Self-reported pain with single leg heel raise or single leg hop offer distinct information as measures of severity in men with midportion and insertional Achilles tendinopathy: An observational cross-sectional study

ObjectivesTo investigate if self-reported pain with single leg heel raise (SLHR) or single leg hop (SLH) are concurrently valid to assess midportion (MPAT) or insertional Achilles tendinopathy (IAT) symptom severity, compared to the VISA-A. Additionally, if SLHR or SLH pain accounts for VISA-A variability, and if they are associated with psychological factors.Participants60 men with MPAT, 26 men with IAT.Main outcomesParticipants rated SLHR and SLH pain on a numerical rating scale (0 = none, 10 = worst). We investigated relationships between loading task pain, VISA-A, VISA-A constructs, and psychological outcomes (Pearson’s correlation coefficients). Linear regression determined best model accounting for VISA-A variability.ResultsIn MPAT, load tests shared fair-negative relationship with VISA-A, and VISA-A function. In IAT, SLHR had moderately strong-negative relationship with VISA-A, and pain and function constructs, and SLH shared fair-negative relationship with VISA-A, and pain and function constructs. Relationships were negligible between load tests and VISA-A activity in both conditions, and VISA-A pain in MPAT. In IAT, there was fair-positive relationship between pain catastrophising and load tests. Remaining psychological outcome relationships were negligible. Best model accounting for VISA-A included SLH in MPAT, and SLHR in IAT.ConclusionsDespite VISA-A and selected VISA-A construct associations, self-reported SLHR and SLH pain appears to provide distinct information.     

Adolescent psychological beliefs,but not parent beliefs,associated with pain and function in adolescents with patellofemoral pain

ObjectivesThe purpose of this study was to assess the association of adolescent and parent psychological beliefs with 1) self-reported functional ability, 2) pain and 3) objective measures of function.Study designCross-sectional study.SettingPediatric Outpatient Hospital.ParticipantsEighty-six adolescents with patellofemoral pain (PFP) (14.6 ± 1.7 years old, 62% female) and 72 parents.Main outcome measuresPatient questionnaires were used to describe pain, knee function, fear avoidance (Fear Avoidance Beliefs Questionnaire-Physical Activity; FABQ-PA), kinesiophobia (Tampa Scale for Kinesiophobia-11; TSK-11), and pain catastrophizing (Pain Catastrophizing Scale; PCS) in adolescents with PFP. Parents (n = 72) completed FABQ-PA, TSK-11, and PCS questionnaires. Hip and knee strength, quadriceps and dorsiflexion motion, the single-leg hop for distance and lateral-step down test measured physical performance.ResultsAdolescent psychological beliefs were significantly associated with pain (FABQ-PA r = 0.33, and PCS r = 0.34), function (FABQ-PA r = −0.59,TSK-11 r = −0.33), hip strength (FABQ-PA r = −0.41, TSK-11 r = −0.32), and single leg hop for distance (FABQ-PA r = −0.38). Parent psychological beliefs were not associated with the adolescent’s beliefs, pain or function.ConclusionsAdolescent, but not parent, psychological beliefs were associated with pain, self-reported function and objective measures of function.     

Are pain coping strategies and neuropathic pain associated with a worse outcome after conservative treatment for Achilles tendinopathy? A prospective cohort study

ObjectivesTo analyse whether (1) passive or active pain coping strategies and (2) presence of neuropathic pain component influences the change of Achilles tendinopathy (AT) symptoms over a course of 24 weeks in conservatively-treated patients.DesignProspective cohort study.MethodsPatients with clinically-diagnosed chronic midportion AT were conservatively treated. At baseline, the Pain Coping Inventory (PCI) was used to determine scores of coping, which consisted of two domains, active and passive (score ranging from 0 to 1; the higher, the more active or passive). Presence of neuropathic pain (PainDETECT questionnaire, −1 to 38 points) was categorized as (a) unlikely (≤12 points), (b) unclear (13–18 points) and (c) likely (≥19 points). The symptom severity was determined with the validated Victorian Institute of Sports Assessment-Achilles (VISA-A) questionnaire (0–100) at baseline, 6, 12 and 24 weeks. We analysed the correlation between (1) PCI and (2) PainDETECT baseline scores with change in VISA-A score using an adjusted Generalized Estimating Equations model.ResultsOf 80 included patients, 76 (95%) completed the 24-weeks follow-up. The mean VISA-A score (standard deviation) increased from 43 (16) points at baseline to 63 (23) points at 24 weeks. Patients had a mean (standard deviation) active coping score of 0.53 (0.13) and a passive score of 0.43 (0.10). Twelve patients (15%) had a likely neuropathic pain component. Active and passive coping mechanisms and presence of neuropathic pain did not influence the change in AT symptoms (p = 0.459, p = 0.478 and p = 0.420, respectively).ConclusionsContrary to widespread belief, coping strategy and presence of neuropathic pain are not associated with a worse clinical outcome in this homogeneous group of patients with clinically diagnosed AT.     

