Publications by authors named "Vasileios Korakakis"

48 Publications

Effect of Strength Versus Strength and Endurance Upper Limb Exercise Training in Patients With Chronic Obstructive Pulmonary Disease: A RANDOMIZED CLINICAL TRIAL.

J Cardiopulm Rehabil Prev 2021 Jun 10. Epub 2021 Jun 10.

Department of Health Sciences, School of Sciences, European University Cyprus, Nicosia, Cyprus (Drs Karagiannis and Savva and Ms Matheou); Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar (Dr Korakakis); Respiratory Clinic, Nicosia General Hospital, Nicosia, Cyprus (Dr Adamide); Private Doctor, Nicosia, Cyprus (Dr Georgiou); Physiotherapy Department, Nicosia General Hospital, and Department of Life and Health Sciences, School of Sciences and Engineering, University of Nicosia, Nicosia, Cyprus (Ms Prodromou); and School of Medicine, European University Cyprus, Nicosia, Cyprus (Dr Xanthos).

Purpose: Pulmonary rehabilitation (PR) including exercise training improves muscle strength, exercise capacity, and health-related quality of life in patients with chronic obstructive pulmonary disease (COPD). However, the evidence of the effect of upper limb exercise training (ULET) on activities of daily living (ADL) is sparse. This study investigated the effect of two different types of ULET on ADL in addition to standard PR.

Methods: Patients were randomly assigned to a strength or a combined ULET group. Both groups exercised 2 d/wk for 12 wk. Outcome measures were handgrip strength and muscle strength of biceps and triceps muscles. Moreover, health-related quality of life was assessed through the COPD assessment test (CAT) and Saint George Respiratory Questionnaire. Ability to perform ADL was evaluated through an ADL simulation test. Dyspnea was evaluated by a modified Medical Research Council scale, whereas dyspnea and fatigue perception during strength and ADL tests were measured through a modified Borg scale.

Results: Thirty-six patients with COPD (67.4 ± 5.3 yr) participated in the study. Significant improvements in upper limb strength and CAT were found within both groups. At the end of the study period, patients in the combined group improved time of the ADL test (P = .02) with reduced perception of fatigue (P = .03) compared with patients in the strength group.

Conclusions: In addition to standard PR of patients with COPD, the combined endurance and resistance ULET program improved ADL and muscle strength, whereas resistance training only increased strength.
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http://dx.doi.org/10.1097/HCR.0000000000000620DOI Listing
June 2021

Evaluating lower limb tendinopathy with Victorian Institute of Sport Assessment (VISA) questionnaires: a systematic review shows very-low-quality evidence for their content and structural validity-part I.

Knee Surg Sports Traumatol Arthrosc 2021 May 21. Epub 2021 May 21.

Department of Orthopaedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.

Purpose: The Victorian Institute of Sport Assessment (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P) questionnaires are widely used in research and clinical practice; however, no systematic reviews have formally evaluated their content, structural, and cross-cultural validity evidence. The measurement properties referring to content, structural and cross-cultural validity of the VISA questionnaires were appraised and synthesized.

Methods: The systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Development studies and cross-cultural adaptations (12 languages) assessing content or structural validity of the VISA questionnaires were included and two reviewers assessed their methodological quality. Evidence for content (relevance, comprehensiveness, and comprehensibility), structural, and cross-cultural validity was synthesized. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to evidence synthesis.

Results: The VISA-A presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility. VISA-G displayed moderate-quality evidence for sufficient comprehensibility and very-low-quality evidence of sufficient relevance and comprehensiveness. The VISA-P presented very-low-quality evidence of sufficient relevance, insufficient comprehensiveness, and inconsistent comprehensibility, while VISA-H presented very-low evidence of insufficient content validity. VISA-A displayed low-quality evidence for structural validity concerning unidimensionality and internal structure, while VISA-H presented low-quality evidence of insufficient unidimensionality. The structural validity of VISA-G and VISA-P were indeterminate and inconsistent, respectively. Internal consistency for VISA-G, VISA-H, and VISA-P was indeterminate. No studies evaluated cross-cultural validity, while measurement invariance across sexes was assessed in one study.

Conclusions: Only very-low-quality evidence exists for the content and structural validity of VISA questionnaires when assessing the severity of symptoms and disability in patients with lower limb tendinopathies.

Level Of Evidence: IV.

Registration: PROSPERO reference-CRD42019126595.
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http://dx.doi.org/10.1007/s00167-021-06598-5DOI Listing
May 2021

Cervical traction combined with neural mobilization for patients with cervical radiculopathy: A randomized controlled trial.

J Bodyw Mov Ther 2021 Apr 2;26:279-289. Epub 2020 Sep 2.

Department of Health Science, European University, Diogenous 6, Engomi, Nicosia, Cyprus.

Background: Although both neural mobilization (NM) and cervical traction (CT) are widely used interventions in cervical radiculopathy (CR), there is limited clinical data to support their use.

Objective: To evaluate the effects of CT, with or without the addition of NM, on pain, function, and disability in patients with CR.

Design: A randomized, double-blinded, placebo-controlled clinical trial.

Methods: 66 patients with CR were randomly allocated to: a group (n = 22) received CT combined with NM (CT + NM), a group (n = 22) received CT combined with sham NM (CT + shamNM) and a wait-list control (WLC) group (n = 22). The Neck Disability Index (NDI), the Patient-Specific Functional Scale, the Numeric Pain Rating Scale (NPRS), grip strength and cervical spine mobility were used as outcome measures. A two-way analysis of variance was used to evaluate differences between the three groups at baseline and at 4-week follow-up.

Results: Statistically and clinically significant between-group differences at 4-week follow-up were found between CT + NM and WLC groups in favor of CT + NM group in NDI scores (d = 1.30), NRPS (d = 1.94), and active cervical rotation towards the opposite arm (d = 1.18) and between CT + NM and CT + shamNM groups in favor of CT + NM group in NRPS (d = 1.21). No significant differences were observed between CT + shamNM and WLC groups in all outcome measures. Clinically significant within-group improvements were found only for the CT + NM group.

