Is combining gait retraining or an exercise programme with education better than education alone in treating runners with patellofemoral pain?A randomised clinical trial.

DESIGN: Single-blind randomised clinical trial. OBJECTIVE: To compare the effects of three 8-week rehabilitation programmes on symptoms and functional limitations of runners with patellofemoral pain (PFP). METHODS: Sixty-nine runners with PFP were randomly assigned to one of three intervention groups: (1) education on symptoms management and training modifications (education); (2) exercise programme in addition to education (exercises); (3) gait retraining in addition to education (gait retraining). Symptoms and functional limitations were assessed at baseline (T0), and after 4, 8 and 20 weeks (T4, T8 and T20) using the Knee Outcome Survey of the Activities of Daily Living Scale (KOS-ADLS) and visual analogue scales (VASs) for usual pain, worst pain and pain during running. Lower limb kinematics and kinetics during running, and isometric strength were also evaluated at T0 and T8. The effects of rehabilitation programmes were assessed using two-way analysis of variance. RESULTS: No significant group × time interactions (p<0.447) were found for KOS-ADLS and VASs. All three groups showed similar improvements at T4, T8 and T20 compared with T0 (p<0.05). Only the exercises group increased knee extension strength following rehabilitation (group × time: p<0.001) and only the gait retraining group (group × time: p<0.001) increased step rate (+7.0%) and decreased average vertical loading rate (-25.4%). CONCLUSION: Even though gait retraining and exercises improved their targeted mechanisms, their addition to education did not provide additional benefits on symptoms and functional limitations. Appropriate education on symptoms and management of training loads should be included as a primary component of treatment in runners with PFP. TRIAL REGISTRATION NUMBER: ClinicalTrials.gov (NCT02352909).

Kinesiotaping for the Rehabilitation of Rotator Cuff-Related Shoulder Pain: A Randomized Clinical Trial.

BACKGROUND: Kinesiotaping (KT) has been widely used in clinical practice. Current evidence is insufficient to support the use of KT for treating rotator cuff-related shoulder pain (RCRSP), as its mid- and long-term effects have not been investigated. HYPOTHESES: Individuals using KT will achieve faster improvements in symptoms and functional limitations compared with those not using it. They will also present a greater increase in pain-free range of motion (ROM) and acromiohumeral distance (AHD) at the end of the treatment. STUDY DESIGN: Randomized controlled trial (NCT02881021). LEVEL OF EVIDENCE: Therapy, level 1b. METHODS: A total of 52 individuals with RCRSP, randomly assigned to 1 of 2 groups (experimental: KT; control: no-KT), underwent a 6-week rehabilitation program composed of 10 physical therapy sessions. KT was added to the treatment of the KT group. Symptoms and functional limitations were assessed using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire (primary outcome); Brief Pain Inventory (BPI); and Western Ontario Rotator Cuff (WORC) index at baseline, 3 weeks, 6 weeks, 12 weeks, and 6 months. AHD, pain-free ROM, and full ROM were measured at baseline and at week 6. The effects of KT were assessed using a nonparametric analysis for longitudinal data. RESULTS: No significant group × time interactions (0.112 ≤ P ≤ 0.726) were found for all outcomes. Time effects were observed as both groups showed significant improvements for all studied outcomes (DASH, BPI, and WORC, p < 0.0001; AHD, p = 0.017; pain-free ROM, p < 0.0001; and full ROM abduction, p ≤ 0.0001). CONCLUSION: Whereas symptoms, functional limitations, ROM, and AHD improved in both groups, the addition of KT did not lead to superior outcomes compared with exercise-based treatment alone, in the mid and long term, for individuals with RCRSP. CLINICAL RELEVANCE: Clinicians should not expect supplementary mid- or long-term gains with KT to reduce pain, improve shoulder function and ROM, or increase AHD if a rehabilitation program focusing on shoulder neuromuscular control is concurrently provided as treatment for individuals with RCRSP.

Electromyographic analysis of rotator cuff muscles in patients with rotator cuff tendinopathy: A systematic review.

The shoulder is inherently an unstable joint which heavily relies on the neuromuscular activation of the rotator cuff (RC) complex for stability during movement. Currently, there is no consensus regarding how the activity of RC muscles is affected among individuals with a RC tendinopathy (RCTe). This study reviewed the evidence of studies comparing the electromyographic (EMG) activity of any RC muscle of shoulders with a symptomatic RCTe to asymptomatic shoulders. Eight databases were searched. Data from 343 participants (201 symptomatic and 209 asymptomatic shoulders) were analyzed from 10 out of 402 included studies. Strong evidence for the infraspinatus and supraspinatus during isometric contractions and limited evidence for the supraspinatus and infraspinatus during isokinetic contractions suggest that the muscular activity is not altered among individuals with a RCTe during these types of contraction. Very limited evidence indicates reduced muscle activity for the infraspinatus and subscapularis in the presence of a RCTe during isotonic contractions, and no alterations for the supraspinatus or teres minor were identified. Lastly, conflicting to moderate evidence suggests alterations in RC muscle activity during unrestrained movements and swimming. These findings indicate that EMG deficits associated with a RCTe can best be appreciated during unrestrained movements.

Effects of kinesiotaping added to a rehabilitation programme for patients with rotator cuff tendinopathy: protocol for a single-blind, randomised controlled trial addressing symptoms, functional limitations and underlying deficits.

