Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial.

OBJECTIVES: There is considerable debate among clinicians as to whether sports tape can provide mechanical support and pain relief. People with greater trochanteric pain syndrome (GTPS) have increased adduction moment, adduction angle and pelvic obliquity, likely contributing to the continuation of the pathology. We aimed to see if Dynamic Tape® could control these movements and reduce pain. METHODS: Fifty women with GTPS participated in a three-dimensional gait analysis. Each participant performed three walking trials: baseline, and two subsequent trials, with active and sham applications of Dynamic Tape. The order of active and sham taping was randomised. Differences in kinetic and kinematic data were analysed using mixed model linear regressions for each condition. Pain scores were obtained before and immediately after walking trials. RESULTS: Hip adduction moment was reduced at first peak by both active (p < 0.001) and sham tape (p = 0.028), with no between group difference; at second peak by the active taping (p < 0.001), with a between-group difference (p < 0.001). Adduction angle was reduced at first peak by both active (p < 0.001) and sham taping (p = 0.026), with the active taping producing a larger effect (p = 0.004); at mid-stance by active taping (p = 0.003), with a between-group difference (p = 0.002); there was no reduction at second peak. Internal rotation was reduced at the first (p < 0.001) and second peaks (p < 0.001), and mid-stance by the active taping alone (p < 0.001). Pelvic obliquity was reduced at the first peak (p = 0.019), mid-stance (p < 0.001) and second peak (p < 0.001) by the active tape, with a between-group difference at mid-stance (p = 0.03). Both the active and sham taping resulted in a clinically meaningful pain reduction. CONCLUSION: Dynamic Tape produced a mechanical effect and a meaningful reduction in pain in women with GTPS. The extent that placebo or somatosensory input may have had on these results is not clear. CLINICAL TRIAL REGISTRATION NUMBER: ACTRN12617001611314.

Variability and Impact of Self-Selected Interset Rest Periods During Experienced Strength Training.

We investigated the variability of strength trained athletes' self-selected rest periods between sets of heavy squat training. Sixteen strength-trained male athletes (Mage = 23, SD = 3 years) completed two squat training sessions 48 hours apart. Each training session consisted of five sets of 5RM squats, interspersed with self-selected interset rest periods. A Gymaware linear optical encoder collected kinetic data for each squat and temporal data for each interset rest period. The participants' subjective ratings of the experience were taken before (Readiness to Lift [RTL]) and after (Rating of Perceived Effort [RPE]) each set. Mean total rest time and mean power output differed significantly between sessions. For both sessions, interset rest period increased, and power output decreased between Sets 3, 4, and 5 (95% CI range [-101, -17]) compared with Set 1. In both sessions, RPE increased significantly in Set 3 compared with Set 1 (95% CI range = [0.68, 2.19]), while RTL decreased significantly from Set 3 (95% CI range [-2.99, -0.58]) compared to Set 1. Interset rest period and power output demonstrated fair reliability between sessions (mean intraclass correlation coefficient = 0.55), while RPE and RTL demonstrated good and excellent reliability, respectively (mean intraclass correlation coefficient = 0.63 and 0.80). In conclusion, highly trained strength athletes demonstrated a significant difference in their between session power output and total rest time when using self-selected interset rest periods, despite stability in their subjective ratings of fatigue and effort. Interset rest periods can be self-selected reliably to complete strength training in heavy squat protocol; however, power output may decline during the set.

Microvascular volume in symptomatic Achilles tendons is associated with VISA-A score.

OBJECTIVES: The role of neovascularisation in tendinopathy is still poorly understood, potentially due to technical limitations of conventional power Doppler ultrasound. This study aimed to investigate the association between contrast-enhanced ultrasound (CEUS) microvascular volume (MV), Victorian Institute of Sports Assessment-Achilles (VISA-A) scores and intrinsic Achilles tendon tenderness, as well as two different Power Doppler modes. DESIGN: Cross-sectional study. METHODS: 20 individuals with uni- or bilateral Achilles tendinopathy completed a VISA-A questionnaire, and underwent microvascular volume measurements of the Achilles tendon mid-portion using both conventional, ultrasensitive (SMI™) power Doppler ultrasound and CEUS. Intrinsic tendon tenderness was assessed with sensation detection threshold to extracorporeal shock waves (ESW). Linear Mixed Model analysis was used to determine the association between microvascular volume (MV), VISA-A, and ESW-detection threshold for both symptomatic and asymptomatic Achilles tendons. RESULTS: There was a significant association between VISA-A and MV (B=-5.3, 95%CI=[-8.5; -2.0], P=0.0004), and between MV and symptom duration (B=-1.7, 95%CI=[-3.2; -5.0], P=0.023). No significant associations were found between power Doppler ultrasound and CEUS-based MV or between CEUS-based MV and ESW-detection threshold. In comparison with conventional power Doppler ultrasound, SMI™ showed on average similar detection capacity for neovessels in the mid-portion of the Achilles tendon, whilst being superior for detecting neovessels within Kager's fat pad (t=3.46, 95%CI=[0.27; 1.03], P<0.005). CONCLUSIONS: Our results indicate that CEUS-based MV of the Achilles tendon is moderately associated with Achilles tendon symptoms. In accordance, CEUS-detected MV could be a novel target for treatment as it seems to be more sensitive than PDU and is correlated with symptoms.

