Vasileios Korakakis

Repeated end range spinal movement while seated abolishes the proprioceptive deficit induced by prolonged flexed sitting posture. A study assessing the statistical and clinical significance of spinal position sense

BACKGROUNDnSustained spinal flexion has been proposed to affect the properties of spinal tissues, increase postural muscles activation latency and act detrimentally on proprioception.nnnOBJECTIVESnThis study evaluated the effect of flexed posture (FP) on spinal proprioception and assessed the immediate effect of spinal movement on the presumable flexion-induced proprioceptive deficit.nnnDESIGNnClinical measurement study.nnnMETHODSnMarker-based kinematic analyses of the head, spine, and pelvis were conducted on 50 individuals. Subjects were educated in a lordotic sitting posture (IOSP) that they reproduced immediately; after 10 and 30xa0min in FP; and after sagittal spinal movement. Nine sagittal angles were calculated. Absolute error (AE) and constant error (CE) were used to evaluate repositioning accuracy. Repeated measures ANOVA was used to test for significant differences in angles obtained among postures, as well as for the AE and CE calculated from the trials.nnnRESULTSnNo significant differences were found in reposition error (RE) after immediate reproduction of IOSP (all pxa0>xa00.0083). Following FP AEs presented significant differences for head (4.1°), head protraction (1.9°), head tilt (2.1°), lumbar (3.2°) and pelvis angle (2.1°). CEs revealed significant differences for head protraction (-1.8°) and lumbar angle (-3.5°). No significant differences were found for AE and CE after spinal sagittal movement (all pxa0>xa00.0083).nnnCONCLUSIONSnProlonged FP can affect spinal position sense, but sagittal spinal movement can abolish the proprioceptive deficit. The significant differences documented, may be of limited clinical utility given their magnitude, and the reliability data presented may be of use in reinterpreting previously documented proprioceptive analyses.

Exercise-induced leg pain in athletes: diagnostic, assessment, and management strategies.

ABSTRACT The purpose of this review is to describe and critically evaluate current knowledge regarding diagnosis, assessment, and management of chronic overload leg injuries which are often non-specific and misleadingly referred to as ‘shin splints’. We aimed to review clinical entities that come under the umbrella term ‘Exercise-induced leg pain’ (EILP) based on current literature and systematically searched the literature. Specifically, systematic reviews were included. Our analyses demonstrated that current knowledge on EILP is based on a low level of evidence. EILP has to be subdivided into those with pain from bone stress injuries, pain of osteo-fascial origin, pain of muscular origin, pain due to nerve compression and pain due to a temporary vascular compromise. The history is most important. Questions include the onset of symptoms, whether worse with activity, at rest or at night? What exacerbates it and what relieves it? Is the sleep disturbed? Investigations merely confirm the clinical diagnosis and/or differential diagnosis; they should not be solely relied upon. The mainstay of diagnosing bone stress injury is MRI scan. Treatment is based on unloading strategies. A standard for confirming chronic exertional compartment syndrome (CECS) is the dynamic intra-compartmental pressure study performed with specific exercises that provoke the symptoms. Surgery provides the best outcome. Medial tibial stress syndrome (MTSS) presents a challenge in both diagnosis and treatment especially where there is a substantial overlap of symptoms with deep posterior CECS. Conservative therapy should initially aim to correct functional, gait, and biomechanical overload factors. Surgery should be considered in recalcitrant cases. MRI and MR angiography are the primary investigative tools for functional popliteal artery entrapment syndrome and when confirmed, surgery provides the most satisfactory outcome. Nerve compression is induced by various factors, e.g., localized fascial entrapment, unstable proximal tibiofibular joint (intrinsic) or secondary by external compromise of the nerve, e.g., tight hosiery (extrinsic). Conservative is the treatment of choice. The localized fasciotomy is reserved for recalcitrant cases.

Evaluation of the within- and between-day intra-tester and inter-tester reliability of positioning subjects into neutral and lordotic sitting postures

Abstract Purpose: To assess the reliability of postural positioning in two different sitting postures (SP), within- and between-days, as well as intra-tester and inter-tester. Methods: Twenty six individuals were facilitated into lordotic (LSP) and neutral (NSP) SP on two different days by four physiotherapists, while kinematic data were collected. Intra-tester and inter-tester reliability were assessed using measures of relative reliability (intra-class correlation coefficients, ICC) and absolute reliability (standard error of measurement-SEM; minimal detectable change; mean difference; limits of agreement). Results: Substantial or almost perfect relative reliability (ICC >0.67), with very good absolute reliability (SEM <2.7°) was found for both intra- and inter-tester (within- and between-day) reliability. However, likely due to methodological variation affecting head angles on Day 2, the reliability of head/neck angles were poor (ICC as low as −0.11, SEM ≤5.71°). Conclusion: This study suggests that postural positioning of asymptomatic individuals into NSP and LSP can be performed with very good reliability for most spinal angles. Therefore, clinicians can have some confidence that positioning in SPs can be done reliably. However, while the degree of error is typically small, the small range of movement occurring at many spinal angles suggests that determining what is a clinically meaningful change in posture is difficult.