Conclusion: At 4-week follow-up, CT in combination with NM resulted in improved outcomes in pain, function and disability in patients with CR.
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http://dx.doi.org/10.1016/j.jbmt.2020.08.019DOI Listing
April 2021

The effect of lumbar spine manipulation on pain and disability in Achilles tendinopathy. A case report.

J Bodyw Mov Ther 2021 Apr 8;26:214-219. Epub 2020 Sep 8.

Department of Health Science, Diogenous 6, Engomi, European University, Nicosia, Cyprus.

Background/purpose: Cervical and thoracic spine manipulation has been found to reduce tendon pain and disability in lateral epicondylalgia and rotator cuff tendinopathy. Based on these findings, the application of lumbar spine manipulation may also provide similar improvements in Achilles tendinopathy (AT). Therefore, the purpose of this study was to evaluate the effect of lumbar spine manipulation on pain and disability in a patient experiencing AT.

Case Description: A 44 years old male ex-football player presented with a 20-year history of persistent Achilles tendon pain (ATP) consistent with AT diagnosis. The patient attended 12 treatment sessions receiving a high-velocity, low amplitude lumbar spine manipulation. Outcome measures were collected at baseline, 2 weeks, 4 weeks, 3 months and 6 months and included pain in visual analogue scale, the American Orthopedic Foot and Ankle Score, the 36-Item Short Form Health Survey and the Victorian Institute of Sport Assessment-Achilles questionnaire. Pressure pain threshold was also assessed using an electronic pressure algometer.

Outcomes: Improvement in all outcome measures was noted 6-months post intervention. Outcome measures indicated substantial improvements in both the patient's pain and disability. The patient was able to perform activities of daily living without difficulties, suggesting higher level of function and quality of life at 6-months post initial evaluation.

Conclusion: These findings have demonstrated the positive effects of lumbar spine manipulation on ATP and disability. Further studies, specifically clinical trials investigating the effect of lumbar spine manipulation or combining this technique with exercises and functional activities are suggested.
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http://dx.doi.org/10.1016/j.jbmt.2020.08.014DOI Listing
April 2021

Tendinopathy VISAs have expired-is it time for outcome renewals?

Knee Surg Sports Traumatol Arthrosc 2021 May 10. Epub 2021 May 10.

Department of Orthopaedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.

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http://dx.doi.org/10.1007/s00167-021-06596-7DOI Listing
May 2021

Lumbo-pelvic proprioception in sitting is impaired in subgroups of low back pain-But the clinical utility of the differences is unclear. A systematic review and meta-analysis.

PLoS One 2021 26;16(4):e0250673. Epub 2021 Apr 26.

Hellenic Orthopaedic Manipulative Therapy Diploma (HOMTD), Athens, Greece.

Background: Altered spinal postures and altered motor control observed among people with non-specific low back pain have been associated with abnormal processing of sensory inputs. Evidence indicates that patients with non-specific low back pain have impaired lumbo-pelvic proprioceptive acuity compared to asymptomatic individuals.

Objective: To systematically review seated lumbo-pelvic proprioception among people with non-specific low back pain.

Methods: Five electronic databases were searched to identify studies comparing lumbo-pelvic proprioception using active repositioning accuracy in sitting posture in individuals with and without non-specific low back pain. Study quality was assessed by using a modified Downs and Black's checklist. Risk of bias was assessed using an adapted tool for cross-sectional design and case-control studies. We performed meta-analysis using a random effects model. Meta-analyses included subgroup analyses according to disability level, directional subgrouping pattern, and availability of vision during testing. We rated the quality of evidence using the GRADE approach.

Results: 16 studies met the eligibility criteria. Pooled meta-analyses were possible for absolute error, variable error, and constant error, measured in sagittal and transverse planes. There is very low and low certainty evidence of greater absolute and variable repositioning error in seated tasks among non-specific low back pain patients overall compared to asymptomatic individuals (sagittal plane). Subgroup analyses indicate moderate certainty evidence of greater absolute and variable error in seated tasks among directional subgroups of adults with non-specific low back pain, along with weaker evidence (low-very low certainty) of greater constant error.

Discussion: Lumbo-pelvic proprioception is impaired among people with non-specific low back pain. However, the low certainty of evidence, the small magnitude of error observed and the calculated "noise" of proprioception measures, suggest that any observed differences in lumbo-pelvic proprioception may be of limited clinical utility.

Prospero-id: CRD42018107671.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0250673PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8075231PMC
April 2021

A systematic review evaluating the clinimetric properties of the Victorian Institute of Sport Assessment (VISA) questionnaires for lower limb tendinopathy shows moderate to high-quality evidence for sufficient reliability, validity and responsiveness-part II.

Knee Surg Sports Traumatol Arthrosc 2021 Apr 16. Epub 2021 Apr 16.

Department of Orthopaedic Surgery, Sports Orthopedic Research Center-Copenhagen (SORC-C), Amager-Hvidovre Hospital, Faculty of Health Sciences, Copenhagen University, Copenhagen, Denmark.

Purpose: The evaluation of measurement properties such as reliability, measurement error, construct validity, and responsiveness provides information on the quality of the scale as a whole, rather than on an item level. We aimed to synthesize the measurement properties referring to reliability, measurement error, construct validity, and responsiveness of the Victorian Institute of Sport Assessment questionnaires (Achilles tendon-VISA-A, greater trochanteric pain syndrome-VISA-G, proximal hamstring tendinopathy-VISA-H, patellar tendon-VISA-P).

Methods: A systematic review was conducted according to Consensus-based Standards for the Selection of Health Measurement Instruments methodology (COSMIN). PubMed, Cochrane, CINAHL, EMBASE, Web of Science, SportsDiscus, grey literature, and reference lists were searched. Studies assessing the measurement properties concerning reliability, validity, and responsiveness of the VISA questionnaires in patients with lower limb tendinopathies were included. Two reviewers assessed the methodological quality of studies assessing reliability, validity, and responsiveness using the COSMIN guidelines and the evidence for these measurement properties. A modified Grading of Recommendations Assessment Development and Evaluation (GRADE) approach was applied to the evidence synthesis.