Recreational runners who recovered from COVID-19 show different running kinetics and muscle activities compared with healthy controls

BackgroundSocial isolation through quarantine represents an effective means to prevent COVID-19 infection. A negative side-effect of quarantine is low physical activity.Research questionWhat are the differences of running kinetics and muscle activities of recreational runners with a history of COVID-19 versus healthy controls?MethodsForty men and women aged 20–30 years participated in this study and were divided into two experimental groups. Group 1 (age: 24.1 ± 2.9) consisted of participants with a history of COVID-19 (COVID group) and group 2 (age: 24.2 ± 2.7) of healthy age and sex-matched controls (controls). Both groups were tested for their running kinetics using a force plate and electromyographic activities (i.e., tibialis anterior [TA], gastrocnemius medialis [Gas-M], biceps femoris [BF], semitendinosus [ST], vastus lateralis [VL], vastus medialis [VM], rectus femoris [RF], gluteus medius [Glut-M]).ResultsResults demonstrated higher peak vertical (p = 0.029; d=0.788) and medial (p = 0.004; d=1.119) ground reaction forces (GRFs) during push-off in COVID individuals compared with controls. Moreover, higher peak lateral GRFs were found during heel contact (p = 0.001; d=1.536) in the COVID group. COVID-19 individuals showed a shorter time-to-reach the peak vertical (p = 0.001; d=3.779) and posterior GRFs (p = 0.005; d=1.099) during heel contact. Moreover, the COVID group showed higher Gas-M (p = 0.007; d=1.109) and lower VM activity (p = 0.026; d=0.811) at heel contact.SignificanceDifferent running kinetics and muscle activities were found in COVID-19 individuals versus healthy controls. Therefore, practitioners and therapists are advised to implement balance and/or strength training to improve lower limbs alignment and mediolateral control during dynamic movements in runners who recovered from COVID-19.     

Trunk muscle endurance in individuals with and without patellofemoral pain: Sex differences and correlations with performance tests

ObjectivesTo compare trunk muscle endurance among females and males with and without patellofemoral pain (PFP), and to investigate the correlations between trunk muscle endurance and performance of the single leg hop test (SLHT) and forward step-down test (FSDT).DesignCross-sectional.SettingLaboratory-based study.Participants110 females and 38 males with PFP, 61 females and 31males without PFP.Main outcome measuresAnterior and lateral trunk muscle endurance were assessed with the prone and bilateral side-bridge tests, respectively. Performance during the SLHT and FSDT was also assessed.ResultsLower anterior and lateral trunk muscle endurance were identified in females (p < .001; d = −0.74 to −0.86), but not in males (p ≥ .806; d = −0.04 to 0.05) with PFP as compared to sex-matched controls. Moderate to large, positive correlations between anterior and lateral trunk muscle endurance with performance in the SLHT and FSDT were identified in females (r = .27 to .50; p < .004) and males (r = 0.27 to 0.59; p < .031) with PFP and females without PFP (r = 0.26 to 0.40; p < .044).ConclusionOur findings highlight that assessing trunk muscle endurance is advised in females with PFP. Trunk muscle endurance of individuals with PFP may have a role in the performance of hopping and stepping down tasks.     

