Have you ever had a therapist tell you that you’ve got a knot in your muscle or a stiff vertebrae in your back?

Did you believe them?

Well maybe you shouldn’t heres why…👇 Experienced therapists can NOT feel the difference in the stiffness of different lumbar vertebrae in those with or without back pain!

pubmed.ncbi.nlm.nih.gov/19539121/

pubmed.ncbi.nlm.nih.gov/24965495/

pubmed.ncbi.nlm.nih.gov/31733430/

Its that time of year again when I select 10 papers I’ve enjoyed reading this year that I think you might too!

These are presented in no particular order and are based mostly on my own personal biases and preferences!

I hope you enjoy them… 👇 No1: a paper I co-authored that attempts to change the outdated narratives and bullshit that surrounds manual therapy

I don’t agree with everything in this paper and it upset some now ex-friends of mine as well… so be it!

pubmed.ncbi.nlm.nih.gov/38773515/

The term ‘acute non-specific low back pain’ is often misunderstood and misrepresented by many patients and clinicians alike!

So lets take a look at what this diagnosis actually means and try to clear a few things up!

A short evidence based thread 👇 The first thing to say is acute non-specific low back pain is really common… with 80-90% of us having it at least once in our lives!

pubmed.ncbi.nlm.nih.gov/38510335/

HNPP or Hereditary Neuropathic Pressure Palsy is a poorly recognised condition that can present like many of the common neural conditions such as carpal tunnel or cubital tunnel syndrome!

Here is a short review on HNPP and some features of it to keep an eye out for… a 🧵 The prevalence of HNPP is not fully know as it is under recognised but currently its around 16 per 100,000 people! pubmed.ncbi.nlm.nih.gov/9447611/

There are many myths and misunderstandings about our spinal discs!

So lets take a look at some facts and evidence about these commonly misunderstood structures!

A short thread 🧵 Despite many claims from many social media gurus our spinal discs are adaptable just like any other tissue in our body! pubmed.ncbi.nlm.nih.gov/6729579/

There are lots of “facts’ about “good posture” here are some that you may not realise… Don’t kid yourself that sitting or standing up straighter will protect you from back pain or injury!

There is little difference in rates of back pain or injury in ALL posture types

Everyone talks about HOW MUCH sleep you should get, but no-one talks about WHEN you should go to sleep!

Here’s why we should… Broadly speaking there are two genetic ‘chronotypes’ when it comes to humans preferred sleeping times… Morning Larks and Night Owls sciencedaily.com/releases/2015/…

Being a physio for 20+ years I know first hand how challenging this job can be!

But here are 10 things that have helped me through the difficult times… 👇 1: Remind yourself regularly why you chose this profession?

If it’s for fame and fortune, you’re going to be disappointed!

But if its to try and help people in pain make sense of what’s going on and find a way forward, then you’re good!

I detest snake oil showman on social media demonstrating ‘quick fixes’ and ‘100% cures’ for pain!

Having tried them all with the people I see in pain they just don’t work like they say!

Real therapists working with real people know it’s just not that simple or easy! For example, a recent patient of mine with 9+ months of non specific low back pain, saw a video of some ‘guru’ claiming a series of 3 stretches would fix it!

And indeed she did get some immediate relief… but it was only brief and returned to baseline within a few hours

Anterior pelvic tilt is often blamed for many things by many people!

But anterior pelvic tilt isn’t the ‘bad guy’ everyone thinks it is!

Heres why… 🧵 Anterior pelvic tilt is thought to be caused by tight hip flexors… mainly the psoas!

Psoas tightness is thought to occur most in those who sit for long periods!

Do you need surgery for a full ACL rupture?

A thread… 🧵 Despite surgical repair of ruptured ACLs being an almost automatic certainty in almost all countries on almost everyone… there is growing evidence that many don’t need surgery!

Can stretching create muscle hypertrophy?

A short thread on some recent research… 🧵 This well conducted study looked at the effects of calf stretching on fit young subjects! pubmed.ncbi.nlm.nih.gov/35694390/

📚TOP TEN📚

As the end of the year draws to a close here are 10 papers I have enjoyed in 2021…

A thread… 1/10 PLACEBO & CONTEXTUAL EFFECTS:

First up is a great paper highlighting how much placebo and contextual effects contribute to overall treatment effects in many things… on average around 50% 🤔

2/10

pubmed.ncbi.nlm.nih.gov/34311793/

Over the last few weeks I’ve been looking at the research into the effects of various types of exercise on lumbar spinal discs, to see if there is any support to the common beliefs that some types are worse than others, and that discs are not adaptable!

This is what I found… 🧵 First I looked at cycling which is often believed to be bad for discs due to the sustained flexed spinal positions! 🚴

Turns out not so, with cyclists seen to have thicker and better hydrated disc than non cyclists pubmed.ncbi.nlm.nih.gov/30157104/

Should you wear a belt when lifting weights? 1/5 Since my back injury many have asked me about my thoughts on belts when training… so I did a bit of reading and belts can do some things that can be helpful… 2/5

Is Blood Flow Restriction (BFR) Training something you should consider using?

Well lets take a quick look in this thread! 1/9 First up, combining traditional resistance training with BFR has just recently been shown to lead to some improvements in both strength, muscle size, and markers of sports performance in healthy athletes. 2/9

pubmed.ncbi.nlm.nih.gov/33196300/

A really frustrating day in clinic repeatedly trying to convince patients that steroid injections are NOT the solution to their problems, and the short term effects are NOT worth the long term defects!

A short thread... One of the ways I often try to explain this is with a car analogy, and I know people are more complex than cars but bear with me...

💥ARTHRITIS💥 a thread!

I often get asked by patients why have I got arthritis, or how does arthritis happen?

Well lets just say its bloody complicated and still not fully understood, and I always struggled to answer this question... But thanks to @RodWhiteley for pointing me in the direction of some very interesting research which lead me down a PubMed rabbit hole for a week, this is now going to be my preferred explanation for arthrits...

Its a bit simplistic, and not 100% accurate so please bear with me!