Results: There is moderate-quality evidence for sufficient VISA-A, VISA-G, and VISA-P reliability. There is moderate-quality evidence for sufficient VISA-G and VISA-P measurement error, and high-quality evidence for sufficient construct validity for all the VISA questionnaires. Furthermore, high-quality evidence exists with regard to VISA-A for sufficient responsiveness in patients with insertional Achilles tendinopathy following conservative interventions.

Conclusions: Sufficient reliability, measurement error, construct validity and responsiveness were found for the VISA questionnaires with variable quality of evidence except for VISA-A which displayed insufficient measurement error.

Level Of Evidence: IV.

Registration Details: Prospero (CRD42018107671); PROSPERO reference-CRD42019126595.
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http://dx.doi.org/10.1007/s00167-021-06557-0DOI Listing
April 2021

Diagnostic accuracy of examination tests for lateral elbow tendinopathy (LET) - A systematic review.

J Hand Ther 2021 Feb 27. Epub 2021 Feb 27.

Physiotherapy Department, University of West Attica, Egaleo, Greece.

Background: Reviews on the diagnostic performance of the examination tests for lateral elbow tendinopathy (LET) based on updated context-specific tools and guidelines are missing.

Purpose: To review the diagnostic accuracy of examination tests used in LET.

Design: Systematic review following PRISMA-DTA guidelines.

Methods: We searched MEDLINE, PubMed, CINAHL, EMBASE, PEDro, ScienceDirect, and Cochrane Library databases. The QUADAS-2 checklist was used to assess the methodological quality of the eligible studies. We included diagnostic studies reporting the accuracy of physical examination tests or imaging modalities used in patients with LET.

Results: Twenty-four studies with 1370 participants were identified reporting the diagnostic performance of Ultrasound Imaging (USI) (18 studies), physical examination tests (2 studies) and Magnetic Resonance Imaging (MRI) (4 studies). Most studies (97%) were assessed with "unclear" or "high risk" of bias. Sonoelastography showed the highest sensitivity (75- 100%) and specificity (85- 96%). Grayscale with or without Doppler USI presented poor to excellent values (sensitivity: 53%-100%, specificity: 42%-90%). MRI performed better in the diagnosis of tendon thickening and enthesopathy (sensitivity and specificity: 81%-100%). The Cozen's test reported high sensitivity (91%) while a grip strength difference of 5%-10% between elbow flexion and extension showed high sensitivity (78%-83%) and specificity (80%-90%).

Conclusions: Cozen's test and grip strength measurement present high accuracy in the diagnosis of LET but are poorly investigated. USI and MRI provide variable diagnostic accuracy depending on the entities reported and should be recommended with caution when differential diagnosis is necessary. Substantial heterogeneity was found in inclusion criteria, operator/ examiner, mode of application, type of equipment and reference standards across the studies.

Systematic Review Registration: PROSPERO ID CRD42020160402.
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http://dx.doi.org/10.1016/j.jht.2021.02.002DOI Listing
February 2021

Arabic translation and cross-cultural adaptation of the Sport Concussion Assessment Tool 5 (SCAT5).

Biol Sport 2021 Mar 21;38(1):129-144. Epub 2020 Aug 21.

Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

The aim was to create a Modern Standard Arabic SCAT5 version for different Arabic dialects. This translation and cross-cultural adaptation was performed in eight stages: initial translations, reconciliation of translations and cultural adaptation, back translation, appraisal of back translations, validation of the translation, review and adjustment by reconciliation committee, pretesting in 12 football players and document finalisation. As an alternative to the problematic Months In Reverse Order Test (MIROT) in Arabic, the Serial 3s test (32 Arabic and 30 English participants), the Days of the Week Backwards test (DWBT), and the 'Adding Serial 3s' test were tested (30 English and 30 Arabic participants) for accuracy, difficulty and time of completion. The Arabic SCAT5 was similar and comparable to the original English version (7-point Likert scales =< 2). Testing of the pre-final version of the Arabic SCAT5 took 20.4 (SD 3.4) and 17.7 (SD 3.0) minutes respectively to complete and was found acceptable in terms of clarity, understandability, grammatical correctness and coherence. The Arabic Serial 3s test (subtraction version) was unsuitable due to high completion time, low pass rate and high difficulty perception [time = 47.2 (SD 28.0) s; accuracy = 55.2%; difficulty = 3.2 (SD 1.1)]. The Arabic DWBT was too fast and undemanding for concentration testing [time = 4.6 (SD 1.5) s; accuracy = 90%; difficulty = 1.1 (SD 0.3)]. The Adding Serial 3s tests produced similar completion times [18.4 (SD 6.8) vs. 21.1 (SD 5.3), p = 0.088], accuracy (100%) and self-rated difficulty [English = 2.0 (SD 0.7) vs. Arabic-speaking participants = 2.1 (SD 0.8), p = 0.512] and was therefore adopted to replace the MIROT. This culturally adapted Arabic-SCAT5 questionnaire is the first concussion assessment tool available for Arabic-speaking healthcare providers and athletes. Sport Concussion Assessment Tool 5 (SCAT5). Biol Sport. 2021;38(1):129-144.
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http://dx.doi.org/10.5114/biolsport.2020.97673DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7996381PMC
March 2021

The analgesic effect of joint mobilization and manipulation in tendinopathy: a narrative review.

J Man Manip Ther 2021 Mar 26:1-12. Epub 2021 Mar 26.

Department of Life and Health Sciences, University of Nicosia, Nicosia, Cyprus.