Characterisation of Achilles tendon pain in recreational runners using multidimensional pain scales

ObjectivesThe main assessment tool for Achilles tendinopathy (AT) is the VISA-A. However, the VISA-A only assesses the physical impairments that result from tendon pain. This study sought to describe and assess tendon pain using other multidimensional pain scales; the short forms of the McGill pain questionnaire (sf-MPQ) and the Brief Pain Inventory (sf-BPI).DesignCross sectional observational study.Methods124 recreational runners with clinically confirmed mid-portion Achilles tendinopathy for at least 3 months were recruited from Cape Town, South Africa. They described and rated their tendinopathy symptoms by completing the VISA-A, sf-BPI and sf-MPQ questionnaires.ResultsTendon pain was largely described as a sensory type of pain with minimal affective elements. Sixty percent described their pain as aching. Significant proportions described it as tender (52.9%), throbbing (33.9%), hot burning (24.8%) and 33.8% ranked it as discomfiting or worse on the pain intensity score of the sf-MPQ. Tendon pain interfered with mood in 50.8% of the participants as well as with walking ability (72.5%), sleep (34.8%) and enjoyment of life (54.2%).ConclusionsTendon pain was described using a variety of adjectives which may suggest that AT has clinical subtypes. Tendon pain interferes with more than just physical function. Therefore, the recommendation is to conduct further studies using various pain questionnaires to elicit more details and better understand the nature of Achilles tendon pain.     

Improvement of lower-extremity stability by rotational leg press training

BackgroundsPrevious reports revealed that balance and stability are essential for human physical activity. The present study aimed to evaluate the comparative outcome of a novel beginning movement load training (BMLT) versus conventional leg press training in terms of improvement of lower-extremity stability.Research questionDoes the leg press training improve the stability of lower extremities?MethodsTwenty adult, asymptomatic and active amateur basketball players were enrolled in this study and randomized in equal numbers into a BMLT group (study group) and a conventional leg press training group (control group).ResultsThe results after eight-week course of training showed that conventional leg press training had an opposite effect on dynamic stability in the left leg (p = 0.015) and backward movement of the right leg (p = 0.038). The athletes in the study group revealed superior dynamic stability maintenance in both legs backwards (p = 0.001), the left leg (p = 0.013), the right leg backwards (p = 0.022) and overall stability (p = 0.002).SignificanceThe study group showed better postural stability in terms of the medial/lateral index (p = 0.017), and the athletes in the control group exhibited a significant inability to maintain postural stability in the medial/lateral aspect after the training (p = 0.016). Rotational BMLT lower-extremity press training yielded superior enhancement of dynamic stability and maintenance of center of gravity and postural stability.     

Self-reported jumpers’ knee is common in elite basketball athletes – But is it all patellar tendinopathy?

ObjectivesTo describe the prevalence and pain location of self-reported patellar tendinopathy and patellar tendon abnormality in a male elite basketball population.DesignCross-sectional.SettingPre-season tournament.ParticipantsSixty male athletes from the Australian National Basketball League.Main outcome measuresSelf-reported patellar tendinopathy (PT) using the Oslo Sports Trauma Research Centre Overuse Questionnaire (OSTRC). Pain location using pain mapping (dichotomised: focal/diffuse) and severity during the single leg decline squat. Ultrasound tissue characterisation scans of both patellar tendons.ResultsThirteen participants (22.7%) self-reported PT. Only 3 who reported PT had localised inferior pole pain. Thirty athletes reported pain during the decline squat, 15 described focal pain; 10 diffuse pain (5 missing data). Those with diffuse pain had greater years played [Md = 21 (13–24), n = 10 than focal pain (Md = 12 (7–26), n = 15), p = 0.042, r = 0.3]. Bilateral tendon abnormality was found in 45% of athletes and 15% had unilateral tendon abnormality.ConclusionElite male basketball athletes self-reporting PT had heterogeneity in pain location. When focal pain with loading was used as a primary definition of PT, ‘jumpers’ knee’ was not common in this cohort. This study found that abnormality of the patellar tendon was common and did not correlate with symptoms.     

