OBJECTIVE: To synthesise and critically evaluate evidence on treatment effect moderators in the primary care management of low back pain (LBP). DESIGN: Systematic review of randomised controlled trials (RCTs) and secondary analyses of RCTs. LITERATURE SEARCH: Medline, EMBASE, CINAHL and Cochrane Library were searched from inception to August 2025. STUDY SELECTION CRITERIA: RCTs investigating moderators for primary care interventions in non-specific LBP. DATA SYNTHESIS: Data were synthesised by exploring data clusters (similar intervention-moderator combinations) and examining high-quality evidence with promising effects. The quality of moderation analyses was assessed using the Instrument for assessing the Credibility of Effect Moderation Analyses (ICEMAN) tool and trial quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. Study diversity precluded meta-analysis. RESULTS: Seventy-three studies were identified. The studies were highly heterogeneous with almost no repeated investigations of the same intervention-moderator combination. While RCT quality was generally high, moderation analysis quality was poor. Six studies (8% of 73) prioritised effect moderation as the primary aim. The remaining studies tended to analyse available data post-hoc rather than assessing theory driven moderators. Ten higher-quality analyses did not identify any clearly important moderators. Results were inconclusive due to high uncertainty (e.g. wide confidence intervals, lack of statistical significance) and conflicting findings. Some promising moderators were identified in fair-quality analyses, for example, graded exposure appeared more effective for those with high catastrophising. CONCLUSION: We identified a broad, but superficial body of literature on effect moderation in LBP primary care. The promising moderators identified require further testing before they can be recommended for clinical practice.
OBJECTIVE: To evaluate the efficacy of exercise therapy interventions differing in frequency, intensity, type, and time (FITT) on disability in individuals with nonspecific chronic low back pain (LBP). DESIGN: Intervention systematic review with meta-analyses. LITERATURE SEARCH: Electronic databases were searched from inception to March 2026. STUDY SELECTION CRITERIA: We included randomized controlled trials (RCTs) that enrolled adults with nonspecific chronic LBP (>3 months) and compared exercise interventions differing in at least 1 FITT component and reported disability outcomes. DATA SYNTHESIS: Random-effects meta-analyses were conducted for each FITT component. Certainty of evidence was assessed using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) framework, and prediction intervals were calculated. A complementary analysis used a 0-100 disability scale, with a 15-point improvement prespecified as the minimal clinically important difference. RESULTS: Seventy RCTs (n = 3991) were included. High-frequency programs (≥3 sessions per week) showed statistically significant improvements in long-term disability compared with low-frequency programs (standardized mean difference [SMD], 0.29; 95% confidence interval [CI]: 0.09, 0.49; moderate certainty). Sensorimotor short-term (SMD, -0.49; 95% CI: -0.78, -0.21; very low certainty) and long-term (SMD, -0.76; 95% CI: -1.48, -0.03; very low certainty), yoga short-term (SMD, -0.39; 95% CI: -0.68, -0.10; moderate certainty), and assisted long-term (mean difference, -3.96; 95% CI: -5.47, -2.45; moderate certainty) exercise programs demonstrated statistically significant reductions in disability compared with other modalities. CONCLUSION: In adults with nonspecific chronic LBP, higher-frequency exercise programs were associated with improvements in disability. Sensorimotor, yoga, and assisted exercises may offer modest additional benefits. Given the low certainty and lack of clinically meaningful effects, exercise prescriptions should prioritize patient preferences, feasibility, and long-term adherence rather than a single FITT component. J Orthop Sports Phys Ther 2026;56(9):571-584. Epub 14 July 2026. doi:10.2519/jospt.2026.14098.
SYNOPSIS: Recently, the use of nonpathoanatomical functional diagnoses has been advocated as a way of reducing patients' psychological distress and limiting the use of low-value interventions aimed at "fixing" perceived causes of pain and disability. However, we argue that not disclosing a pathoanatomical diagnosis may withhold essential information that patients need to fully understand their prognosis and treatment plan, as well as appropriate precautions and contraindications. The way clinicians communicate a pathoanatomical diagnosis can mitigate its potential drawbacks while also supporting patients in making sense of what is happening in their body. J Orthop Sports Phys Ther 2026;56(9):566-568. Epub 3 June 2026. doi:10.2519/jospt.2026.14197.
