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Afonso J, Reurink G, Clemente FM, Ramirez-Campillo R, Pizzari T, Andrade R. Revisiting the hamstring injury prevention and rehabilitation literature: filling the gaps! Br J Sports Med 2024; 58:243-244. [PMID: 38071509 DOI: 10.1136/bjsports-2023-106878] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 03/10/2024]
Affiliation(s)
- José Afonso
- Centre of Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport, University of Porto, Porto, Portugal
| | - Guus Reurink
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- The Sport Physician Group, Department of Sports Medicine, OLVG, Amsterdam, The Netherlands
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Viana do Castelo, Portugal
- Gdańsk University of Physical Education and Sport, Gdańsk, Poland
| | - Rodrigo Ramirez-Campillo
- Exercise and Rehabilitation Sciences Institute, School of Physical Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Tania Pizzari
- La Trobe University La Trobe Sport and Exercise Medicine Research Centre, Melbourne, Victoria, Australia
| | - Renato Andrade
- Porto Biomechanics Laboratory (LABIOMEP), Porto, Portugal
- Clínica Espregueira - FIFA Medical Centre of Excellence, Porto, Portugal
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Warby SA, Ganderton C, Watson L, Pizzari T, Balster S, Hoy G, Barwood S, Kerr B, Lawrence S, Lenssen R, Rotstein A, Takla A, Civier O, Hughes M. Effect of a physiotherapy-directed rehabilitation programme on patients with multidirectional instability of the glenohumeral joint: a multimodal interventional MRI study protocol. BMJ Open 2024; 14:e071287. [PMID: 38373861 PMCID: PMC10882378 DOI: 10.1136/bmjopen-2022-071287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
INTRODUCTION Altered neuromuscular control of the scapula and humeral head is a typical feature of multidirectional instability (MDI) of the glenohumeral joint, suggesting a central component to this condition. A previous randomised controlled trial showed MDI patients participating in the Watson Instability Program 1 (WIP1) had significantly improved clinical outcomes compared with a general shoulder strength programme. The aim of this paper is to outline a multimodal MRI protocol to identify potential ameliorative effects of the WIP1 on the brain. METHODS AND ANALYSIS Thirty female participants aged 18-35 years with right-sided atraumatic MDI and 30 matched controls will be recruited. MDI patients will participate in 24 weeks of the WIP1, involving prescription and progression of a home exercise programme. Multimodal MRI scans will be collected from both groups at baseline and in MDI patients at follow-up. Potential brain changes (primary outcome 1) in MDI patients will be probed using region-of-interest (ROI) and whole-brain approaches. ROIs will depict areas of functional alteration in MDI patients during executed and imagined shoulder movements (MDI vs controls at baseline), then examining the effects of the 24-week WIP1 intervention (baseline vs follow-up in MDI patients only). Whole-brain analyses will examine baseline versus follow-up voxel-wise measures in MDI patients only. Outcome measures used to assess WIP1 efficacy will include the Western Ontario Shoulder Index and the Melbourne Instability Shoulder Score (primary outcomes 2 and 3). Secondary outcomes will include the Tampa Scale for Kinesiophobia, Short Form Orebro, Global Rating of Change Score, muscle strength, scapular upward rotation, programme compliance and adverse events. DISCUSSION This trial will establish if the WIP1 is associated with brain changes in MDI. ETHICS AND DISSEMINATION Participant confidentiality will be maintained with publication of results. Swinburne Human Research Ethics Committee (Ref: 20202806-5692). TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trial Registry (ACTRN12621001207808).
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Affiliation(s)
- Sarah Ann Warby
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University-Bundoora Campus, Melbourne, Victoria, Australia
| | - Charlotte Ganderton
- Nursing and Allied Health, Swinburne University of Technology Faculty of Health Arts and Design, Hawthorn, Victoria, Australia
| | - Lyn Watson
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
- Mill Park Physiotherapy, Melbourne, Victoria, Australia
| | - Simon Balster
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Gregory Hoy
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
- Department of Surgery, Monash University, Clayton, Victoria, Australia
| | - Shane Barwood
- Melbourne Orthopaedic Group, Windsor, Victoria, Australia
| | - Bonnie Kerr
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Sam Lawrence
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, Melbourne, Victoria, Australia
| | - Andrew Rotstein
- Victoria House Medical Imaging, Melbourne, Victoria, Australia
| | - Annalaise Takla
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Oren Civier
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
| | - Matthew Hughes
- School of Health Sciences (SoHS) Centre for Mental Health and Brain Sciences, Swinburne University of Technology, Hawthorn, Victoria, Australia
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Pietsch S, Green B, Schache AG, Pizzari T. Epidemiology of quadriceps muscle strain injuries in elite male Australian football players. Scand J Med Sci Sports 2024; 34:e14542. [PMID: 37994173 DOI: 10.1111/sms.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To describe the epidemiology of quadriceps muscle strain injury (QMSI) in elite Australian Football League (AFL) players, explore recovery milestones and determine whether recovery is impacted by factors such as injury type (index vs. re-injury), the primary muscle injured and the mechanism of injury. MEASURES All QMSI data reported to the Soft Tissue Injury Registry of the AFL from the 2014 to 2020 seasons were evaluated. Player demographic data, circumstances of injury, MRI reports and recovery outcomes following injury were extracted. Descriptive statistics and frequency distributions are presented. Recovery outcomes for injury type, primary muscle injured and the mechanism of injury were compared using univariate analyses. RESULTS There were 164 QMSIs from 122 players reported (134 index; 30 re-injuries). Almost all (91.3%) QMSIs involved the rectus femoris. Half (48.4%) of the QMSIs occurred during kicking and most commonly affected the dominant kicking leg (72%). The majority occurred at training (64.6%). All re-injuries involved the rectus femoris, most occurred from kicking (63.0%) and within 6 months of the preceding injury (70%). The mean return to play (RTP) time was 25.4 days (95%CI = 22.6-28.2) and rectus femoris injuries took around 14 days longer to RTP than vastii injuries (p = 0.001). QMSIs with a kicking mechanism took the longest to RTP of all injury mechanisms. CONCLUSION In AFL players, QMSIs occur mostly in the dominant leg from a kicking mechanism. Rectus femoris injuries are more prevalent and result in longer RTP time frames. Re-injuries exclusively involved the rectus femoris, primarily from kicking.
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Affiliation(s)
- Samuel Pietsch
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Brady Green
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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McNally T, Edwards S, Halaki M, O'Dwyer N, Pizzari T, Blyton S. Quantifying demands on the hamstrings during high-speed running: A systematic review and meta-analysis. Scand J Med Sci Sports 2023; 33:2423-2443. [PMID: 37668346 DOI: 10.1111/sms.14478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 07/24/2023] [Accepted: 08/16/2023] [Indexed: 09/06/2023]
Abstract
INTRODUCTION Hamstring strain injury (HSI) remains a performance, economic, and player availability burden in sport. High-speed running (HSR) is cited as a common mechanism for HSI. While evidence exists regarding the high physical demands on the hamstring muscles in HSR, meta-analytical synthesis of related activation and kinetic variables is lacking. METHODS A systematic search of Medline, Embase, Scopus, CINAHL, SportDiscus, and Cochrane library databases was conducted in accordance with the PRISMA 2020 guidelines. Studies reporting hamstring activation (electromyographic [EMG]) or hamstring muscle/related joint kinetics were included where healthy adult participants ran at or beyond 60% of maximum speed (activation studies) or 4 m per second (m/s) (kinetic studies). RESULTS A total of 96 studies met the inclusion criteria. Run intensities were categorized as "slow," "moderate," or "fast" in both activation and kinetic based studies with appropriate relative, and raw measures, respectively. Meta-analysis revealed pooled mean lateral hamstring muscle activation levels of 108.1% (95% CI: 84.4%-131.7%) of maximal voluntary isometric contraction (MVIC) during "fast" running. Meta-analysis found swing phase peak knee flexion internal moment and power at 2.2 Newton meters/kilogram (Nm/kg) (95% CI: 1.9-2.5) and 40.3 Watts/kilogram (W/kg) (95% CI: 31.4-49.2), respectively. Hip extension peak moment and power was estimated as 4.8 Nm/kg (95% CI: 3.9-5.7) and 33.1 W/kg (95% CI: 17.4-48.9), respectively. CONCLUSIONS As run intensity/speed increases, so do the activation and kinetic demands on the hamstrings. The presented data will enable clinicians to incorporate more objective measures into the design of injury prevention and return-to-play decision-making strategies.
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Affiliation(s)
- Timothy McNally
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Suzi Edwards
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Mark Halaki
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Nicholas O'Dwyer
- Faculty of Medicine & Health, Sydney School of Health Sciences, Discipline of Exercise & Sport Science, Sydney, New South Wales, Australia
| | - Tania Pizzari
- School of Allied Health, La Trobe University, Melbourne, Victoria, Australia
| | - Sarah Blyton
- School of Health Sciences (Physiotherapy), University of Newcastle, Newcastle, New South Wales, Australia
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Kinsella R, Nasser A, Menz HB, Pizzari T, Collins NJ, Semciw AI. Effects of foot orthoses and footwear interventions on impairments and quality of life in people with hip pain: A systematic review. Musculoskeletal Care 2023; 21:1529-1550. [PMID: 37823790 DOI: 10.1002/msc.1826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/10/2023] [Accepted: 09/14/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND Foot orthoses and footwear interventions are advocated for the management of lower limb musculoskeletal conditions including the hip, but much of the research is focused on knee disorders. The aim of this systematic review was to synthesise the literature that investigates the use of foot orthoses or footwear in people with hip-related pain. METHODS MEDLINE, EMBASE, CINAHL, AMED and SPORTDiscus were searched from inception to March 2023. Randomised controlled trials (RCT), cohort and pre-post studies reporting on footwear and foot orthoses interventions, in participants with hip-related pain, were eligible for inclusion. Outcomes included pain, physical function, and quality of life (QoL). Effect sizes were calculated where sufficient data were available. Reporting quality was assessed using the Cochrane Risk of Bias Tool (Rob-2) and the Joanna Briggs Institute Checklist. The overall quality of evidence was rated according to the Grading of Recommendations, Assessment, Development, and Evaluations framework. RESULTS Of the seven included studies (n = 266 participants), there was one RCT, one cohort and five single-group pre-post designs. Interventions included customised and non-customised arch supports, heel lifts, and footwear modifications, used in the following hip conditions: trochanteric pain, non-specific hip pain, hip osteoarthritis, and leg length dysfunction following total hip arthroplasty. Meta-analysis was possible for outcomes in two studies, demonstrating moderate improvement in pain following foot orthoses use. Overall certainty of evidence ranged from very low to low. CONCLUSION Single-group pre-post study designs describe positive relationships between foot orthoses and footwear use and improvements in hip pain, function, and QoL. However, these results were not supported by the only available RCT. Given this is a relatively inexpensive and non-invasive treatment approach, further rigorous studies are warranted.