Cross-cultural adaptation and evaluation of the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S)

ObjectiveTo cross-culturally adapt and evaluate the psychometric properties of the University of Wisconsin Running Injury and Recovery Index questionnaire in Spanish (UWRI-S) in Chilean runners with a running-related injury.DesignCross-cultural adaptation and validation study, following the Consensus-based Standards for selecting health Measurement Instruments (COSMIN) recommendations.SettingOutpatient sports medicine clinic and running clubs.ParticipantsUWRI was forward and backward translated, and culturally adapted. Thirty-one runners participated in the content validity of the UWRI-S; and fifty-seven in the assessment of psychometric properties.Main outcome measuresRunners seeking care from a physiotherapist completed the UWRI-S (baseline and after 48–72 h for reliability), Lower Extremity Functional Scale (LEFS), Patient Specific Functional Scale (PSFS), Global Rating of Change scale (GROC), and Numeric Pain Rating Scale (NPRS).ResultsSuggestions about accuracy of wording and understanding of items were incorporated. UWRI-S showed a positive moderate correlation with LEFS (r = 0.6; p < 0.05), positive fair with GROC (r = 0.5, p < 0.05), negative fair with NPRS (r = −0.4; p < 0.05) and no correlation with PSFS (r = 0.3; p = 0.1). UWRI-S demonstrated acceptable internal consistency (α = 0.87) and test-retest reliability (ICC = 0.87).ConclusionUWRI-S is a valid and reliable measure to evaluate running ability of Chilean runners during recovery from a running-related injury.     

Implementation of In vivo exposure therapy to decrease injury-related fear in females with a history of ACL-Reconstruction: A pilot study

ObjectiveThe objective of this pilot study was to examine the preliminary feasibility and efficacy of in vivo exposure therapy (IVET) to decrease injury-related fear in females with history of ACLR.DesignPilot Study.SettingSports Medicine Research Laboratory.Participants12 female participants with history of ACLR (≥ 1 year post-operative) were randomized into a 5-week IVET group (n = 6) or 5-week sham physical activity (PA) monitoring group (n = 6).Main outcome measuresThe independent variables were Group and Time. The dependent variables were the Photographic Series of Sports Activities for ACLR (PHOSA-ACLR) and the Tampa Scale of Kinesiophobia-11 (TSK-11) scores. A Group x Time repeated measures two-way analysis of variance was completed for the PHOSA-ACLR and the TSK-11. Partial η² effect sizes were used to examine clinically meaningful differences.ResultsHigh retention and adherence rates were observed in the intervention group. The PHOSA-ACLR exhibited a significant main effect for Time (F_1,10 = 9.92, p = 0.01, partial η² = 0.50), but not for Group. No statistically significant or clinically meaningful differences were observed for the TSK-11.ConclusionBoth groups exhibited decreased injury-related fear for specific functional tasks. Future research should further examine the efficacy of IVET and PA monitoring to decrease injury-related fear in patients after ACLR.     

Evaluation of patellar tendinopathy using the single leg decline squat test: Is pain location important?

Study designA cross-sectional study of non-elite volleyball players aged 13–17years.ObjectivesTo evaluate the presence and location of pain during the single leg decline squat (SLDS) and compare patellar tendon thickness, structure, neovascularisation and symptom severity between SLDS-derived groups.Methods32 male and 25 female participants attending a 5-day volleyball training camp underwent clinical evaluation by SLDS, describing the location of pain during this test using a pain map. The patellar tendon was examined using ultrasound imaging, performed by an assessor blinded to other assessments. Differences between participants experiencing local patellar tendon pain (PTP), other knee pain (OKP) or no-pain during the SLDS were evaluated.ResultsFifteen (26.3%) participants experienced pain during the SLDS. Local PTP was recorded for 12.3% and OKP for 10.5% of right legs. The PTP group was distinguished from the other groups by larger thickness and cross-sectional area of the mid-patellar tendon (p < 0.001), more frequent neovascularisation (p = 0.005) and greater pain and disability (p < 0.036). No differences between OKP and no-pain groups was observed.ConclusionAdolescent non-elite volleyball players reported symptoms indicative of patellar tendinopathy. In this cohort, the SLDS test combined with a pain map was associated with imaging and questionnaire-based outcomes.Level of evidenceDiagnosis, Level 2; Cross-sectional study.     

