Hand Splinting and Fabrication

Back pain is a common ailment that many of us have experienced at some point in our lives. One specific type of back pain, known as discogenic low back pain (LBP), is characterized by pain originating from the intervertebral discs (IVDs) in the spine. Despite extensive research, the exact causes of discogenic LBP have remained elusive. However, a recent study conducted by Seiji Ohtori and his colleagues sheds new light on the underlying mechanisms of this condition.Animal Models and Discogenic LBP:Through the use of animal models, researchers have made significant discoveries regarding discogenic LBP. They have found that sensory nerves grow into the inner layer of the lumbar IVDs, and this nerve ingrowth is induced by certain inflammatory substances called cytokines. These cytokines, such as tumor necrosis factor-α and interleukins, stimulate the ingrowth of sensory nerves into the discs. Moreover, nerve growth factor has been identified as a key player in inducing this nerve ingrowth. Animal models have also revealed that disc degeneration triggers the production of collagenases, enzymes that break down collagen, leading to hypermobility and pain. Sinuvertebral NervesUnveiling Human Discogenic LBPFurther insights into the mechanisms of discogenic LBP have been gleaned from the examination of degenerated human IVD specimens. These specimens have revealed sensory innervation and nerve ingrowth, similar to what has been observed in animal models. The presence of cytokines in human discs suggests a shared mechanism with animal models. This indicates that the findings from animal studies can be applied to human patients as well. In addition to sensory innervation and cytokine involvement, sensitization of sensory nerve fibers innervating the IVDs is a crucial factor in discogenic LBP. When these nerve fibers become sensitized, they become more responsive to pain stimuli, leading to heightened pain perception.Psychosocial factors also play a role in the perception and experience of pain associated with discogenic LBP. Factors such as stress, anxiety, depression, and social support can influence an individual’s pain experience. Understanding the interplay between these psychosocial factors and the physiological aspects of discogenic LBP is important in developing comprehensive treatment approaches.Tackling Discogenic LBP: Treatment ApproachesUnderstanding the underlying pathomechanisms of discogenic LBP opens up avenues for potential treatment strategies. To effectively manage this condition, it is crucial to prevent sensitization of sensory nerve fibers within the IVDs. This can be achieved through targeted interventions that aim to suppress the pathogenic increases of cytokines. By reducing the levels of pro-inflammatory cytokines, such as tumor necrosis factor-α and interleukins, the ingrowth of sensory nerves into the discs can be controlled, thereby reducing pain.In addition to cytokine regulation, addressing disc hypermobility is an essential aspect of treating discogenic LBP. Hypermobile discs can magnify pain and further damage the disc structure. Treatment options such as physical therapy and specific exercises can help stabilize the spine, reduce hypermobility, and alleviate pain. Other interventions, such as spinal manipulative therapy and epidural steroid injections, may also be considered in certain cases to manage pain and promote healing.Conclusion:Discogenic low back pain is a complex condition with multiple underlying mechanisms. The research conducted by Seiji Ohtori and his colleagues has provided valuable insights into the pathomechanisms of this condition, highlighting the role of sensory nerve ingrowth, cytokines, and disc hypermobility. By understanding these mechanisms, health professionals can develop more targeted treatment approaches to help patients suffering from discogenic LBP.One innovative product that aids in the understanding and communication of discogenic LBP is the Professional LxH Dynamic Disc Model by Dynamic Disc Designs. This model accurately represents the structure and function of the intervertebral discs, allowing health professionals to visually demonstrate the impact of disc degeneration, nerve ingrowth, and hypermobility to their patients. By using this model during patient consultations, health professionals can help individuals better comprehend the nature of their condition and the rationale behind the recommended treatment approaches.Check out MMT's Exclusive Blue Nucleus model!Via Dr. Jerome Fryer - Dynamic Disc Designs Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below! Learn more online - new online discussion group included! Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.  NEW - Online Discussion Group Live cases webinars lecture Live Q&A over 600 videos - hundreds of techniques and more!  Check out MMT Insiders Keeping it Eclectic... This article was originally posted on Modern Manual Therapy Blog

Andrew is back talking about a colleague's recent case. This is a new grad, only practicing for 5 weeks or so, but kudos to his differential diagnosis skills and applying the Wells Criteria for Pulmonary Embolism. If you're not familiar with it, its something you should keep in the back of your mind, especially with post op patients, those who have been recently immobilized, or with history of Cancer or PE. Untold Physio Stories is sponsored by⁠The Eclectic Approach Network⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠EDGE Mobility System⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com⁠Curv Health⁠ - Start your own Virtual Clinic Side Hustle for FREE! Create your profile in 3 minutes, set your rates, and Curv will handle the rest! From scheduling to payments, messaging, charting, and a full exercise library that allow for patient/clinician tracking, it's never been easier! ⁠Click to join Dr. E's new Virtual Clinic Collective⁠ to help promote best online practices.  Keeping it Eclectic... This article was originally posted on Modern Manual Therapy Blog