OBJECTIVES: The aims of this study were to (a) investigate whether the timing and magnitude of exposure to high-speed running (HSR), sprinting, and high-intensity accelerations during on-field rehabilitation after hamstring strain injury were associated with reinjury risk and (b) examine changes in match running performance upon return to play (RTP). DESIGN: Retrospective cohort study. METHODS: Data from 95 elite male football (soccer) players from five professional clubs competing in major European and Middle Eastern leagues were analyzed. Players with complete rehabilitation load profiles were included in the 2-month and 6-month reinjury analysis. Modified Poisson regression assessed associations between rehabilitation load characteristics and reinjury risk. Match running performance (HSR distance, sprint distance, and high-intensity accelerations per minute) during the five matches before injury and the first five matches after RTP was compared using paired t-tests for the entire cohort. RESULTS: Late introduction of HSR, sprinting, and high-intensity accelerations during rehabilitation (ie, ≥ 60% of rehabilitation progression) was associated with a significantly lower reinjury risk at 2 months (relative risk [RR] range = 0.948-0.969; P < .01) and 6 months (RR range = 0.964-0.979; P < .05). Higher daily exposure to high-intensity accelerations once introduced was protective (RR = 0.861 (0.778-0.951)). There were no meaningful associations between total volume of HSR or sprinting and reinjury. Match running performance metrics did not differ between pre-injury and post-RTP matches (all P > .05). Changes in performance were not correlated with rehabilitation load characteristics. CONCLUSION: The timing of high-intensity running exposure during on-field rehabilitation appeared associated with a lower hamstring reinjury risk. Delaying the introduction of HSR, sprinting, and accelerations, followed by a structured and progressive build-up, was associated with lower risk of reinjury without compromising the subsequent match performance of elite male football players. J Orthop Sports Phys Ther 2026;56(9):611-621. Epub 7 Jul 2026. doi:10.2519/jospt.2026.14077.
OBJECTIVES: We aimed (1) to estimate the dose-response relationships between isotonic lower extremity resistance exercise volume and outcomes of pain, function, and strength in people with knee osteoarthritis (OA) and (2) to compare different intensities and delivery methods of isotonic resistance exercise for patients with knee OA. DESIGN: Systematic review with dose-response meta-analysis of randomized controlled trials (RCTs). LITERATURE SEARCH: MEDLINE (Medical Literature Analysis and Retrieval System Online)/PubMed, CENTRAL (Cochrane Central Register of Controlled Trials), Web of Science, CINAHL (Cumulative Index of Nursing and Allied Health), and EMBASE (Excerpta Medica Database) were searched from inception to January 2, 2025. STUDY SELECTION CRITERIA: RCTs evaluating isolated isotonic resistance training without other exercise interventions in people with knee OA were included. DATA SYNTHESIS: Pain, function, and muscle strength were analyzed. Risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool; certainty of evidence, using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach; and dose-response relationships, using restricted cubic spline models. RESULTS: Twenty RCTs were included (n = 791). Low- to very low-certainty evidence indicated that isotonic resistance training may reduce pain, improve function, and increase muscle strength in people with knee OA. Very light- to moderate-intensity isotonic exercise produced the greatest reductions in pain; moderate-intensity, the greatest improvements in function; and moderate- to vigorous-intensity, similar gains in muscle strength. Benefits were seen with home- and center-based programs; the effects were more pronounced with center-based programs. For the dose-response analyses, there was a nonlinear relationship, with greater estimated pain reductions at 6000 repetitions (mean difference [MD], -3.52; 95% confidence interval [CI]: -4.08, -2.96), peak functional improvements at 2600 repetitions of moderate intensity (MD, -16.66; 95% CI: -18.80, -14.51), and maximal strength gains at 1600 repetitions (standardized MD, 0.12; 95% CI: 0.01, 0.22). CONCLUSION: Isotonic resistance training may improve pain, function, and muscle strength in people with knee OA. Moderate-intensity exercise and specific training volumes were associated with the greatest estimated benefits, although the certainty of evidence was low to very low. J Orthop Sports Phys Ther 2026;56(9):585-595. Epub 6 Aug 2026. doi:10.2519/jospt.2026.13477.
