James Debenham

Association of psychological variables and outcome in tendinopathy: a systematic review

Objective Fear, anxiety, depression, distress and catastrophisation are all factors known to affect pain and disability levels. To date, the association of such psychological factors has yet to be established in tendinopathy. Therefore, the purpose of this paper was to determine if psychological variables are associated with tendinopathy and whether any such variables may be associated with pain and disability outcomes in conservative management of tendinopathy. Design A systematic review was undertaken and included studies were appraised for risk of bias using the Newcastle-Ottawa Scale. Owing to heterogeneity of studies, a qualitative synthesis was undertaken. Data sources An electronic search of MEDLINE, CiNAHL, SPORTDiscus, PsycINFO, EMBASE and PsycARTICLES was undertaken from their inception to April 2016. Eligibility criteria for selecting studies Any study design that incorporated psychological measures and clinical outcomes using participants with tendinopathy. Results Ten articles describing nine studies and 1108 participants were included. Conflicting evidence exists regarding the association of anxiety, depression and lateral epicondylalgia (LE). Strong evidence suggests LE is not associated with kinesiophobia. Moderate evidence links catastrophisation and distress with LE. Moderate evidence suggests distress is not associated with rotator cuff tendinopathy, but kinesiophobia and catastrophisation are. Limited evidence suggests patellar tendinopathy is not associated with anxiety or depression and kinesiophobia may be linked with suboptimal outcomes in Achilles tendinopathy. Summary/conclusions Tendinopathy requires an individualised approach to management. Clinicians should consider using validated screening tools for the presence of psychological variables as a part of their holistic management.

Eccentric fatigue modulates stretch-shortening cycle effectiveness - a possible role in lower limb overuse injuries

The role of fatigue in injury development is an important consideration for clinicians. In particular, the role of eccentric fatigue in stretch-shortening cycle (SSC) activities may be linked to lower limb overuse conditions. The purpose of this study was to explore the influence of ankle plantarflexor eccentric fatigue on SSC effectiveness during a hopping task in healthy volunteers. 11 healthy volunteers (23.2±6.7 years) performed a sub-maximal hopping task on a custom-built sledge system. 3D motion capture and surface EMG were utilised to measure lower limb stiffness, temporal kinematic measures and muscle timing measures at baseline and immediately following an eccentric fatigue protocol. A linear mixed model was used to test whether measures differed between conditions. Compared to baseline, eccentric fatigue induced increased stiffness during the hopping task (+ 15.3%; P<0.001). Furthermore, ankle stretch amplitude decreased (- 9.1%; P<0.001), whilst all other ankle kinematic measures remained unchanged. These changes were accompanied by a temporal shift in onset of activity in soleus and tibialis anterior muscles (- 4.6 to - 8.5%; p<0.001). These findings indicate that eccentric fatigue alters SSC effectiveness in healthy volunteers. These findings may be applied to inform pathogenetic models of overuse injury development.

Exploring the job satisfaction and career progression of musculoskeletal physiotherapists working in private practice in Western Australia

BACKGROUND Despite increasing workforce numbers, new graduate physiotherapists are reporting short career intentions due to low job satisfaction. Job satisfaction improves retention among allied health professionals, however we have limited understanding of its influence specific to physiotherapists. OBJECTIVES The aim of this study was to explore factors contributing to the job satisfaction of musculoskeletal physiotherapists working in private practice across different career stages (new graduates, graduates, postgraduates, and owners) in Western Australia. DESIGN Mixed-methods design with an anonymous self-administered survey capturing job satisfaction and employment characteristics of Western Australian physiotherapists working in private practice. Factors including peer support and mentoring, career progression and professional development were explored. METHOD Physiotherapists were recruited through snowball sampling, with 60 practices approached to participate. Survey results were analysed using linear regression models and basic thematic analysis. RESULTS Two-hundred and five surveys were completed by physiotherapists across 52 practices. The mean job satisfaction score was 41.9 out of 50, and increased job satisfaction was associated with practice ownership, salary satisfaction, established career pathways, and access to mentoring and professional development. CONCLUSIONS Practice owners were significantly more satisfied with their job compared to new graduate, graduate and postgraduate physiotherapists. Findings illustrated the changing needs for support across different career stages, the importance of accessible senior clinicians, and the limited recognition for the efforts made by physiotherapists to pursue ongoing education.

