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Objectives: To measure the medial and lateral retinaculum thickness in individuals with and without patellofemoral pain using ultrasound and to assess associations with the symptom duration and function., Methods: Medial and lateral patellofemoral joint retinaculum thicknesses of 32 knees (16 with patellofemoral pain and 16 asymptomatic) were measured with B-mode ultrasound at 0.5, 1, and 1.5 cm from the patella border. Participants with patellofemoral pain completed a Kujala questionnaire, and both groups underwent a single-leg squat performance assessment. Two-way analyses of variance (site × group) determined the overall effect, and Cohen d values were calculated to describe the magnitude of the difference for each measurement., Results: The groups were matched for age, height, and weight. Compared to controls, participants with patellofemoral pain had thicker lateral (overall effect, P = .03) and medial (overall effect, P < 0.01) retinacula. No correlations between retinaculum thickness and Kujala scores (lateral retinaculum, r = 0.106 [0.5 cm], -0.093 [1 cm], and -0.207 [1.5 cm]; and medial retinaculum, r = 0.059, 0.109, and -0.219), symptom duration (lateral retinaculum, r = 0.001, -0.041, and 0.302; and medial retinaculum, r = -0.027, -0.358, and -0.346), or single-leg squat performance scores (lateral retinaculum, r = 0.051, 0.114, and 0.046; and medial retinaculum, r = -0.119, -0.292, and 0.011) were observed., Conclusions: Increased lateral and medial retinaculum thickness in individuals with patellofemoral pain compared to controls identifies structural changes that may be associated with the pathogenesis of patellofemoral pain. The absence of a significant correlation between retinaculum thickness and the symptom duration or function further shows a lack of an association between structure and function in individuals with patellofemoral pain., (© 2018 by the American Institute of Ultrasound in Medicine.)

Objectives: The ability to maintain a lumbopelvic position (LPP) was assessed in athletes with a history of long-standing groin pain (LSGP) and athletes without LSGP., Design: Case-control study., Setting: University motion analysis laboratory., Participants: Thirty male athletes-15 with a history of LSGP (>12 weeks) and 15 without., Main Outcome Measures: Maintenance of LPP was assessed using a pressure biofeedback unit (PBU) during supine single leg lift (SLL), single leg extension (SLE) and bent knee fallout (BKFO). Repeatability was assessed using intra-class correlation coefficients (ICC) and group differences analysed using MANOVA., Results: Differences were detected between involved and uninvolved sides in the LSGP group during SLL (mean difference [md] = 9.82 mmHg, p < 0.01) and BKFO (md = 8.56 mmHg, p < 0.01) but not during SLE (md = 0.38 mmHg, p = 0.96). Between group differences were found during the SLL of the involved leg (md = 5.22 mmHg p = 0.034) and the BKFO of the uninvolved leg (md = 6.22 mmHg p = 0.017). Inter-session reliability varied for the different movement tasks in both groups (ICC = 0.35-0.94)., Conclusions: Ability to maintain LPP differed between the involved and uninvolved legs within the LSGP group and between the athletes with and without LSGP. Despite resolution of groin pain, altered control of lumbopelvic position existed with possible implications for later injury recurrence., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Sports-related groin pain (SRGP) is a common entity in rotational sports such as football, rugby and hockey, accounting for 12-18 % of injuries each year, with high recurrence rates and often prolonged time away from sport., Objective: This systematic review synthesises movement and muscle function findings to better understand deficits and guide rehabilitation., Study Selection: Prospective and retrospective cross-sectional studies investigating muscle strength, flexibility, cross-sectional area, electromyographic activation onset and magnitude in patients with SRGP were included., Search Methods: Four databases (MEDLINE, Web of Knowledge, EBSCOhost and EMBASE) were searched in June 2014. Studies were critiqued using a modified version of the Downs and Black Quality Index, and a meta-analysis was performed., Results: Seventeen studies (14 high quality, 3 low quality; 8 prospective and 9 retrospective) were identified. Prospective findings: moderate evidence indicated decreased hip abduction flexibility as a risk factor for SRGP. Limited or very limited evidence suggested that decreased hip adduction strength during isokinetic testing at ~119°/s was a risk factor for SRGP, but no associations were found at ~30°/s or ~210°/s, or with peak torque angle. Decreased hip abductor strength in angular velocity in ~30°/s but not in ~119°/s and ~210°/s was found as a risk factor for SRGP. No relationships were found with hip internal or external rotation range of movement, nor isokinetic knee extension strength. Decreased isokinetic knee flexion strength also was a potential risk factor for SRGP, at a speed ~60°/s. Retrospective findings: there was strong evidence of decreased hip adductor muscle strength during a squeeze test at 45°, and decreased total hip external rotation range of movement (sum of both legs) being associated with SRGP. There was strong evidence of no relationship to abductor muscle strength nor unilateral hip internal and external rotation range of movement. Moderate evidence suggested that increased abduction flexibility and no change in total hip internal rotation range of movement (sum of both legs) were retrospectively associated with SRGP. Limited or very limited evidence (significant findings only) indicated decreased hip adductor muscle strength during 0° and 30° squeeze tests and during an eccentric hip adduction test, but a decrease in the isometric adductors-to-abductors strength ratio at speed 120°/s; decreased abductors-to-adductors activation ratio in the early phase in the moving leg as well as in all three phases in the weight-bearing leg during standing hip flexion; and increased hip flexors strength during isokinetic and decrease in transversus abdominis muscle resting thickness associated with SRGP., Conclusions: There were a number of significant movement and muscle function associations observed in athletes both prior to and following the onset of SRGP. The strength of findings was hampered by the lack of consistent terminology and diagnostic criteria, with there being clear guides for future research. Nonetheless, these findings should be considered in rehabilitation and prevention planning., Competing Interests: Compliance with Ethical Standards Funding Dylan Morrissey is part funded by the National Institute for Health Research (NIHR)/Health Education England Senior Clinical Lecturer scheme. This report presents independent research part funded by the NIHR. The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR or the Department of Health. Conflict of interest Paulina Kloskowska, Dylan Morrissey, Claire Small, Peter Malliaras and Christian Barton declare that they have no conflicts of interest relevant to the content of this review.

