Michael J. Callaghan

The measurement of lumbar proprioception in individuals with and without low back pain

Study Design. A clinical trial comparing a back pain group with a pain‐free group. Objectives. To investigate whether proprioceptive deficits existed in a group of individuals reporting low back pain. Summary of Background Data. Little work has so far been conducted on the measurement of proprioception in the spine. Those studies that have been carried out, however, have failed to identify proprioceptive deficits in individuals with back pain. Previous work on peripheral joints has revealed that proprioception is affected with muscular or joint injury or degeneration. Methods. Forty individuals took part in the study, 20 with back pain and 20 with no pain. Participants were required to reproduce a predetermined target position, in standing and four‐point kneeling, 10 times in 30 seconds. A computer screen was used to provide visual feedback on position. A mean deviation from the target position was obtained for each individual. A measurement of left elbow position sense was conducted in five individuals from each group to establish differences in short‐term motor memory between the groups. Results. There were no differences between the subject groups in terms of short‐term motor memory (P > 0.05). A two‐way analysis of variance between subject groups and position to identify differences in accuracy (deviation from the target) found that there were differences between subject groups in either position (P < 0.05). There was no significant difference in accuracy between the positions used (P > 0.05). Conclusions. Differences in proprioception do exist between individuals with back pain and those free from back pain. Further research needs to be undertaken on proprioceptive exercise programs and their effect on back pain.

Role of ankle taping and bracing in the athlete.

Adhesive tape is often used to help athletes recover from ligament sprains of the ankle or to prevent further injury. The choice of taping technique or material is often decided by personal preference, superstition, or anecdote. More recently, the use of ankle braces has become more prevalent, but reasons for their use are similarly variable. As ankle sprains are a major cause of an athletes disability and time off sport, the choice of the method of support should be more scientifically reasoned. This paper attempts to review the literature concerning the effects of various methods of ankle support on swelling, stability, range of movement, proprioception, muscle function, gait, and performance tests. There is still some contradiction in the literature about the effects of taping and braces in both the acute and chronic phases of ligament sprains of the ankle.

Quadriceps atrophy: to what extent does it exist in patellofemoral pain syndrome?

Background: Quadriceps atrophy is a commonly cited accompaniment to patellofemoral pain syndrome (PFPS), yet there is little valid, objective evidence for its existence. Objective: To investigate atrophy and weakness of the quadriceps femoris muscle group in patients with PFPS using measures of cross-sectional area and peak extension torque. Methods: A total of 57 patients with insidious onset of PFPS and 10 healthy control subjects had ultrasound scanning of the quadriceps femoris. The scans were analysed using computerised planimetry to estimate the cross-sectional area of the quadriceps femoris. Lower limb peak torque was also measured using a Biodex dynamometer. Results: The mean of % differences revealed a 3.38% (95% confidence interval (CI) 1.3 to 5.45) difference in cross-sectional area (CSA) between the affected and unaffected limb in PFPS patients and a 1.31% (95% CI 0.06 to 2.55) difference in the dominant and non-dominant limb of the control group; the between-groups difference was not significant (p = 0.409). There was a 18.4% (95% CI 13 to 23.8) difference between the affected and unaffected limb in peak torque in PFPS patients and a 7.6% (95% CI 3.2 to 12) difference between the dominant and non-dominant limb in the control group; the between-groups difference was significant (p = 0.002). Conclusions: The mean of % differences of 3.38% quadriceps atrophy between limbs was considerably less than the only other study using ultrasound scanning on the quadriceps in PFPS and was not significant between the groups. There were greater and more significant between-group differences in lower limb peak torque indicating that muscle strength may not be related to muscle size. These results help to re-appraise of the amount of quadriceps atrophy in PFPS.

The role of massage in the management of the athlete: a review.

Massage has been a therapeutic modality in all cultures since early civilization and has had a long tradition of use in the sporting context. However, there has been a paucity of scientific evidence of the physiological, psychological and therapeutic effects of commonly used massage techniques. This paper reviews the early and more recent studies on the effects of massage and also the more recent literature on its use on the sports person. Little agreement was found in English publications of the efficacy of massage and there were contradictory findings as to the optimum technique and length of time of application. It is clear that the role of massage - a time-consuming technique for a physiotherapist to perform - needs to be evaluated further in order to resolve some contentious issues arising about this mode of treatment and to justify its use.