Collagen Supplementation for Joint Pain and Arthritis: Does it Really Work?By Dr. Sean M.Wells, DPT, PT, OCS, ATC/L, CSCS, NSCA-CPT, CNPT, Cert-DNRecently I was presenting at the annual conference of Athletic Trainers' Association of Florida (ATAF) and I was overwhelmed by one consistent question: why didn't you talk about collagen supplementation? My talk was specifically on orthopedics for older adults and naturally I focused on osteoarthritis (OA) and how important exercise and diet are for that condition. I did touch on some supplementation, but I left off collagen because my last examination of this supplement, using one of my favorite websites Examine.com, yielded mediocre results. However the participants at the sports medicine conference piqued my interest and convinced me that perhaps I had missed something -- almost every single one of these participants had some form of joint pain or stiffness and felt significantly better after taking collagen daily. So, back to the literature, and asking some of my clients, I went!What is Collagen?Collagen is a protein found in the body that provides structure and support to various tissues, including joints, bones, tendons, and ligaments. It may play a role in maintaining joint health and may have potential benefits for individuals with joint pain. A few small-scale studies have shown positive results in reducing joint pain and improving joint function when individuals with osteoarthritis took collagen supplements. These studies often used specific collagen formulations, such as collagen peptides or hydrolyzed collagen, which are broken down into smaller peptides for better absorption by the body. However, it's important to note that the findings of these studies are not yet conclusive, and more robust research is necessary.The ResearchIt's worth mentioning that joint pain can have various causes, and collagen supplementation may not be effective for everyone. Factors like age, underlying health conditions, overall diet, and lifestyle habits can also influence joint health. For instance, a meta-analysis on collagen supplementation for OA showed improvements in the WOMAC, a functional score for knee arthritis, but it didn't yield significant results for knee pain. Meanwhile, another review article looking at collagen supplementation for joint pain, muscle protein synthesis, and body composition found that collagen did significantly reduce joint pain (it had effect on the other metrics). Here's a nice table listed in the article:The joint pain included in the review included knee pain and Achilles tendinopathy, all predominately in an athletic population. Another glaring observation is several of these studies included physical therapy and exercise prescriptions with the supplementation (Yay! Nutrition and Physical Therapy), which can also alter the results and effects of collagen as well. It's important to see the doses varied in the studies from 5, 10, to 40 grams per day; moreover, the collagen can come in varying form from peptides, hydrolyzed proteins, to denatured collagen.  Having such variability in the type of collagen also likely explains the variability in responses and data.DosingSo, roughly how much and what type of collagen should a client take? Well, many studies have used dosages ranging from 8 to 12 grams of collagen peptides or hydrolyzed collagen per day for joint-related benefits. Research suggests that type II collagen supplementation may help reduce joint pain and improve joint function in individuals with arthritis, particularly osteoarthritis. It is believed to work by helping to restore and support cartilage health, potentially reducing inflammation and promoting joint mobility. It's important to note that collagen supplements are available in various forms, such as powders, capsules, and liquids, and their concentration of collagen can vary. Therefore, it's crucial to follow the manufacturer's instructions and consult with a healthcare professional to determine the appropriate dosage for your specific needs.It's also worth mentioning that collagen supplements are often combined with other ingredients, such as vitamins, minerals, or herbal extracts, which may influence their effectiveness. If you decide to try collagen supplementation for joint pain, it's a good idea to choose a reputable brand and look for products that have been tested for quality and safety. I suggest using Labdoor.com to help you or your client find a high-quality collagen supplement, if and when appropriate.SummaryIn the end, perhaps the participants at the ATAF conference were right -- there is something to say about collagen and joint pain. Not every study is exact and more research needs to be done on what dose, what age, what condition, and what exercises should be done with the collagen -- but that's why we  practice physical therapy! Love to hear your thoughts and maybe some of your clients' responses to collagen. If you like what you see here then know there is more in our 3 board-approved continuing education courses on Nutrition specific for Physical Therapists. Enroll today in our new bundled course offering and save 20%, a value of $60! Earn CEUs in most states for PTs! Want to learn in person? Attend a #manualtherapyparty! Check out our course calendar below! Learn more online - new online discussion group included! Want an approach that enhances your existing evaluation and treatment? No commercial model gives you THE answer. You need an approach that blends the modern with the old school.  NEW - Online Discussion Group Live cases webinars lecture Live Q&A over 600 videos - hundreds of techniques and more!  Check out MMT Insiders Keeping it Eclectic... This article was originally posted on Modern Manual Therapy Blog

In this episode, Erson goes over a tough case of constant and flared up cervical pain with radiating complaints. What do you think of his solution? Have you ever had a similar case that responded to sustained holds better than repeated loading or traditional techniques? Untold Physio Stories is sponsored by⁠The Eclectic Approach Network⁠ - Check out Dr. E's all new private, non tracking and ad free network for rehab pros! It's free to join, has chat, feed, and all the features of other social networks without the creeping tracking.Check out ⁠EDGE Mobility System⁠'s Best Sellers - Something for every PT, OT, DC, MT, ATC or Fitness Minded Individual https://edgemobilitysystem.com⁠Curv Health⁠ - Start your own Virtual Clinic Side Hustle for FREE! Create your profile in 3 minutes, set your rates, and Curv will handle the rest! From scheduling to payments, messaging, charting, and a full exercise library that allow for patient/clinician tracking, it's never been easier! ⁠Click to join Dr. E's new Virtual Clinic Collective⁠ to help promote best online practices.  Keeping it Eclectic... This article was originally posted on Modern Manual Therapy Blog