International Older Peoples Day – 1st October

The 1st of October is the UN International Day of Older Persons.

It’s spoken about a lot in the media, the fact we have a global aging population. According to the UN “Between 1950 and 2010 life expectancy worldwide rose from 46 to 68 years, and it is projected to increase to 81 by the end of the century.” For the first time in human history, in 2050, there will be more persons over 60 than children in the world. To make it clear by 2050, 2 billion people, over 20 per cent of the world’s population, will be 60 or older. It doesn’t matter where in the world you live the facts are the same. Obviously this has implications for physiotherapy intervention and service provision.

The 1st of October provides us with an opportunity to reflect, plan and build a physiotherapy future which caters for our soon to be biggest client group. We are biased as healthcare professionals as we tend to only see the acutely unwell, frail older person. However their are some amazing people out there and sometimes you hear of their stories, sometimes you don’t. One thing is for sure, we always underestimate the ability of older people and their ability to bounce back. Physiotherapy is well placed to help everyone age well and age strong, look at this MRI. If you do anything this October, perhaps don’t rule out someone for rehabilitation or exercise therapy because of their age.

Do We Really Understand Osteoarthritis of the Knee?

Osteoarthritis (OA) is a major cause of disability worldwide and according to “The global burden of hip and knee osteoarthritis: estimates from the Global Burden of Disease 2010 study“, OA of the knee is the 11th highest contributor to global disability. Put simply, millions of lives are affected by the disease every single day. It is predicted that it will advance to become the 4th leading cause of disability by 2020.

The cause of knee osteoarthritis is complex and certainly multi-factorial in nature.  There is a great summary over on Physiopedia, but in brief, it is a complex interaction between systemic and local factors. These factors include: advancing age, genetics, trauma, knee malalignment, increased biomechanical loading of joints through obesity, augmented bone density and an imbalance in physiological processes. It has been frequently reported, and it is a common thought, that obesity and advancing age are the two critical, and biggest, contributors to increasing prevalence of OA. This belief is being challenged by new evidence which may suggest that perhaps we have been approaching our understanding from the wrong perspective.

A novel study entitled “Knee osteoarthritis has doubled in prevalence since the mid-20th century” investigated the long-term historical trends of knee OA prevalence in the US from the past 6000 years. This data was collected through the use of historical records, cadaver studies and human skeletons from thousands of years ago (for the nitty gritty details please go to the original source!). Their results indicated that “…increases in longevity and BMI are insufficient to explain the approximate doubling of knee OA prevalence that has occurred in the United States since the mid-20th century. Knee OA is thus more preventable than is commonly assumed, but prevention will require research on additional independent risk factors that either arose or have become amplified in the postindustrial era“.

Obviously retrospective studies cannot directly test causation, and there could be a number of factors at play, but the authors attribute environmental factors as the biggest contributor. Therefore, OA knee is more easily preventable than initially thought. Considering that loading is likely to be the biggest contributor of OA knee, through abnormal loading or weak structural tissues, joint loading is a topic worth investigating. As the authors explain, footwear, pavements and BMI could all be plausible risk factors. However, they see physical activity as the most important change across history and likely to be key to understanding why prevalence has doubled.

Less physically active individuals who load their joints less develop thinner cartilage with lower proteoglycan content (3435) as well as weaker muscles responsible for protecting joints by stabilizing them and limiting joint reaction forces (36). Chronic low-grade inflammation, which is exacerbated by physical inactivity (37), modern diets rich in highly refined carbohydrates (38), and excessive adiposity (10), can further magnify and accelerate loading-induced damage to joint tissues and may also directly affect knee OA pathogenesis (5). Evaluating which of these or additional features of modern environments are responsible for today’s high knee OA levels is necessary. (Wallace et al 2017).

This study highlights the direction modern physiotherapy should adopt. We should use studies like this to empower our patients. Clearly there are caveats to a study of this kind, however we should not let that affect it’s clinical significance. We should not let our patients believe OA knee is an inevitability of getting older or becoming overweight; people can do something about it. As physiotherapists, we have proven the effectiveness of management of OA knee through the mediums of lifestyle advice, education and exercise, just as this study suggests. Let’s be proactive not reactive. We need to further promote the importance of exercise and we should aim to correct joint loading through strength and proper technique to enable people to stay stronger for longer.