: To summarize the available literature with regards to the potential analgesic effect and mechanism of joint mobilization and manipulation in tendinopathy. : The effect of these techniques in rotator cuff tendinopathy and lateral elbow tendinopathy, applied alone, compared to a placebo intervention or along with other interventions has been reported in some randomized controlled trials which have been scrutinized in systematic reviews. Due to the small randomized controlled trials and other methodological limitations of the evidence base, including short-term follow-ups, small sample size and lack of homogenous samples further studies are needed. Literature in other tendinopathies such as medial elbow tendinopathy, de Quervain's disease and Achilles tendinopathy is limited since the analgesic effect of these techniques has been identified in few case series and reports. Therefore, the low methodological quality renders caution in the generalization of findings in clinical practice. Studies on the analgesic mechanism of these techniques highlight the activation of the descending inhibitory pain mechanism and sympathoexcitation although this area needs further investigation. : Study suggests that joint mobilization and manipulation may be a potential contributor in the management of tendinopathy as a pre-conditioning process prior to formal exercise loading rehabilitation or other proven effective treatment approaches.
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http://dx.doi.org/10.1080/10669817.2021.1904348DOI Listing
March 2021

Single leg hop for distance symmetry masks lower limb biomechanics: time to discuss hop distance as decision criterion for return to sport after ACL reconstruction?

Br J Sports Med 2021 Mar 9. Epub 2021 Mar 9.

Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium.

Background: We evaluated the lower limb status of athletes after anterior cruciate ligament reconstruction (ACLR) during the propulsion and landing phases of a single leg hop for distance (SLHD) task after they had been cleared to return to sport. We wanted to evaluate the biomechanical components of the involved (operated) and uninvolved legs of athletes with ACLR and compare these legs with those of uninjured athletes (controls).

Methods: We captured standard video-based three-dimensional motion and electromyography (EMG) in 26 athletes after ACLR and 23 healthy controls during SLHD and calculated lower limb and trunk kinematics. We calculated lower limb joint moments and work using inverse dynamics and computed lower limb muscle forces using an EMG-constrained musculoskeletal modelling approach. Between-limb (within ACLR athletes) and between-group differences (between ACLR athletes and controls) were evaluated using paired and independent sample t-tests, respectively.

Results: Significant differences in kinematics (effect sizes ranging from 0.42 to 1.56), moments (0.39 to 1.08), and joint work contribution (0.55 to 1.04) were seen between the involved and uninvolved legs, as well as between groups. Athletes after ACLR achieved a 97%±4% limb symmetry index in hop distance but the symmetry in work done by the knee during propulsion was only 69%. During landing, the involved knee absorbed less work than the uninvolved, while the uninvolved knee absorbed more work than the control group. Athletes after ACLR compensated for lower knee work with greater hip work contribution and by landing with more hip flexion, anterior pelvis tilt, and trunk flexion.

Conclusion: Symmetry in performance on a SLHD test does not ensure symmetry in lower limb biomechanics. The distance hopped is a poor measure of knee function, and largely reflects hip and ankle function. Male athletes after ACLR selectively unload the involved limb but outperform controls on the uninvolved knee.
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http://dx.doi.org/10.1136/bjsports-2020-103677DOI Listing
March 2021

Does blood flow restriction training enhance clinical outcomes in knee osteoarthritis: A systematic review and meta-analysis.

Phys Ther Sport 2021 May 3;49:37-49. Epub 2021 Feb 3.

School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland.

Objective: To systematically review the efficacy of blood flow restriction training (BFRT) on individuals with knee osteoarthritis (OA).

Design: Systematic review with meta-analysis.

Literature Search: Eight electronic databases were searched by one researcher.

Study Selection Criteria: Randomised clinical trials (RCTs) comparing BFRT to regular resistance training (RT) for knee OA.

Data Synthesis: One reviewer selected the eligible RCTs and exported the data. Two reviewers evaluated study quality using the PEDro scale. We performed meta-analysis where appropriate using a random-effects model. We rated the quality of evidence using GRADE.

Results: Five studies were eligible. The key outcomes analysed were pain, self-reported function, objective physical function, strength and muscle size. Across all comparisons, there was low to moderate quality evidence of no difference between BFRT and traditional RT.

Conclusion: The limited available evidence does not suggest that BFRT enhances outcomes for people with knee OA. These findings do not support clinicians using BFRT in people with knee OA. Instead, evidence-based messages regarding exercise and education should remain the mainstay of rehabilitation. Additional studies should clarify whether some people with knee OA who cannot complete an adequate exercise programme due to pain, might still benefit from BFRT to facilitate less painful exercise.
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http://dx.doi.org/10.1016/j.ptsp.2021.01.014DOI Listing
May 2021

Vertical and Horizontal Hop Performance: Contributions of the Hip, Knee, and Ankle.

Sports Health 2021 Mar 9;13(2):128-135. Epub 2021 Feb 9.

Department of Rehabilitation, Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Background: Single-leg vertical and horizontal hop tests are commonly used to assess performance of healthy athletes and as a measure of progress during rehabilitation from knee injury. It is unclear if they measure similar aspects of leg function, as the relative joint contributions of the hip, knee, and ankle joints during propulsion and landing are unknown.

Hypothesis: The proportion of work done by the hip, knee, and ankle will not be the same for these 2 jump types and will vary for propulsive and landing phases.

Study Design: Cross-sectional cohort study.

Level Of Evidence: Level 3.

Methods: Twenty physically active participants completed instrumented single-leg hop analysis in both vertical and horizontal directions. Joint peak power, work generated or absorbed, and percentage contribution of each joint during propulsive and landing phases were compared between tasks using paired tests.

Results: Vertical hop was performed with roughly similar contributions of the hip, knee, and ankle for both propulsion (31%, 34%, 35%, respectively) and landing (29%, 34%, 37%, respectively). Horizontal hop distance was mostly (87%) determined by the hip and ankle (44% and 43%), but landing was mostly (65%) performed by the knee with lesser contribution from the hip and ankle (24% and 11%). Propulsive phase showed a proximal-to-distal temporal sequence for both hop types, but landing was more complex.