SYNOPSIS:Patients with hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) frequently present to outpatient musculoskeletal practice. Yet many physical therapists feel uncertain about how best to manage these complex conditions. Individuals often report years of recurrent sprains, joint subluxations, widespread pain, and fatigue, accompanied by normal imaging and inconsistent clinical explanations. As a result, care may become fragmented, overly passive, or prematurely discontinued when pain persists. Although high-quality randomized trials remain limited, international classification updates and emerging consensus provide sufficient direction to guide practice. This editorial argues that a preparation gap exists in musculoskeletal physical therapy and outlines five principles for best-practice care: recognizing hypermobility as a multisystem condition, prioritizing education and validation, emphasizing active stabilization over passive strategies, accounting for altered pain processing and fatigue, and collaborating within a broader interdisciplinary framework. Applying these principles shifts the focus from eliminating pain to restoring function, participation, and self-efficacy. Patients with HSD or hEDS do not require rare-disease specialty clinics to improve; they require clinicians who are prepared to recognize their presentation and deliver thoughtful, evidence-informed care. The responsibility now lies with individual practitioners, educators, and professional organizations to translate existing knowledge into everyday musculoskeletal practice. J Orthop Sports Phys Ther 2026;56(8):478-481. Epub 25 March 2026. doi:10.2519/jospt.2026.13979
Recently, the use of non-pathoanatomical functional diagnoses has been advocated as a way of reducing patients’ psychological distress and limiting the use of low-value interventions aimed at “fixing” perceived causes of pain and disability. However, we argue that avoiding the disclosure of a pathoanatomical diagnosis may withhold essential information that patients need to fully understand their prognosis and treatment plan, as well as appropriate precautions and contraindications. Importantly, the way clinicians communicate a pathoanatomical diagnosis can mitigate its potential drawbacks, while also supporting patients in making sense of what is happening in their body.
Researchers conduct prognosis and prediction studies to measure the course of symptoms for various conditions over time and try to identify which patients will do better or worse. Although this type of research is common in the musculoskeletal field, there are few available tools that reliably predict outcome. This is because developing and testing a prediction tool requires a multi-stage process that is rarely carried out, and prediction studies frequently contain critical errors in methods and interpretation. J Orthop Sports Phys Ther 2026;56(8):563-565. Epub 24 Jun 2026. doi:10.2519/jospt.2026.0701
OBJECTIVES: We aimed to determine whether, for patients with severely disabling chronic low back pain (cLBP), initiating care with cognitive functional therapy combined with psychologist support (CFT+) improved disability and pain, and was cost-effective compared with an interdisciplinary pain management program (IPMP) at 12 months. METHODS: We conducted a randomized controlled trial (NCT04399772) with concealed allocation, blinded patients, and intention-to-treat analysis. One hundred thirty-three adults with severely disabling cLBP, who were referred to an interdisciplinary pain center, were randomized to CFT+ for 3 months, with optional access to IPMP thereafter, or to IPMP alone. The primary outcome was the proportion of patients who achieved a ≥8-point improvement on the Oswestry Disability Index (ODI) at 12 months. Secondary outcomes were pain intensity, pain catastrophizing, patient enablement, global impression of change, and cost-effectiveness assessed using quality-adjusted life years (QALYs) derived from the EQ-5D-3L (EuroQol 5-Dimension 3-Level Questionnaire) and health care contacts. RESULTS: At 12 months, ODI data were available for 46 (70%) patients in the CFT+ group and 45 (67%) in the IPMP group. A ≥8-point ODI improvement was achieved by 22% of patients who received CFT+ and 18% who received IPMP (difference, 3.9%; 95% CI: -12.4%, 20.3%; P = .64). Mean ODI change did not differ between groups (difference, 0.2; 95% CI: -3.8, 4.2; P = .92). There were no significant between-group differences for the secondary outcomes. Economic analysis estimated an incremental cost-effectiveness ratio of €53 075 per QALY for CFT+ versus IPMP. CONCLUSION: CFT+ was not superior to IPMP for people with severely disabling cLBP. J Orthop Sports Phys Ther 2026;56(9):596-610. Epub 25 June 2026. doi:10.2519/jospt.2026.14238.