Thermal profiles over the Patella tendon in a cohort of non-injured collegiate athletes over the course of a cross-country season

ObjectivesTo determine normal temperatures over the Patella tendon over eleven weeks.DesignA prospective cohort study with eleven weeks of observation.SettingUniversity’s Human Biomechanics and Physiology Laboratory.ParticipantsMale or female collegiate runners running at least 25 miles per week who did not report pain in the region of the Patella tendon over 11 weeks of data collection.Main outcome measuresThermal images taken at the same time and day of the week, were used to measure the temperature of the skin over the Patella tendon.ResultsEighteen athletes were eligible for analysis. The mean temperature of the Patella tendon was 30.13 °C (SD = 1.51 °C). Patella tendon temperature changes over time were insignificant (right p = 0.66, left p = 0.90) with ICC right = 0.92, left = 0.94. Mean temperature difference side to side was 0.14 °C (SD = 0.60 °C). Mixed-model Linear regression for mean temperature differences found the effect of (i) time (t = 0.39, p = 0.70, df = 361) and (ii) side (t = −0.89, p = 0.38, df = 361) to be insignificant.ConclusionsThis is the first report of normal thermal profiles of collegiate runners over an extended period. Temperature variation above 1.20 °C may represent an abnormal asymmetry in the running population. Variations in Patella tendon temperatures left to right, and over time were not significant.     

The effect of heel-to-toe drop of running shoes on patellofemoral joint stress during running

BackgroundTraditional running shoes with heel-to-toe drops is thought to be a contributor to increased patellofemoral joint stress, which is proposed as a mechanism of patellofemoral pain.Research questionIs there an increase in patellofemoral joint stress when running in shoes with drops compared to running in shoes without a drop?MethodsLower limbs kinematics and ground reaction force were collected from eighteen healthy runners during over-ground running in shoes with 15 mm, 10 mm, 5 mm drops, and without a drop. Patellofemoral joint force and stress were calculated from the kinematic and kinetic data using a biomechanical model of the patellofemoral joint.ResultsThe peak patellofemoral joint stress was increased by more than 15% when running in shoes with 15 mm and 10 mm drops compared to running in shoes without a drop (p = 0.003, p = 0.001). The knee flexion angle was significantly increased when running in shoes with 15 mm, 10 mm and 5 mm drops (p = 0.014, p = 0.003, p = 0.002), the knee extension moment (p = 0.009, p = 0.002) and patellofemoral joint force (p = 0.003, p = 0.001) were increased when running in shoes with 15 mm and 10 mm drops, compared to running in shoes without a drop.SignificanceCompared to running in shoes without a drop, running in shoes with drops > 5 mm increase the peak patellofemoral joint stress significantly, which is mainly due to the increased knee extension moment.     

Movement quality in adolescence depends on the level and type of physical activity

ObjectivesThis study examined the relationship between functional movement and physical activity (PA) levels in adolescents.DesignCross-sectional study.SettingThis research is a part of the CRO-PALS longitudinal study conducted in a random sample of adolescents in Zagreb at the Faculty of Kinesiology, University of Zagreb, Croatia.ParticipantsSeven hundred and twenty-five adolescents aged between 16 and 17 years were included.Main outcome measureTotal Functional Movement Screen score (total FMS score).ResultsAfter adjusting for age, body fat and SES, both VPA and MVPA showed minor but significant effects on total FMS score among girls (β = 0.011, p = 0.001, β = 0.005, p = 0.006, respectively), but not in boys (β = 0.004, p = 0.158; β = 0.000, p = 0.780). Regarding PA type, volleyball and dance improved total FMS score (β = 1.003, p = 0.071; β = 0.972, p = 0.043, respectively), while football was associated with lower FMS score (β = −0.569, p = 0.118).ConclusionResults suggest that the PA level is positively associated with the functional movement in adolescent girls, but not in boys, where the type of PA moderates these associations. Therefore, functional movement patterns incorporated into physical education curriculum could be beneficial to the musculoskeletal health of the children.     

