5 For Monday

Monday rolls around again, don't fear your up-to-date email is here! Let's take a dive into the articles that have piqued my interest this week:

1 – Effectiveness of Progressive Rehabilitation After Acute Ankle Sprain: A Randomized Controlled Trial

This RCT compared standard care versus a progressive, criterion-based rehabilitation programme for adults following acute lateral ankle sprains. Results showed that the progressive programme led to quicker return to function, better balance outcomes, and reduced recurrence at 6-month follow-up.

Key take-home points:

• A structured, criteria-driven progression (rather than time-based) enhances recovery speed and reduces re-injury risk.
• Advanced programmes should include objective progression milestones (strength, balance, hop tests).

Clinical Application Tips:

• Use performance benchmarks (e.g., single-leg balance >30 s, HHD strength >90% side-to-side) rather than calendar days to guide progression.
• Incorporate multidirectional balance and sport-specific drills early in later stages.

2 – Exercise Intervention Dosage for Chronic Low Back Pain: What Dose Works Best?

This systematic review and meta-regression examined how exercise dosage (frequency, intensity, duration) influences outcomes in chronic non-specific low back pain. The authors found that higher frequency with progressive loading was consistently associated with larger improvements in pain and disability.

Key take-home points:

• More frequent supervised or structured sessions (e.g., 4–5×/week) with progressive intensity tend to outperform lower-frequency programmes.
• There’s no single optimal dosage — but progression and dose consistency matter.

Clinical Application Tips:

• Aim for minimum weekly exposures that allow meaningful load progression (e.g., ≥3 sessions/week).
• Tailor intensity using pain-guided progression (e.g., 0–3/10 during exercise) and recovery tracking.

3 – Tele-Physiotherapy for Shoulder Pain: A Multi-Centre Randomised Trial

This multi-centre RCT compared tele-physiotherapy (using video consultations + remote exercise prescription) with standard in-clinic management for patients with shoulder pain. Results showed non-inferior outcomes for function and pain at 12 weeks, with high satisfaction in both groups.

Key take-home points:

• Tele-physio can deliver outcomes on par with in-clinic care for many shoulder presentations.
• Patient satisfaction with remote care remains high, supporting it as a legitimate pathway.

Clinical Application Tips:

• Develop standardised remote assessment protocols (e.g., validated online ROM tests, strength self-tests).
• Include video demonstrations and regular remote check-ins to support adherence and technique.

4 – Neuromuscular Electrical Stimulation (NMES) as an Adjunct in Knee Osteoarthritis Management

This recent clinical trial examined the addition of NMES to conventional exercise programmes in knee osteoarthritis. Patients receiving NMES demonstrated greater quadriceps strength gains and superior functional performance compared with exercise alone.

Key take-home points:

• NMES may augment strength gains in populations with pain-limited voluntary activation.
• Best applied when combined with exercise rather than as a standalone modality.

Clinical Application Tips:

• Use NMES for patients with significant quadriceps inhibition or weakness, especially early in rehab.
• Ensure appropriate ramp times and tolerable intensities to promote compliance.

5 – Patterns and Predictors of Recurrence in Low Back Pain: A Prospective Cohort Study

This 2025 cohort study followed adults with recurrent low back pain over 12 months to identify predictors of recurrence. Key factors included lower baseline physical activity, higher fear-avoidance beliefs, and poor trunk endurance.

Key take-home points:

• Recurrence is influenced by modifiable factors (activity, endurance, beliefs), not just structural pathology.
• Prevention strategies should address behavioural and physical determinants.

Clinical Application Tips:

• Incorporate endurance training and fear-avoidance education into rehab plans to reduce recurrence risk.
• Use activity tracking and graded exposure to support long-term movement confidence.