OBJECTIVE: To determine the trajectory of (1) change in pain-related fear and catastrophizing factors, (2) changes in pain-related fear and catastrophizing by treatment satisfaction groups, and (3) the relationship between pain-related fear trajectories, and catastrophizing factors and shoulder disability during an 8-week resistance exercise program. DESIGN: Prospective longitudinal observational study. METHODS: Sixty-four people with rotator cuff tendinopathy completed the exercise protocol. Outcomes of Penn Shoulder Score (Penn) shoulder disability and pain-related fear and catastrophizing via the Optimal Screening for Prediction of Referral and Outcome-Yellow Flag (OSPRO-YF) were assessed at baseline and at 2, 4, and 8 weeks. Patient Acceptable Symptom State (PASS) defined satisfaction with treatment at 8 weeks. RESULTS: All pain-related fear and catastrophizing measures changed over time during resistance exercise (P < .01) but differed by PASS-defined responder and nonresponder groups. For the Fear-Avoidance Beliefs Questionnaire-Work subscale (FABQ-W), nonresponders had an increase (0.63 pt) while responders had a decrease (-3.5 pt) (mean difference, 4.2 pt; 95% confidence interval [CI]: -7.6, -0.7; P = .02). For TSK-11, nonresponders had less of a decrease (-0.1) than responders (-3.2 pt) (mean difference, 3.1 pt; 95% CI: -5.9, -0.3; P = .03). Reduced shoulder disability was related to less pain-related fear and catastrophizing (P < .01), and differed by responder group. Nonresponders had no relationship between change in pain-related fear and catastrophizing and disability (P>.05); responders had an overall negative relationship (P < .04). CONCLUSION: Pain-related fear and catastrophizing changed over time for individuals with rotator cuff tendinopathy, and changes varied by participant. Those who were not satisfied at 8 weeks had higher levels of pain-related fear and catastrophizing, while those who were satisfied had reduced pain-related fear and catastrophizing. Less pain-related fear and catastrophizing was related to decreased disability. J Orthop Sports Phys Ther 2026;56(8):546-554. Epub 9 Jun 2026. doi:10.2519/jospt.2026.13563.
OBJECTIVE: To assess whether adding psychologically informed education (PIE) videos to usual care physical therapy (PT) improved function (primary outcome) and pain-related beliefs, pain intensity, and physical activity (secondary outcomes) in adolescents with atraumatic leg pain. DESIGN: Double-blinded randomized controlled trial. METHODS: Eighty-three adolescents (mean age, 14.7 ± 1.6 years; 62% female) with atraumatic leg pain (including patellofemoral pain, apophyseal injuries, tendinopathy) were randomized to view 3 PIE or control videos. All participants completed 6 weeks of PT. The PIE videos targeted kinesiophobia, fear avoidance, and catastrophizing; the control videos addressed anatomy and biomechanics. Outcomes were assessed at baseline, 1 month, and 12 months. The primary outcome was change in function (Lower Extremity Functional Scale). Secondary outcomes were pain-related beliefs, pain intensity, and physical activity. RESULTS: There was no between-group difference in function over time ( P = .40), with similar changes at 1 month (PIE: 12.5 [95% CI: 7.4, 17.5]; control: 8.9 [95% CI: 5.1, 12.8]) and 12 months (PIE: 17.1 [95% CI: 11.8, 22.5]; control: 14.9 [95% CI: 10.3, 19.5]). Adolescents in the PIE group had a greater reduction in pain-related beliefs after 1 month (fear avoidance: PIE, 50% vs control, 23%; kinesiophobia: PIE, 50% vs control, 8%; catastrophizing: PIE, 27% vs control, 19%; P = .01). There were no between-group differences in pain ( P = .82) or physical activity ( P = .50). At 12 months, 34% (n = 26) reported persistent pain. CONCLUSION: Brief PIE did not improve function, pain intensity, or physical activity when added to usual PT care for adolescents with atraumatic leg pain. Adolescents who received the PIE videos reduced pain-related beliefs. J Orthop Sports Phys Ther 2026;56(8):555-562. Epub 26 May 2026. doi:10.2519/jospt.2026.14057
SYNOPSIS: Musculoskeletal treatments often appear simple, yet the mechanisms underlying their effects remain difficult to explain. Patients and clinicians routinely ask why exercises, manual techniques, or psychologically informed interventions help, but current evidence rarely supports the intuitive explanations offered in practice. Although mechanistic research promises more precise and individualized care, most studies isolate single pathways under controlled conditions that fail to reflect the complexity of human recovery. In real-world musculoskeletal care, physiological, psychological, and social processes interact continuously, producing therapeutic effects that are multifactorial, dynamic, and only partially measurable. This interconnectedness creates an inverse relationship between what is easy to study and what meaningfully explains clinical outcomes. Persistent uncertainty should not be interpreted as treatment inefficacy but as a reflection of living systems in which no single mechanism dictates recovery. Embracing complexity allows the field to move beyond reductionist debates and toward more meaningful scientific and clinical questions. J Orthop Sports Phys Ther 2026;56(9):569-570. Epub 3 Jun 2026. doi:10.2519/jospt.2026.14486.
