Mentoring Minutes: Quadratus Lumborum and Psoas Major Exercises

This week's Mentoring Minutes, Dr Marshall LeMonie talks about Quadratus Lumborum and Psoas major exercises.

These muscles are often given a bad rap when it comes to low back pain, but the Quadratus and Psoas can play an important role in trunk and pelvic strength and stability. Just because they are stiff or tight, doesn’t always mean they are strong. Happy planking!

Source & Notes:

Evaluation of Psoas Major and Quadratus Lumborum Recruitment Using Diffusion-Weighted Imaging Before and After 5 Trunk Exercises

Journal of Orthopaedic & Sports Physical Therapy 2017 47:2, 108-114 

• Nine healthy male participants performed the right side bridge, knee raise, and 3 front bridges, including the hand-knee, elbow-knee, and elbow-toe bridges. Diffusion-weighted imaging was performed before and after each exercise.

• Of the 5 exercises investigated, the elbow-toe bridge and side bridge exercises elicit the greatest recruitment of the PM and QL.

Mentoring Minutes: Drop vertical jump for return to sport

Source and Notes:

Cognitive Demands Influence Lower Extremity Mechanics During a Drop Vertical Jump Task in Female Athletes

Journal of Orthopaedic & Sports Physical Therapy 2018 48:5, 381-387 

• Drop vertical jump task is commonly used to screen for anterior cruciate ligament

  injury risk.

• Purpose: Investigate the influence of additional cognitive demands on lower

  extremity mechanics during execution of the drop vertical jump task (stood on a 31-

  cm-high box, positioned 15.24 cm behind the force plates, with their feet 35 cm

  apart, were required to drop off the box, land with their feet on separate force

  plates, and immediately perform a maximum vertical jump, raising both arms as if

  they were jumping to grab a rebound).

• Methods: - 4 different conditions: (1) without decision making or an overhead goal

  (DVJ), (2) without decision making but with an overhead goal (OG), (3) with

  decision making (jump or no jump) but without an overhead goal (DM), and (4) with

  both decision making and an overhead goal (DM+OG).

• Results: Inclusion of the overhead goal resulted in higher peak vertical ground

  reaction forces and lower peak knee flexion angles in comparison to the standard

  drop vertical jump task. Greater peak knee abduction angles in trials incorporated

  temporal constraints on decision making and/or required participants to attend to

  an overhead goal, in comparison to the standard drop vertical jump task.

• Discussion- Higher vGRFs and lower knee flexion angles are indicative of a relatively

  stiff landing pattern, which may increase forces acting on the ACL.. Collectively,

  these additional cognitive demands appear to have resulted in a landing pattern

  whereby participants relied more on knee motion in the frontal plane to decelerate

  their center of mass.
  

Mentoring Minutes: Wrist Mobility Deficits

Today's reference article is an older one. However, the content and concepts are timeless and very helpful. Explore the article by clicking, HERE.

Mentoring Minutes: Total Hip Replacement

Welcome to PhysioU’s Mentoring Minutes! Each episode of Mentoring Minutes directly applies a clinical approach with relevant research for effective results.

 Studies show that patients who have had a total hip replacement have a higher risk for low back pain one year after the surgery.  Why is this the case for total hip replacements and not total knee replacements?  In today’s episode of Mentoring Minutes, Dr. Marshall Lemoine will be discussing different strategies to help regain patient function after total hip replacement surgery!

Thank you for watching!  

The newest Mentoring Minutes get posted on Facebook every Monday.  If you are not on Facebook, you can find most of our videos on YouTube.  See you next week!