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Affiliation(s)
- Rita Kinsella
- Department of Surgery, St Vincent's Hospital, Faculty Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - Anthony Nasser
- Graduate School of Health, University of Technology Sydney, Ultimo, New South Wales, Australia
| | - Hylton B Menz
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
| | - Natalie J Collins
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Bundoora, Melbourne, Victoria, Australia
- Department of Allied Health, Northern Hospital, Melbourne, Australia
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Edouard P, Reurink G, Mackey AL, Lieber RL, Pizzari T, Järvinen TAH, Gronwald T, Hollander K. Traumatic muscle injury. Nat Rev Dis Primers 2023; 9:56. [PMID: 37857686 DOI: 10.1038/s41572-023-00469-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.
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Affiliation(s)
- Pascal Edouard
- Université Jean Monnet, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, France.
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France.
| | - Gustaaf Reurink
- Department of Orthopedic Surgery and Sports Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands
- The Sports Physicians Group, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Abigail L Mackey
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, USA
- Hines VA Medical Center, Maywood, IL, USA
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tero A H Järvinen
- Tampere University and Tampere University Hospital, Tampere, Finland
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Nasser A, Grimaldi A, Vicenzino B, Rio E, Rich A, Pizzari T, Semciw A. Towards development of a core outcome set in proximal hamstring tendinopathy - A systematic review of measurement instruments and their clinimetric properties. Musculoskelet Sci Pract 2023; 66:102774. [PMID: 37247583 DOI: 10.1016/j.msksp.2023.102774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 04/26/2023] [Accepted: 05/04/2023] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To find measurement instruments for proximal hamstring tendinopathy, map them to outcome domains, and evaluate their measurement properties. METHODS There were three phases. Phase one involved a search of MEDLINE, CINAHL, EMBASE, SPORTSDISCUS and PUBMED (February 2022) to identify measurement instruments used in proximal hamstring tendinopathy research. In phase two we mapped these measurement instruments to the International Tendinopathy Scientific Consensus (ICON) core outcome domains. The third phase involved conducting a second search (same databases/census date) to identify studies that evaluated measurement properties of measurement instruments in participants with proximal hamstring tendinopathy. Measurement properties were then evaluated following the Consensus-based-Standards for the Selection of Health Instruments methodology -including risk of bias assessment and synthesis of findings. RESULTS Twenty-eight different measurement instruments were identified in phase one. These were mapped to six of nine ICON domains in phase two. In phase three, there was only one instrument that had been evaluated for its measurement properties (4 studies, n = 302) - the Victorian Institute of Sport Assessment - Proximal Hamstring Tendinopathy (VISA-H). For the VISA-H there was moderate-quality evidence of sufficient construct validity, low-quality evidence of sufficient responsiveness, reliability and measurement error, very low-quality evidence of sufficient relevance and comprehensibility and very low-quality evidence of insufficient comprehensiveness. CONCLUSION The VISA-H - mapped to the ICON disability domain - is the only one of the 28 different measurement instruments identified that was validated in this population. Caution in applying it is warranted given it is supported by lower quality evidence.
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Affiliation(s)
- Anthony Nasser
- University of Technology, Graduate School of Health, Australia; La Trobe University, Department of Rehabilitation, Nutrition and Sport, Australia.
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Ebonie Rio
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Australia
| | - Aidan Rich
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Australia
| | - Tania Pizzari
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Australia
| | - Adam Semciw
- La Trobe University, Department of Rehabilitation, Nutrition and Sport, Australia; Allied Health, Northern Health, Victoria, Australia
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McMillan RM, Mayes S, Cook J, Semciw AI, Plass LM, Pizzari T. Gluteal Muscle Size and Quality in Professional Ballet Dancers Compared to Non-Dancing Athletes. J Dance Med Sci 2023:1089313X231177161. [PMID: 37287234 DOI: 10.1177/1089313x231177161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Professional ballet dancers load their hips in extreme ranges of motion and commonly report hip pain. Evaluating gluteal muscle size and quality may help guide exercise programs. Objectives of this study were to compare gluteal muscle size and quality (fatty infiltration) in ballet dancers compared to athletes; and to investigate the relationship between gluteal muscle size and quality, and reports of hip-related pain. METHODS This study was a case-control design. Professional ballet dancers (current and retired, n = 49, mean age 35 years, range 19-63) and age and sex-matched athletes (current and retired, n = 49) underwent magnetic resonance imaging of both hips. Muscle cross-sectional areas (CSA) were obtained at standardized landmarks for gluteus maximus (GMax) and gluteus medius (GMed). Full muscle volume was calculated for gluteus minimus (GMin). Fatty infiltration was rated using the Goutallier classification system. Muscle size was compared between groups using linear mixed models. Fatty infiltration was compared using a mixed model binary logistic regression. Hip-related pain, participation status, limb side and sex were included as covariates. RESULTS Ballet dancers had significantly larger GMax (upper P < .01, middle P < .01, lower P = .01) and GMed (level of anterior inferior iliac spine P < .01, greater sciatic foramen P < .01) CSA and larger GMin volume (P < .01), when normalized to weight. There was no difference in fatty infiltration ratings between dancers and non-dancing athletes. Retired dancers and athletes reporting hip-related pain were more likely to have fatty infiltration in GMax lower (P = .04). CONCLUSION Gluteal muscles are larger in ballet dancers compared to athletes suggesting high-level loading of these muscles. There is no relationship between hip-related pain and gluteal muscle size. Dancers and athletes have comparable muscle quality.
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Affiliation(s)
| | - Susan Mayes
- The Australian Ballet, Southbank, VIC, Australia
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Watson L, Hoy G, Wood T, Pizzari T, Balster S, Barwood S, Warby SA. Posterior Shoulder Instability in Tennis Players: Aetiology, Classification, Assessment and Management. Int J Sports Phys Ther 2023; V18:769-788. [PMID: 37425109 PMCID: PMC10324327 DOI: 10.26603/001c.75371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 03/14/2023] [Indexed: 07/11/2023] Open
Abstract
Background Micro-traumatic posterior shoulder instability (PSI) is an often missed and misdiagnosed pathology presenting in tennis players. The aetiology of micro-traumatic PSI in tennis players is multifactorial, including congenital factors, loss of strength and motor control, and sport-specific repetitive microtrauma. Repetitive forces placed on the dominant shoulder, particularly combinations of flexion, horizontal adduction, and internal rotation contribute to the microtrauma. These positions are characteristic for kick serves, backhand volleys, and the follow-through phase of forehands and serves. The aim of this clinical commentary is to present an overview of the aetiology, classification, clinical presentation, and treatment of micro-traumatic PSI, with a particular focus on tennis players. Level of Evidence 5.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Gregory Hoy
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
- Monash University, Department of Surgery, Monash Medical Centre Level 5, Block E 246 Clayton Road Clayton, Victoria, Australia, 3168
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Timothy Wood
- Glenferrie Private Hospital, 25 Linda Crescent, Hawthorn, Victoria, Australia, 3122
| | - Tania Pizzari
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, Victoria, Australia, 37522
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
| | - Shane Barwood
- Melbourne Orthopaedic Group, 33 The Avenue Windsor, Victoria, Australia, 3181
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, Victoria, Australia, 3181
- La Trobe University, Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, Corner of Kingsbury Drive and Plenty Road Bundoora, Victoria, Australia, 3080
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Blyton SJ, Snodgrass SJ, Pizzari T, Birse SM, Likens AD, Edwards S. The impact of previous musculoskeletal injury on running gait variability: A systematic review. Gait Posture 2023; 101:124-133. [PMID: 36801698 DOI: 10.1016/j.gaitpost.2023.01.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 01/02/2023] [Accepted: 01/25/2023] [Indexed: 02/23/2023]
Abstract
BACKGROUND Growing evidence suggests that identifying movement variability alterations in pathological vs. healthy gait may further understanding of injury mechanisms related to gait biomechanics; however, in the context of running and musculoskeletal injuries the role of movement variability remains unclear. RESEARCH QUESTION What is the impact of a previous musculoskeletal injury on running gait variability? METHODS Medline, CINAHL, Embase, Cochrane library and SPORTDiscus were searched from inception until February 2022. Eligibility criteria were (a) included a musculoskeletal injury group, (b) compared running biomechanics data to a control group, (c) measured movement variability for at least one dependent variable, (d) provided a statistical between-group comparison of variability outcomes. Exclusion criteria were neurological conditions impacting gait, upper body musculoskeletal injuries and age < 18 years old. A summative synthesis was performed instead of a meta-analysis due to methodological heterogeneity. RESULTS Seventeen case-control studies were included. The most common deviations in variability observed among the injured groups were: (1) high and low knee-ankle/foot coupling variability and (2) low trunk-pelvis coupling variability. Significant (p < 0.05) between-group differences in movement variability were identified in 8 of 11; 73% of studies of runners with injury-related symptoms, and 3 of 7; 43% of studies of recovered or asymptomatic populations. SIGNIFICANCE This review identified limited to strong evidence that running variability is altered in adults with a recent history of injury for specific joint couplings only. Individuals with ankle instability or pain employed altered running strategies more often than those who have recovered from injury. Altered variability strategies have been proposed to contribute to future running-related injuries, therefore these findings are relevant to clinicians managing active populations.
