Pt Inquest

Uncertainty is not just a reality in life it is a reality of professional practice. The ability to embrace uncertainty is known to have a positive effect on critical thinking and avoiding errors in judgement. That's all great, but do medical professionals acknowledge uncertainty in their practice? Is this harmful to patients? Does it raise healthcare costs? What about informed consent? As William Osler once said, "The greater the ignorance, the greater the dogmatism."

A couple years ago, Alessandro Lelli described his new test for ACL insufficiency via YouTube. Originally known as "Lelli's Test", he first published it in the literature as the "Lever Sign" in late 2014 reporting 100% accuracy. Ok - seemed a little TOO perfect. Now the literature has its first independent study on the Lever Sign so let's take a closer look at this test.

Sure, we know that ACLs get torn and the vast majority of those mechanisms are non-contact. So what EXACTLY happens in those knees? We have some plausible ideas like dynamic valgus, but how does that tear the ACL without any injury to the MCL? How would we answer such a question? Will JW survive the current heatwave in Minnesota?

When dealing with a high ankle sprain (syndesmosis injury) Grade I never requires surgery whereas Grade III always requires surgery. But what about Grade II? In this episode we explore predictors of syndesmotic instability when assessing a Grade II sprain and the return to sport prognoses. All this while JW approaches absolute zero!

Sports-related concussions have been getting more and more attention over the past decade. The growing understanding of the potential for developing chronic brain disease is creating a cause for concern. Are sports medicine professionals managing concussions differently today? How well do we understand this process? Has Erik had too many concussions over the years to form a complete sentence? Here is a link to the NATA Position Statement on Management of Sport Concussion.

It's that time of year again and the PT Podcast Network crew are in the holiday spirit! The gang got together, as best they can scattered across the world, to share a little eggnog and make fun of each other. So pour yourself a drink, sit by the fire (or pool in the Southern Hemisphere), and enjoy a little holiday cheer.

It is well known that quadriceps strength asymmetries are commonly seen in subjects who have difficulty returning to sport after anterior cruciate ligament reconstruction (ACLR), but does that asymmetry correlate to a specific presentation on landing mechanics? What do we know about second injury in these subjects? Can we do anything about it? We ask these and many other questions when we chat with lead author from The Ohio State University, Laura Schmitt, PhD, PT! Also, this is the last podcast of the current 12 episode season before we go on our usual 3 month hiatus. While we're gone, catch up on previous episodes or check out some of the other shows on the network!

There is a belief out there that weak hips may cause patellofemoral pain, but this article found the opposite. How can we make any sense out of all the ambiguity? If only we had a Masters in Biomechanics. Luckily special guest Greg Lehman does! For more info on Greg including his teaching schedule, visit his website!

Orthopedic surgeons have a lot to consider when they are deciding whether or not to recommend surgery for rotator cuff tears, but how do they implement that decision process in practice? What makes a surgeon more or less likely to go towards early surgery vs physical therapy? Will JW take "the Bard-Parker solution"???

There are a maze of treatment options for people with pain, "each backed by enthusiastic and highly motivated advocates, all of whom lay claim to 'evidence'". How do clinicians wade through all the different ideas out there and get a handle on effectiveness? Or is it efficacy? Confused? Even if you're not, listen to this episode with special guest Neil O'Connell!!!

Exercise-based interventions are known to be most effective for patellofemoral pain but how good are they really? Do adolescents with patellofemoral pain respond in a similar manner? What do we know, what don't we know? Can you handle the dueling Barry Whites???

When talking about whether or not to repair someone's rotator cuff, we often consider the Goutallier/Fuchs category which is a grading of the amount of fat infiltration in the muscle. Should we start doing the same when considering repairs of the gluteal tendons, the "rotator cuff of the hip"? Might it predict outcomes better than the size of the tendon tear? Can JW pass on his disease to Erik via the internet???

80 years ago Ernest Codman proposed that calcific tendinopathy was initiated by tendon degeneration. This has never been validated. In recalcitrant cases, would surgical decompression lead to better outcomes than simple debridement of the calcium? Is this another case of "makes sense" turning out to be wrong?

There is a lot of talk about "inflammation", or lack thereof, around tendinopathies; but what does that even mean? Could this still be present in chronic conditions? Are NSAIDs pure evil or are they the ultimate answer??? This episode includes Peter Gettings, one of the authors of this systematic review and someone you should follow on Twitter!!!

The idea of hip strength having an effect on lower extremity dynamics is not new. Is there actually a correlation between the two? What is the difference between kinematics and kinetics? Is the gluteus medius as important as we used to think? Can JW break down the number 60 into its component prime numbers???

There is some evidence that repeated loads can fatigue an ACL in a cadaveric model. There is some other evidence that lack of hip internal rotation is a risk factor for ACL injury. This episode explores these ideas and asks how these factors might play a role in this common yet serious injury. How does one tear an ACL? Assuming they matter, is there anything we can really do proactively about these concerns? Can JW afford a new bike? Does Erik have a thing for foot piercings?

On this episode we look at the correlation between hip weakness and femoroacetabular impingement/labral tears. Is it all about the glute med? Can we just strengthen out of intra-articular hip injuries? Also, have you seen An Honest Liar yet???

We are back from hiatus and on this episode we look at the correlation between quadriceps weakness and patellofemoral chondral damage after ACLR. Might the chondral damage progress due to quadriceps weakness? Is this another reason to aggressively seek quad strength after surgery? How was JW's summer?

In this last episode before the hiatus, we explore exercise interventions for chronic low back pain (CLBP). Are they truly effective for the treatment of CLBP? If they are, does the type of exercise matter? What about stabilization exercises? Is JW a carpetbagger?

Desensitization treatments have known effects on sensitivity in healthy controls, but what about in those with chronic pain? Does it matter if the patient has low pain sensitivity or high pain sensitivity? Will JW remodel his clinic to have nothing but ice buckets and exercise bikes?