Objective: We hypothesized that individuals with a normal foot posture would be less likely to experience patellar tendon pain and pathology than those with a pronated or supinated foot., Design: Observational study., Setting: Field-based study among competing athletes., Participants: Volleyball players competing in the Victorian State League, Australia., Assessment of Risk Factors: Patellar tendinopathy (PT) is common in sports involving running and jumping and can severely limit athletes' ability to compete. Several studies have investigated potential etiological factors for the development of PT, but little is known about the association between PT and foot posture., Main Outcome Measures: Static foot posture index (FPI), patellar tendon pain during single-leg decline squatting, and gray scale ultrasound imaging were measured in 78 recreational to elite volleyball players (48 men and 30 women)., Results: Men with patellar tendon pain were more likely to have a normal foot posture and men without pain were more likely to be pronated according to the FPI (P < 0.05). Women showed no association between FPI and pain or imaging (P > 0.05)., Conclusions: Men with a normal foot posture were more likely to have PT compared to men with a pronated foot type.

Background and Purpose: Nondistally fixated (ie, what is often referred to as "open kinetic chain" [OKC]) knee extensor resistance training appears to have lost favor for some forms of rehabilitation due partly to concerns that this exercise will irritate the extensor mechanism. In this randomized, single-blind clinical trial, nondistally fixated versus distally fixated (ie, often called "closed kinetic chain" [CKC]) leg extensor training were compared for their effects on knee pain., Subjects: Forty-three patients recovering from anterior cruciate ligament (ACL) reconstruction surgery (34 male, 9 female; mean age=29 years, SD=7.9, range=16-54)., Methods: Knee pain was measured at 2 and 6 weeks after ACL reconstruction surgery using visual analog scales in a self-assessment questionnaire and during maximal isometric contractions of the knee extensors. Between test sessions, subjects trained 3 times per week using either OKC or CKC resistance of their knee and hip extensors as part of their physical therapy., Results: No differences in knee pain were found between the treatment groups., Discussion and Conclusion: Open kinetic chain and CKC leg extensor training in the early period after ACL reconstruction surgery do not differ in their immediate effects on anterior knee pain. Based on these findings, further studies are needed using different exercise dosages and patient groups.