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Affiliation(s)
- Sarah J Blyton
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
| | - Suzanne J Snodgrass
- Discipline of Physiotherapy, The University of Newcastle, Callaghan, New South Wales, Australia.
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
| | - Samantha M Birse
- School of Environmental and Life Sciences, The University of Newcastle, Ourimbah, New South Wales, Australia.
| | - Aaron D Likens
- Department of Biomechanics and Center for Research in Human Movement Variability, The University of Nebraska, Omaha, United States.
| | - Suzi Edwards
- School of Health Sciences, The University of Sydney, Camperdown, New South Wales, Australia.
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Rostron ZPJ, Zacharias A, Semciw AI, Kingsley M, Pizzari T, Woodley SJ, Green R. Comparison between a targeted exercise program and a sham intervention on gluteal muscle activity in people with hip osteoarthritis: Analysis of secondary outcomes from a randomised clinical trial. Gait Posture 2023; 100:33-40. [PMID: 36469965 DOI: 10.1016/j.gaitpost.2022.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 10/23/2022] [Accepted: 11/29/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND People with hip osteoarthritis (OA) typically display altered gluteus minimus (GMin) and gluteus medius (GMed) activity during gait, in addition to reduced walking speed and stride length. It is unknown if current rehabilitation programs address changes in gluteal muscle activity in people with hip OA. RESEARCH QUESTION Can a targeted gluteal intervention restore normal gluteal muscle segment activity during gait in people with hip OA? METHODS This study presents secondary outcomes from a multi-site, double-blinded clinical trial in which participants with radiologically confirmed mild-moderate hip OA were randomised into a targeted gluteal or sham intervention for 12-weeks following baseline testing. Electromyography (EMG) outcomes were only conducted at a single site and data were collected from 22 participants. Intramuscular electrodes were inserted into two segments of GMin (anterior, posterior) and three segments of GMed (anterior, middle, posterior) to record average amplitude, peak amplitude and time to peak (TTP) during the first 60 % of the gait cycle (stance phase) at baseline and post-intervention. RESULTS Following the targeted gluteal intervention, posterior GMin displayed a decrease in average (P = 0.032, ES=1.04) and peak (P = 0.017, ES=1.17) muscle activity during late stance phase with a shift to an earlier TTP (P = 0.034, ES=1.02). There were no further significant changes between groups for other outcome measures. Similar trends for an earlier TTP were observed for the posterior segment of GMed following the targeted intervention (P = 0.095, ES=0.87). The earlier TTP in the posterior segments of both GMin and GMed post-intervention resembled patterns observed in a healthy young population. SIGNIFICANCE A targeted gluteal intervention can positively impact activity in posterior GMin during gait in people with hip OA when compared to a sham intervention.
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Affiliation(s)
- Zachary P J Rostron
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia.
| | - Anita Zacharias
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Adam I Semciw
- Department of Physiotherapy, Podiatry, and Pr osthetics and Orthotics, School of Allied Health La Trobe University, Bundoora, VIC, Australia; School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, Australia
| | - Michael Kingsley
- Department of Exercise Sciences, Faculty of Science, University of Auckland, Auckland, New Zealand; Holsworth Research Initiative, College of Science, Health & Engineering, La Trobe University, Bendigo, VIC, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, and Pr osthetics and Orthotics, School of Allied Health La Trobe University, Bundoora, VIC, Australia
| | - Stephanie J Woodley
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, New Zealand
| | - Rodney Green
- Department of Rural Clinical Sciences, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
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Green B, McClelland JA, Semciw AI, Schache AG, McCall A, Pizzari T. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. Sports Med - Open 2022; 8:10. [PMID: 35032233 PMCID: PMC8761182 DOI: 10.1186/s40798-021-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00364-0.
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Dooley K, Snodgrass S, Drew M, Donnan L, Blyton S, Pizzari T, Rio E, Schultz A, Edwards S. Are we failing athletes with recurrent groin pain by focusing on group-level biomechanical analysis of their movement strategies? J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Blyton S, Snodgrass S, Pizzari T, Birse S, Likens A, Edwards S. Movement variability in runners with a current or recent musculoskeletal injury: a systematic review. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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15
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Kinsella R, Pizzari T, Watson L, Cowan S. A comparison of isometric, concentric and eccentric rotator cuff exercises in the physiotherapy management of subacromial pain syndrome: feasibility study for a randomised controlled trial. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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16
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Cowan R, Mayes S, Cook J, Semciw A, Plass L, Pizzari T. Gluteal muscle size and quality in professional ballet dancers compared to non-dancing athletes. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Akhundov R, Saxby D, Diamond L, Snodgrass S, Clausen P, Drew M, Dooley K, Pizzari T, Rio E, Schultz A, Donnan L, McGann T, Edwards S. Game-play affects hamstring but not adductor muscle fiber mechanics in elite U20 basketball athletes. J Sci Med Sport 2022. [DOI: 10.1016/j.jsams.2022.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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18
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Rostron ZPJ, Zacharias A, Semciw AI, Kingsley M, Pizzari T, Woodley SJ, Green R. Effects of a targeted resistance intervention compared to a sham intervention on gluteal muscle hypertrophy, fatty infiltration and strength in people with hip osteoarthritis: analysis of secondary outcomes from a randomised clinical trial. BMC Musculoskelet Disord 2022; 23:944. [PMID: 36309690 PMCID: PMC9617418 DOI: 10.1186/s12891-022-05907-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 10/24/2022] [Indexed: 11/12/2022] Open
Abstract
Background People with hip osteoarthritis are typically offered a combination of education and exercise to address muscle atrophy and weakness. Limited evidence exists to assess the efficacy of exercise programs on muscle structure or function in this population. The aim of this study was to evaluate the effects of targeted resistance exercise on gluteal muscle hypertrophy and strength in people with mild-to-moderate hip osteoarthritis. Methods Twenty-seven participants with radiologically confirmed hip osteoarthritis recruited from a single site of a multi-site, double-blind clinical trial were randomly allocated to receive a 12-week targeted gluteal intervention or sham intervention. Magnetic resonance imaging and hand-held dynamometry were used to determine change in gluteal muscle volume, fatty infiltration and hip muscle strength. For gluteal muscle volume and strength outcomes mixed model analyses of variance (ANOVA) were conducted. A general linear model (ANOVA) analysis with fixed effects parameter estimates was used to assess the impact of sex on gluteal muscle size and strength of the affected limb only. For muscle fat index a mixed method ANOVA was used to assess the differences between groups and over time. Results In the targeted intervention group, gluteus minimus volume increased from baseline to post-intervention in both limbs (pooled mean difference: 0.06 cm3/kg, 95% confidence interval: 0.01 to 0.11) while no change occurred in the sham group (time x group effect: P = 0.025). Gluteus medius, gluteus maximus and tensor fascia lata volume did not change significantly over time. Hip strength (abduction, adduction, flexion, extension, external and internal rotation) improved similarly in both groups (time main effect: P ≤ 0.042). There was a consistent, albeit non-significant, pattern of reduced fatty infiltration after the targeted intervention. Conclusion Targeted resistance exercise resulted in gluteus minimus hypertrophy, but improvements in hip strength occurred in both groups. Clinicians delivering hip osteoarthritis rehabilitation programs might consider implementing a targeted exercise program to attenuate disease associated changes within gluteal muscles. Trial registration Australian New Zealand Clinical Trials Registry, ID: ACTRN12617000970347. Registered prospectively on 5 July 2017. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05907-4.
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Akhundov R, Saxby DJ, Diamond LE, Snodgrass S, Clausen P, Drew M, Dooley K, Pizzari T, Rio E, Schultz A, Donnan L, McGann T, Edwards S. Game-play affects hamstring but not adductor muscle fibre mechanics in elite U20 basketball athletes. Sports Biomech 2022:1-17. [PMID: 36254725 DOI: 10.1080/14763141.2022.2133006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 09/21/2022] [Indexed: 10/24/2022]
Abstract
Muscle tendon unit fibre mechanics of hamstring and adductor strain injuries are not well studied, with factors such as fatigue promoted as risk factors in the absence of mechanistic evidence. In this study, musculoskeletal modelling was used to estimate fibre mechanics of four hamstring (biceps femoris long head, biceps femoris short head, semimembranosus and semitendinosus) and four adductor (adductor brevis, adductor longus, adductor magnus and gracilis) muscles during an anticipated cut task. The cut task was performed by 10 healthy elite male U20 basketball players both before and immediately after they played in one (of four) competitive basketball game. Biceps femoris long head produced significantly lower (p = 0.032) submaximal force post-game in the latter part of swing (30.7% to 35.0% of stride), though its peak force occurred later (37%) and remained unchanged. Semimembranosus produced significantly lower (p = 0.006) force post-game (32.9% to 44.9% of stride), which encompassed the instance of peak force (39%). Neither fibre velocity nor fibre length of the investigated muscles were significantly affected by game-play. These finding suggest that if fatigue is a factor in hamstring and adductor muscle strain injuries and is brought about by game-play, it is unlikely through the fibre mechanisms investigated in this study.
