Structured physiotherapy has been suggested as treatment before as well as after surgery to improve clinical outcomes in patients with cervical radiculopathy (CR), but randomized clinical trials to inform evidence-based clinical guidelines for the treatment of patients with CR after surgery are lacking. The aim of this study was to compare the results of structured postoperative physiotherapy combining neck-specific exercises with a behavioral approach to a standard postoperative approach in patients who had undergone surgery for cervical disc disease with CR at 6 months after surgery.
Patients with cervical disc disease and persistent CR who were scheduled for surgery were randomized preoperatively to structured postoperative physiotherapy (n = 101) or a standard postoperative approach (n = 100). The latter included pragmatic physiotherapy in accordance with the usual Swedish postoperative care. Outcome measures included patient-reported neck disability as measured with the Neck Disability Index (NDI), intensity and frequency of neck and arm pain, global outcome of treatment, and expectation fulfillment, as well as enablement. RESULTS Patients who received structured postoperative physiotherapy reported greater expectation fulfillment (p = 0.01), and those who attended at least 50% of the treatment sessions reported less neck pain frequency (p = 0.05), greater expectation fulfillment (p = 0.001), and greater enablement (p = 0.04) compared with patients who received the standard postoperative approach. No other difference between treatment groups was found (p > 0.15). The NDI and neck and arm pain intensity were improved in both groups at 6 months after surgery (p < 0.001). Additional use of postoperative physiotherapy was reported by 61% of the patients who received the standard postoperative approach.
The results from this first randomized clinical trial of postoperative physiotherapy showed only minor additional benefit of structured postoperative physiotherapy compared with standard postoperative approach 6 months postoperatively in patients who underwent surgery for cervical disc disease with CR. Patients who received structured postoperative physiotherapy reported higher expectation fulfillment, and many patients in the standard postoperative approach group perceived a need for additional treatments after surgery, suggesting that patients with CR are in need of further postoperative support. The results confirm that neck-specific exercises are tolerated postoperatively by patients with CR, but more studies of postoperative physiotherapy are needed to inform clinical guidelines for this patient group.
We know that performing eccentric hamstring exercises such as the Nordic Hamstring Exercise can be beneficial in hamstring strain rehabilitation and injury risk reduction. The problem is, you don’t always have a partner willing to hold your legs down while performing the Nordic Hamstring Exercise.
Eccentric Hamstring Progression
Here are a few variations of eccentric hamstring exercises that do not require a partner:
1️⃣ Hamstring Walkouts:
🔸 This is a very basic exercise in which you maintain a bridge position while slowly walking your feet out a little bit at a time until your legs are straight. This causes to hamstrings to work throughout their range of motion.
🔸 Step your feet right back up to the starting position to take away the concentric component.
🔸 Here, you are going to have a slider under one heel. Perform a bridge, lift one leg up, then slowly straighten the working leg. Drop your hips down to the floor and start at the beginning.
🔸 You may feel a little hamstring cramping when you first start performing this exercise. That is totally normal!
3️⃣ Sliders on Floor:
🔸 In this variation, all you need is a tile or wood floor and a sock!
🔸 Lift your hips into a bridge position, lift one leg up into the air, and slowly extend the working leg. Let your hips drop to the floor and return to starting position.
4️⃣ Physio Ball:
🔸 Same idea as the sliders, bridge up, lift one leg into the air, and slowly extend the working leg. Put your other leg back on the ball to bring it back to the starting position. (2 legs in 1 leg out).
🔸 For more of a challenge, curl the ball back in with only the working leg. This will work both the concentric and eccentric phases.
🔸 In this variation, both heels are in the loop of the TRX. Bridge your hips up, then slowly extend your legs out to a straight position. Drop your hips down before bringing your knees back up.
🔸To make this more challenging, stay in a bridged position during both the concentric and eccentric portions.
Thanks to Dr. Nicole Canning, DPT, CSCS – @dr.nicolept on instagram for the video!
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Keeping it Eclectic…
World COPD Day is organized by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) in collaboration with health care professionals and COPD patient groups throughout the world. Its aim is to raise awareness about chronic obstructive pulmonary disease (COPD) and improve COPD care throughout the world.
Each year GOLD chooses a theme and coordinates preparation and distribution of World COPD Day materials and resources. World COPD Day activities are organized in each country by health care professionals, educators, and members of the public who want to help reduce the burden of COPD.