OBJECTIVE: The primary aim was to quantify changes in structural and functional nerve parameters following carpal tunnel release. The secondary aims were to describe recovery trajectories and describe the regenerative capacity of the median nerve. DESIGN: Prognosis systematic review with meta-analysis. LITERATURE SEARCH AND SELECTION CRITERIA: Six databases were searched from inception to June 2024 for studies reporting at least 1 of the following outcomes: electrodiagnostic measures, quantitative sensory testing, grip/pinch strength, 2-point discrimination, Semmes-Weinstein monofilament, intraepidermal nerve fiber density, autonomic measures, brain function/structure, or Boston Carpal Tunnel Questionnaire. DATA SYNTHESIS: Outcomes were categorized by time post surgery: <2, 2 to 4, 5 to 7, 8 to 12, and >12 months. Randomized and observational studies were included, with quality assessed using the RoB 2 tool (revised Cochrane Risk of Bias tool for randomized trials) and the Newcastle-Ottawa Scale, respectively. RESULTS: A total of 199 studies comprising 15 636 patients and 578 healthy controls were included. We observed significant, time-dependent improvement in most outcomes. Grip and pinch strength did not show marked recovery until 5 to 7 months postoperatively. Compared to healthy controls, patients had persistent deficits in several electrodiagnostic measures even 1 year after surgery. Impairments in warm, vibration, and mechanical detection thresholds persisted up to 6 months postoperatively. CONCLUSION: Carpal tunnel release led to gradual improvement in median nerve function and structure. Key measures—including electrodiagnostics, detection thresholds, and intraepidermal nerve fiber density—often remained below normal levels after surgery. J Orthop Sports Phys Ther 2026;56(8):482-529. Epub 19 May 2026. doi:10.2519/jospt.2026.13846
OBJECTIVE: To compare the effects of aerobic exercise, resistance exercise, and combined interventions on pain, function, and quality of life (QoL) in patients with knee osteoarthritis (OA) at short-term (≤12 weeks) and long-term (>12 weeks). DESIGN: Intervention systematic review with Bayesian network meta-analysis (NMA). LITERATURE SEARCH: MEDLINE, PubMed, EMBASE, CENTRAL, CINAHL, PEDro, AMED, and SPORTDiscus were searched from inception until July 2025. STUDY SELECTION CRITERIA: We included randomized controlled trials (RCT) of patients with knee OA that evaluated exercise interventions aimed at improving pain, function, and QoL. DATA SYNTHESIS: Using random-effects models, the NMA synthesized effect sizes and ranked interventions by the surface under the cumulative ranking curve (SUCRA), with evidence certainty assessed via the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Thirty-five RCTs (n = 3808 patients) were included. For pain, short-term combined aerobic and resistance exercise had the largest effect among the interventions (standardized mean difference [SMD] = −0.937, low certainty). For function, short-term combined aerobic and resistance exercise had the largest effect estimates (SMD = −0.590, low certainty), followed by long-term aerobic exercise (SMD = −0.540, very low certainty). Short-term combined aerobic and resistance exercise had the largest effect (SMD = 0.663, low certainty) for improving QoL. CONCLUSION: Aerobic and resistance exercise, alone or in combination, and delivered over the short- or long-term, improved pain, function and QoL for patients with knee OA. Short-term combined aerobic and resistance exercise had clinically meaningful improvements for pain, with relatively favorable effects on function and QoL. Evidence regarding the clinical significance of long-term exercise interventions was limited.