Conclusion: Performance during vertical and horizontal hops (jump height and jump distance, respectively) measures different aspects of hip, knee, and ankle function during the propulsive and landing phases.

Clinical Relevance: Assessment of knee joint function during rehabilitation should not be done using a horizontal hop. The knee contributes about a third to vertical hop height, but only about an eighth to horizontal hop distance. Practitioners carrying out performance testing using either vertical or horizontal hops should be mindful of the relative contributions for meaningful training inferences to be derived.
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http://dx.doi.org/10.1177/1941738120976363DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8167345PMC
March 2021

Relationships between physical capacities and biomechanical variables during movement tasks in athletic populations following anterior cruciate ligament reconstruction.

Phys Ther Sport 2021 Mar 22;48:209-218. Epub 2021 Jan 22.

Institute of Sport, Exercise and Health, London, United Kingdom; School of Sport and Exercise, University of Gloucestershire, Gloucester, United Kingdom.

Background: Anterior cruciate ligament (ACL) reconstruction has a detrimental impact on athletic performance. Despite rehabilitation guidelines and criterion-based progressions to ensure safe restoration of fundamental physical capacities and maladaptive movement strategies, residual deficits in maximal strength, rate of force development (RFD), power and reactive strength are commonly reported. These combined with associated compensatory inter and intra-limb strategies increase the risk of re-injury.

Objective: The aim of this article is to examine the relationships between fundamental physical capacities and biomechanical variables during dynamic movement tasks.

Design: Narrative review.

Results: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS CONCLUSION: The available data suggests that quadriceps strength and rate of torque development, explain a moderate portion of the variance in aberrant kinetic and kinematic strategies commonly detected in ACL reconstructed cohorts in the later stages of rehabilitation and RTS.
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http://dx.doi.org/10.1016/j.ptsp.2021.01.006DOI Listing
March 2021

Participant characteristics are poorly reported in exercise trials in tendinopathy: A systematic review.

Phys Ther Sport 2021 Mar 16;48:43-53. Epub 2020 Dec 16.

School of Allied Health, University of Limerick, Limerick, Ireland; Ageing Research Centre, University of Limerick, Limerick, Ireland.

Objective: To evaluate the reporting of eligibility criteria and baseline participant characteristics in randomised controlled trials investigating the effects of exercise interventions in tendinopathy.

Methods: Randomised controlled trials investigating the effects of exercise therapy compared to a non-exercising intervention in upper and lower limb tendinopathy were included. Data extraction was categorised into the following domains: participant demographics, tendinopathy descriptors, general health, participant recruitment and eligibility criteria.

Results: The review included the following tendinopathies: Achilles (n = 9), gluteal (n = 2), lateral elbow tendinopathy (n = 15), patellar (n = 3) plantar (n = 3), and rotator cuff (n = 13). Age, sex, duration of symptoms and symptom severity were commonly reported across the review, while prior history of tendinopathy was poorly reported (6/45). Variables such as physical activity level (17/45), sleep (0/45), psychological factors (2/45), medication at baseline (8/45), co morbid health complaints (10/45) and sociodemographic factors (11/45) were poorly reported across the included studies. Substantial variation existed between studies in the specific eligibility criteria used.

Conclusion: The findings of this systematic review demonstrate that participant characteristics are poorly reported in exercise trials in tendinopathy. To improve effectiveness of exercise interventions in tendinopathy, improved reporting of participant characteristics may allow better comparisons and targeted interventions for specific subgroups.
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http://dx.doi.org/10.1016/j.ptsp.2020.12.012DOI Listing
March 2021

Notions of "optimal" posture are loaded with meaning. Perceptions of sitting posture among asymptomatic members of the community.

Musculoskelet Sci Pract 2021 02 27;51:102310. Epub 2020 Nov 27.

Department of Physical Education and Sport Sciences, ErgoMech Lab, University of Thessaly, Greece.

Background: Notions of "optimal" posture are widespread in modern society and strongly interconnected with preconceived beliefs.

Objectives: To quantitatively evaluate spinal posture among members of the community during habitual sitting, and when asked to assume an "optimal" posture.

Design: Observational study.

Methods: Marker-based kinematic analyses of the head, spine, and pelvis were conducted on 100 individuals. Habitual sitting posture and self-perceived "optimal" posture, and whether participants believed that their habitual sitting reflected an "optimal" posture, were evaluated. The Wilcoxon signed-rank test assessed angular differences between the two postures adopted. Exploratory post-hoc analyses were conducted by using the Mann-Whitney U test to assess differences between genders.

Results: None of the participants stated that their habitual sitting was "optimal". Statistically significant differences were observed in most of the measured angles (p < 0.001) between habitual and self-perceived "optimal" posture. In habitual sitting posture, a significant interaction with gender was found only in the thoracolumbar (p < 0.05) and pelvic (p < 0.001) angles, with small effect sizes. In self-perceived "optimal" posture females were more extended in the head, upper thoracic, lower thoracic, lumbar and pelvic (p < 0.01) regions, than the males.

Conclusions: A group of young, asymptomatic participants, consistently changed their habitual sitting posture to a more upright posture when asked to assume an "optimal" sitting posture, although the amount of change observed varied between spinal regions. These findings also highlight gender differences in not just habitual sitting posture, but also the degree to which habitual sitting posture is modified when trying to assume an "optimal" sitting posture.
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http://dx.doi.org/10.1016/j.msksp.2020.102310DOI Listing
February 2021

Strength, rate of force development, power and reactive strength in adult male athletic populations post anterior cruciate ligament reconstruction - A systematic review and meta-analysis.

Phys Ther Sport 2021 Jan 10;47:91-104. Epub 2020 Nov 10.

London Sport Institute, School of Science and Technology, Middlesex University, Greenlands Lane, London, United Kingdom. Electronic address:

Background: Residual deficits in athletic performance are common despite rehabilitation guidelines following anterior cruciate ligament reconstruction including criterion-based progressions to protect healing structures, ensure safe restoration of fundamental physical capacities, and guide appropriate return to sports activities. A synthesis of the available literature is warranted to examine the physical readiness to re-perform of athletic populations in the later stages of rehabilitation in comparison to healthy controls.

