OBJECTIVE:To refine the delivery of a targeted 16-form Tai Chi program for chronic ankle instability (CAI) through a modified Delphi process. METHODS:Eighteen Tai Chi and sports science experts were invited; 10 completed round 1 and 8 of these completed round 2. To improve geographic diversity, 4 nonresponders outside Mainland China were recontacted; 3 completed 2 rounds, and their feedback was integrated. A self-developed 10-item questionnaire (5-point Likert) was rated. Consensus was defined a priori as ≥70% of ratings 4 to 5, median ≥4, IQR ≤1, and CV ≤0.25. Internal consistency was assessed using Cronbach α, and overall agreement using Kendall W. RESULTS:In round 1, all items had median ≥4, but several failed agreement thresholds, prompting revision; α = 0.93 and W = 0.704. In round 2, all items met consensus criteria; α = 0.94 and W = 0.712. The final delivery set included 10 modifications and 6 additions. Five CAI participants were recruited for preliminary validation; 4 provided feedback supporting deliverability and informing refinements. CONCLUSION:This study produced a standardized, consensus-based delivery framework for a 16-form Tai Chi program tailored to CAI. Clinical trials are needed to determine its effectiveness on ankle-related outcomes.

The endocannabinoid system is a potent regulator of energy intake, but effects of cannabidiol (CBD) on appetite/eating behaviour in humans are not documented. We examined whether acute CBD ingestion affects energy intake, subjective appetite, or postprandial glucose and lipid metabolism in fifteen healthy adults (four females). A double-blind, randomized, crossover design was used. Participants ingested 298 mg CBD or placebo, with postprandial metabolic outcomes (blood-based energy substrates/hormones, and indirect calorimetry) assessed following consumption of a mixed-macronutrient breakfast 30 min later. Subjective outcomes were recorded hourly, and an ad libitum lunch provided 180 min post-CBD ingestion. Energy intake was 193 (95%CI: 80 to 306) kcal greater following CBD ingestion (CBD 979 ± 462 kcal; placebo 786 ± 280 kcal; p = 0.003; dz = 0.94 [0.32 to 1.55]). Ghrelin concentrations were 93 (37 to 148) and 107 (72 to 142) pg/mL less than placebo (p ≤ 0.01) at 120 and 180 min, respectively, following CBD. Minimum ghrelin concentration and AUC were 108 (67 to 150) pg/mL and 10.0 (16.6 to 3.3) ng/mL·180min less after CBD than placebo (p ≤ 0.01). There were no between-conditions differences in plasma glucose, triacylglycerol, non-esterified fatty acids, insulin, Glucagon-like peptide-1, energy expenditure, carbohydrate/lipid oxidation, or any subjective outcome (p > 0.05). Healthy adults ate more at lunch following CBD ingestion, providing the first evidence that CBD isolate can increase energy intake in humans. Energy intake increased despite lesser ghrelin concentrations and no differences in subjective appetite. Future research should explore mechanisms and/or utility in clinical populations.

New recovery pathways to improve and sustain strength and functional outcomes in the veteran amputee population are required to reduce the onset of comorbidities with aging. To date, no comprehensive study has quantified key gait parameters with clinically applied tests and measured lower limb strength in this cohort and their relationship to potential indicators of onset of musculoskeletal (MSK) injuries. This study fills this gap. ADVANCE Study cohorts of unilateral transtibial (UTT; n = 12) and unilateral transfemoral (UTF; n = 10) veteran amputees were matched to military able-bodied controls (n = 10). Participants were tested using 3D motion capture system and force plates permitting analysis of the spatial-temporal intact knee joint kinetic parameters during a 6-minute walking test. An isokinetic dynamometer measured peak knee extension/flexion isometric torque and Hamstring:Quadriceps (H:Q) ratio. UTT amputees displayed a H:Q torque ratio below recommended, an imbalance that may alter their gait functionality within their intact limb. The intact knee extension-flexion torques across the cohorts did not display significant differences, suggesting the extensive military rehabilitation outcomes remained successful 12.5 years post injury. Six-minute walk test (6MWT) analysis demonstrated a similar walking speed and total distance covered between controls and UTT amputees. However, significantly lower values were found for UTF amputees. Ground reaction forces during weight acceptance on the intact side showed no significant differences between cohorts. However, at mid-support and push-off both injured cohorts displayed significantly greater forces in the last 30 s of the 6MWT, indicating kinetic asymmetries. The literature suggests that such differences may indicate unhealthy knee joints. This biomechanical study suggests that the U.K. veteran population conserved exceptional strength levels in their intact limb. However, submaximal exercises representing activities of daily living revealed focus for improvement in amputee gait. This highlights that individualized rehabilitation protocols and tools concentrating on prolonging patient quality of life may delay the early onset of MSK comorbidities.

