. [Epub ahead of print] 

Want to test your knowledge on differentiating carpal tunnel syndrome from it’s lookalikes? Try our 6-question quiz.

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

Sakai S et al. Quantity and quality of the peroneus longus assessed using ultrasonography in leg with chronic ankle instability. J Phys Ther Sci. 2018 Dec;30(12):1396-1400. doi: 10.1589/jpts.30.1396. Epub 2018 Nov 21.

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).”

Bach K et al. Morphometric Analysis of Lumbar Intervertebral Disc Height: An Imaging Study. World Neurosurg. 2018 Dec 19. pii: S1878-8750(18)32836-5. doi: 10.1016/j.wneu.2018.12.014. [Epub ahead of print]

 

Want to see how the disc thins over time? Check out this link to our popular 3-minute illustrated refresher of Kirkaldy-Willis degenerative cascade.

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)

Whitlock EL, Diaz-Ramirez LG, Glymour MM, Boscardin WJ, Covinsky KE, Smith AK. Association Between Persistent Pain and Memory Decline and Dementia in a Longitudinal Cohort of Elders. JAMA Intern Med. 2017;177(8):1146-1153. 

Bailey DM et al. Low Back pain. Lancet. Volume 392, Issue 10164, P2548, December 15, 2018

 


 

Ready to put this research to work? ChiroUp makes it easy! ChiroUp was built to save you time while improving clinical outcomes & increasing your income. It’s everything your practice needs in one easy-to-use system. See for yourself at ChiroUp.com OR click below to try us out free for 14 days – no commitment & no credit card required.

About the Author

Dr. Tim Bertelsman

Dr. Tim Bertelsman

DC, CCSP, DACO

Dr. Tim Bertelsman graduated with honors from Logan College of Chiropractic and has been practicing in Belleville, IL since 1992. He has lectured nationally on various clinical and business topics and has been published extensively. He has served in several leadership positions within the Illinois Chiropractic Society and currently serves as President of the executive board.

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