Richard Lebert
4345 Petrolia Line N0N 1R0 Petrolia, ON, Canada

PEACE & LOVE: New acronym for the treatment of soft tissue injuries ( Open Access Research Paper) Traditional treatment of an acute sprain or strain consists of RICE (Rest, Ice, Compression, Elevation). It is now recognized that ice can delay healing, increase swelling, and possibly cause additional damage to injured tissues. New recommendations are to provide soft tissue injuries with the PEACE & LOVE protocol. This helps encourage optimal loading of the joint and tissue a...round the affected injury which can impact the amount swelling and lead to a faster recovery. PEACE makes up the first steps you would take after an injury. Immediately after the injury you would want to protect (P) the injured structure, followed by elevating (E) the limb higher than the heart, avoid anti-inflammatory (A) both over-the-counter or prescriptions and ice, as they slow down tissue healing. Compress (C) the injured area to decrease swelling. Ensure patient education (E) on the risks of overtreatment. LOVE makes up the progressive return to activities a few days after the injury. Gradual load (L) will facilitate healing, optimistic (O) influences the perception of pain and recovery speed. Loading and progressive return to activity will facilitate vascularization (V) of the injured tissues. The last step involves activity exercises (E) can help recover range of motion, strength and proprioception. Reference. Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 7273. https://bjsm.bmj.com/content/54/2/72.long

Open Access Paper - Call to action to reduce low value care for low back pain. "Major international clinical guidelines have moved away from medicalized management of low back pain and prioritized nonpharmacological approaches as first line care." Visit the paper (link at the bottom of the post) for a detailed overview, or see the list below to see ten proposed actions to improve care for low back pain.... https://journals.lww.com//The_Lancet_Series_call_to_action

New Evidence-Based Clinical Practice Guidelines for Acute Musculoskeletal Pain This study involved a meta-analysis of 207 studies with 32,959 patients looking at the effectiveness of pharmacological and nonpharmacologic treatments. People included in the study had suffered various injuries including: muscle strains, sprains, contusion, whiplash and nonsurgical fractures. Based on the best available evidence of the benefits and harms this clinical practice guideline rec...ommends the use topical NSAIDs with or without menthol gel as a first line treatment. The guideline also suggests that oral NSAIDS, acetaminophen, acupressure, or transcutaneous nerve stimulation are effective treatments. The guideline recommends against opioids for patients with acute pain except in cases of severe injury or intolerance of first-line therapies. "This guideline is not intended to provide a one-size-fits-all approach to managing non-low back pain," said Gary LeRoy, MD, president of the AAFP. "Our main objective was to provide a sound and transparent framework to guide family physicians in shared decision making with patients." Qaseem et al. (2020). Nonpharmacologic and Pharmacologic Management of Acute Pain From NonLow Back, Musculoskeletal Injuries in Adults: A Clinical Guideline From the American College of Physicians and American Academy of Family Physicians. Annals of Internal Medicine. https://www.acpjournals.org/doi/10.7326/M19-3602

Infographic & Research Summary (Exercise & Fibromyalgia) People who experience symptoms of fibromyalgia may benefit from a moderate amount of exercise or physical activity. This review suggests that 30-60 mintues of aerobic exercise or strength training 2-3 times a week is an appropriate dose for people with fibromyalgia.... An important note is that people may experience exercise-related side effects as they start up a new program. Andrade, A., Dominski, F. H., & Sieczkowska, S. M. (2020). What we already know about the effects of exercise in patients with fibromyalgia: An umbrella review. Seminars in arthritis and rheumatism.