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 1: Terminology, definitions, clinical examination, natural history, patellofemoral osteoarthritis and patient-reported outcome measures

Patellofemoral pain (PFP) typically presents as diffuse anterior knee pain, usually with activities such as squatting, running, stair ascent and descent. It is common in active individuals across the lifespan,1–4 and is a frequent cause for presentation at physiotherapy, general practice, orthopaedic and sports medicine clinics in particular.5 ,6 Its impact is profound, often reducing the ability of those with PFP to perform sporting, physical activity and work-related activities pain-free. Increasing evidence suggests that it is a recalcitrant condition, persisting for many years.7–9 In an attempt to share recent innovations, build on the first three successful biennial retreats and define the ‘state of the art’ for this common, impactful condition; the 4th International Patellofemoral Pain Research Retreat was convened. The 4th International Patellofemoral Research Retreat was held in Manchester, UK, over 3 days (September 2–4th, 2015). After undergoing peer-review for scientific merit and relevance to the retreat, 67 abstracts were accepted for the retreat (50 podium presentations, and 17 short presentations). The podium and short presentations were grouped into five categories; (1) PFP, (2) factors that influence PFP (3) the trunk and lower extremity (4) interventions and (5) systematic analyses. Three keynote speakers were chosen for their scientific contribution in the area of PFP. Professor Andrew Amis spoke on the biomechanics of the patellofemoral joint. Professor David Felson spoke on patellofemoral arthritis,10 and Dr Michael Ratleffs keynote theme was PFP in the adolescent patient.11 As part of the retreat, we held structured, whole-group discussions in order to develop consensus relating to the work presented at the meeting as well as evidence gathered from the literature. ### Consensus development process In our past three International Patellofemoral Research Retreats, we developed a consensus statement addressing different presentation categories.12–14 In Manchester in 2015, we revised the format. For the exercise and …

A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions

Objective Braces used to treat (PF) osteoarthritis (OA) may reduce contact stress across the PF joint. We hypothesised that in PF OA, braces would decrease knee pain and shrink PF bone marrow lesions (BMLs). Methods Eligible subjects had painful PF OA. Subjects were randomly allocated to brace or no brace for 6 weeks. Knee MRIs were acquired at baseline and 6 weeks. We measured BMLs on post-contrast fat suppressed sagittal and proton density weighted axial images. The primary symptom outcome was change in pain at 6 weeks during a preselected painful activity, and the primary structural outcome was BML volume change in the PF joint. Analyses used multiple linear regression. Results We randomised 126 subjects aged 40–70 years (mean age 55.5  years; 72 females (57.1%)). Mean nominated visual analogue scale (0–10 cm) pain score at baseline was 6.5 cm. 94 knees (75%) had PF BMLs at baseline. Subjects wore the brace for a mean of 7.4 h/day. 6 subjects withdrew during the trial. After accounting for baseline values, the brace group had lower knee pain than the control group at 6 weeks (difference between groups −1.3 cm, 95% CI −2.0 to −0.7; p<0.001) and reduced PF BML volume (difference −490.6 mm3, 95% CI −929.5 to −51.7; p=0.03) but not tibiofemoral volume (difference −53.9 mm3, 95% CI −625.9 to 518.2; p=0.85). Conclusions A PF brace reduces BML volume in the targeted compartment of the knee, and relieves knee pain. Trial registration number UK. ISRCTN50380458.