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Affiliation(s)
- Riad Akhundov
- Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - David J Saxby
- Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
| | - Laura E Diamond
- Griffith Centre for Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- School of Health Sciences and Social Work, Griffith University, Gold Coast, Queensland, Australia
| | - Suzanne Snodgrass
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Phil Clausen
- School of Engineering, University of Newcastle, Callaghan, New South Wales, Australia
| | - Michael Drew
- Athlete Availability Program, Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
- University of Canberra Research Institute for Sport and Exercise (UCRISE), University of Canberra, Bruce, Australian Capital Territory, Australia
- Australian Centre for Research into Injury in Sport and its Prevention, Bundoora, Victoria, Australia
| | - Katherine Dooley
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adrian Schultz
- School of Environment and Life Sciences, University of Newcastle, Callaghan, New South Wales, Australia
| | - Luke Donnan
- Faculty of Science, Charles Sturt University, Albury, New South Wales, Australia
| | - Tye McGann
- School of Health Sciences, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Suzi Edwards
- School of Environment and Life Sciences, University of Newcastle, Callaghan, New South Wales, Australia
- Discipline of Exercise and Sport Science, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
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20
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King MG, Kemp JL, Hon R, Pizzari T, Wong J, Menz H, Taylor NF, Harms A, McClelland JA, Semciw AI. Prefabricated contoured foot orthoses to reduce pain and increase physical activity in people with hip osteoarthritis: protocol for a randomised feasibility trial. BMJ Open 2022; 12:e062954. [PMID: 36691129 PMCID: PMC9453946 DOI: 10.1136/bmjopen-2022-062954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 08/09/2022] [Indexed: 01/26/2023] Open
Abstract
INTRODUCTION The aim of this randomised feasibility trial is to determine the feasibility of conducting an adequately powered randomised controlled trial (RCT) investigating the efficacy of prefabricated contoured foot orthoses in people with hip osteoarthritis (OA). The secondary aims of the trial are to compare the effect of prefabricated contoured foot orthoses to a flat shoe insert comparator on outcomes of hip-related pain, physical activity and quality of life. We hypothesise that the demand, implementation, acceptability and practicality of foot orthoses as a treatment option for people with hip OA will be deemed feasible, informing the development of an adequately powered RCT to evaluate the efficacy and long term outcomes. METHODS AND ANALYSIS We will recruit 28 people with hip OA who will be randomised to receive either prefabricated contoured foot orthoses or flat shoe inserts to use for a 6-week period. Both groups will receive standardised education on hip OA and physical activity. The study's primary outcome is the feasibility domains of demand, implementation, acceptability and practicality. The secondary outcomes include the change in Hip Osteoarthritis Outcome Score-12, Patient Health Questionnaire-9, Brief Fear of Movement Scale for OA, Physical activity accelerometry and the Physical Activity Questionnaire-short form. Descriptive statistics will be used to describe feasibility outcomes with limited efficacy analysis used for the secondary outcomes. Linear mixed models will be used to analyse between-group differences at 6 weeks, with baseline values used as covariates, treatment allocation as a fixed factor and participant as a random factor. ETHICS AND DISSEMINATION This trial has been approved by the La Trobe University Human Research Ethics Committee (HEC20427), St. Vincent's Hospital Melbourne, Human Research Ethics Committee (HREC 266/20) and Northern Health Research Governance (NH-2021-292862). The results will be disseminated via a peer-reviewed journal and presented at international conferences. TRIAL REGISTRATION NUMBER NCT05138380.
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Affiliation(s)
- Matthew G King
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Ryan Hon
- Northern Health, Epping, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Justin Wong
- Northern Health, Epping, Victoria, Australia
| | - Hylton Menz
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Podiatry, La Trobe University, Melbourne, Victoria, Australia, LaTrobe University, Melbourne, Victoria, Australia
| | - Nicholas F Taylor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
- Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria, Australia
| | - Anton Harms
- Northern Health, Epping, Victoria, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Ivan Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
- Discipline of Physiotherapy, LaTrobe University, Melbourne, Victoria, Australia, La Trobe University, Bundoora, Victoria, Australia
- Northern Health, Epping, Victoria, Australia
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21
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Watson L, Pizzari T, Balster S, Lenssen R, Warby SA. Advances in the Non-Operative Management of Multidirectional Instability of the Glenohumeral Joint. J Clin Med 2022; 11:5140. [PMID: 36079068 PMCID: PMC9456769 DOI: 10.3390/jcm11175140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 08/26/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
Multidirectional instability (MDI) of the glenohumeral joint refers to symptomatic subluxations or dislocations in more than one direction. The aetiology of MDI is multifactorial, which makes the classification of this condition challenging. A shoulder rehabilitation program is the initial recommended treatment for MDI, however available rehabilitation programs have varying levels of evidence to support their effectiveness. In 2016, we published the details of an evidence-based program for MDI that has been evaluated for efficacy in two single-group studies and a randomised controlled trial. In 2017, we published a clinical commentary on the aetiology, classification, and treatment of this condition. The aim of this paper is to provide an update on the components of these publications with a particular focus on new advances in the non-operative management of this condition.
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Affiliation(s)
- Lyn Watson
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
- Mill Park Physiotherapy, 22/1 Danaher Dr, South Morang, VIC 3752, Australia
| | - Simon Balster
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Ross Lenssen
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
| | - Sarah Ann Warby
- Melbourne Shoulder Group, 305 High Street, Prahran, VIC 3181, Australia
- Department of Physiotherapy, Podiatry, Prosthetics and Orthotics, La Trobe University, Corner of Kingsbury Drive and Plenty Road Bundoora, Bundoora, VIC 2080, Australia
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22
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Nasser A, Semciw A, Grimaldi A, Rio E, Pizzari T, Vicenzino B. Core outcome set development for proximal hamstring tendinopathy (COS-PHT): a study protocol. Physical Therapy Reviews 2022. [DOI: 10.1080/10833196.2022.2077066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Anthony Nasser
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
- Graduate School of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Adam Semciw
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
- Allied Health, Northern Health, Melbourne, VIC, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
| | - Ebonie Rio
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, La Trobe University, Melbourne, VIC, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, QLD, Australia
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Cowan RM, Ganderton CL, Cook J, Semciw AI, Long DM, Pizzari T. Does Menopausal Hormone Therapy, Exercise, or Both Improve Pain and Function in Postmenopausal Women With Greater Trochanteric Pain Syndrome? A 2 × 2 Factorial Randomized Clinical Trial. Am J Sports Med 2022; 50:515-525. [PMID: 34898293 DOI: 10.1177/03635465211061142] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is a debilitating chronic condition, most prevalent in postmenopausal women. A positive association between high estrogen levels and tendon health may exist, and postmenopausal women have reduced estrogen. Menopausal hormone therapy (MHT) may reduce the incidence of tendon abnormality, particularly when combined with exercise. PURPOSE To determine the effect of MHT and exercise on tendon pain and function in postmenopausal women with GTPS. STUDY DESIGN Randomized controlled clinical trial; Level of evidence, 1. METHODS Postmenopausal women (N = 132; n = 12, lost to follow-up) with GTPS were randomized into MHT and placebo transdermal cream groups combined with tendon-specific or sham exercise. All groups received education about avoiding gluteal tendon compression and load management throughout 12 weeks of intervention. The primary outcome was the Victorian Institute of Sport Assessment for gluteal tendinopathy (VISA-G), and secondary outcomes were measured at baseline and at 12 and 52 weeks. The Global Rating of Change was assessed at 12 and 52 weeks. A linear mixed-effects model was used to assess differences. Body mass index (BMI) was included as a covariate. RESULTS All participant groups improved over time (baseline vs 12 weeks, P < .001; baseline vs 52 weeks, P < .001). There was no difference among exercise groups measured by all outcomes (VISA-G: baseline, P = .97, mean difference [MD] = 0.10; 12 weeks, P = .49, MD = 2.15; 52 weeks, P = .32, MD = -3.08). There was a significant interaction effect between cream and BMI; therefore, the population was stratified by BMI levels (<25, <30, ≥30). The MHT groups (with exercise and education) had significantly better VISA-G outcomes (baseline, P = .04, MD = -11.20, 95% CI = -21.70 to -0.70; 12 weeks, P < .001, MD = -20.72, 95% CI = -31.22 to -10.22; 52 weeks, P = .002, MD = -16.71, 95% CI = -27.21 to -6.22) and secondary measure scores as compared with placebo at all time points when BMI was <25. CONCLUSION MHT or placebo combined with tendon-specific or sham exercise plus education reduced pain and increased function for this population. For women with a BMI <25, MHT with any exercise plus education was better than placebo. A targeted exercise or sham exercise strategy is effective when prescribed with education about avoiding gluteal tendon compression and load management. REGISTRATION ACTRN12614001157662 (Australian New Zealand Clinical Trials Registry).
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Affiliation(s)
- Rachael Mary Cowan
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.,Olympic Park Sports Medicine Centre, Victoria, Australia
| | - Charlotte Louise Ganderton
- Department of Nursing and Allied Health, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
| | - Jillianne Cook
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
| | - Adam Ivan Semciw
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia.,Allied Health Research, Northern Health, Epping, Australia
| | - David Michel Long
- Olympic Park Sports Medicine Centre, Victoria, Australia.,School of Medicine, Deakin University, Geelong, Australia
| | - Tania Pizzari
- Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Melbourne, Victoria, Australia
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Opar DA, Ruddy JD, Williams MD, Maniar N, Hickey JT, Bourne MN, Pizzari T, Timmins RG. Screening Hamstring Injury Risk Factors Multiple Times in a Season Does Not Improve the Identification of Future Injury Risk. Med Sci Sports Exerc 2022; 54:321-329. [PMID: 34559727 DOI: 10.1249/mss.0000000000002782] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine if eccentric knee flexor strength and biceps femoris long head (BFlh) fascicle length were associated with prospective hamstring strain injury (HSI) in professional Australian Football players, and if more frequent assessments of these variables altered the association with injury risk. METHODS Across two competitive seasons, 311 Australian Football players (455 player seasons) had their eccentric knee flexor strength during the Nordic hamstring exercise and BFlh architecture assessed at the start and end of preseason and in the middle of the competitive season. Player age and injury history were also collected in preseason. Prospective HSIs were recorded by team medical staff. RESULTS Seventy-four player seasons (16%) sustained an index HSI. Shorter BFlh fascicles (<10.42 cm) increased HSI risk when assessed at multiple time points only (relative risk [RR], 1.9; 95% confidence interval [CI], 1.2-3.0). Neither absolute (N) nor relative (N·kg-1) eccentric knee flexor strength was associated with HSI risk, regardless of measurement frequency (RR range, 1.0-1.1); however, between-limb imbalance (>9%), when measured at multiple time points, was (RR, 1.8; 95% CI, 1.1-3.1). Prior HSI had the strongest univariable association with prospective HSI (RR, 2.9; 95% CI, 1.9-4.3). Multivariable logistic regression models identified a combination of prior HSI, BFlh architectural variables and between-limb imbalance in eccentric knee flexor strength as optimal input variables; however, their predictive performance did not improve with increased measurement frequency (area under the curve, 0.681-0.726). CONCLUSIONS More frequent measures of eccentric knee flexor strength and BFlh architecture across a season did not improve the ability to identify which players would sustain an HSI.
