This most recent release by IFOMPT focuses on recent research for patellofemoral pain, the best exercises for Achilles tendinopathy, cost efficacy of various treatment strategies for lateral epicondylagia, and an editorial by Peter O’Sullivan on lumbago.
Barton CJ, Lack S, Hemmings S, Tufail, S and Morrissey, D. The ‘Best Practice Guide to Conservative Management of Patellofemoral Pain’: Incorporating level 1 evidence with expert clinical reasoning (2015). British Journal of Sports Medicine, 49, 923–934
This mixed methods design study used six systemic reviews up to September 2013 to demonstrate that multimodal treatments worked best for treating patellofemoral pain syndrome. Treatments consisting of strengthening for gluteal and quadriceps muscles, manual therapy patellar taping, and education on activity modification had the best outcomes. Foot orthoses and acupuncture treatment options were also supported. When treating patients with PFP our goals should be: 1. utilize a multifactoral approach. 2. Pain relief initially will improve patient trust. 3. Empower the patient through active over passive treatments and 4. Patient education and activity modification is crucial to success.
Beyer, R., Konsgaard, M., Kjaer,B., Øhlenschlæger, T., Kjaer, M and Magnusson, S.et al (2015). Heavy Slow Resistance Versus Eccentric Training as Treatment for Achilles Tendinopathy. The American Journal of Sports Medicine, 43, No.7 1704 -1711 DOI: 10.1177/036354651558476
The purpose of this randomized controlled trial was to compare the effectiveness of eccentric training (ECC) and heavy slow resistance training (HSR) among patients with mid-portion Achilles tendinopathy. Subjects were reassessed at 0, 12 and 52 weeks. Both groups demonstrated improvements in the Victorian Institute of Sports Assessment-Achilles and visual analog scale at 0, 12 and 52-week follow-ups. The HSR group was 92% compliant compared to the ECC 78%. The results demonstrated improvements in both groups however the HSR group reported higher patient satisfaction at 12 but not 52 weeks.
Coombes, B., Connelly, L., Bissett, L., and Vincenzino, B. (2015). Economic evaluation favours physiotherapy but not corticosteroid injection as a first-line intervention for chronic lateral epicondylalgia: evidence from a randomised clinical trial. British Journal of Sports Medicine, 0:1–7. doi:10.1136/bjsports-2015-094729.
The purpose of this study was to determine the cost-effectiveness of lateral epicondylalgia treatments: corticosteroid injection, physiotherapy (elbow manipulation and exercise) and corticosteroid injection, saline (placebo) injection or saline plus physiotherapy. Quality of life measures with the EuroQol-5D and cost of treatment over 1 year were assessed. While physiotherapy was more expensive, it had the best statistical significance for improvement in quality of life. This article is excellent evidence for a trial of physiotherapy before pursuing a corticosteroid injection which was less cost effective.
O’Sullivan, P. (2015). Common misconceptions about back pain in sport: Tiger Woods’case brings five fundamental questions into sharp focus. British Journal of Sports Medicine, 49 (14), 906-907.
This editorial by Peter O’Sullivan reviews the roles of physiotherapists in treating back pain. When do we image for a ‘pinched nerve?’ What surgical management is available? Manual therapy is discussed as one intervention yielding positive results. It discusses core strengthening as a key component to recovery. To quote O’Sullivan “Effective management of persistent pain involves providing a clear understanding of the factors that drives pain, developing graduated strategies to normalize and optimize movement patterns while controlling pain, coupled with sports specific conditioning and a graduated return to sport. Addressing psychosocial stressors and unhealthy lifestyle factors (ie, poor sleep patterns) is part of this process, especially where ‘central’ pain features are dominant. Magic bullets do not exist, so do not promise them.”