Objectives: To determine the level of strength, power, rate of force development, and reactive strength in adult males who are more than six months following anterior cruciate ligament reconstruction.

Methods: A systematic review of the literature was undertaken using the Medline, CINAHL and SPORTDiscus databases and the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies including males only and assessed strength, power, rate of force development and reactive strength comparing performance to healthy controls were included. A meta-analysis was also performed to compute standardized mean differences (SMD ± 95% confidence intervals), calculated using Hedge's g, and examine the effect of ACLR on these fundamental physical capacities.

Results: 2023 articles were identified, of which 14 articles with similar level of evidence and methodological quality met the inclusion criteria. The most commonly investigated and impaired physical capacity was quadriceps (g = -0.89, 95% CI [-1.33,-0.44]) and hamstring strength (g = -0.44, 95% CI [-0.78,-0.10]). Only one study investigated rate of force development and none measuring reactive strength met our eligibility criteria.

Conclusions: Pooled data showed moderate evidence indicating large and small negative deficits on knee peak extension and flexion, respectively, in male adults at more than 6 months post anterior cruciate ligament reconstruction. The magnitude of these differences are influenced by graft type and can be mitigated by targeted rehabilitation programs. Insufficient evidence is available in male adults following anterior cruciate ligament reconstruction to examine rate of force development and reactive strength.
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http://dx.doi.org/10.1016/j.ptsp.2020.11.024DOI Listing
January 2021

Exercise interventions in lateral elbow tendinopathy have better outcomes than passive interventions, but the effects are small: a systematic review and meta-analysis of 2123 subjects in 30 trials.

Br J Sports Med 2021 May 4;55(9):477-485. Epub 2020 Nov 4.

Physiotherapy, University of West Attica, Egaleo, Greece.

Objective: To evaluate the effectiveness of exercise compared with other conservative interventions in the management of lateral elbow tendinopathy (LET) on pain and function.

Design: Systematic review and meta-analysis.

Methods: We used the Cochrane risk-of-bias tool 2 for randomised controlled trials (RCTs) to assess risk of bias and the Grading of Recommendations Assessment, Development and Evaluation methodology to grade the certainty of evidence. Self-perceived improvement, pain intensity, pain-free grip strength (PFGS) and elbow disability were used as primary outcome measures.

Eligibility Criteria: RCTs assessing the effectiveness of exercise alone or as an additive intervention compared with passive interventions, wait-and-see or injections in patients with LET.

Results: 30 RCTs (2123 participants, 5 comparator interventions) were identified. Exercise outperformed (low certainty) corticosteroid injections in all outcomes at all time points except short-term pain reduction. Clinically significant differences were found in PFGS at short-term (mean difference (MD): 12.15, (95% CI) 1.69 to 22.6), mid-term (MD: 22.45, 95% CI 3.63 to 41.3) and long-term follow-up (MD: 18, 95% CI 11.17 to 24.84). Statistically significant differences (very low certainty) for exercise compared with wait-and-see were found only in self-perceived improvement at short-term, pain reduction and elbow disability at short-term and long-term follow-up. Substantial heterogeneity in descriptions of equipment, load, duration and frequency of exercise programmes were evident.

Conclusions: Low and very low certainty evidence suggests exercise is effective compared with passive interventions with or without invasive treatment in LET, but the effect is small.

Prospero Registration Number: CRD42018082703.
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http://dx.doi.org/10.1136/bjsports-2020-102525DOI Listing
May 2021

Why do tendon researchers overlook the patient's psychological state? The review with no papers.

Br J Sports Med 2021 Mar 26;55(5):244-245. Epub 2020 Aug 26.

Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

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http://dx.doi.org/10.1136/bjsports-2020-102359DOI Listing
March 2021

Test-Retest Reliability of Handgrip Strength in Patients with Chronic Obstructive Pulmonary Disease.

COPD 2020 10 19;17(5):568-574. Epub 2020 Aug 19.

School of Medicine, European University of Cyprus, Nicosia, Cyprus.

The purpose of this study was to investigate the intra-rater reliability and agreement of handgrip strength (HGS) measurement using a hydraulic hand dynamometer in patients with chronic obstructive pulmonary disease (COPD). A sample of 19 COPD patients (18 males and 1 female; mean ± SD age, 66.9 ± 6.3 years) was evaluated using a hand dynamometer by the same rater in two different testing sessions with a 7-d interval. During each session, patients were asked to exert three maximal isometric contractions on the dominant hand and the mean value of the 3 efforts (measured in kilogram-force [Kgf]) was used for data analysis. The intraclass correlation coefficient (ICC), the standard error of measurement (SEM), the minimal detectable change (MDC), and Bland-Altman methods were used to estimate the degree of test-retest reliability and the measurement error, respectively. HGS in COPD patients revealed an ICC score of 0.99, suggesting excellent test-retest reliability. The calculated SEM was relatively small (0.59 Kgf), and the MDC presented a clinically acceptable value of 1.64 Kgf. These findings, in conjunction with the narrow width of the 95% limits of agreements (95% limits of agreement, -2.5-2.1 Kgf) in the Bland-Altman plot, reflected the measurement precision and the narrow variation of the differences during the 2 testing sessions. The results of this study demonstrated an excellent test-retest reliability of HGS measurement, indicating that this method is reliable for repeated monitoring of peripheral muscle strength in patients with COPD.
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http://dx.doi.org/10.1080/15412555.2020.1808604DOI Listing
October 2020

"Sit Up Straight": Time to Re-evaluate.