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Affiliation(s)
| | | | - Morgan D Williams
- School of Health, Sport and Professional Practice, Faculty of Life Sciences and Education, University of South Wales, Pontypridd, UNITED KINGDOM
| | | | - Jack T Hickey
- School of Behavioural and Health Sciences, Australian Catholic University, Fitzroy, Victoria, AUSTRALIA
| | | | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, AUSTRALIA
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Heerey J, Kemp J, Agricola R, Srinivasan R, Smith A, Pizzari T, King M, Lawrenson P, Scholes M, Link T, Souza R, Majumdar S, Crossley K. Cam morphology is associated with MRI-defined cartilage defects and labral tears: a case-control study of 237 young adult football players with and without hip and groin pain. BMJ Open Sport Exerc Med 2022; 7:e001199. [PMID: 34987861 PMCID: PMC8679114 DOI: 10.1136/bmjsem-2021-001199] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2021] [Indexed: 12/29/2022] Open
Abstract
Objective Football players are at risk of developing hip osteoarthritis (OA). Cam morphology (present in almost two of every three football players) may explain this heightened risk, but there is limited research on its role in hip OA development in younger athletes. Knowledge of this relationship will advance our understanding of the aetiology of hip OA in football players. We aimed to study the relationship between cam morphology size and MRI-defined cartilage defects and labral tears, and if this relationship differs by symptomatic state in young adult football players. Methods For this case–control study, 182 (288 hips) symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 (110 hips) pain-free football players (soccer or Australian football) underwent anteroposterior and Dunn 45° radiographs, and 3-Tesla MRI. Cam morphology size was defined using alpha angle, and cartilage defects and labral tears were scored semiquantitatively. Presence, location and score (severity) of cartilage defects and labral tears were determined. Each participant completed the International Hip Outcome Tool 33 and Copenhagen Hip and Groin Outcome Score. Results Greater alpha angle was associated with cartilage defects (OR 1.03, 95% CI 1.01 to 1.04) and labral tears (OR 1.02, 95% CI 1.01 to 1.04). Greater alpha angle was associated with superolateral cartilage defects (OR 1.03, 95% CI 1.02 to 1.05) and superior labral tears (OR 1.03, 95% CI 1.02 to 1.05). The association of alpha angle with MRI-defined cartilage defects and labral tears was no greater in football players with symptoms than in those without (p=0.189–0.937) Conclusion Cam morphology size was associated with cartilage defects and labral tears in young adult football players with and without pain. This study provides evidence that cam morphology may contribute to the high prevalence of hip OA in football players. Prospective studies of football players are now needed to establish if cam morphology causes progression of cartilage defects and labral tears and development of hip OA.
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Affiliation(s)
- Joshua Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Joanne Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Rintje Agricola
- Department of Orthopaedic Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ramya Srinivasan
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Anne Smith
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Matthew King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Peter Lawrenson
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Thomas Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Richard Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA.,Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, San Francisco, California, USA
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, San Francisco, California, USA
| | - Kay Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
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Visentini PJ, McDowell AH, Pizzari T. Factors associated with overuse injury in cyclists: A systematic review. J Sci Med Sport 2021; 25:391-398. [DOI: 10.1016/j.jsams.2021.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 12/05/2021] [Accepted: 12/21/2021] [Indexed: 10/19/2022]
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27
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Cook J, Cowan R, Ganderton C, Long D, Pizzari T, Semciw A. Hormone therapy and exercise as interventions for post-menopausal women with greater trochanteric pain syndrome. A randomised clinical trial. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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28
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Agricola R, Crossley K, Heerey J, Kemp J, King M, Lawrenson P, Link T, Majumdar S, Pizzari T, Smith A, Souza R, Srinivasan R. Cam morphology is associated with early hip OA features in young adult football players with and without hip and groin pain. J Sci Med Sport 2021. [DOI: 10.1016/j.jsams.2021.09.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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29
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Esteve E, Casals M, Saez M, Rathleff MS, Clausen MB, Vicens-Bordas J, Hölmich P, Pizzari T, Thorborg K. Past-season, pre-season and in-season risk assessment of groin problems in male football players: a prospective full-season study. Br J Sports Med 2021; 56:484-489. [PMID: 33692032 DOI: 10.1136/bjsports-2020-102606] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 11/03/2022]
Abstract
OBJECTIVE We assessed past-season, pre-season and in-season risk factors to investigate their association with an in-season groin problem in male amateur football players. METHODS Past-season groin-pain information and pre-season short-lever and long-lever adductor squeeze strength were obtained at baseline, together with anthropometrics (weight, lower limb lever length) and player age. In-season hip-related and groin-related sporting function was monitored every 4 weeks using the Sports and Recreation (Sport) subscale from the Hip And Groin Outcome Score questionnaire (HAGOS (Sport)). Groin problems, including time-loss groin injuries and groin pain irrespective of time loss, were collected over a 39-week competitive in-season. We estimated relative risk (RR), and 95% credibility interval (ICr) from logistic regressions fitted in a Bayesian framework. RESULTS Players (n=245) suffering from groin pain during the past-season had 2.4 times higher risk of experiencing a groin problem in the new season (2.40 RR; 95% ICr 1.5 to 3.7). This risk was reduced by 35% (0.65 RR; 95% ICr 0.42 to 0.99) per unit (N·m/kg) increase in the long-lever adductor squeeze test. Player age, short-lever squeeze test and the HAGOS (Sport) scores were not associated with the risk of a groin problem. CONCLUSIONS Past-season groin pain increased the risk of a groin problem in the new in-season. This risk was reduced by higher pre-season long-lever adductor squeeze strength. Past-season groin-pain information and long-lever adductor squeeze strength can be quickly obtained during pre-season to identify players with an elevated risk of in-season groin problems. This may be key to reduce these problems in the new season.
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Affiliation(s)
- Ernest Esteve
- Universtiy School of Health and Sport (EUSES), University of Girona, Girona, Catalunya, Spain
| | - Marti Casals
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Catalunya, Spain.,Servicios Médicos, Futbol Club Barcelona, Barcelona, Catalunya, Spain
| | - Marc Saez
- Research Group on Statistics, Econometrics and Health, GRECS, University of Girona, Girona, Catalunya, Spain.,CIBER of Epidemiology and Public Health, CIBERESP, Madrid, Comunidad de Madrid, Spain
| | - Michael Skovdal Rathleff
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, North Denmark Region, Denmark
| | - Mikkel Bek Clausen
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark.,Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Kobenhavn, Hovedstaden, Denmark
| | - Jordi Vicens-Bordas
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Catalunya, Spain.,NEOMA Research Group, Department of Medical Sciences, Universitat de Girona, Girona, Catalunya, Spain
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Hovedstaden, Denmark.,Physical Medicine and Rehabilitation-Copenhagen (PMR-C), Amager-Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark
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Heerey JJ, Srinivasan R, Agricola R, Smith A, Kemp JL, Pizzari T, King MG, Lawrenson PR, Scholes MJ, Souza RB, Link T, Majumdar S, Crossley KM. Prevalence of early hip OA features on MRI in high-impact athletes. The femoroacetabular impingement and hip osteoarthritis cohort (FORCe) study. Osteoarthritis Cartilage 2021; 29:323-334. [PMID: 33387651 PMCID: PMC8900484 DOI: 10.1016/j.joca.2020.12.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 11/03/2020] [Accepted: 12/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare early hip osteoarthritis (OA) features on magnetic resonance imaging (MRI) in high-impact athletes with and without hip and/or groin pain, and to evaluate associations between early hip OA features, the International Hip Outcome Tool (iHOT33) and Copenhagen Hip and Groin Outcome Score (HAGOS). DESIGN This case-control study evaluated data of the femoroacetabular impingement and hip osteoarthritis cohort (FORCe). One hundred and eighty-two symptomatic (hip and/or groin pain >6 months and positive flexion-adduction-internal-rotation (FADIR) test) and 55 pain-free high-impact athletes (soccer or Australian football (AF)) without definite radiographic hip OA underwent hip MRI. The Scoring Hip Osteoarthritis with MRI (SHOMRI) method quantified and graded the severity of OA features. Each participant completed the iHOT33 and HAGOS. RESULTS Hip and/or groin pain was associated with higher total SHOMRI (0-96) (mean difference 1.4, 95% CI: 0.7-2.2), labral score (adjusted incidence rate ratio (aIRR) 1.33, 95% CI: 1.1-1.6). Differences in prevalence of cartilage defects, labral tears and paralabral cysts between symptomatic and pain-free participants were inconclusive. There was a lower prevalence of effusion-synovitis in symptomatic participants when compared to pain-free participants (adjusted odds ratio (aOR) 0.46 (95% CI: 0.3-0.8). Early hip OA features were not associated with iHOT33 or HAGOS. CONCLUSIONS A complex and poorly understood relationship exists between hip and/or groin pain and early hip OA features present on MRI in high-impact athletes without radiographic OA. Hip and/or groin pain was associated with higher SHOMRI and labral scores.
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Affiliation(s)
- J J Heerey
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - R Srinivasan
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA.
| | - R Agricola
- Department of Orthopaedics, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - A Smith
- School of Physiotherapy and Exercise Science, Curtain University, Perth, Australia.
| | - J L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - T Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - M G King
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | | | - M J Scholes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
| | - R B Souza
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA; Department of Physical Therapy and Rehabilitation Science, University of California-San Francisco, CA, USA.
| | - T Link
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA.
| | - S Majumdar
- Department of Radiology and Biomedical Imaging, University of California-San Francisco, CA, USA.
| | - K M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.