The first World COPD Day was held in 2002. Each year organizers in more than 50 countries worldwide have carried out activities, making the day one of the world’s most important COPD awareness and education events.
What is COPD?
COPD is a complex interaction between chronic bronchitis, emphysema and asthma which is primarily caused by prolonged exposure to tobacco smoke. Other risk factors such as exposure to pollution, occupational dusts and chemicals.
This video explains the complex process involved in COPD.
As Always Exercise is Crucial
Encouraging patients with COPD to stop smoking is critical to their success and outcomes in terms of mortality and lung function but a driver towards this change is exercise. Regardless of smoking cessation or not, exercise plays a crucial role in enabling quality of life in those with COPD and has been well documented to do so. This article could linger on the point of exercise for ever but the focus should be about something often overlooked. This being inhaler technique.
The Trouble with Inhaler Techniques
As this WSJ report explains inhaler technique is fraught with multiple steps and often rate, depth and timing of breath are often incorrect which means LABA and SABA inhalers are made redundant by the user and this has multiple implications in the care of the individual.
The correct technique, as shown below, is essential to those using inhalers. This week let’s make sure we are aware of the correct technique so that we enable our patients to independently manage their exacerbation. Oh, or use a spacer!
The prevalence of diabetes is rapidly rising all over the globe at an alarming rate. In India, more than 61.3 million people have been presently diagnosed with type 2 diabetes mellitus. It is possible to control the circulating blood glucose levels by reducing life style risk factors through physical activities comprising of muscle stretches, aerobic training, resistance exercises (REs), yoga, etc. The aim of this study is to identify and compare the immediate effect of passive static stretching (PSS) versus RE on blood glucose level in individuals with type 2 diabetes mellitus.
The study included 51 participants between the age of 40–65 years with type 2 diabetes mellitus, to study the immediate effect of 60-min PSS (n=25) and 60-min RE (n=26). The outcome measure was blood glucose level which was checked by glucometer (free-style neo). Blood sugar was assessed at 3 points of time that included fasting blood sugar level, 2 hr after the meal and immediately after the exercise regimen.
Results of this study showed significant reduction in blood glucose level in subjects according to glucometer with PSS (P=0.000) and RE (P=0.00). However, both groups demonstrated equal effect in terms of lowering blood sugar level immediately after the exercise. The conclusion is both PSS and RE are effective in reducing postprandial blood glucose level in type 2 diabetes mellitus and must be prescribed for the patients who demonstrate difficulty in controlling post prandial spike.
Approximately half of individuals newly admitted to long-term care (LTC) nursing homes (NHs) experienced a prior hospitalization followed by discharge to a skilled nursing facility (SNF). The objective was to examine characteristics associated with new institutionalizations of older adults on this care trajectory.
This was achieved through a retrospective cohort study of medicare fee-for-service beneficiaries admitted to 7,442 SNFs in 2013 (N = 597,986). The authors used demographic and clinical characteristics from Medicare data and the Minimum Data Set. We defined “new institutionalization” as LTC NH residence for longer than 90 non-SNF days, starting within 6 months of hospital discharge.
For individuals who survived 6 months after hospital discharge, the overall rate of new LTC institutionalizations was 10.0% (N = 59,736). Older age, white race, being unmarried, Medicaid eligibility, higher income, more comorbidities, cognitive impairment, depression, functional limitations, hallucinations and delusions, aggressive behavior, incontinence, and pressure ulcers were associated with higher adjusted odds of new LTC institutionalization. In analyses stratified according to race and ethnicity, higher income was associated with lower odds of LTC institutionalization for whites (odds ratio (OR) = 0.92, 95% confidence interval (CI) = 0.89-0.96) and greater odds for blacks (OR = 1.40, 95% CI = 1.27-1.55) and Hispanics (OR = 1.44, 95% CI = 1.25-1.66). Moderate or severe depression, functional limitations, hallucinations and delusions, aggressive behavior, and being unmarried were stronger risk factors for LTC for cognitively intact individuals than for those with moderate to severe cognitive impairment. Being unmarried and having more comorbidities were stronger predictors in those aged 66 to 70 than in those aged 81 to 85 and 91 and older.
Associations between risk factors and new LTC institutionalizations varied according to race and ethnicity, age, and level of cognitive function. Programs that target older adults at greater risk may be an effective strategy for reducing new institutionalizations and fostering aging in place.