Where does the time go?!

 Hello Blog Readers - Long time, no see!

In the past few weeks, two queries came my way related to some of my older blog posts. I found myself dusting off the Abby's World cobwebs to share those prior experiences. A PT student asked about my time volunteering in Tanzania and my clinic aide, who aspires to be a physician, asked me for articles that could provide a basic overview about central sensitization, so I shared what I had written about a chronic pain course with Morten Hoegh at the San Diego Pain Summit which included several related articles. 

Once I returned to these old stomping grounds, a wave of nostalgia hit me. I re-read the last post I wrote, where I announced that I'm writing a book! The book is still in progress, and it has been an awesome learning experience. I can't believe how difficult it is to write a book! I took a few months off from writing while I prepared two talks for the APTA (American Physical Therapy Association) CSM (Combined Sections Meeting) talks. The conference talks are only 90 mins long, but they take many more hours across several months to prepare. I got to read a bunch of articles and meet with my awesome co-presenters as part of the planning to make sure we were well organized. I'm pretty sure that's where my dedicated writing time went. In the immortal words of Congresswoman Maxine Waters, "I'd like to reclaim my time."

While re-reading my last post from a year ago, I saw that I was missing writing in this way, and I still do.  Blogs help me to organize what I'm learning and process my thoughts. While I have still been writing articles for The IX Sports occasionally, that's also different. In 2025, I wrote an article about the inaugural sensory friendly University of Washington Women's Basketball game and another about the recently launched associations for the WNBA medical providers.  All in all, I've been writing... but not sharing... and while it's still awesome, it eliminates the opportunity for conversation, which is part of what I like. 

I probably should have decided what comes next before writing this post. Should I be using substack more? Will my blog topics continue to revolve around sports medicine and pain? Do I need to be organized or can I stay random? While I debate my blogging future, I decided to write about a post I saw on social media this morning that prompted me to seek out an article to read and then which I directly applied to my patient care.

I saw this post on instagram this morning.  It's from Dr. Dan Cobian at the University of Wisconsin Badger Athletic Lab. He was describing his research from this article, "Knee Extensor Torque Steadiness and Quadriceps Activation Variability in Collegiate Athletes 4, 6, and 12 months After ACL Reconstruction." (open access, Orthopedic Journal of Sports Medicine, 2024). 

I had never heard of torque steadiness, so my initial thought was - is this what I'm seeing when my patient's leg shakes while they're straightening their knee? We see shaky post-surgical legs in the clinic all the time. The article didn't include a description of the visual presentation of the athletes, and neither does Dr. Google, but I'm going to assume that if the measurements indicate a movement isn't steady, this could be visible in some patients/athletes. The article does, however, explain how electrodes are applied to specific locations on the muscles and these can measure Athletes who underwent an ACL Reconstruction showed decreased torque steadiness at all three post-surgical timepoints.

A few hours later, I was in the clinic working with my post op ACL patient who could easily hold an isometric knee extension on her non-surgical limb, but then on her surgical limb, the leg was shaking right from the start. Concentric contractions are difficult and eccentrics are even harder. Her surgical limb is weaker than the other one and her leg is atrophied. She's working hard, but sometimes the shaking scares the younger patients and they ask a lot of questions about it...

Per usual, whenever I read an article, I come out with more questions than I went in. Is it a reasonable assumption to use my patient's visible leg shaking as a proxy for torque steadiness?  How long after the visible leg shaking resolves would there still be EMG findings of torque unsteadiness and quad atrophy? The article points out study limitations which makes me wonder if the outcomes would differ in a pediatric population or with more quad tendon grafts, because it primarily examined bone-tendon-bone grafts, which aren't what I'm seeing in the clinic. 

It's good to put my questions out into the world... great article.  I hope the researchers repeat with a bigger sample... and maybe they can tell me if my observation of shaking legs is a useful tool in the clinic.