Introduction: Running overuse injuries are among the most common running-related musculoskeletal injuries. Modifying gait has been recognized as an effective strategy for preventing running overuse injuries. This study investigates whether gentle heel strike (GHS) running decreases the impact loading rate during 30-minute runs in healthy participants. Methods: In this prospective cohort interventional study, 20 male participants underwent gait modification in a controlled laboratory setting, with the goal of reducing heel impact through real-time visual feedback. Comprehensive measurements, including plantar contact, force, pressure, and detailed kinetic and kinematic analyses, were employed to assess changes in gait dynamics. Results: GHS significantly shifted plantar pressure, reducing heel forces and increasing forefoot load. Mean heel force decreased by 0.32 (0.1) body weight (BW) and heel pressure reduced by 0.1 kPa/BW. Although peak vertical ground reaction force and anterior-posterior ground reaction force did not change significantly across the entire stance phase, early stance vertical ground reaction force (7%-12% of the gait cycle) was reduced, leading to the disappearance of the vertical impact peak. Vertical impact peak dropped from 1.45 (0.23) to 1.27 (0.25) BW. Significant reductions were also seen in the vertical instantaneous loading rate, which decreased from 68.32 (14.20) to 46.77 (13.95) BW/s, and the vertical average loading rate, which fell from 54.96 (14.38) to 38.84 (12.62) BW/s (P <.001). Discussion: GHS has the potential to modify running mechanics by redistributing plantar pressure and diminishing heel impact force. This reduction in heel impact force could lead to a change in landing pattern anteriorly and a decrease in loading rates, potentially reducing the risk of running overuse injuries. Conclusion: Visual biofeedback-guided GHS is feasible in healthy participants, and it effectively reduces the loading rate during running for 30 minutes.

OBJECTIVES:To identify 12 forms from the traditional 108-form Tai Chi with the highest muscle activation values in the peroneus longus, peroneus brevis, and tibialis anterior and to design a Tai Chi training routine suitable for individuals with chronic ankle instability. DESIGN:Cross-sectional study. SETTING:Sports Biomechanics Laboratory. PARTICIPANTS:Eight Tai Chi instructors were recruited, with data from six used for analysis. MAIN OUTCOME MEASURES:The independent variable was the Tai Chi forms, while the dependent variable was the muscle activation measured using electromyography. The Vicon motion capture system recorded kinematic changes for form segmentation. Electromyography values from different segments were normalised to the maximum voluntary isometric contraction ratio for comparison. RESULTS:In the 12 Tai Chi forms, peroneus longus, peroneus brevis, and tibialis anterior exhibited muscle activation exceeding 55 %, 55 %, and 30 % of maximum voluntary isometric contraction in integrated electromyography, respectively, with root mean square reaching 116.9 %, 111.7 %, and 60.3 %. Adding transition stages expanded these into a 16-form routine, with no significant side differences. CONCLUSIONS:The 16-form Tai Chi has the potential to enhance ankle stability by selectively training the muscles that counter ankle inversion. Randomised controlled trials are needed to assess its effectiveness in chronic ankle instability.