Predictors of response to intra-articular steroid injections in knee osteoarthritis—a systematic review

Objective. IA steroid injections (IASIs) have been shown to relieve pain in knee OA and are widely used in clinical practice. There is, however, evidence of some variation in response. Knowledge of predictors of response could aid in the selection of patients for this therapy. The aim of this systematic review was to determine factors associated with response to IASI in knee OA. Methods. Medline, Embase, AMED, CINAHL, Web of Science and Cochrane Central Registers for Controlled Trials up to January 2012 were searched with additional hand searches of relevant articles. Studies included were those that involved adults diagnosed with knee OA in whom IASIs were administered and factors that predicted treatment response were investigated. Results. Eleven publications meeting these criteria were reviewed and relevant information extracted. It was not possible to pool the results because of the different predictors studied, variable outcome measures, different criteria for symptom change and missing data. Given the relative paucity of data and small heterogeneously designed studies, it was difficult to identify predictors of response. Data from individual publications, although not consistent across studies, suggest that the presence of effusion, withdrawal of fluid from the knee, severity of disease, absence of synovitis, injection delivery under US guidance and greater symptoms at baseline may all improve the likelihood of response to IASI. Conclusion. Further larger-scale studies using standardized methods are required to characterize predictors of response and should focus on synovitis, effusion, pain and structural severity of disease. Such data would help in better targeting therapy to those most likely to benefit.

Patellofemoral Pain: Proximal, Distal, and Local Factors - 2nd International Research Retreat.

Patellofemoral pain (PFP) is one of the most common lower extremity conditions seen in orthopaedic practice. The mission of the second International Patellofemoral Pain Research Retreat was to bring together scientists and clinicians from around the world who are conducting research aimed at understanding the factors that contribute to the development and, consequently, the treatment of PFP. The format of the 2.5-day retreat included 2 keynote presentations, interspersed with 6 podium and 4 poster sessions. An important element of the retreat was the development of consensus statements that summarized the state of the research in each of the 4 presentation categories. In this supplement, you will find the consensus documents from the meeting, as well as the keynote addresses, schedule, and platform and poster presentation abstracts.P ain under the kneecap, also known as anterior knee pain or patellofemoral pain, is one of the most common reasons why active people seek healthcare. Each year, 2.5 million runners are diagnosed with patellofemoral pain. Unfortunately, 74% of people with this problem will decrease their overall physical activity levels for at least 5 years after the initial injury, and 70% to 90% of them will experience more than 1 episode of pain. Recently, a panel of 50 experts from 9 countries gathered in Belgium to discuss the potential causes of and best treatments for this condition. A synopsis of this meeting is published in the June 2012 issue of JOSPT and provides new insights and discussion of evidence-based treatments for those who have knee pain.

The role of quadriceps exercise in the treatment of patellofemoral pain syndrome

SummaryIn recent years there has been increased interest in the role of exercise in the alleviation of patellofemoral pain syndrome. Contradictions which result in a lack of a consensus amongst clinicians and researchers as to the most beneficial type of exercise are reviewed. The popularly held belief that there are imbalances between some components of the quadriceps femoris is also reviewed and conflicting evidence that quadriceps contractions can be enhanced by altering hip and knee positions is found. Some traditional exercises, previously considered essential to any regime for this common condition, were not found to be as beneficial as previously thought. Consequently, some of these exercises should be less prominent in a rehabilitation programme for patellofemoral pain syndrome.

An evaluation of exercise regimes for patients with osteoarthritis of the knee: a single-blind randomized controlled trial:

Osteoarthritis (OA) of the knee is a major public health problem in the United Kingdom and various forms of physiotherapy are used in the treatment of this condition despite the lack of studies evaluating its efficacy. The purpose of this study was to compare the efficacy of two different forms of physiotherapy exercise management with a control group. Twenty-seven patients with OA knee were recruited from routine orthopaedic clinics and were on the waiting-list for physiotherapy. Patients were randomly allocated to three groups. Group 1 (n = 9) consisted of a control group; Group 2 (n = 8) consisted of supervised sessions of exercises; Group 3 (n = 10) consisted of an advice and instruction session plus a functional home exercise regime. Parameters measured were: pain; range of motion; quadriceps strength; knee joint swelling; exercise tolerance. Results were analysed using a Kruskal-Wallis analysis of variance and a Mann-Whitney U-test with the significance level set at p <0.05. The results showed no significant difference (p >0.05) between any of the outcome measures of the three groups. This study concludes that patients with OA knee can be helped most economically by one session of advice and a functional home exercise regime. This can be done in a group setting under supervision of one physiotherapist.