Eccentric loading increases peak torque angle of the ankle plantar flexors in healthy volunteers

Eccentric loading of the ankle plantar Flexor’s (PF) has demonstrated clinical efficacy in the conservative treatment of Achilles tendinopathy, however, its mechanism of therapeutic benefit remains unclear. The purpose of this study was to examine the effects of PF eccentric loading on PF angle to peak torque (AtPT), peak torque (PT) and lower limb vertical stiffness. Thirty healthy volunteers were randomised to an eccentric (n=15) or concentric (n=13) exercise group. A 10-week loading programme of the ankle plantar flexors was completed. AtPT, PT and vertical stiffness were compared within and between groups before and after the interventions. AtPT increased in the eccentric group by 3.2 ° dorsiflexion (p=0.001) and decreased by 0.7 ° dorsiflexion (p=0.528) for the concentric group with significant post-intervention group differences (p 0.2); however, postintervention the eccentric group showed a greater PT than the concentric group (p>0.05). Between group comparison showed no significant difference in vertical stiffness (p>0.5). However, the concentric group demonstrated a vertical stiffness increase of 765kNm ¹ (p ≥ 0.05). This study demonstrates that a clinicallyderived eccentric loading programme can produce an adaptive shift in AtPT of the ankle plantar flexors in a healthy population. These results support the theory that in part, eccentric loading derives its therapeutic benefit from mechanisms that influence plantar flexor motor performance.

29 Eccentric Vs. Concentric Loading Of The Plantarflexors – A Biomechanical Investigation

Introduction Achilles tendinopathy is a common musculoskeletal condition driven in part by alterations in muscle performance.1 Whilst eccentric loading has demonstrated clinical efficacy, and superiority to concentric loading, the underlying mechanisms behind this benefit are largely unknown.2 One potential mechanism is a shift of angle to peak torque (AtPT) of the plantarflexors to a lengthened position as has been demonstrated elsewhere.3 This study compared the influence of eccentric vs. concentric loading on the AtPT and peak torque (PT) of the plantarflexors. Methods Double-blind randomised control design. 30 healthy volunteers (23 ± 4 years) were randomly allocated to eccentric (ECC) or concentric (CON) groups. Baseline measures of AtPT and PT were obtained using isokinetic dynamometry. The exercise intervention reflected that described by Alfredson [1998], with the ECC and CON groups performing eccentric or concentric contractions only respectively; load was progressively increased over a 10-week intervention period. Repeated measures of AtPT and PT were obtained and statistically analysed. Results AtPT was significantly increased (p < 0.001) in the ECC group (pre, 25.6º ±. 6 to post, 28.7º ±. 7) but not in the CON group (p = 0.498). Furthermore, post-exercise comparison of the 2 groups revealed a significant difference in AtPT (p < 0.001) (Figure 1). There was no significant difference in PT for the ECC (p = 0.814) or CON groups (p = 0.216) (Figure 2). Discussion These findings demonstrate that a clinically-derived eccentric loading protocol results in a shift in AtPT towards a longer length (i.e. further towards dorsiflexion), whilst not altering peak torque. This is in contrast to a concentric loading protocol that did not induce such changes. These findings offer a novel explanation regarding the mechanism of efficacy for eccentric loading, consistent with a mechanical pathoaetiological model of stretch-shortening cycle failure. Abstract 29 Figure 1 Angle to peak torque Abstract 29 Figure 2 Peak torque References Fu, et al. Sports Med Arthrosc Rehabil Ther Technol. 2010;2:30 Crill, et al. Foot Ankle Spec. 2014 Epub 20 July 2014, DOI: 10.1177/1938640014539812 Brocket, et al. Med Sci Sports Exerc. 2001;33:783–790 Alfredson et al. Am J Sports Med. 1998;26:360–366