J Orthop Sports Phys Ther 2019 08;49(8):562-564

Posture is a frequent topic of discussion for patients, clinicians, the media, and society. A common belief is that spinal pain is caused by sitting, standing, or bending "incorrectly." Despite the absence of strong evidence to support these common beliefs, a large posture industry has flourished, with many interventions and products claiming to "correct" posture and prevent pain. Unfortunately, many health care professionals provide advice in line with this non-evidence-based perspective. In this Viewpoint, the authors reflect on common beliefs regarding posture and spinal health and why they are so widely held, and consider how clinicians can positively influence these beliefs. .
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http://dx.doi.org/10.2519/jospt.2019.0610DOI Listing
August 2019

Cross-cultural adaptation and psychometric properties' evaluation of the modern standard Arabic version of Cumberland Ankle Instability Tool (CAIT) in professional athletes.

PLoS One 2019 11;14(6):e0217987. Epub 2019 Jun 11.

Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Purpose: To cross-culturally adapt the Cumberland Ankle Instability Tool into modern standard Arabic and to assess its psychometric properties.

Method: Cross-cultural adaptation followed a combination of guidelines and for psychometric evaluation a sample of 107 athletes as recruited. All recommended measurement properties by the Consensus-based Standards for the selection of health status Measurement Instruments were evaluated, including face, structural, convergent, and discriminant validity; reproducibility; distribution-based responsiveness, and interpretability. We also used a structured content analytic method to evaluate content validity.

Results: The tool presented excellent internal consistency (α = 0.92) and reliability (ICC 0.75-0.98), and good convergent validity compared with Lower Extremity Functional Scale (ρ = 0.67). For reproducibility testing: Minimal detectable change ranged from 0.41 to 6.0 points; for responsiveness assessment: the effect sizes were large (Glass'Δ range 2.03-2.08, Cohen's d range 2.22 to 2.53) and the Area under the Curve was 0.869. Its unidimensionality was proved by a 1-factor solution explaining 63.8% of the variance.

Conclusion: The Arabic version of Cumberland Ankle Instability Tool presented acceptable psychometric properties comparable to the original version. The questionnaire is understood across most of the Arabic speaking world and can be used in research and clinical practice to assess patients suffering from chronic ankle instability.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217987PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6559661PMC
February 2020

Translation into modern standard Arabic, cross-cultural adaptation and psychometric properties' evaluation of the Lower Extremity Functional Scale (LEFS) in Arabic-speaking athletes with Anterior Cruciate Ligament (ACL) injury.

PLoS One 2019 10;14(6):e0217791. Epub 2019 Jun 10.

Sports and Exercise Medicine Clinic, Thessaloniki, Greece.

Background: The Lower Extremity Functional Scale evaluates the functional status of patients that have lower extremity conditions of musculoskeletal origin. Regional Arabic dialects often create barriers to clear communication and comparative research. We aimed to cross-culturally adapt the Lower Extremity Functional Scale in modern standard Arabic that is widely used and understood in the Middle East and North Africa region, and assess its psychometric properties.

Methods: Cross-cultural adaptation followed a combination of recommended guidelines. For psychometric evaluation 150 patients with anterior cruciate ligament injury and 65 asymptomatic individuals were recruited. All measurement properties as indicated by the Consensus-based Standards for the selection of health status Measurement Instruments recommendations were evaluated, including content-relevance analysis, structural validity, longitudinal reproducibility, anchor- and distribution-based methods of responsiveness, as well as the longitudinal pattern of change of Lower Extremity Functional Scale in anterior cruciate ligament injured patients' functional status.

Results: The questionnaire presented excellent internal consistency (α = 0.96), reliability (0.80-0.98), and good convergent validity (ρ = 0.85). For reproducibility testing: minimal detectable change was 9.26 points; for responsiveness assessment: minimal clinically important difference was 9 points and presented moderate effect sizes (Glass'Δ = 0.71, Cohen's d = 0.81). Its unidimensionality was not confirmed and an exploratory factor analysis indicated a 2-factor solution explaining 78.1% of the variance.

Conclusion: The Arabic Lower Extremity Functional Scale presented acceptable psychometric properties comparable to the original version. The Arabic version of Lower Extremity Functional Scale can be used in research and clinical practice to assess the functional status of Arabic-patients suffering an anterior cruciate ligament injury.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0217791PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6557503PMC
March 2020

Measuring only hop distance during single leg hop testing is insufficient to detect deficits in knee function after ACL reconstruction: a systematic review and meta-analysis.

Br J Sports Med 2020 Feb 29;54(3):139-153. Epub 2019 May 29.

Department of Movement Sciences, Human Movement Biomechanics Research Group, KU Leuven, Leuven, Belgium.

Objective: To systematically review the biomechanical deficits after ACL reconstruction (ACLR) during single leg hop for distance (SLHD) testing and report these differences compared with the contralateral leg and with healthy controls.

Design: Systematic review with meta-analysis.

Data Sources: A systematic search in Pubmed (Ovid), EMBASE, CINAHL, Scopus, Web of Science, PEDro, SPORTDiscus, Cochrane Library, grey literature and trial registries, was conducted from inception to 1 April 2018.

Eligibility Criteria For Selecting Studies: Studies reporting kinematic, kinetic and/or electromyographic data of the ACLR limb during SLHD with no language limits.

Results: The literature review yielded 1551 articles and 19 studies met the inclusion criteria. Meta-analysis revealed strong evidence of lower peak knee flexion angle and knee flexion moments during landing compared with the uninjured leg and with controls. Also, moderate evidence (with large effect size) of lower knee power absorption during landing compared with the uninjured leg. No difference was found in peak vertical ground reaction force during landing. Subgroup analyses revealed that some kinematic variables do not restore with time and may even worsen.

Conclusion: During SLHD several kinematic and kinetic deficits were detected between limbs after ACLR, despite adequate SLHD performance. Measuring only hop distance, even using the healthy leg as a reference, is insufficient to fully assess knee function after ACLR. CRD42018087779.
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http://dx.doi.org/10.1136/bjsports-2018-099918DOI Listing
February 2020

Validation study of the Functional Assessment Scale for Acute Hamstring injuries in Spanish professional soccer players.

Clin Rehabil 2019 Apr 10;33(4):711-723. Epub 2018 Dec 10.