As a recent tweet by Anna Lowe demonstrates, we need to get better at advising our patients to become more active, more exercise focused and stronger. The implications of leading an exercise-centric life are evident, well documented and overwhelmingly positive. Let’s get to work.


Whiplash – A New Integrated Model

Whiplash injury is caused by a rapid and sudden movement to the neck and in turn it may lead to a variety of clinical manifestations called Whiplash-Associated Disorders (WAD). It can result from many mechanisms such as diving into a swimming pool, being in a fight or falling however the most common preceding factor is a car crash.

It is estimated that about 20% to 50% of patients who sustain a symptomatic whiplash injury go on to report chronic and persistent pain. Neck pain is probably the best example of a medical condition where there is a disconnect between the magnitude of injury and the magnitude of disability as well as economic cost, particularly those resulting from a car accident.

Many different models and explanations have been proposed to help improve outcomes for people with WAD and to try and reduce the cost burden on the economy, but to date there has been a lack of clarity and unity between such tools. Current concepts include the fear avoidance model, the diathesis-stress model as well as classification systems such as the Quebec Task Force Classification (QTF) and the hunt for a specific pathoanatomical lesion, a particular structure which is the source of the chronic pain, goes on.

As with all of models, regardless of topic, they each have their own strengths and weaknesses and there is concern that current concepts have become outdated and lack the incorporation of biopschyosocial concepts. James Elliot and David Walton have done something about this. They have created a new integrated model of WAD. They hope will bring future WAD research towards a more inter-disciplinary focus to allow policy makers, patients and healthcare professionals to work together to improve patient and consumer outcomes. The model has recently been published in the Journal of Orthopedic & Sports Physical Therapy.

Read the Article

To learn more about the latest evidence, assessment and treatment of common neck conditions, like WAD, keep your eyes peeled for our neck course which is coming soon.

Congratulations APTA on Achieving a Milestone

Congratulations to the American Physiotherapy Association (APTA) for achieving 100,000 members across its 51 chapters and divisions. As the numbers grow the profile of physio in the US will only get stronger and stronger.

The APTA is the organization which represents more than 100,000 member Physiotherapists (+students) and assistants. It seeks to improve the health and quality of its members and advance physio practice, education, and research, and by increasing the awareness and understanding in America. APTA members are represented by the state chapters and special-interest sections, each with its own leadership, as well as a physical therapist assistant caucus and student assembly, collectively called “components.”

With a proud history that dates back to 1921, APTA is guided by the Vision Statement for the Physical Therapy Profession and by the association’s dynamic Strategic Plan, which informs decision making and helps APTA achieve the vision.

ICYMI – A New Feature – July 2017

It’s easy to miss great content when you are busy. That’s why we will endeavor to give you a quick hit of CPD at the end of each month so you don’t miss out. This new monthly post will include the most read content from the past 30 days, this will enable you to keep up to date with the best content. We hope that this will help improve your clinical practice consistently, and allow you to be grounded in the best evidence base available anywhere on the internet. So here we go, let’s dive in!

Enthesitis under the spotlight

My favourite gluteal activation exercises

Book Review: Explain Pain Supercharged

Adverse effects as a consequence of being the subject of orthopaedic manual therapy training, a worldwide survey.

Effectiveness of conservative interventions adults with shoulder impingement a systematic review of RCTs

Ted Talk: Hugh Herr & Bionics

Bionics is bridging the gap between disability and ability. Technology can overcome profound physical limitations from horrific diseases to traumatic injuries. As our understanding of the human body and technology improves we can create more advanced adaptations to overcome debilitating injury and disease. Hugh Herr and his programme at MIT aims to do just that; further our ability to overcome disability with design and technology. This is bionics.

The centre of extreme bionics at MIT is a revolution. The developments are incredible, the research projects are complex and the level of detail is mind boggling. We might not be able to understand the science behind what they do but we can all relate to the outcome, enabling movement to those who otherwise can’t.

What do you think the future holds for bionics?