Blood Flow Restriction induces hypoalgesia in recreationally active adult male anterior knee pain patients allowing therapeutic exercise loading

OBJECTIVEnTo evaluate if a single blood flow restriction (BFR)-exercise bout would induce hypoalgaesia in patients with anterior knee pain (AKP) and allow painless application of therapeutic exercise.nnnDESIGNnCross-sectional repeated measures design.nnnSETTINGnInstitutional out-patients physiotherapy clinic.nnnPATIENTSnConvenience sample of 30 AKP patients.nnnINTERVENTIONnBFR was applied at 80% of complete vascular occlusion. Four sets of low-load open kinetic chain knee extensions were implemented using a pain monitoring model.nnnMAIN OUTCOME MEASUREMENTSnPain (0-10) was assessed immediately after BFR application and after a physiotherapy session (45u202fmin) during shallow and deep single-leg squat (SSLS, DSLS), and step-down test (SDT). To estimate the patient rating of clinical effectiveness, previously described thresholds for pain change (≥40%) were used, with appropriate adjustments for baseline pain levels.nnnRESULTSnSignificant effects were found with greater pain relief immediate after BFR in SSLS (du202f=u202f0.61, pu202f<u202f0.001), DSLS (du202f=u202f0.61, pu202f<u202f0.001), and SDT (du202f=u202f0.60, pu202f<u202f0.001). Time analysis revealed that pain reduction was sustained after the physiotherapy session for all tests (d(SSLS)u202f=u202f0.60, d(DSLS)u202f=u202f0.60, d(SDT)u202f=u202f0.58, all pu202f<u202f0.001). The reduction in pain effect size was found to be clinically significant in both post-BFR assessments.nnnCONCLUSIONnA single BFR-exercise bout immediately reduced AKP with the effect sustained for at least 45u202fmin.

What are patients’ knowledge, expectation and experience of radial extracorporeal shockwave therapy for the treatment of their tendinopathies? A qualitative study

BackgroundExtracorporeal shockwave therapy (ESWT) is used to manage different tendinopathies and appears to be effective in some tendinopathies but not others. The reasons for this are unclear. There is evidence that patient outcomes can be influenced by a patient-centred approach. There is therefore a need to qualitatively evaluate patient experiences for a treatment like ESWT where uncertainties exist. The aim of this study was to understand patients’ overall perspective of ESWT to manage their tendinopathy.MethodsA qualitative semi-structured face-to-face interview study design was used and the data was analysed thematically using ‘Framework Analysis’.ResultsEleven participants that have had radial ESWT (rESWT) to treat a range of tendinopathies were recruited from a private London sports clinic and interviewed in person or via Skype™. Four main themes and 16 subthemes were identified. Subthemes included previous failed treatment, clinician factors, mechanisms of ESWT, positive aspects, negative aspects, responsibility over own health and perceived outcomes.ConclusionThe participants understood the procedural aspects of rESWT, but were largely unaware of its mechanism of action and whether it was found to be effective for their condition or not. The participants felt that self-management measures were equally or more important than rESWT to help treat their tendinopathies. Recommendations would be for rESWT providers to offer patients written information, maintain continuity of care, address patients’ expectations, feedback on progress, and encourage self-management measures such as activity modification.

Individualised radial extracorporeal shock wave therapy (rESWT) for symptomatic calcific shoulder tendinopathy: a retrospective clinical study

BackgroundA retrospective single centre cohort analysis was performed to evaluate an individualised radial extracorporeal shock wave therapy (rESWT) protocol for treatment of symptomatic calcific shoulder tendinopathy.Methods67 patients (79 Shoulders) were identified with 76 shoulders included for analysis. rESWT treatment protocol was adapted according to individual response to treatment. Variables included number of sessions, shockwave impulses, pressure and frequency. Success rate was estimated as the percentage of patients having ≥60% visual analogue score (VAS) pain decrease at follow-up. Recurrence at 1xa0year was recorded.ResultsUsing this individualised symptom guided protocol, patients underwent a mean of 7u2009±u20091.5 rESWT sessions, with mean pressure of 1.7u2009±u20090.2xa0bar, mean frequency of 5u2009±u20090.3xa0Hz and 2175u2009±u2009266 impulses. The mean pre-treatment VAS score of 6.7u2009±u20091.1 was significantly decreased to 3.2u2009±u20090.8 immediately post-treatment, 2.6u2009±u20090.9 at 1xa0month, 1.7u2009±u20091.0 at 3xa0months and 0.8u2009±u20091.0 at 1xa0year follow up (αu2009=u20090.05). One-year success rate was estimated at 92% and 1-year recurrence rate was 7%.ConclusionsWe conclude that in this retrospective study an individualised rESWT protocol resulted in a high success rate with low number of recurrences. Randomised controlled trials to support these findings are recommended.