BACKGROUND:Outcomes following radial extracorporeal shockwave therapy (rESWT) in patients with chronic noninsertional Achilles tendinopathy are investigated. METHODS:Patients with chronic noninsertional Achilles tendinopathy were recruited from a single National Health Services clinic, randomized equally to either "therapeutic" or "minimal-dose" ("presumed sham") rESWT (3 sessions at weekly intervals). Both groups had an identical structured home rehabilitation program of progressive loading, balance, and stretching exercises. RESULTS:Fifty-seven patients were recruited; mean age 49.7±7.2 years, 60% female, symptom duration: 22.2±19.5 months. No between-group differences were identified at the final or any interim time points. Clinically and statistically significant within-group improvements were identified in pain/local function patient-reported outcome measures for both groups, with "average pain" improving by 34% at 6 months. No consistent benefits were seen in global function, activity levels, or mood. CONCLUSION:"Recommended-dose" rESWT is not superior to "minimal-dose" rESWT and may be ineffective for patients with chronic noninsertional Achilles tendinopathy.

The number of runners and the incidence of running-related injuries (RRIs) are on the rise. Real-time biofeedback gait retraining offers a promising approach to RRIs prevention. However, due to the diversity in study designs and reported outcomes, there remains uncertainty regarding the efficacy of different forms of feedback on running gait biomechanics. Three databases: MEDLINE, PUBMED, and SPORTDiscus were searched to identify relevant studies published up to March 2024, yielding 4646 articles for review. The quality of the included studies was assessed using the Downs and Black Quality checklist. Primary outcomes, including Peak Tibial Acceleration (PTA), Vertical Average Loading Rate (VALR), and Vertical Instantaneous Loading Rate (VILR), were analysed through meta-analysis. 24 studies met the inclusion criteria and were analysed in this review.17 used visual biofeedback (VB) while 14 chose auditory biofeedback (AB). The meta-analysis revealed a reduction in loading variables both immediately following the intervention and after extended training, with both visual and auditory feedback. Notably, the decrease in loading variables was more pronounced post-training and VB proved to be more effective than AB. Real-time biofeedback interventions are effective in lowering loading variables associated with RRIs. The impact is more substantial with sustained training, and VB outperforms AB in terms of effectiveness.

Hamstring muscle injuries (HMI) are a common and recurrent issue in the sport of athletics, particularly in sprinting and jumping disciplines. This review summarizes the latest literature on hamstring muscle injuries in athletics from a clinical perspective. The considerable heterogeneity in injury definitions and reporting methodologies among studies still needs to be addressed for greater clarity. Expert teams have recently developed evidence-based muscle injury classification systems whose application could guide clinical decision-making; however, no system has been adopted universally in clinical practice, yet.The most common risk factor for HMI is a previously sustained injury, particularly early after return-to-sport. Other modifiable (e.g. weakness of thigh muscles, high-speed running exposure) and non-modifiable (e.g. older age) risk factors have limited evidence linking them to injury. Reducing injury may be achieved through exercise-based programs, but their specific components and their practical applicability remain unclear.Post-injury management follows similar recommendations to other soft tissue injuries, with a graded progression through stages of rehabilitation to full return to training and then competition, based on symptoms and clinical signs to guide the individual speed of the recovery journey. Evidence favoring surgical repair is conflicting and limited to specific injury sub-types (e.g. proximal avulsions). Further research is needed on specific rehabilitation components and progression criteria, where more individualized approaches could address the high rates of recurrent HMI. Prognostically, a combination of physical examination and magnetic resonance imaging (MRI) seems superior to imaging alone when predicting 'recovery duration,' particularly at the individual level.