To estimate Achilles tendon forces and their relationship with self-reported pain in runners with Achilles tendinopathy (AT) during common rehabilitation exercises. Cross-sectional. Laboratory. 24 recreational male runners (45.92 (8.24) years old; 78.20 (8.01) kg; 177.17 (6.69) cm) with symptomatic AT. Kinematic and kinetic data were collected to estimate Achilles tendon forces during 12 commonly prescribed exercises. Achilles tendon forces were estimated from biomechanical data and normalised to the participant's bodyweight. The secondary aim was to investigate the relationship between Achilles tendon forces and pain during these exercises. Two exercise clusters were identified based on Achilles tendon forces. Cluster1 included various exercises including double heel raises, single heel raises, and walking (range: 1.10–2.76 BWs). Cluster2 included running, jumping and hopping exercises (range: 5.13–6.35 BWs). Correlation between tendon forces and pain was at best low for each exercise (range: −0.43 - 0.20). Higher force exercises lead to more tendon load for a given amount of pain (R2 = 0.7505; y = 0.2367x + 0.6191). This study proposes a hierarchical exercise progression based on Achilles tendon forces to guide treatment of runners with AT. Achilles tendon forces and pain are not correlated in runners with AT. • A two-cluster exercise progression has been identified in male runners with AT. • Achilles tendon forces and patients reported pain have low and negligible correlation. • Cluster 2 exercises lead to more tendon load for a given amount of pain. • The proposed progression can be useful for clinicians treating runners with AT. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify and describe the psychological and psychosocial constructs and outcome measures used in tendinopathy research. tDESIGN: Scoping review. tLITERATURE SEARCH: We searched the PubMed, EMBASE, Scopus, Web of Science, PEDro, CINAHL, and APA PsychNet databases on July 10, 2021, for all published studies of tendinopathy populations measuring psychological and psychosocial factors. tSTUDY SELECTION: Studies using a clinical diagnosis of tendinopathy or synonyms (eg, jumper's knee or subacromial impingement) with or without imaging confirmation. tDATA SYNTHESIS: We described the volume, nature, distribution, and characteristics of psychological and psychosocial outcomes reported in the tendinopathy field. tRESULTS: Twenty-nine constructs were identified, including 16 psychological and 13 psychosocial constructs. The most frequently-reported constructs were workrelated outcomes (32%), quality of life (31%), depression (30%), anxiety (18%), and fear (14%). Outcome measures consisted of validated and nonvalidated questionnaires and 1-item custom questions (including demographics). The number of different outcome measures used to assess an individual construct ranged between 1 (emotional distress) and 11 (quality of life) per construct. tCONCLUSION: There was a large variability in constructs and outcome measures reported in tendinopathy research, which limits conclusions about the relationship between psychological and psychosocial constructs, outcome measures, and tendinopathies. Given the wide range of psychological and psychosocial constructs reported, there is an urgent need to develop a core outcome set in tendinopathy. [ABSTRACT FROM AUTHOR]

Objective: This systematic review aimed to synthesize current evidence on contributing factors influencing outcome following exercise management for Achilles tendinopathy (AT). Data Sources: Databases (PubMed, Embase, and Cochrane Library) were searched from inception to February 2020. Study Selection: Studies investigating factors (e.g., age, BMI) associated with outcome (e.g., pain and function questionnaires) following exercise interventions for AT were included. Data Extraction: Data were extracted into a standardized form, including patient demographics, population sample, study type, factors associated with outcome, and outcome measures. Data Synthesis: Meta‐analysis was planned to be performed, where appropriate. Where data could not be pooled, we summarized the findings descriptively. Results: Six studies investigating 11 different factors were included; overall the quality of evidence was poor. There was conflicting evidence that imaging measures had an association with a change in VISA‐A outcome. These included signal intensity and tendon size determined by MRI, and Ultrasound Tissue Characterization echopattern. Three studies found that duration of symptoms was not associated with a change in VISA‐A. Also, three studies found that age, and one study found that prior sporting activity level, were not associated with outcome. Baseline pain with activity, baseline VISA‐A, sex, and BMI were inconsistently associated with specific outcomes. Conclusion: Due to the poor quality of evidence overall, no firm conclusions can be drawn. At best, there was inconsistent evidence that imaging factors, baseline pain and function, BMI, and sex showed some associations with outcomes, but these findings need to be confirmed in more extensive studies. Highlights: Knowledge of associated factors following exercise interventions for Achilles tendinopathy may help clinicians target exercise interventions to people who are most likely to respond.This systematic review synthesized prognostic factors of clinical outcome (pain, function, global change, quality of life) following AT exercise management.Age, duration of symptoms, and prior sporting activity level was not associated with outcome.Female gender, higher BMI, and greater self‐reported pain and function were associated with outcome but not consistently among outcome constructs.The majority of imaging measures were not associated with outcome.Due to the poor quality of evidence overall, no firm conclusions can be drawn and there is limited and low quality evidence for the factors associated with outcome. [ABSTRACT FROM AUTHOR]