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31
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Heerey J, Agricola R, Smith A, Kemp J, Pizzari T, King M, Lawrenson P, Scholes M, Crossley K. The Size and Prevalence of Bony Hip Morphology Do Not Differ Between Football Players With and Without Hip and/or Groin Pain: Findings From the FORCe Cohort. J Orthop Sports Phys Ther 2021; 51:115-125. [PMID: 33356776 DOI: 10.2519/jospt.2021.9622] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To compare the size and prevalence of bony hip morphology in football players with and without hip and/or groin pain. DESIGN Case-control. METHODS We recruited 184 soccer and Australian football players with self-reported hip and/or groin pain of greater than 6 months in duration and a positive flexion, adduction, and internal rotation (FADIR) test (290 hips, 21% women), and 55 football players with no pain and a negative FADIR test (110 hips, 26% women) as a control group. Bony hip morphology was identified by the alpha angle and lateral center-edge angle (LCEA) on anteroposterior pelvis and Dunn 45° radiographs. The alpha angle and LCEA were analyzed as continuous measures (size) and dichotomized using threshold values to determine the presence of bony hip morphology (cam, large cam, pincer, and acetabular dysplasia). Regression analyses estimated differences in the size and prevalence of bony hip morphology between football players with and without pain. RESULTS In all football players and in men, the size and prevalence of bony hip morphology did not differ between those with and without hip and/or groin pain. Cam morphology was evident in 63% of hips in players without pain and 71% of symptomatic hips in players with hip and/or groin pain. In female football players with hip and/or groin pain compared to those without pain, larger alpha angle values were observed on the Dunn 45° view (5.9°; 95% confidence interval: 1.2°, 10.6°; P = .014). CONCLUSION The size and prevalence of bony hip morphology appear to be similar in football players with and without hip and/or groin pain. J Orthop Sports Phys Ther 2021;51(3):115-125. Epub 25 Dec 2020. doi:10.2519/jospt.2021.9622.
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Dooley K, Drew MK, Snodgrass SJ, Schultz A, McGann T, Blyton S, Pizzari T, Rio E, Donnan L, Edwards S. Male basketball players who report hip and groin pain perceive its negative impact both on- and off-court: A cross-sectional study. J Sci Med Sport 2021; 24:660-664. [PMID: 33707154 DOI: 10.1016/j.jsams.2021.02.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To identify if basketball players aged <20 years (U20) self-report hip and/or groin pain and if they perceive this as a problem. To determine potential differences in self-reported playing (training and match play) loads and Copenhagen Hip and Groin Outcome Score (HAGOS) between those with and without hip/groin pain. DESIGN Cross-sectional. METHODS Fifty-one pre-elite (state/national representative level) male U20 basketball players (Australian n=38; Italian n=13) self-reported current/historical hip/groin 'discomfort/pain' and 'problems', and playing loads. A two-factor regression model was fitted including main effects for hip/groin pain and Cohort and their interaction, with outcome variables playing loads and HAGOS subscale scores and dependent variable hip/groin pain. RESULTS Twenty-one players (41%) self-reported hip/groin 'discomfort/pain', of which nine perceived no 'problems'. Two of these nine players reported training/playing time loss due to pain. Those self-reporting hip/groin discomfort/pain scored lower than those without in HAGOS subscales Symptoms (mean difference in score 8.94; 95%CI -25.24, -5.97), Pain (5.00; -16.42, -2.81), Function in daily living (0.00; -26.72 to -5.59), Function in sport and recreation (6.25; -21.24, -5.33), and hip and/or groin Quality of Life (5.00; -28.63, -8.10), indicating worse hip/groin problems. Participation subscale scores were different only for Italian players (36.25; -51.25, -20.00), with players self-reporting hip/groin discomfort/pain scoring lower. CONCLUSION Most players who perceive both hip/groin 'discomfort/pain' and 'problems' also report training/playing time loss, suggesting players' perceptions of problematic symptoms and time-loss are associated. Adolescent basketball players perceive hip/groin pain to negatively impact their daily lives and sporting function.
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Affiliation(s)
- Katherine Dooley
- School of Health Sciences, The University of Newcastle, Australia.
| | - Michael K Drew
- Department of Physical Therapies, Australian Institute of Sport, Australia
| | | | - Adrian Schultz
- School of Environmental & Life Sciences, The University of Newcastle, Australia
| | - Tye McGann
- School of Health Sciences, The University of Newcastle, Australia
| | - Sarah Blyton
- School of Environmental & Life Sciences, The University of Newcastle, Australia
| | - Tania Pizzari
- Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - Ebonie Rio
- Sport and Exercise Medicine Research Centre, La Trobe University, Australia
| | - Luke Donnan
- School of Community Health, Charles Sturt University, Australia
| | - Suzi Edwards
- School of Environmental & Life Sciences, The University of Newcastle, Australia
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Nasser AM, Pizzari T, Grimaldi A, Vicenzino B, Rio E, Semciw AI. Proximal hamstring tendinopathy; expert physiotherapists' perspectives on diagnosis, management and prevention. Phys Ther Sport 2020; 48:67-75. [PMID: 33378733 DOI: 10.1016/j.ptsp.2020.12.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/05/2020] [Accepted: 12/08/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To explore and summarise expert physiotherapists' perceptions on their assessment, management and prevention of proximal hamstring tendinopathy (PHT). METHODS We conducted semi-structured interviews with expert physiotherapists until data saturation was met (n = 13). Interviews were transcribed verbatim and data were analysed systematically and organised into categories and sub-categories according to study aims. RESULTS Experts report using a clinical reasoning-based approach, incorporating information from the patient interview and results of clinical load-based provocation tests, in the physical examination to diagnose PHT. Experts manage the condition through education and progressive loading targeting the hamstring unit and kinetic chain, avoiding provocative activities in positions of compression in early-mid stage rehab and a gradated and controlled return to sport. Passive therapies including injection therapies and surgery were believed to have limited utility. Prevention of recurrence primarily involved continuation of hamstring and kinetic chain strengthening programs and management of physical workload. CONCLUSION Experts rely on a combination of information from the patient interview and a battery of pain provocation tests to diagnose PHT. Education and graded exercise of the hamstring group and synergists, minimising early exposure to hip flexion, were the foundation of management of the condition.
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Affiliation(s)
- Anthony M Nasser
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia; University of Technology Sydney, Graduate School of Health, Australia.
| | - Tania Pizzari
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Alison Grimaldi
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, University of Queensland, Australia
| | - Ebonie Rio
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Adam Ivan Semciw
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia; Northern Centre for Health Education and Research, Northern Health, Victoria, Australia
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Esteve E, Rathleff MS, Hölmich P, Casals M, Clausen MB, Vicens-Bordas J, Pizzari T, Thorborg K. Groin problems from pre- to in-season: a prospective study on 386 male Spanish footballers. Res Sports Med 2020; 29:498-504. [PMID: 33317337 DOI: 10.1080/15438627.2020.1860044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigated the weekly prevalence of groin problems over a 3-week football pre-season, compared to a 39-week competitive in-season. We registered time-loss groin injuries, and self-reported weekly groin-pain in 17 amateur male football teams (386 players). The average weekly prevalence of groin problems (prevalence ratio (PR)) was 1.8 times higher (95% CI 1.6 to 2.0) during pre-season (21%) compared to in-season (12%). We found a higher weekly prevalence (PR 1.8; 95% CI 1.6 to 2.1) of groin problems without time loss, during the pre-season (19%) compared to the in-season (10%), but no significant difference in the weekly prevalence of groin problems with time loss (PR 1.5; 95% CI 1.0 to 2.4). Attention should be given to optimal load progression, and early implementation of preventive measures during the football pre-season to reduce the prevalence of groin problems in both pre- and in-season.
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Affiliation(s)
- Ernest Esteve
- School of Health and Sport Sciences (EUSES), Universitat de Girona, Salt, Spain.,Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain
| | - Michael Skovdal Rathleff
- SMI, Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark.,Department of Occupational Therapy and Physiotherapy, Aalborg University Hospital, Aalborg, Denmark
| | - Per Hölmich
- Sports Orthopedic Research Center (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark
| | - Martí Casals
- Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic - Central University of Catalonia, Barcelona, Spain.,Medical Department, Futbol Club Barcelona, Barça Innovation Hub, Barcelona, Spain
| | - Mikkel Bek Clausen
- Sports Orthopedic Research Center (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.,Department of Midwifery, Physiotherapy, Occupational Therapy and Psychomotor Therapy, Faculty of Health, University College Copenhagen, Copenhagen, Denmark
| | - Jordi Vicens-Bordas
- Sportclínic, Physiotherapy and Sports Training Centre, Girona, Spain.,Sport and Physical Activity Studies Centre (CEEAF), Faculty of Medicine, University of Vic - Central University of Catalonia, Barcelona, Spain
| | - Tania Pizzari
- Department of Rehabilitation, Nutrition and Sport, La Trobe University Sport and Exercise Medicine Research Centre, Bundoora, Australia
| | - Kristian Thorborg
- Sports Orthopedic Research Center (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Copenhagen, Denmark.,Physical Medicine and Rehabilitation - Copenhagen (PMR-C), Amager-Hvidovre Hospital, Copenhagen University, Hvidovre, Denmark
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35
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Green B, Lin M, McClelland JA, Semciw AI, Schache AG, Rotstein AH, Cook J, Pizzari T. Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players. Am J Sports Med 2020; 48:3306-3315. [PMID: 33030961 DOI: 10.1177/0363546520959327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited. PURPOSE To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury. RESULTS Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence. CONCLUSION A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Medical Imaging, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Northern Centre for Health Education and Research, Northern Health, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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Simpson M, Pizzari T, Cook T, Wildman S, Lewis J. Effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy: A systematic review. J Rehabil Med 2020; 52:jrm00119. [PMID: 32830280 DOI: 10.2340/16501977-2725] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE To evaluate the effectiveness of non-surgical interventions for rotator cuff calcific tendinopathy. DATA SOURCES Medline, EMBASE, CINAHL, Cochrane Register of Clinical Trials, PEDro and SPORTDiscus from inception to March 2018, and accompanying reference lists. Peer-reviewed randomized clinical trials of non-surgical interventions for adults with rotator cuff calcific tendinopathy were included. DATA EXTRACTION The same 2 reviewers independently evaluated eligibility, extracted data and evaluated risk of bias of the included randomized clinical trials. A system to resolve any disagreements was established a priori. Short-term, medium-term and long-term outcomes for pain, shoulder function and calcific morphology related to rotator cuff calcific tendinopathy were extracted. Due to diversity in outcome measures a meta-analyses was not conducted. DATA SYNTHESIS Of the 2,085 articles identified, 18 met the inclusion criteria, all of which had high risk of bias. Five non-surgical interventions were identified (extracorporeal shockwave therapy, ultrasound-guided percutaneous intervention, pulsed ultrasound, acetic acid iontophoresis, and transcutaneous electrical nerve stimulation). CONCLUSION There was moderate evidence for high-energy extracorporeal shockwave therapy over low-energy extracorporeal shockwave therapy for pain and function between 3 and 6 months, and over placebo for function in the first 6 months. There was moderate evidence for ultrasound-guided percutaneous intervention over medium/high-energy extracorporeal shockwave therapy for reduced pain and calcific morphology over a 1-year period. Methodological concerns preclude definitive recommendations.