Interaction of foot and hip factors identifies Achilles tendinopathy occurrence in recreational runners

ObjectivesTo investigate the interaction of ankle-foot complex and hip joint factors with Achilles Tendinopathy (AT) occurrence in recreational runners.DesignCross-sectional.SettingResearch Laboratory.Participants51 runners, 26 healthy and 25 with AT.Main outcomes measuresShank-forefoot alignment (SFA), weight bearing lunge test (WBLT), passive hip internal rotation (IR) range of motion (ROM), hip external rotators (ER) and ankle plantar flexors (PF) isometric strength. CART analyses were performed to assess interactions that could distinguish those with AT.ResultsPassive hip IR ROM, ankle PF torque, SFA, and hip ER isometric torque were associated AT occurrence. The model correctly classified 92% of individuals without AT and 72% of those with AT. The area under the receiver operating characteristic curve was 0.88. Interaction factors revealed in nodes 3 and 10 were statistically significant. In node 3, runners with more than 29.33° of passive hip IR ROM had a 130% increased likelihood (PR = 2.30) of AT. Node 10 showed that individuals with higher PF torque, SFA varus, ER torque, but reduced passive hip IR ROM had an 87% increased likelihood (PR = 1.87) of AT.ConclusionInteractions between hip and foot factors could accurately classify recreational runners with and without AT.     

What differentiates rearfoot strike runners with low and high vertical load rates?

BackgroundRunners with a rearfoot strike pattern typically show high vertical ground reaction force loading rates (LRs), that are associated with injuries, compared with forefoot strikers. However, some runners with a rearfoot strike pattern run in a way that reduces LRs. Our purpose was to identify differences in running mechanics between rearfoot strike runners with high and low vertical LRs.Methods42 healthy runners, 21 with high (≥ 80.5 BW/s) and 21 with low (≤ 46.3 BW/s) LRs, were included in the current study. Lower extremity kinematic and kinetic data were then collected while participants ran along a 30 m runway. Running mechanics were calculated, including sagittal plane knee stiffness during early stance, the components of knee stiffness (Δ knee flexion and flexion moment), sagittal joint angles at initial contact, as well as cadence. The two LR groups were compared for differences in outcome variables using independent t-tests or Mann Whitney U tests.FindingsKnee stiffness was significantly lower in the low LR group (p < 0.01, d = 0.87), due to higher knee flexion excursion (p < 0.01, d = 1.38). At initial contact, the low LR group showed lower hip and knee flexion, but greater ankle and foot dorsiflexion (p = 0.01–0.04, d = 0.64–0.93). No differences were found in cadence.InterpretationThese results provide potential targets, related to gait kinematics and kinetics, for gait retraining aimed at reducing LRs in rearfoot strike runners.     

The effect of fatigue on running mechanics in older and younger runners

BackgroundThe presence of fatigue has been shown to modify running biomechanics. Throughout a run individuals become more fatigued, and the effectiveness of the musculoskeletal protective mechanism can diminish. Older adults are at an elevated risk for sustaining an overuse running related injury. This can be partially explained by changes in the musculoskeletal system and load attenuation.Research questionThe purpose was to compare post-fatigue running mechanics between older and younger runners.MethodsThirty runners (15 young, 15 older) between the ages of 18–65 participated in this study. All participants ran at least 15 miles/week. Running kinematics were captured using a 10-camera motion capture system while participants ran over a 10-m runway with force platforms collecting kinetic data under two conditions: C1: rested state at a controlled pace of 3.5 m/s ( ± 5%); C2: post-exertional protocol where pace was not controlled, rather it was monitored based on heartrate and RPE representative of somewhat-hard to hard intensity exercise. Prior to C2, participants underwent an exertional protocol that consisted of a maximal exercise test to induce fatigue and a required cool-down. A 2 (state of fatigue) x 2 (age) MANOVA was run to test for the effects of fatigue and age and their interactions. Results: No state of fatigue x age interaction was observed. A main effect of age for peak knee extension moment (Y > O; p = 0.01), maximum knee power (Y > O; p = 0.04), maximum hip power (O >Y; p = 0.04), and peak vertical ground reaction force (Y > O; p = 0.007). Regardless of age, participants exhibited decreased knee ROM (p = 0.007) and greater hip extension moment (p < 0.001) in C2 compared to C1.ConclusionWhile different in knee and hip mechanics overall, the subtle differences observed demonstrate that older runners exhibit comparable gait adaptions post-fatigue to younger volume-matched runners.     

