An interdisciplinary examination of attentional focus strategies used during running gait retraining.

The aim was to investigate the biomechanical, physiological, and perceptual responses to different motor learning strategies derived to elicit a flatter foot contact. Twenty-eight rearfoot-striking recreational runners (age 24.9 ± 2.8 years; body mass 78.8 ± 13.6 kg; height 1.79 ± 0.09 m) were matched by age, mass, and height and assigned to one verbal cue group: internal focus of attention (IF), external focus of attention (EF), and a clinically derived condition (CLIN) incorporating an IF followed by an EF statement. Participants completed two treadmill runs at 10 km h-1 for 6 minutes each: normal running (control) followed by the experimental condition (IF, EF, or CLIN). Lower limb kinematics, oxygen consumption ( V ˙ O 2 ), and central and peripheral ratings of perceived exertion (RPE) were recorded for each run. Compared to the control condition, foot angle was reduced in the IF (difference = 5.86°, d = 2.58) and CLIN (difference = 3.00°, d = 1.31) conditions, but unchanged in the EF condition (difference = 0.33°, d = 0.14), while greater knee flexion at initial contact in the EF and CLIN conditions was observed (difference = -5.19°, d = 1.97; difference = -3.66°, d = 1.39, respectively). A higher V ˙ O 2 was observed in the CLIN condition (difference = -4.56 mL kg-1  min-1 , d = 2.29), but unchanged in the IF (difference = -1.87 mL kg-1  min-1 , d = 0.94) and EF conditions (difference = -0.37 mL kg-1  min-1 , d = 0.19). All experimental conditions increased central and peripheral RPE (difference = -1.08, d = 0.54 and difference = -2.39, d = 1.33, respectively). Providing gait retraining instructions using an internally directed focus of attention was the most effective way to target specific changes in running kinematics, with no detrimental effect on physiological responses. Yet, perceptual effort responses increased regardless of the type of cue provided.

Proximal Hamstring Tendinopathy: Clinical Aspects of Assessment and Management.

Synopsis Proximal hamstring tendinopathy (PHT) typically manifests as deep buttock pain at the hamstring common origin. Both athletic and nonathletic populations are affected by PHT. Pain and dysfunction are often long-standing and limit sporting and daily functions. There is limited evidence regarding diagnosis, assessment, and management; for example, there are no randomized controlled trials investigating rehabilitation of PHT. Some of the principles of management established in, for example, Achilles and patellar tendinopathy would appear to apply to PHT but are not as well documented. This narrative review and commentary will highlight clinical aspects of assessment and management of PHT, drawing on the available evidence and current principles of managing painful tendinopathy. The management outline presented aims to guide clinicians as well as future research. J Orthop Sports Phys Ther 2016;46(6):483-493. Epub 15 Apr 2016. doi:10.2519/jospt.2016.5986.