OBJECTIVE: To evaluate the reporting quality and exercise characteristics of exercise-based rehabilitation programs for athletes with long-standing groin pain. DESIGN: Scoping review. LITERATURE SEARCH: We searched the Scopus, Cochrane Library, PubMed, and Google Scholar databases in March 2025. STUDY SELECTION CRITERIA: We included original research studies on exercise-based rehabilitation programs for athletes (≥18 years) with long-standing groin pain. DATA SYNTHESIS: Reporting quality was evaluated according to Consensus on Exercise Reporting Template (CERT) (score range of 0-19) and Fundamental Resistance Exercise Descriptors (FRED) (score range of 0-13) recommendations. Intervention content was extracted. RESULTS: Twenty-two reports were included. Four reports used the same rehabilitation protocol and were considered as 1 study. According to the CERT, 3 studies had moderate and 16 studies had low reporting quality. The mean CERT score was 7.7 (SD, ±4.3; range, 1-14), and the mean FRED score was 3.7 (SD, ±1.8; range, 0-7). The CERT items reported by most studies were whether exercises were generic or tailored (89%), the setting (68%), and whether there were nonexercise components (68%). The FRED items reported by most studies were the repetition and set number (73%), the session number per day/week (73%), and the program duration (63%). CONCLUSION: The quality of reporting in the rehabilitation of long-standing groin pain was generally poor and should be improved to help with replication in future research and clinical practice. Most protocols included exercises targeting the injured and uninjured structures, tending toward a more general exercise prescription for rehabilitation of long-standing groin pain in athletes. J Orthop Sports Phys Ther 2026;56(7):427-447. Epub 19 May 2026. doi:10.2519/jospt.2026.13708.
OBJECTIVE: To evaluate a 3-month post-hip arthroscopy rehabilitation program within a randomized controlled trial comparing hip arthroscopy to sham surgery for femoroacetabular impingement syndrome (HIP ARThroscopy International [HIPARTI] trial) by describing exercise adherence, type, and pain; 6-month changes in International Hip Outcome Tool-33 (iHOT-33); and physical impairments and functional performance. DESIGN: Exploratory cohort study nested in a pilot randomized controlled trial. METHODS: Participants aged 18 to 50 years with femoroacetabular impingement syndrome completed a 3-month, physical therapist-led, postsurgical rehabilitation program, self-reporting rehabilitation adherence and pain levels on the visual analog scale using weekly training diaries. Baseline to 6-month changes in quality of life (iHOT-33), physical impairment (hip strength, range of motion [ROM]), and functional performance (single-leg hop, side bridge endurance) were reported as mean (standard deviation). RESULTS: Twenty-nine people (37% female, 29.9 ± 7.9 years) participated. Hip extension, abduction, and functional exercises were performed most often. Exercise adherence analysis was limited by underreporting. Training diary data adequate to assess adherence were available for 20 participants (69%). Among those with available data, 16 (80%) met the predefined adherence target of ≥2 sessions per week, and average pain remained acceptable (<2 visual analog scale); iHOT-33 (+18.6 ± 22.5; 95% confidence interval: 10.2, 27.0) and hip flexion ROM (+6°; 95% confidence interval: 2.14, 9.60) improved significantly. Hip extension, adduction, external and internal rotation strength improvements exceeded the minimal detectable change, although they were not significant. CONCLUSION: Adherence was generally high among participants with available data, though limited by underreporting. Hip-related quality of life (iHOT-33) improved despite limited changes in physical impairments, and no improvement in functional performance. J Orthop Sports Phys Ther 2026;56(7):456-464. Epub 23 April 2026. doi:10.2519/jospt.2026.13775.
OBJECTIVES: The primary aim was to assess the radiographic features of the pubic symphysis in elite female football players. The secondary aim was to explore associations between radiographic findings and groin complaints. DESIGN: Cross-sectional study. METHODS: This was a multicenter study of 100 elite female football players from three Dutch professional clubs. Players completed questionnaires (including Hip and Groin Outcome Score) and had clinical assessments (including palpation and squeeze tests) and radiographic imaging. Skeletal maturity was graded using the Maturing Adolescent Pubic Symphysis (MAPS) classification. Five radiographic pubic symphysis findings were evaluated using the Aspetar protocol. Players were classified as having groin complaints if player-reported complaints and positive clinical findings from the symphyseal and/or adductor region were present. RESULTS: MAPS stages increased with age. In 23% (7 of 30) of otherwise skeletally mature players, the pubic symphysis was immature, including players up to age 27 years. Sixty-nine (69%) players had 1 or more radiographic findings. The most prevalent findings were bony proliferations (49%) and sclerosis (47%). Fifteen of the 100 players had groin complaints. No differences were found in number or type of radiographic findings in those with and without groin complaints. Fifty-eight players (68% of 85) without complaints (vs. 11 [73% of 15] with complaints) had at least one Aspetar protocol finding. CONCLUSION: Radiographic findings of the pubic symphysis were common in female football players and appeared irrespective of groin complaints. Nearly one quarter of otherwise skeletally mature young adult players were not fully mature at the pubic symphysis. J Orthop Sports Phys Ther 2026;56(7):448-455. Epub 4 May 2026. doi:10.2519/jospt.2026.13580.