Objectives: Physical activity (PA) has a number of benefits for rheumatoid arthritis (RA) patients. However, these patients are more physically inactive than the general population. The primary aim of this study was to investigate factors associated with PA engagement among RA patients. The secondary aim was to identify their preference for PA support. Methods: There were 96 participants, 76 of whom were female, with a mean age of 56.9 years (range = 34–72 years) and a median RA disease duration of 5 years (interquartile range = 2–12). All patients completed questionnaires assessing demographic status, health status (including cardiovascular disease [CVD] risk and RA disease profile), PA levels and preferences, alongside the perceived benefits of—and barriers to—PA. Hierarchical regressions were carried out to assess the relationship between reported PA levels and both engagement determinants and disease features. Results: Forty‐five per cent (n = 44) had low levels (<600 metabolic equivalent‐min/week) of PA. Low level of PA was significantly associated with: CVD risk profile (ηp2 = 0.118, p < 0.002); functional disability (ηp2 = 0.206, p < 0.032); pain (ηp2 = 0.154, p < 0.028); general personal (ηp2 = 0.190, p < 0.001) and arthritis‐specific personal (ηp2 = 0.170, p < 0.001) barriers to PA; age (ηp2 = 0.076, p < 0.026); and sedentary behaviour (ηp2 = 0.275, p < 0.001). Participants displayed a preference for unsupervised (n = 37, 38.5%), low‐intensity (n = 45, 46.9%), indoor home (n = 50, 52.1%) exercises, with no preferences for the diversity of the exercise prescribed (n = 39, 40.6%) or for who provided the exercise counselling (n = 34, 35.4%). Conclusions: These results suggest that CVD profile, disability, pain, and general and arthritis‐specific personal barriers are associated with PA levels among RA patients. Intervention development should address these factors to facilitate an increase in PA uptake. [ABSTRACT FROM AUTHOR]

Background: Patellofemoral pain (PFP) is highly prevalent within both sporting and recreationally active populations. Multiple treatment approaches have been advocated for the management of PFP, attempting to address both intrinsic and extrinsic factors thought to contribute to the development and persistence of pain. A number of predictors of treatment success have been proposed, and evaluated, for directing intervention choice. Objective: Our aim was to systematically review the literature that identifies outcome predictors of specific conservative interventions in the management of PFP, including quality of the current evidence, to guide clinical practice and future studies investigating outcome predictors within this population. Data Sources: The AMED, CINAHL, EMBASE, MEDLINE and Web of Science databases were searched from inception to April 2013. Study Selection: Randomized controlled trials (RCTs) and cohort studies. Study Appraisal and Synthesis Methods: Following initial searching, all potential papers were assessed by two independent reviewers for inclusion using a checklist developed from the inclusion criteria. Cited, and citing, references were also searched in Google Scholar, but unpublished work was not sought. Methodological quality was assessed using a previously designed quality assessment scale. Definitions for levels of evidence were guided by recommendations made by van Tulder et al. Results: Fifteen low-quality (LQ) cohort studies were included. No RCTs were found. This systematic review identified the evaluation of 205 conservative management outcome predictor variables. Of this large number of variables that have been assessed, 19 (9 %) were found to significantly predict a successful outcome. Where two or more outcome predictors and success determinants were consistent between studies, data were pooled. Within these studies, the low number of participants per output variable, and absence of controls, is likely to compromise the validity of the predictor's accuracy. Very limited evidence identified higher functional index questionnaire scores (mean 0.82, 95 % confidence interval [CI] 0.18-1.46), greater forefoot valgus (mean 0.67, 95 % CI 0.05-1.28) and greater rearfoot eversion magnitude peak (mean −0.93, 95 % CI −1.84 to −0.01) to significantly predict improved outcomes with orthoses interventions. Shorter symptom duration ( p = 0.019), lower frequency of pain ( p = 0.012), younger age, faster vastus medialis oblique reflex response time ( p = 0.026), negative patella apprehension, absence of chondromalacia patella, tibial tubercle deviation of <14.6 mm and greater total quadriceps cross-sectional area on magnetic resonance imaging ( p = 0.01), and reduced eccentric average quadriceps peak torque ( p = 0.015) significantly predicted exercise intervention success following multivariate statistical analysis. Limited evidence identified increased Q-angle (mean 0.38, 95 % CI 0.05-0.72) and very limited evidence identified greater usual pain (mean 0.43, 95 % CI 0.01-0.85) to predict taping intervention success. Conclusions: This systematic review provides a comprehensive summary of current derivation level studies identifying indicators of prediction for conservative PFP management. The overall strength of evidence was low. With appropriate caution, clinicians should consider taping for those with greater usual pain, orthoses for older individuals and exercise for younger individuals, and orthoses intervention for patients with greater forefoot valgus and rearfoot eversion magnitude peak. RCTs with evaluation of outcome prediction as a primary aim are clearly warranted to provide clinicians with robust evidence and facilitate evidence-informed, tailored intervention to this heterogeneous patient population. [ABSTRACT FROM AUTHOR]

