Pt Inquest

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?

What hip movements are required for being an elite ice hockey goaltender? Does this make them at a higher risk for hip pathology? Can a person with a cam even GET to an elite level as a goaltender? Can Erik survive a pun avalanche???

What kinds of strength deficits remain after hamstring autograft ACLR? Will the quadriceps fare better? Do they just need more time? Was JW's poorly told joke left in the episode? (You bet it was!)

Can the kinesiophobic beliefs of a physical therapist have an influence on the people they are educating? Might this also occur in patient populations? When JW said in a previous episode, "You don't have kinesiophobia but dammit I can give it to you!" was he right?

When the literature starts to question an intervention that you use, how long does it take you to abandon it? Is JW a laggard?

Erik and JW have asked for more inquiry into the mechanisms of manual therapy and this article does not disappoint! What about those neurophysiological effects? Are they specific or non-specific? Does it matter? Why does JW carry a galvanized bucket of vomit in the car?

We take a look at whether or not lack of eccentric hip strength is a risk factor for developing patellofemoral pain in novice runners. How hard is it to do a prospective study like this? What conclusions can we draw from this? Does this fit with our previous understanding? Is JW afraid of chickens?

We take a look at a meta-analysis on nonsurgical management of lateral epicondylalgia which does not show much difference in the long term. Do short term changes matter? What exactly are we treating? No comment on the miscommunication that occurs during the episode.

We take a skeptical look at ACL injury prevention programs and whether they are doing what we think they are doing. Do we need to think differently? What can we learn from motor learning theory? Is reviewing a Level 5 article a waste of our time???