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Affiliation(s)
- Mitchell Simpson
- Melbourne Medical School, University of Melbourne, , 3010 Parkville, Australia . E-mail:
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Nunes GS, Pizzari T, Neate R, Barton CJ, Semciw A. Gluteal muscle activity during running in asymptomatic people. Gait Posture 2020; 80:268-273. [PMID: 32563058 DOI: 10.1016/j.gaitpost.2020.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 05/17/2020] [Accepted: 06/03/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip abductor muscle function is associated with running-related injuries. Previous electromyography (EMG) studies that reporting gluteal muscle activity when running have failed to account for the multiple segments of the gluteals, and have used surface electrodes, which may be contaminated by cross-talk of surrounding muscles. RESEARCH QUESTION This study aimed to: (i) develop EMG profiles of gluteus medius (GMed - anterior, middle and posterior) and gluteus minimus (GMin - anterior and posterior) segments during running; (ii) compare the activation patterns of each gluteal segment between running and walking; and (iii) compare surface EMG signals of running and walking to fine wire EMG signals of middle GMed. METHODS Ten physically active and asymptomatic people participated. Gluteal segment activation was assessed during running and walking over 10 m. Muscle activation was assessed using bipolar fine wire intramuscular EMG electrodes and GMed activation was also assessed using surface EMG. RESULTS During running, all gluteal segments presented peak amplitude during the stance phase and anterior GMin presented additional second peak amplitude during the swing phase. All gluteal segments evaluated demonstrated consistently higher amplitudes during the stance and swing phases of running compared to walking. The mean amplitude assessed using surface EMG was 32-87% higher compared to fine wire during both phases for running and walking. SIGNIFICANCE Greater activation of GMed segments during the stance phase and the increased anterior GMin activity during the swing phase indicate a potentially important role for pelvis and hip stabilization, respectively, which should be considered during development of targeted rehabilitation for running populations. The overestimated activation using surface electrodes highlights a limitation of using surface EMG during running and walking.
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Affiliation(s)
- Guilherme S Nunes
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia; Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Australia
| | - Rachel Neate
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia
| | - Christian J Barton
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia; Department of Surgery, St Vincent's Hospital, University of Melbourne, Australia
| | - Adam Semciw
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Australia; Department of Physiotherapy, Podiatry and Prosthetics and Orthotics, La Trobe University, Australia; Northern Centre for Health, Education and Research, Northern Health, Victoria, Australia.
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38
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Bourne MN, Williams M, Timmins R, Pizzari T. Pre-season Hip/groin Strength Is Associated With Subsequent Injury In Professional Male Soccer Players. Med Sci Sports Exerc 2020. [DOI: 10.1249/01.mss.0000682468.17632.da] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Zacharias A, Pizzari T, Semciw AI, English DJ, Kapakoulakis T, Green RA. Gluteus medius and minimus activity during stepping tasks: Comparisons between people with hip osteoarthritis and matched control participants. Gait Posture 2020; 80:339-346. [PMID: 32603886 DOI: 10.1016/j.gaitpost.2020.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/02/2020] [Accepted: 06/09/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Altered gluteus minimus (GMin) activity has been identified in people with hip osteoarthritis (OA) during gait with some evidence of altered gluteus medius (GMed) activity in patients with advanced OA. It is not known whether these muscles also exhibit altered activity during other functional tasks. RESEARCH QUESTION Does gluteal muscle activity during stepping tasks differ between people with hip OA and healthy older adults? METHODS Participants included 20 people with unilateral hip OA and 20 age-and sex-matched controls. Muscle activity in the three segments within GMed and two segments of GMin were examined using intramuscular electromyography during step-up, step-down and side-step tasks. RESULTS Participants in the OA group demonstrated reduced muscle activity early in the step-up task and a later time to peak activity in most muscle segments. Greater activity was identified in anterior GMin in people with hip OA during the side-step task. A delay in time to peak activity was identified in most muscle segments in people with OA during the side-step task. SIGNIFICANCE For participants with OA, reduced activity in most muscle segments and increased time spent in double limb stance during the step-up task could reflect the decreased strength and pain associated with single limb stance on the affected limb. This study provides further evidence of altered function of the deep gluteal muscles in people with hip OA and highlights the importance of addressing these muscles in rehabilitation.
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Affiliation(s)
- Anita Zacharias
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia; Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia.
| | - Tania Pizzari
- Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia; La Trobe University Sports and Exercise Medicine Research Centre, Victoria, Australia
| | - Adam I Semciw
- Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia; La Trobe University Sports and Exercise Medicine Research Centre, Victoria, Australia
| | - Daniel J English
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia; Fusion Physiotherapy, Bendigo, Victoria, Australia
| | | | - Rodney A Green
- Department of Pharmacy and Biomedical Sciences, College of Science, Health and Engineering, La Trobe University, Victoria, Australia; Sport, Exercise and Rehabilitation Research Focus Area, La Trobe University, Victoria, Australia
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40
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Ganderton C, Kinsella R, Watson L, Pizzari T. Getting more from standard rotator cuff strengthening exercises. Shoulder Elbow 2020; 12:203-211. [PMID: 32565922 PMCID: PMC7285972 DOI: 10.1177/1758573219888829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/16/2019] [Accepted: 10/21/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND A simple modification to standard rotator cuff exercises using an additional resistance band around the scapula has been recommended in the clinical setting, postulated to encourage activation of the posterior scapular stabilisers and increase rotator cuff activation. The aim of this clinical laboratory study was to compare scapular and rotator cuff muscle activation between standard and modified exercises. METHODS Electromyographic data were collected from 10 healthy adults via surface and intramuscular electrodes from the scapular and rotator cuff muscles. Internal and external rotation exercises of the shoulder with the arm abducted to 0°, 45° and 90° were performed using one handheld resistance band (standard) or two bands with the additional band applied to the scapula (modified). RESULTS Activation of the trapezii and rhomboid muscles during the modified exercises at 0° and 45° of abduction was significantly greater when compared to the standard exercises (P < 0.05). No significant differences were found in rotator cuff muscle activation. DISCUSSION Applying resistance to the posterior scapula increases activation of some scapular stabilising muscles particularly in lower ranges of abduction. This study provides preliminary evidence that this simple modification can elicit greater scapular muscle activity, potentially producing enhanced exercise outcomes with minimal additional effort.
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Affiliation(s)
- C Ganderton
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia,Department of Health Professions, Faculty of Health, Arts and Design, Swinburne University of Technology, Melbourne, Australia
| | - R Kinsella
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia,Physiotherapy Department, St Vincent’s Hospital, Melbourne, Australia
| | - L Watson
- Melbourne Shoulder Group, Melbourne, Australia
| | - T Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia,T Pizzari, La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Melbourne, Australia.
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41
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Moore D, Semciw AI, Wisbey-Roth T, Pizzari T. Adding hip rotation to therapeutic exercises can enhance gluteus medius and gluteus minimus segmental activity levels – An electromyography study. Phys Ther Sport 2020; 43:157-165. [DOI: 10.1016/j.ptsp.2020.02.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 01/12/2023]
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42
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Green B, Bourne MN, van Dyk N, Pizzari T. Recalibrating the risk of hamstring strain injury (HSI): A 2020 systematic review and meta-analysis of risk factors for index and recurrent hamstring strain injury in sport. Br J Sports Med 2020; 54:1081-1088. [PMID: 32299793 DOI: 10.1136/bjsports-2019-100983] [Citation(s) in RCA: 128] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVE To systematically review risk factors for hamstring strain injury (HSI). DESIGN Systematic review update. DATA SOURCES Database searches: (1) inception to 2011 (original), and (2) 2011 to December 2018 (update). Citation tracking, manual reference and ahead of press searches. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies presenting prospective data evaluating factors associated with the risk of index and/or recurrent HSI. METHOD Search result screening and risk of bias assessment. A best evidence synthesis for each factor and meta-analysis, where possible, to determine the association with risk of HSI. RESULTS The 78 studies captured 8,319 total HSIs, including 967 recurrences, in 71,324 athletes. Older age (standardised mean difference=1.6, p=0.002), any history of HSI (risk ratio (RR)=2.7, p<0.001), a recent HSI (RR=4.8, p<0.001), previous anterior cruciate ligament (ACL) injury (RR=1.7, p=0.002) and previous calf strain injury (RR=1.5, p<0.001) were significant risk factors for HSI. From the best evidence synthesis, factors relating to sports performance and match play, running and hamstring strength were most consistently associated with HSI risk. The risk of recurrent HSI is best evaluated using clinical data and not the MRI characteristics of the index injury. SUMMARY/CONCLUSION Older age and a history of HSI are the strongest risk factors for HSI. Future research may be directed towards exploring the interaction of risk factors and how these relationships fluctuate over time given the occurrence of index and recurrent HSI in sport is multifactorial.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Matthew N Bourne
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.,School of Allied Health Sciences, Griffith University, Gold Coast Campus, Queensland, Australia
| | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
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Crow J, Semciw A, Couch J, Pizzari T. Does a recent hamstring muscle injury affect the timing of muscle activation during high speed overground running in professional Australian Football players? Phys Ther Sport 2020; 43:188-194. [PMID: 32208357 DOI: 10.1016/j.ptsp.2020.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/13/2020] [Accepted: 03/14/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To investigate if the temporal characteristics of hamstring and gluteal muscle activation are altered during high speed overground running in professional Australian Football players following hamstring muscle injury. DESIGN Cohort study. SETTING Field-based testing. PARTICIPANTS Elite professional Australian Football players who had sustained a hamstring muscle injury in the six months prior to testing (n = 7) and a group of players from the same club who had no history of hamstring muscle injury (n = 8). MAIN OUTCOME MEASURES Muscle onset timing, muscle offset timing and muscle onset duration of the medial hamstrings, biceps femoris and gluteus maximus muscles during high-speed running using electromyographic data. RESULTS No significant differences in any of the temporal aspects of muscle activation were found between groups for any of the muscles tested (p > 0.05). CONCLUSIONS Persistent alterations to the timing of muscle activation following hamstring muscle injury that have been reported in recreational athletes were not observed during high speed running in professional athletes who have completed comprehensive rehabilitation programs.