Manual therapy to the hand, arm, and cervical spine is an evidence-based treatment option for patients suffering from carpal tunnel syndrome. Simple home-care instructions for tendon/nerve gliding exercise program have been shown to be useful for patients with carpal tunnel syndrome. Fernández-de-Las-Peñas, C., Arias-Buría, J. L., Cleland, J. A., Pareja, J. A., Plaza-Manzano, G., & Ortega-Santiago, R. (2020). Manual Therapy Versus Surgery for Carpal Tunnel Syndrome: 4-Yea...r Follow-up From a Randomized Controlled Trial. Physical therapy, pzaa150. Advance online publication. https://pubmed.ncbi.nlm.nih.gov/32766779/ See more

New Chronic Pain Resources from Ontario Health This is a great example of partnering with the community to create a meaningful treatment guideline for those living with chronic pain. "The quality standard allows clinicians to focus on the chronic pain as a disease. It helps them to treat patients’ pain in an organized way, instead of just haphazardly trying to deal with it and potentially missing gentler methods to help the patient. The patient-focused gui...de helps people with chronic pain understand the process and know what to ask. With these tools, the physician and the patient create a plan, understand the plan, and deal with the plan as a team it’s a time-saver for physicians and the patient. And there are better outcomes: there are measuring points and timelines to follow to ensure success. If this quality standard can be implemented and bought into, it will be a huge step forward." - Lutz Plotzke, Lived Experienced Advisor, Chronic Pain Quality Standard Advisory Committee https://www.hqontario.ca//View-all-/Chronic-Pain/Resources

Best-practice for back pain supports a multidisciplinary approach that addresses biopsychosocial influences and empowers patients to actively self-manage. Once serious pathologies are excluded there are some consistent treatment recommendations. When consulting with someone living with low back pain provide reassurance and educational resources on condition and management options and encourage the use of exercise and physical activity to help manage symptoms.... An evidence-based interprofessional strategy for back pain can include the use of cognitive behavioural therapy, mindfulness-based stress reduction, exercise therapy, acupuncture, massage therapy and spinal manipulation. Simple home-care recommendations such as hydrotherapy, yoga, pilates, resistance training and aerobic exercise may be useful for people with back pain Opioid analgesics have small effects on back pain and are associated with adverse effects. Surgery is a last resort for treating back pain, but sometimes it's necessary. Link to references & additional resources https://ecampusontario.pressbooks.pub/handbookformassage//

Best-practice for carpal tunnel syndrome supports a multidisciplinary approach that addresses biopsychosocial influences and empowers patients to actively self-manage. Here are some consistent recommendations for high-value care Education and support for self-management promotes therapeutic alliance and self-efficacy. Undertake a physical examination which may or may not include orthopedic special tests, assessing for referred pain, neurological screening test, assessme...nt of mobility (active and passive range of motion) and muscle strength/endurance. Manual therapy to the hand, arm, and cervical spine is an evidence-based treatment option for patients suffering from carpal tunnel syndrome. Simple home-care recommendations such as stretching, splinting and home exercises have been shown to be useful for patients with carpal tunnel syndrome. Progress should be evaluated using validated outcome measures. Surgery is a last resort for treating carpal tunnel syndrome but sometimes it's necessary. https://ecampusontario.pressbooks.pub//carpal-tunnel-synd/

After four decades, the International Association for the Study of Pain (IASP) has released an updated definition for pain, it is An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage This is a minor revision of the previous definition but with six key notes to accompany the new definition: 1 Pain is always a personal experience that is influenced to varying degrees by biological, psycholog...ical, and social factors. 2 Pain and nociception are different phenomena. Pain cannot be inferred solely from activity in sensory neurons. 3 Through their life experiences, individuals learn the concept of pain. 4 A person’s report of an experience as pain should be respected. 5 Although pain usually serves an adaptive role, it may have adverse effects on function and social and psychological well-being. 6 Verbal description is only one of several behaviors to express pain; inability to communicate does not negate the possibility that a human or a nonhuman animal experiences pain. https://journals.lww.com//The_revised_International_Associ

A good overview of what is currently going on to attempt to manage the current coronavirus outbreak. Video from - Central Lambton Family Health Team

A fantastic image illustrating three different types of headaches: migraines, tension headache, and cluster headache. Source: https://artibiotics.com/blog/causes-of-headache

A list of online courses from Ed-X & Coursera on a wide range of topics. http://www.rmtedu.com/blog/massive-open-online-courses