WHO Global Conference on NCDs – Lets Talk About the BIG FOUR

The global burden of non-communicable disease is a major threat to long-term sustainable healthcare models. People are living longer with chronic conditions and at the same time dying prematurely. Just look at the statistics from the WHO. In 2015 NCDs were responsible for 70% of deaths worldwide, over 15 million people (38% of NCD deaths and 27% of all global deaths) died between the ages of 30 and 70. 85% of premature deaths from NCDs occurred in developing countries, including 41% in lower-middle-income countries where the probability of dying from an NCD between the ages of 30 and 70 is up to four times higher than in developed countries. Most of these 15 million premature deaths from NCDs could have been prevented or delayed.

There are four types of disease which significantly contribute to the burden of NCDs more than any other. The big four are cardiovascular disease, cancer, diabetes and chronic respiratory disease. Each of the big four can benefit greatly from physiotherapy input. The evidence and been well researched and documented.

Montevideo, Uruguay 18-20th October 2017

Later this year, the President of Uruguay is host to the WHO conference with the objectives of:

  • Providing guidance to Member States on how to reach SDG target 3.4 by 2030 by influencing public policies in sectors beyond health and enhancing policy coherence;
  • Launching a set of new global initiatives to help countries accelerate progress in reducing premature mortality from NCDs and fast track efforts to attain SDG target 3.4;
  • Exchanging national experiences in enhancing policy coherence to attain the 9 voluntary global NCD targets for 2025;
  • Highlighingt the health sector as the key advocate for enhancing policy coherence for the attainment of SDG target 3.4.

Participants include heads of state and government, ministers from relevant cabinets, public policy makers, UN organizations and global experts.

Let’s make sure that before this conference takes place we make sure the stakeholders are aware that Physiotherapy is uniquely positioned. Our profession is key to helping reduce the financial and emotional strain of these long-term illnesses and this conference is a great opportunity to promote the profession. We need a loud Physiotherapy presence to shout about the necessity to back us, to let us help combat chronic disease. We are part of the solution.

The discussions from the conference will be published soon afterwards.

The Conference Brochure

Apprenticeship Consultation – UK Physio’s Have Their Say

UK Physiotherapists will have between the 20th of July and the 8th of September to consult about the Physiotherapy Apprenticeship Standards. This could have radical implications for the entire physiotherapy workforce.

The apprenticeship standards are needed to describe the knowledge, skills and behaviours required to carry out a specific occupation. The standard must be a short document therefore these descriptors do not provide detailed curriculum.

The groups developing these standards are called ‘Trailblazers’, the Physiotherapy Trailblazer has developed the standard for Physiotherapists and required your opinion.

Take Part in the Survey

The Chartered Society of Physiotherapy (CSP) sees the benefits of expanding the Physio workforce through alternative routes to full-time study. Thanks to the major apprenticeship reform in England a Physiotherapy apprenticeship could become a reality in September 2018. The major change to the previous rules are the level of academic qualification gained post apprenticeship. The new rules would allow BSc as well as MSc level qualifications.

To keep up to date with developments, make sure you bookmark the CSP Apprenticeship page.

$3 Million for Physical Therapy Foundation

After the largest donation in its 38 year history, the Foundation PT has secured a future for clinical research funding. This is thanks to Fellows of the APTA, Stanley Paris and his wife Catherine Patla.

“This generous gift will transform the Foundation’s ability to fund clinical research at a higher level, providing significant and ongoing support for research that forms the basis of physical therapist practice,” says Foundation President E.Field-Fonte PhD.

Find out more by watching the interview below.

KineMan Complements the PP Anatomy Project

Learning and understanding the anatomy of the human body is challenging. It is one thing remembering all of the muscle and joints they act on, but it is another thing being able to apply this knowledge to understand how treatments work.

Not everyone is lucky enough to have access to cadavers whilst at University. Being able to see joints moving when exposed is a great learning opportunity. Don’t worry if you haven’t got access to cadavers there are many excellent virtual-type educational tools to help you visualise the human body moving. One such great example is KineMan.

Kineman is a new 3D web application skeleton which allows you to move the joints of the body by clicking and dragging on the skeleton in any direction. You can then view the changed joint position from any angle, furthermore you can change multiple joints at a time to create poses.

The level of detail is great and you can really get to grips with how joints move in a complex position such as during manipulations and manual therapy.

Kineman compliments the Anatomy Project on Physiopedia extremely well. Make sure you read the pages to learn the fundamentals first to make the most of this great application.