Mentoring Minutes: Achilles Tendinopathies

Notes & References

-       wrong use vs over use  - Not every tendon problem is the same; location matters

o   Midsubstance- Most common: associated with over/wrong use; treat with load and reload;

-Most common (have ICF guidelines); goal is to stiffen it (so isometrics/eccentrics verse stretches)

-Can use tape, soft tissue, heel lifts, some modalities, all can help with pain (for the itis), but do not reload tendon, needed for Osis treatment

-Treatment: slow and controlled, involving cognition (think about it), need to exceed elongation than during walking (on step); high volume required, and overload it;

- Progression from flat ground to step to adding weight

- Goal with treatment is to make tendon more organized, thinner, faster reaction time;

-Palpation: if very localized, may more degeneration/thickening, verse entire tendon than more related to inflammation;  

o   Tenosseous junction (insertional)- associated with collagen disease, wide age range- teat surgery, casting, shockwave; Avoid resistive exercises, more to rest and boot/immobilize

-Running technique/skill training (change how they load the foot/calcaneus);

- Look at rear foot and mid foot mechanics.

Muscle Tendinous Junction: associated with immobilization (deprived loading); treat with progressive reloading- more rare, often inflammatory and need rest first

Sports Med. 2012 Nov 1;42(11):941-67. doi: 10.2165/11635410-000000000-00000.

Conservative management of midportion Achilles tendinopathy: a mixed methods study, integrating systematic review and clinical reasoning.

Rowe V1, Hemmings S, Barton C, Malliaras P, Maffulli N, Morrissey D.

MID PORTION ACHILLES

- Evidence was strong for eccentric loading exercises and extracorporeal shockwave therapy; moderate for splinting/bracing, active rest, low-level laser therapy and concentric exercises (i.e. inferior to eccentric exercise). In-shoe foot orthoses and therapeutic ultrasound had limited evidence.

J Orthop Sports Phys Ther. 2015 Nov;45(11):876-86. doi: 10.2519/jospt.2015.5885. Epub 2015 Sep 21.

A Proposed Return-to-Sport Program for Patients With Midportion Achilles Tendinopathy: Rationale and Implementation.

Silbernagel KG, Crossley KM.

Mid protion; 2-6 cm proximal to insertion (55-65%)

Eccentric protocol: 15x3, knee straight and 15x 3 knee bent; 2x a day, 7 days, no more than 5/10 during and after next day, slowly add load.

Return to sport: 3x15 with weight off step SL heel raises; 3x15 eccentric off step with weight, and 3x20 quick rebounding heel raises - 3 days recovery - need to load heavy, and speed

Clin J Sport Med. 2009 Jan;19(1):54-64. doi: 10.1097/JSM.0b013e31818ef090.

Nonoperative treatment of midportion Achilles tendinopathy: a systematic review.

Magnussen RA1, Dunn WR, Thomson AB.

Eccentric exercises have the most evidence of effectiveness in treatment of midportion Achilles tendinopathy.

Sports Med. 2013 Apr;43(4):267-86. doi: 10.1007/s40279-013-0019-z.

Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness.

Malliaras P1, Barton CJ, Reeves ND, Langberg H.

• CONCLUSION: There is little clinical or mechanistic evidence for isolating the eccentric component,
• Concentric- eccentric loading better (3 sec up, 3 sec down)- time under tension-  3 sets of 10-20, enough load to be painful in third set

J Orthop Sports Phys Ther. 2016 Aug;46(8):664-72. doi: 10.2519/jospt.2016.6494. Epub 2016 May 12.

Patellofemoral Joint and Achilles Tendon Loads During Overground and Treadmill Running.

Willy RW, Halsey L, Hayek A, Johnson H, Willson JD.

• Treadmill running resulted in greater achilles tendon loading compared with overground running ; peak concentric ankle power greater with Treadmill runnning

Am J Sports Med. 2015 Jul;43(7):1704-11. doi: 10.1177/0363546515584760. Epub 2015 May 27.

Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy: A Randomized Controlled Trial.

Beyer R1, Kongsgaard M2, Hougs Kjær B3, Øhlenschlæger T2, Kjær M2, Magnusson SP4.

• chronic  mid portion achilles tendinopathy;
• eccentric training 3x15 7x week, 12 weeks vs: Heavy slow resitance 3x week, knee flexed seated, and knee extended standing (15 rep max to 6 rep max);
• sports allowed if < 3; 4-5/10 while training if subsides next session
• Both groups: improved pain, and sports assessments, reduction in tendon thickness and neovascularization
• Patient satisfaction > in heavy slow resistnace group (96 vs 76%), with higher compliance (96% vs 76%))