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Affiliation(s)
- Justin Crow
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; Paralympics Australia, Melbourne, Australia.
| | - Adam Semciw
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia
| | - Jamon Couch
- Mill Park Physiotherapy Centre, Melbourne, Australia
| | - Tania Pizzari
- La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Australia; Mill Park Physiotherapy Centre, Melbourne, Australia
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Green B, Lin M, Schache AG, McClelland JA, Semciw AI, Rotstein A, Cook J, Pizzari T. Calf muscle strain injuries in elite Australian Football players: A descriptive epidemiological evaluation. Scand J Med Sci Sports 2020; 30:174-184. [PMID: 31494970 DOI: 10.1111/sms.13552] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 08/23/2019] [Accepted: 09/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) show consistent rates of prevalence and re-injury in elite Australian Football players. An epidemiological evaluation is warranted to better understand the clinical presentation and recovery of CMSI. PURPOSE First, to describe the epidemiology of CMSI in elite Australian Football players. Second, to determine if recovery following injury is different according to: (a) injury type (index vs re-injury); (b) muscle injured (soleus vs gastrocnemius); and (c) mechanism of injury (running-related activity vs non running-related activity). STUDY DESIGN Descriptive epidemiological. METHODS Data retrieved from the Soft Tissue injury Registry of the Australian Football League were analyzed. Sixteen clubs submitted data on CMSI from 2014 to 2017. Data included: player characteristics, training and match history at the time of injury, MRI, and the time to reach recovery milestones. RESULTS One hundred and eighty-four CMSI were included (149 index injuries; 35 re-injuries). Soleus injuries were most prevalent (84.6%). Soleus injuries took 25.4 ± 16.2 days to return to play, whereas gastrocnemius injuries took 19.1 ± 14.1 days (P = .097). CMSI sustained during running-related activities took approximately 12 days longer to recover than injuries sustained during non running-related activities (P = .001). Compared to index injuries, re-injuries involved older players (P = .03) and significantly more time was taken to run at >90% of maximum speed, return to full training, and return to play (P ≤ .001). Almost all of the observed re-injuries involved soleus (91.4%). CONCLUSION Soleus injuries are more prevalent than gastrocnemius injuries in elite Australian Football players. Prognosis appears to be influenced by clinical factors, with CMSI sustained during running-related activities and re-injuries needing more time to recover.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Imaging, Melbourne, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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45
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Sherry LJ, Briggs AM, Pizzari T. Safeguarding injured Victorians: development and implementation of an evidence-informed system to manage therapeutic uncertainty and decision making in a compensable environment. AUST HEALTH REV 2019; 44:493-496. [PMID: 31767052 DOI: 10.1071/ah19155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 07/29/2019] [Indexed: 11/23/2022]
Abstract
WorkSafe Victoria and the Transport Accident Commission are two Victorian government agencies that determine the policies that guide decisions to fund treatments and services provided to Victorians injured in transport or workplace accidents. These agencies identified that an internal system was required to manage requests for funding of new or emerging treatments. In particular, the agencies recognised a system that supported consistency in decision making in the context of therapeutic uncertainty and ensured the safety of injured Victorians was needed. The New, Emerging or Non-Established Treatments (NENETs) policy was launched in its current form by the agencies in 2013. The NENETs system includes a record of contemporary evidence for emerging treatments and an evidence-informed decision-making system to ensure consistency and information sharing. A system of recording decisions on emerging treatments was also implemented to ensure that funding decisions could later be reversed if necessary. The NENETs system has proved to be a robust and sustainable method of managing uncertainty for WorkSafe Victoria and the Transport Accident Commission and could be transferable to other funding bodies.
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Affiliation(s)
- Lisa J Sherry
- Health Strategy, WorkSafe Victoria, Level 9, 567 Collins Street, Melbourne, Vic. 3000, Australia. ; and Corresponding author.
| | - Andrew M Briggs
- Health Strategy, WorkSafe Victoria, Level 9, 567 Collins Street, Melbourne, Vic. 3000, Australia. ; and Faculty of Health Sciences, Curtin University, GPO Box U1987, Perth, WA 6845, Australia.
| | - Tania Pizzari
- Health Strategy, WorkSafe Victoria, Level 9, 567 Collins Street, Melbourne, Vic. 3000, Australia. ; and La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, Vic. 3086, Australia.
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46
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Cowan RM, Semciw AI, Pizzari T, Cook J, Rixon MK, Gupta G, Plass LM, Ganderton CL. Muscle Size and Quality of the Gluteal Muscles and Tensor Fasciae Latae in Women with Greater Trochanteric Pain Syndrome. Clin Anat 2019; 33:1082-1090. [DOI: 10.1002/ca.23510] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 09/24/2019] [Accepted: 10/27/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Rachael Mary Cowan
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Adam Ivan Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | - Melissa Kate Rixon
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
| | | | - Lindsey Marie Plass
- The University of Chicago Medicine, Department of Therapy Services Illinois United States of America
| | - Charlotte Louise Ganderton
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University Victoria Australia
- Department of Health Professions, Swinburne University of Technology Victoria Australia
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Nunes GS, de Oliveira Silva D, Crossley KM, Serrão FV, Pizzari T, Barton CJ. People with patellofemoral pain have impaired functional performance, that is correlated to hip muscle capacity. Phys Ther Sport 2019; 40:85-90. [DOI: 10.1016/j.ptsp.2019.08.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 08/24/2019] [Accepted: 08/24/2019] [Indexed: 12/22/2022]
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Wollin M, Thorborg K, Drew M, Pizzari T. A novel hamstring strain injury prevention system: post-match strength testing for secondary prevention in football. Br J Sports Med 2019; 54:498-499. [PMID: 31630091 DOI: 10.1136/bjsports-2019-100707] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Martin Wollin
- Australian Institute of Sport, Belconnen, Australian Capital Territory, Australia .,Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Arthroscopic Center, Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre Hospital, Hvidovre, Denmark
| | - Michael Drew
- Department of Physiotherapy, Australian Institute of Sport, Canberra, Australian Capital Territory, Australia.,Australian Collaboration for Research into Injury in Sport and its Prevention (ACRISP), Federation University Australia, Ballarat, Victoria, Australia
| | - Tania Pizzari
- Physiotherapy, La Trobe University, Mebourne, Victoria, Australia
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Papagoras H, Pizzari T, Coburn P, Sleigh K, Briggs AM. Supporting return to work through appropriate certification: a systematic approach for Australian primary care. AUST HEALTH REV 2019; 42:164-167. [PMID: 28263703 DOI: 10.1071/ah16247] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 01/12/2017] [Indexed: 11/23/2022]
Abstract
Primary care practitioners play a critical role in supporting return to work (RTW) and minimising the detrimental physical and psychosocial sequelae of unnecessary and prolonged work absence in injured and ill workers. Accurate and consistent certification of capacity is an essential component of this role that has been scrutinised recently given the identified variation in certification practices between and within professions. This Perspective outlines the importance of correct certification of capacity for injured workers and provides a RTW flowchart to support systematised and appropriate certification. The flowchart is aimed at primary care practitioners (e.g. general practitioners or physiotherapists). The flowchart was developed at the Transport Accident Commission and WorkSafe Victoria as a guide for Australian primary care practitioners when certifying capacity. A more systematised approach to certification coupled with professional education and support may reduce variations and inaccuracies in certification, improve RTW rates and reduce the increasing burden of disease related to workplace injuries.
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Affiliation(s)
- Harry Papagoras
- Health Strategy Group, WorkSafe Victoria, 222 Exhibition Street, Melbourne, Vic. 3000, Australia.
| | - Tania Pizzari
- Health Strategy Group, WorkSafe Victoria, 222 Exhibition Street, Melbourne, Vic. 3000, Australia.
| | - Paul Coburn
- Health Strategy Group, WorkSafe Victoria, 222 Exhibition Street, Melbourne, Vic. 3000, Australia.
| | - Kevin Sleigh
- Health Strategy Group, WorkSafe Victoria, 222 Exhibition Street, Melbourne, Vic. 3000, Australia.
| | - Andrew M Briggs
- Health Strategy Group, WorkSafe Victoria, 222 Exhibition Street, Melbourne, Vic. 3000, Australia.
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50
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Green B, Lin M, McClelland J, Semciw A, Schache A, Rotstein A, Cook J, Pizzari T. Which factors are predictive of return to play and re-injury following calf muscle strain injury? J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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