Hi friends,

I spent this past week in Boston at the largest physical therapy conference in the United States. Most of the lectures I attended pertained to sports and orthopedics and here are some things I learned from them.

Achilles tendon rupture and tendinopathy

• Increased age and BMI lead to an increased risk of Achilles rupture.

• 80% of achilles ruptures occur in men and they typically occur from a sports injury.

• Tendon pain usually decreases before the tendon structure is returned to normal in people with Achilles tendinopathy. You need to keep loading the tendon even if there are hardly any painful symptoms.

Restore quadriceps function after ACL reconstruction

• There are increased levels of myostatin after ACL reconstruction. This is problematic because myostatin acts on muscle cells to inhibit muscle growth and can cause atrophy of the quadriceps musculature.

• Quadriceps hypertrophy should be the early focus of rehabilitation after ACL reconstruction. The bigger the muscle, the greater the potential to generate force.

• Open-chain exercises are safe and beneficial in ACL reconstruction rehabilitation. Knee extensions are a great exercise to focus on quadriceps strength and hypertrophy. Patients can compensate for a lack of quadriceps strength with other muscle groups during squats and leg pressing, this can lead to decreased quadriceps function and improper movement patterns.

Whiplash Associated Disorders

• Whiplash is caused by hyperextension of the neck followed by hyperflexion that occurs in many motor vehicle accidents (MVA).

• The number of people diagnosed with whiplash is increasing due to the increased survivorship of people in MVAs because of improved car safety technologies.

• Up to 50 percent of people with whiplash never fully recover.

• People with whiplash can experience chronic pain and increased sensitization of the central nervous system.

• Pain neuroscience education, exercise, and tools to calm down the nervous system are beneficial in people with whiplash who experience chronic pain.

Refreshing the lens for the management of patellofemoral pain

• Patellofemoral pain is the most common injury of the knee and is movement-evoked pain aggravated by loading.

• Elevated patellofemoral joint stress is what likely causes pain. Increases in joint reaction forces and decreased patella contact area within the trochlea of the femur are what lead to high patellofemoral joint stress.

• Addressing the strength of the hip and foot musculature is crucial in decreasing patellofemoral joint stress.

• The style of foot strike runners use, whether it be forefoot, midfoot, or rearfoot striking, doesn’t matter as much as the running cadence. Increasing the number of steps per minute decreases the ground reactive forces at the knee.

On minimal footwear

• Minimal shoes have the following—no motion control, no cushioning, zero drop, no arch support, no midsole, and no flare.

• Studies have shown that the less support you wear, the stronger your feet will be.

• For individuals who want to try minimal shoes, the transition out of the more supportive, cushiony shoes should be gradual. They can experiment by slowly spending more time in the minimalist shoes and less time in their supportive shoes until they are fully adapted to the new footwear.

Overall, I thoroughly enjoyed this conference and it was a phenomenal opportunity to hear different perspectives from some of the best physical therapists in the world. It was also a bonus to devour Boston’s signature seafood.

Until next week,

Kevin