This week we discuss cervical examination for vascular pathology prior to cervical manipulation. In general, our biases are against cervical manipulation. However, if you choose to perform cervical manipulations, this could be a useful paper to understand to limit the risk of adverse event from the technique. The authors primarily advocate for thorough history taking, multiple clinical tests including blood pressure and cranial nerve exam, and utilizing clinical reasoning and prior knowledge of neurovascular pathology presentation and risk factors to appropriately determine safety of cervical manipulation. While we agree this is crucial to ensuring safety performing the technique, we wonder if clinicians are able/willing to spend the amount of time required to perform all the appropriate screening prior to performing a cervical manipulation?

The abstract can be found here: https://www.jospt.org/doi/epdf/10.2519/jospt.2022.11147

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This week we discuss the training of marathon runners! Most PT's likely won't need to know about marathon training in the detail provided by this article, so we try to also distill down the main concepts. These are: more easy volume is associated with improvements in performance, therefore if you are working with marathoners you want to really push them to make sure their body can withstand the stresses they are going to be placing on them. Since most runners do not do much, or any, strength training, this is a big bucket that can be maximized. For the recreational runner that wants to improve their marathon performance, but does not have the time to do more volume, they may want to emphasize time doing zone 2 and 3 running. Since this is a higher stress to the body, it is vital to educate on proper recovery (sleep, nutrition, stress management) to ensure their body can appropriately tolerate the demands of running. Again, emphasizing strength training will help to build the body's capacity to training.

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/39616560/

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This week we discuss a recent article from the Journal of Athletic Training which asserts transdisciplinary collaboration is required for high performing medical teams in elite sport. They introduce two "largely competing" models for athletics organizations: the high performance model and medical models. The high performance model places a performance director at the center of a team of ATs, PTs, physician, strength and conditioning coaches, dieticians, and sports psychologists. These high performance directors synthesize the information from the sport performance team and directly communicate with sport coaches and management. In contrast, the medical model has more siloing of medical staff and emphasizes autonomy of medical dicisions. This is "designed to minimize potential conflicts of interest that could adversely affect athlete health". The authors believe this distinction is relatively arbitrary: “We argue that the medical model is theoretically consistent with the high performance model only if we reject the notion that the ‘performance director’ is an administrative person and instead conceptualize this as a ‘health and performance information hub’ that facilitates transdisciplinary collaboration”. Instead, organizations should strive for a transdisciplinary approach to the sport performance staff where the team uses their experience and expertise to solve a problem through a shared conceptual framework. There is standardization to information and data flow, and although there may be different documentation systems, they all feed into a central system that allows for synthesis of the parts. The authors say it best: “Injury prevention is a team effort, requiring structured and trusted data sharing.”

The abstract can be found here: https://pubmed.ncbi.nlm.nih.gov/38477160/

As always, if you enjoy what you hear, be sure to follow us on your favorite podcast platform and on Instagram @readingrehabpod. If you have any article recommendations be sure to send them our way!