INTRODUCTION: Rotator cuff tendinopathy (RCTe) is the most frequent cause of shoulder pain, resulting in considerable losses to society and public resources. Muscle imbalance and inadequate sensorimotor control are deficits often associated with RCTe. Kinesiotaping (KT) is widely used by clinicians for rehabilitation of RCTe. While previous studies have examined the immediate effects of KT on shoulder injuries or the effects of KT as an isolated method of treatment, no published study has addressed its mid-term and long-term effects when combined with a rehabilitation programme for patients with RCTe. The primary objective of this randomised controlled trial (RCT) will be to assess the efficacy of therapeutic KT, added to a rehabilitation programme, in reducing pain and disabilities in individuals with RCTe. Secondary objectives will look at the effects of KT on the underlying factors involved in shoulder control, such as muscular activity, acromiohumeral distance (AHD) and range of motion (ROM). METHODS AND ANALYSIS: A single-blind RCT will be conducted. Fifty-two participants, randomly allocated to one of two groups (KT or no-KT), will take part in a 6-week rehabilitation programme. The KT group will receive KT added to the rehabilitation programme, whereas the no-KT group will receive only the rehabilitation programme. Measurements will be taken at baseline, week 3, week 6, week 12 and 6 months. Primary outcomes will be symptoms and functional limitations assessed by the Disabilities of the Arm, Shoulder and Hand questionnaire. Secondary outcomes will include shoulder ROM, AHD at rest and at 60° of abduction, and muscle activation during arm elevation. The added effects of KT will be assessed through a two-way analysis of variance for repeated measures. ETHICS AND DISSEMINATION: Ethics approval was obtained from the Ethics Committee of Quebec Rehabilitation Institute of the Centre Integrated University Health and Social Services. Results will be disseminated through international publications in peer-reviewed journals, in addition to international conference presentations. TRIAL REGISTRATION NUMBER: Protocol was registered at ClinicalTrials.gov (NCT02881021) on 25 August 2016. The WHO Trial Registration Data Set can also be found as an online supplementary file.

Lower limb control and strength in runners with and without patellofemoral pain syndrome.

Recreational runners with patellofemoral pain syndrome (PFPS) have been shown to present altered movement kinematics, muscle activations, and ground reaction forces (GRF) during running as well as decreased lower limb strength. However, these variables have never been concurrently evaluated in a specific cohort. Therefore, the aim of this study was to compare lower limb control variables during running in recreational runners with and without PFPS. Lower limb control during treadmill running under typical training conditions (usual shoes, foot strike pattern, and speed) was compared between runners with (n=21) and without (n=20) PFPS using lower limb kinematics, electromyographic (EMG) recordings from representative muscles (gluteus medius/maximus, quadriceps and soleus), and vertical GRF. Isometric muscle strength was also evaluated. When comparing all runners from both groups, no between-group differences were found in variables commonly associated with PFPS such as peak hip adduction, hip internal rotation, contralateral pelvic drop, EMG of gluteal and quadriceps muscles, vertical loading rate, or lower limb strength. However, runners with PFPS showed significantly higher hip adduction at toe-off, lower excursion in hip adduction during late-stance, and longer duration of soleus activation. Sub-analyses were performed for females and for rearfoot strikers (RFS), and revealed that these subgroups accounted for most of between-group differences in hip adduction kinematics. Specifically for RFS with PFPS, lower activation of gluteus medius as well as lower GRF were observed. Our results suggest that deficits reported in runners with PFPS may vary depending on gender and on foot strike pattern.

Psychometric evidence of self-reported questionnaires for patellofemoral pain syndrome: a systematic review.

PURPOSE: To conduct a systematic review of psychometric properties of self-reported questionnaires used to assess the level of symptoms and disability in individuals with patellofemoral pain syndrome (PFPS). METHODS: A structured search was conducted in four databases (Medline, Embase, CINAHL, SportDiscus). A total of 24 studies about five different self-reported questionnaires were analyzed. A pair of independent raters extracted data on validity, reliability and responsiveness to change, and performed critical appraisal (0-100%). RESULTS: Activities of Daily Living Scale (ADLS), Anterior Knee Pain Scale (AKPS), International Knee Documentation Committee (IKDC) and Lysholm Scale (LS) present excellent test-retest reliability (weighted average intraclass correlation coefficients [ICC] > 0.80), whereas Functional Index Questionnaire (FIQ) is moderately reliable (ICC = 0.61). Minimal detectable change is 8.3% for ADLS, 9.0% for AKPS, 19% for FIQ, 8.5% for IKDC and 30% for LS. ADLS, AKPS, IKDC and LS are highly responsive (effect size/standardized response mean >0.95) in individuals with PFPS, while FIQ is lowly responsive (effect size = 0.49). CONCLUSION: Based on available evidence, ADLS presents the best psychometric properties and should be preferred when evaluating patients with PFPS. AKPS and IKDC are also adequate, while FIQ and LS are not recommended for individuals with PFPS. IMPLICATIONS FOR REHABILITATION: While several questionnaires have been developed to assess symptoms and functional limitations caused by knee pain, their psychometric properties can vary depending on the condition presented by the patient. The Activities of Daily Living Scale of the Knee Outcome Survey should be preferred by clinicians when evaluating a patient with PFPS. The Anterior Knee Pain Scale and International Knee Documentation Committee Subjective knee evaluation are also adequate for use with this population. The Functional Index Questionnaire and Lysholm Scale are not recommended for PFPS.