Experimental pain in the groin may refer into the lower abdomen: Implications to clinical assessments.

OBJECTIVES: To investigate the effects of experimental adductor pain on the pain referral pattern, mechanical sensitivity and muscle activity during common clinical tests. DESIGN: Repeated-measures design. METHODS: In two separate sessions, 15 healthy males received a hypertonic (painful) and isotonic (control) saline injection to either the adductor longus (AL) tendon to produce experimental groin pain or into the rectus femoris (RF) tendon as a painful control. Pain intensity was recorded on a visual analogue scale (VAS) with pain distribution indicated on body maps. Pressure pain thresholds (PPT) were assessed bilaterally in the groin area. Electromyography (EMG) of relevant muscles was recorded during six provocation tests. PPT and EMG assessment were measured before, during and after experimental pain. RESULTS: Hypertonic saline induced higher VAS scores than isotonic saline (p<0.001), and a local pain distribution in 80% of participants. A proximal pain referral to the lower abdominal region in 33% (AL) and 7% (RF) of participants. Experimental pain (AL and RF) did not significantly alter PPT values or the EMG amplitude in groin or trunk muscles during provocation tests when forces were matched with baseline. CONCLUSIONS: This study demonstrates that AL tendon pain was distributed locally in the majority of participants but may refer to the lower abdomen. Experimental adductor pain did not significantly alter the mechanical sensitivity or muscle activity patterns.

Behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity: a systematic review and meta-analysis.

Poor adherence to lifestyle intervention remains a key factor hindering treatment effectiveness and health outcomes for adults with obesity. The aim of this systematic review and meta-analysis is to determine if behavioural treatment strategies (e.g. goal setting, motivational interviewing, relapse prevention, cognitive restructuring etc.) improve adherence to lifestyle intervention programmes in adults with obesity. Randomized controlled trials that investigated the use of behavioural treatment strategies in obesity management were identified by systematically reviewing the literature within Medline, PsycINFO, CINAHL, SPORTDiscus and Web of Science from their inception to August 2016. This meta-analysis shows that behavioural treatment interventions have a significant positive effect on session attendance (percentage) and physical activity (total min/week) in adults with obesity (M = 17.63 (95% confidence interval (CI) = 10.77, 24.50), z =5.0337, P < 0.0001 and M = 105.98 (95% CI = 58.64, 153.32), z =4.3878, P < 0.0001, respectively). This meta-analysis of randomized controlled trials provides evidence that behavioural treatment strategies improve adherence to lifestyle intervention programmes in adults with obesity. These strategies should be routinely incorporated into lifestyle intervention, obesity management and weight loss programmes with the aim of improving engagement and adherence. If adherence were improved, treatment effectiveness, health outcomes and the ultimate burden of chronic disease could also be improved.

How ignoring physiological noise can bias the conclusions from fMRI simulation results.

Neuroimaging researchers use simulation studies to validate their statistical methods because it is acknowledged that this is the most feasible way to know the ground truth of the data. The noise model used in these studies typically varies from a simple Gaussian distribution to an estimate of the noise distribution from real data. However, although several studies point out the presence of physiological noise in fMRI data, this noise source is currently lacking in simulation studies. Therefore, we explored the impact of adding physiological noise to the simulated data. For several experimental designs, fMRI data were generated under different noise models while the signal-to-noise ratio was kept constant. The sensitivity and specificity of a standard statistical parametric mapping (SPM) analysis were determined by comparing the known activation with the detected activation. We show that by including physiological noise in the data generation process, the simulation results in terms of sensitivity and specificity drop dramatically. Additionally, we used the new proposed simulation model to compare a standard SPM analysis against the method proposed by Cabella et al. (2009). The results indicate that the analysis of data containing no physiological noise yields a better performance of the SPM analysis. However, if physiological noise is included in the data, the sensitivity and specificity of the Cabella method are higher compared to the SPM analysis. Based on these results, we argue that the results of current simulation studies are likely to be biased, especially when analysis methods are compared using ROC curves.