An accessory navicular (AN), often referred to as os naviculare, is prevalent in adolescent females and is a recognised cause of medial foot pain. There are many differential causes of medial foot pain in adolescent female athletes, and a painful AN should be considered as part of the differential diagnosis. This article presents a case report to investigate medial foot pain as a result of an AN. The article notes the similarities with Crisp-Padhiar syndrome where there is presence of a Type 2 AN, tibialis posterior dysfunction, tibialis posterior tendinopathy, anomalous tibialis posterior tendon attachment, acquired flat foot and synchondrosis. One difference is also noted; there is no acute trauma. The presenting symptoms of AN and its genetic pedigree are also outlined, along with the suggested management, both conservative and surgical. [ABSTRACT FROM AUTHOR]

Background: Neovascularisation is associated with pain in Achilles tendinopathy (AT). The anatomical relationship between ultrasound (US)-defined indicators of tendinopathy and clinically determined pain sites has not been investigated. Purpose: To measure the spatial correlation between the sites of maximum palpated tenderness, site of patient-indicated pain, maximum US-determined neovascularisation and maximum antero-posterior tendon thickness in patients with chronic recalcitrant AT (CRAT). Methods: A custom-designed measuring apparatus and clinical examination were used to measure the sites of maximum tenderness and subjectively defined pain on 29 tendons from patients diagnosed with mid-tendon CRAT. All tendons had been previously non-responsive to eccentric loading. Maximal neovascularisation and tendon thickness were measured by US scanning in conjunction with the measuring device. Results: A significant association exists between clinically determined pain and neovascularisation (r=0.85, p<0.001), patient reported pain (r=0.91, p<0.001), maximal tendon thickness (r=0.91, p<0.001), maximal thickness and maximal neovascularisation (r=0.86, p<0.001). Conclusion: Sites of subjectively defined pain, clinically palpated tenderness, tendon thickness and neovascularisation are anatomically associated. Palpation can be reliably used as a clinical guide when planning interventions in patients with CRAT. [Copyright &y& Elsevier]

Background: the aim was to establish the effect of a high volume-image guided injection and structured rehabilitation (HVIGI&SR) on both pain and function in shoulder impingement syndrome (SIS). Methods: 44 participants treated between January 2008 and January 2012 with a >3 month history of recalcitrant ultrasound-confirmed SIS were sent a retrospective questionnaire. All participants had received a HVIGI under ultrasound-guidance consisting of 20 mls of Marcaine with 50 mg of hydrocortisone, followed by a period of physiotherapist-led rehabilitation. The validated Shoulder Pain and Disability Index (SPADI) score was used to establish the change in the score between 1 week pre-injection and 3 weeks post-injection, along with an 11-point pain scale. Results: 59% of participants responded. There was a clinically and statistically significant decrease in the SPADI score of 58.7 ± 29.9 (p<0.01). 76% of participants had an improvement in their score of over 50% from their initial score. There was a clinically and statistically significant improvement in pain of 5.19 ± 2.62 (p<0.01) on the numerical rating scale of pain. Conclusion: HVIGI&SR should be considered for short-term treatment of SIS as it showed a significant improvement in both pain and function. A prolonged period of physiotherapist-led rehabilitation can then be undertaken for long term benefits. [ABSTRACT FROM AUTHOR]