1 Centro de Investigación Traslacional en Fisioterapia and Department of Pathology and Surgery, Physiotherapy Area, Miguel Hernandez University, Sant Joan d'Alacant, Spain.

Objective:: To cross-culturally adapt and validate the Functional Assessment Scale for acute hamstring injury for professional Spanish-speaking soccer players.

Design:: Clinical measurement study. Cross-cultural adaptation was conducted following international recommendations. Indicators of validity, reliability and responsiveness are provided.

Subjects:: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale was administered to 165 participants: 45 professional soccer players with acute hamstring muscle injury diagnosis, 40 healthy subjects, 40 individuals at-risk for a hamstring muscle injury and 40 patients with injuries of the lower limb other than hamstring muscle injury.

Main Measures:: The Functional Assessment Scale for acute hamstring injury.

Reference Measures:: Spanish version of the Quality of Life Short-Form 36 questionnaire (SF-36) and the Lower Limb Functional Index (LLFI).

Results:: Cronbach's alpha (internal consistency) for the Spanish version of the Functional Assessment Scale for acute hamstring injury scale was >0.8. The intraclass correlation coefficient using the two-way random model (ICC) (test-retest) was 0.993 (95% confidence interval (CI): 0.991-0.995; P < 0.05). In the exploratory factor analysis, a one-factor solution explained 85% of the variance. Subjects with hamstring muscle injury scored significantly lower than the other groups in the Spanish version of the Functional Assessment Scale for acute hamstring injury scale ( P < 0.001). The Spanish version of the Functional Assessment Scale for acute hamstring injury scale score within the hamstring muscle injury group showed moderate and significant correlations with SF-36 physical components (Spearman's r > 0.6; P < 0.001), and LLFI score at baseline ( r = 0.42; P < 0.01). The standard error of measurement (SEM) and minimum detectable change threshold (MDC) were 2.6 and 7.2 points, respectively. The responsiveness indicators have an effect size of 3.62, and the standardized response mean is 3.24.

Conclusion:: The Spanish version of the Functional Assessment Scale for acute hamstring injury scale showed satisfactory psychometric properties. It can be considered a reliable and valid instrument to assess the functional impact of acute hamstring muscle injury in professional Spanish-speaking football players.
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http://dx.doi.org/10.1177/0269215518815540DOI Listing
April 2019

Physiotherapist perceptions of optimal sitting and standing posture.

Musculoskelet Sci Pract 2019 02 17;39:24-31. Epub 2018 Nov 17.

Faculty of Physical Education and Sport Sciences, University of Thessaly, Trikala, Greece.

Background: Assessment of, and advice about, spinal posture is common when people with spinal pain present to physiotherapists. Most descriptions regarding optimal spinal posture have been qualitative in nature.

Objectives: To determine the beliefs of physiotherapists regarding optimal sitting and standing posture.

Design: Online survey.

Method: 544 Greek physiotherapists selected an optimal sitting (choice of seven) and standing (choice of five) posture, while providing justification for their choice.

Results: Education regarding optimal sitting and standing posture was considered "considerably" or "very" important by 93.9% of participants. Three different sitting postures, and two different standing postures, were selected as the optimal posture by 97.5% and 98.2% of physiotherapists respectively. While this reflects a lack of complete consensus on optimal posture, the most commonly selected postures were all some variation of upright lordotic sitting, in contrast slouched spinal curves (sitting) or forward head posture (sitting and standing) almost never being selected as optimal. Interestingly, participants used similar arguments (e.g. natural curves, muscle activation) to justify their selection regardless of the spinal configuration of each selected posture.

Conclusions: These results reinforce previous data suggesting that upright lordotic sitting postures are considered optimal, despite a lack of strong evidence that any specific posture is linked to better health outcomes. While postural re-education may play a role in the management of spinal pain for some patients, awareness of such widespread and stereotypical beliefs regarding optimal posture may be useful in clinical assessment and management.
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http://dx.doi.org/10.1016/j.msksp.2018.11.004DOI Listing
February 2019

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

Phys Sportsmed 2019 02 5;47(1):47-59. Epub 2018 Nov 5.

d William Harvey Research Institute, Centre for Sports & Exercise Medicine , Queen Mary University of London , London , UK.

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.
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http://dx.doi.org/10.1080/00913847.2018.1537861DOI Listing
February 2019

Low load resistance training with blood flow restriction decreases anterior knee pain more than resistance training alone. A pilot randomised controlled trial.

Phys Ther Sport 2018 Nov 19;34:121-128. Epub 2018 Sep 19.

Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar.

Objectives: To evaluate if application of blood flow restriction (BFR) combined with low-load resistance training (LLRT) would induce significant anterior knee pain (AKP) reduction compared to LLRT alone.

Design: Randomised Controlled Trial.

Setting: Institutional physiotherapy clinic.

Participants: Forty males suffering from AKP were randomly allocated in the LLRT-BFR or LLRT group. BFR was applied at 80% of complete vascular occlusion. Four sets of open kinetic chain knee extensions were implemented in both groups using a pain monitoring model.

Main Outcome Measures: Pain (0-10) was assessed immediately after LLRT-BFR or LLRT application and after a physiotherapy session (45 min) during shallow and deep single-leg squat (SLS, SLS), and step-down test (SDT).

Results: Significant immediate pain reduction was found in LLRT-BFR group in SLS, SLS and SDT (d = 1.32, d = 1.12, d = 0.88 respectively), but no difference was found in LLRT group. Following the physiotherapy session pain reduction was sustained in LLRT-BFR group in both SLSs and SDT (d = 1.32, d = 0.78, d = 0.89 respectively). For the control group significant pain reduction was only found in SLS (d = 0.56). No significant between-group differences were observed.

Conclusions: The pain reduction induced by LLRT-BFR could indicate this intervention as a preconditioning process prior to the rehabilitation of AKP.
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http://dx.doi.org/10.1016/j.ptsp.2018.09.007DOI Listing
November 2018