Weekly Research Blog

B12 Levels are Related to Rotator Cuff Tears

BMC Musculoskeletal Disorders:

"Vitamin B12 (Vit B12) deficiency results in elevated homocysteine levels and interference with collagen cross-linking, which may affect tendon integrity. Low serum levels of Vit B12 were independently related to degenerative RC tear."

*Peer reviewed article: * https://link.springer.com/article/10...


Neck Pain Patients Benefit From Aerobic Exercise

International Archives of Occupational and Environmental Health:

"Combining moderate aerobic exercise and neck-specific exercise improved the work ability of patients with neck pain more than neck-specific exercise alone."

*Peer reviewed article: * https://link.springer.com/article/10...


SMT for Pediatric Headaches

A new headache study in children age 7-14 found:

Chiropractic spinal manipulation resulted in fewer headaches and higher global perceived effect, with only minor side effects. Since the treatment is easily applicable, of low cost and minor side effects, chiropractic spinal manipulation might be considered as a valuable treatment option for children with recurrent headaches.

*Peer reviewed article: * https://link.springer.com/article/10...


Conservative Care Rivals Surgery for Disc Herniation

A systematic review of athletes with symptomatic lumbar disc herniation compared surgical vs. non-surgical outcomes and concluded:

There was no significant difference in return-to-play rate between athletes treated with operative or nonoperative management of LDHs, nor did operative management have a faster time to **return-to-play**. Athletes should consider the lack of difference in **return-to-play** rate in addition to the potential risks associated with spinal surgery when choosing a treatment option.

*Peer reviewed article: * https://journals.sagepub.com/doi/full/10...


Traction is Effective for Lumbar Radiculopathy

*The literature suggests that, for pain and disability in lumbar radiculopathy, there is short-term effectiveness of supine mechanical traction when added to traditional conservative intervention.

*Peer reviewed article: * https://pubmed.ncbi.nlm.nih.go...


Lumbar Stenosis

*“The presence of lumbosacral transitional vertebra increases the likelihood of degenerative spinal stenosis [by a factor of 3.74]”*

* Peer reviewed article: * https://www.hindawi.com/journals/bmri/2019/3871819/


TMD

*“Fifty individuals with TMD were randomly assigned to receive cervical HVLAT or sham manipulation for four visits over 4-weeks. Significant interactions were noted in [pain & functional disability]… with significant differences in successful outcomes noted immediately after baseline treatment and at 4-weeks.”*

*Peer-reviewed article: https://www.jospt.org/doi/abs/...


Physiotherapist survey: Increasing thoracic spine movement within the management of chronic subacromial impingement syndrome.

*“It is beneficial to include treatment to increase thoracic spine mobility within shoulder impingement syndrome management.”*

* Peer reviewed article: * https://www.ncbi.nlm.nih.gov/pubmed/31987570


Start at the Spine

A new JMPT study published by the McKenzie Institute director of education concluded that on average, 43.5% of extremity pain originates from the (asymptomatic) spine. Here's their joint-by-joint breakdown of spinally-referred pain:

- Shoulder pain - 47%
- Elbow pain - 44%
- Wrist/Hand pain - 38%
- Hip pain - 71%
- Knee - 25%
- Ankle/Foot - 29%

Editorial Conclusion: *"when patients present with a complaint of extremity pain, we need to rule out the spine as a possible source. It's hard to fathom how much time and money has been wasted treated the wrong body part (across all professions)."*

*Peer reviewed article: * https://www.tandfonline.com/doi/abs/10.1080/10669817.2019.1661706


Early Imaging Associated With Undesirable Outcomes

In a study of 57,293 LBP patients, 46.4% received "early" imaging. Early imaging was associated with increased risks:

- Up to 1.8 times risk of short-term and chronic opioid use
- 2.5 times risk of steroid injections
- 3.4 times risk of spinal surgery
- 1.1 times risk of persistent pain

Conclusion: *"Early imaging for low back pain in older individuals was common, and was associated with greater utilization of downstream services and persistent pain."*

*Peer reviewed article: * https://www.jabfm.org/content/32/6/773


A new systematic review in *Circulation* has questioned what was once considered a healthy alternative:

*"Coconut oil consumption significantly increased LDL-cholesterol by 10.47 mg/dL and HDL-cholesterol by 4.00 mg/dL as compared with nontropical vegetable oils. Conclusions: Coconut oil consumption results in significantly higher LDL-cholesterol than nontropical vegetable oils."*

*Peer reviewed article: * https://www.ahajournals.org/doi/abs/10.1161/CIRCULATIONAHA.119.043052


Reconsidering "If It's Not Broke"

JMPT: *"People with **subclinical neck pain** have slower visual and multisensory response times than asymptomatic individuals...and these differences do not improve on their own in the absence of treatment." *

* Peer reviewed article: * https://www.sciencedirect.com/science/article/pii/S0161475417302014


Gluteal Rehab is Essential for "Hip Bursitis"

*"Magnetic resonance imaging of 16 women with greater trochanteric pain
syndrome (GTPS) and 15 asymptomatic controls was undertaken. Significantly
smaller muscle volumes were identified in the symptomatic group for the
gluteus maximus, gluteus medius, and gluteus minimus. There was no
difference in TFL volume. Gluteal muscle atrophy and fatty infiltration in
women with GTPS suggests (the gluteal muscles) may be an important target
for rehabilitation."*

*Peer reviewed article:* https://europepmc.org/article/...


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