BACKGROUND: While hip osteoarthritis (OA) typically affects older adults, its prevalence in young adults is growing. Hip OA exists on a continuum; the early stages may be when treatments (surgical or nonsurgical) have the greatest chance of slowing or changing its trajectory. Most research and clinical interest have centered on early-stage symptomatic knee OA, with several global initiatives in place to improve diagnosis, classification, and treatment. Early-stage symptomatic hip OA has not had adequate attention. Clinicians and patients often do not recognize the condition or understand when and how to provide effective treatment. CLINICAL QUESTIONS: Why is it important to identify early-stage symptomatic hip OA? What are the benefits and challenges of developing classification criteria? Which candidate features should inform future consensus-based classification? What evidence exists regarding its development, trajectory, clinical and imaging characteristics, and management? KEY RESULTS: We propose candidate symptom, clinical, and imaging (radiographic and magnetic resonance imaging) criteria to stimulate clinical and research interest and to support future initiatives. Mechanical factors are implicated in the development and progression of early-stage symptomatic hip OA. A major clinical challenge is differentiating imaging findings indicative of symptomatic disease from normal age-related variation or incidental changes. Surgical and nonsurgical treatments may be appropriate for early-stage symptomatic hip OA. CLINICAL APPLICATION: Clinicians should consider early-stage symptomatic hip OA in patients with hip pain. While evidence specific to this stage of OA is still evolving, familiarity with its trajectory, key clinical and imaging findings, and factors associated with its development may improve early recognition and guide management decisions. J Orthop Sports Phys Ther 2026;56(7):399-412. Epub 26 May 2026. doi:10.2519/jospt.2026.14223.
SYNOPSIS: This focused issue of JOSPT highlights emerging research in hip and groin pain, with particular emphasis on amplifying the contributions of early career researchers who often face significant barriers to recognition and funding in a competitive academic landscape. The issue encompasses a range of conditions including pubic-related groin pain, hip dysplasia, and femoroacetabular impingement syndrome (FAIS), addressed through diverse methodologies spanning viewpoints, reviews, and rehabilitation trials. Notable contributions examine rehabilitation strategies for long-standing groin pain, diagnostic and treatment pathways for hip dysplasia, muscle function impairments in patients with FAIS, postsurgical recovery outcomes, and early-stage hip osteoarthritis. While large-scale randomized controlled trials remain forthcoming, the work collected in this focused issue reflects an active and evolving field. The issue also prioritizes inclusive authorship, with a focus on broad representation across sex, professional discipline, and international geography. J Orthop Sports Phys Ther 2026;56(7):374-375. Epub 3 Jun 2026. doi:10.2519/jospt.2026.14485.
BACKGROUND: Hip dysplasia is a common cause of hip-related pain in young adults. Hip dysplasia is frequently overlooked by clinicians, leading to delayed diagnosis and subsequent adverse outcomes, including debilitating pain, functional impairments, and poor quality of life. Diagnosing hip dysplasia is often challenging due to its variable clinical presentation, its overlap with other conditions, and the absence of standard diagnostic criteria. Despite these challenges, an emerging body of research provides valuable insight into the management of hip dysplasia. CLINICAL QUESTION: How can new and existing evidence on hip dysplasia be synthesized to support clinicians in understanding its etiopathogenesis and diagnostic approaches-including both imaging and clinical evaluation-and in improving management strategies to enable timely diagnosis and treatment of this common condition? KEY FINDINGS: Hip dysplasia presents with variable symptoms and commonly coexists with other musculoskeletal conditions. Clinical examinations should include assessment of generalized joint hypermobility, hip range of motion, symptom-reproducing tests, and extra-articular structures. Imaging remains essential but must be interpreted in the clinical context. Evidence for non-surgical management, including exercise and education, is emerging but remains limited. CLINICAL APPLICATION: Clinicians should adopt a comprehensive and structured assessment approach that integrates patient history, physical examination, and imaging findings. Awareness of coexisting conditions and alternative pain sources is critical. Early recognition may facilitate timely referral and appropriate management. In the absence of strong condition-specific evidence, clinicians should combine available research with clinical reasoning and consider outcomes beyond pain, including quality of life, physical function, and participation. J Orthop Sports Phys Ther 2026;56(7):382-398. Epub 9 April 2026. doi:10.2519/jospt.2026.13860.