Running mechanics during 1600 meter track runs in young adults with and without chronic ankle instability

ObjectiveTo evaluate biomechanical measures in runners with and without chronic ankle instability (CAI) using wearable sensors during two 1600 m track runs at a slow- and fast-pace.DesignObservational case-control.SettingField.Participants18 recreational runners (CAI: n = 9; Healthy: n = 9) with rearfoot strike patterns.Main outcome measuresPronation excursion, maximum pronation velocity, peak braking g, peak impact g, contact time, cycle time, and stride length of every step of two 1600 m runs were collected using RunScribe™ sensors and binned to each 400 m lap (Lap 1 to Lap 4).ResultsSignificant group-by-lap interactions were identified for contact time (p = .05) during the slow-intensity run. The CAI group had greater contact time (p = 0.05) that progressively increased with distance completed. CAI group also had higher impact g than the control group throughout the slow-intensity run (p = .03). During the fast-intensity run, significant group by lap interaction was observed for pronation excursion with the CAI group exhibiting less pronation excursion than the healthy group as the run progressed (p = .002).ConclusionsRegardless of speed, runners with CAI demonstrated altered gait mechanics compared to healthy controls. During the higher intensity run, decreased pronation excursion was observed in the CAI group and differences became more prominent as the distance increased.     

High volume image guided injections for the management of chronic tendinopathy of the main body of the Achilles tendon

ObjectivesSeveral substances are routinely injected in and around tendons. The present study evaluated the long term effects of high volume image guided injection (HVIGI) of normal saline, local anaesthetic and aprotinin in athletic patients with resistant tendinopathy of the main body of the Achilles tendon.DesignCase series.MethodsThe study included a series of 94 athletes (69 men and 25 women; average age 37.5 years, range 22–63) with ultrasound confirmed tendinopathy of the main body of the Achilles tendon. All the patients had not improved after at least three months of conservative management. Patients were injected with 10 mL of 0.5% Bupivacaine Hydrochloride, 25 mg aprotinin, and up to 40 mL of injectable normal saline. We prospectively administered the Victorian Institute of Sport Assessment–Achilles tendon (VISA-A) to assess the short- and long-term pain and functional improvement.ResultsAt baseline (n = 94), the VISA-A score was 41.7 ± 23.2 (range 11–60), and had improved to 74.6 ± 21.4 (range 71–100) by 12 months (n = 87) (p = 0.003), with no significant difference between sexes.ConclusionHVIGI with aprotinin significantly reduces pain and improves function in patients with chronic Achilles tendinopathy in the short- and long-term follow up.     

The relationship between kinesiophobia and biomechanics in anterior cruciate ligament reconstructed females

ObjectiveKinesiophobia has been associated with deleterious biomechanical alterations during dual-limb landing tasks in anterior cruciate ligament (ACL) reconstructed females, however, no research has yet investigated single-limb tasks related to ACL injury. The aim of this investigation was to examine the relationship between kinesiophobia and biomechanics during a series of dual and single-limb functional tasks associated with ACL injury risk.DesignCross-sectional study.ParticipantsFifteen females (age = 22.67 ± 2.58yrs, height = 1.65 ±0 .05m, mass = 65.28 ± 10.36 kg) with a history of ACL reconstruction (time post surgery = 3.40 ±0 .74yrs) were recruited for this investigation.Main outcome measuresKinesiophobia, measured via the Tampa Scale of Kinesiophobia (TSK-11). Kinematics and muscle activation were measured during three functional tasks: the drop jump (DJ), single-limb hop (SLH), and single-limb landing (SLL).ResultsFor the DJ task, there was a strong negative correlation between kinesiophobia and knee flexion (r = −.592, p = .20) and between kinesiophobia and trunk flexion (r = −0.724, p = .002). For the SLH task, there was a strong positive correlation between kinesiophobia and hip flexion (r = 0.560, p = .03).ConclusionsThese findings indicate that kinesiophobia is associated with movement alterations years after completion of ACL reconstruction and rehabilitation.