Introduction: Cannabidiol (CBD) is a nonintoxicating phytocannabinoid used in clinical treatments and sold widely in consumer products. CBD products may be designed for sublingual or oral delivery, but it is unclear whether either is advantageous for CBD absorption. This study compared CBD pharmacokinetics after providing CBD oil as sublingual drops and within orally ingested gelatin capsules, at a dose relevant to consumer products. Materials and Methods: Eight males completed three conditions in a participant-blinded, randomized crossover design. Participants received the following combinations of placebo and CBD-containing (69 mg/mL) hemp oil in capsules and as sublingual drops: placebo capsules/placebo drops (Placebo), CBD capsules/placebo drops (CBD-Caps), and placebo capsules/CBD drops (CBD-Drops). Blood samples, blood pressure, and subjective scales were obtained/completed hourly for 6 h and at 24 h. Discussion: Plasma CBD concentrations were not different between CBD-Caps and CBD-Drops (interaction effect p=0.76). Peak CBD concentration (28.0±15.6 vs. 24.0±22.2 ng/mL), time of peak CBD concentration (4±1 vs. 4±2 h), and area under the concentration curve (45.3±20.3 vs. 41.8±23.3 ng/mL·6 h) were not different between conditions (p≥0.25). Cardiometabolic outcomes (plasma glucose/triacylglycerol, heart rate, blood pressure), liver function (plasma alanine aminotransferase/aspartate aminotransferase), kidney function (plasma creatinine), and subjective feelings/symptoms were not different between conditions (p≥0.07). Conclusions: Plasma CBD profiles were comparable between CBD-Caps and CBD-Drops, suggesting that there were not meaningful differences in routes of CBD absorption between conditions. This implies that CBD oil delivered sublingually is swallowed before oral mucosal CBD absorption occurs, which may have implications for research design, CBD product design, and consumer product choice.

Background: Autologous blood injection (ABI) for patients with chronic plantar fasciitis has been promoted as an approach to improve outcomes over standard dry-needling approaches. The purpose of this trial was to investigate if there are improved outcomes following an ultrasonography-guided ABI compared to dry needling alone for patients with chronic plantar fasciitis. Methods: A double-blinded (participant-blinded and observer-blinded) RCT within a single clinic enrolled 90 patients with symptoms of plantar fasciitis that had failed to improve with a minimum of 3 months of rehabilitation. The mean age was 49.5±8.9 years, 67% were female, and the mean symptom duration was 40.0±28.2 months (range: 8 months–10 years). Participants were randomized to receive ABI or an identical dry-needle fenestration-procedure without coadministration of autologous blood. All participants received identical structured rehabilitation and were followed up at 2, 6, 12, and 26 weeks. Outcome measures included local foot pain, validated foot patient-reported outcome measures (Foot Function Index–revised, Manchester-Oxford Foot Questionnaire, Foot and Ankle Ability Measure), measures of general function and “ability” (EuroQol [EQ]-5D-5L, Oswestry Disability Index), specific measures of activity (International Physical Activity Questionnaire), sleep (Pittsburgh Sleep Quality Index), and mood (Hospital Anxiety and Depression Scale). Results: There were no significant between-group differences seen at any time-point studied. There were a number of statistically significant within-group improvements for local foot pain and function in both groups comparing baseline/follow-up data. Overall, levels of pain improved by 25% by 6 weeks and by 50% at 6 months. There were improvements in some generalized function markers. Activity rates did not change, demonstrating that improvements in pain did not necessarily influence physical activity. Conclusion: Coadministration of 3 mL of autologous blood had no additional effect compared to a dry-needling procedure alone for patients with chronic plantar fasciitis. Level of Evidence: Level I, double-blinded randomized controlled trial.

OBJECTIVE:To compare the outcomes for patients with chronic plantar fasciitis after extracorporeal shockwave therapy (ESWT) or autologous blood injection (ABI).DESIGN:Cohort study-retrospective analysis of prospectively collected data.SETTING:Hospital-based Sports Medicine Outpatient Clinic.PATIENTS:One hundred two consecutive patients with chronic plantar fasciitis, treated with either radial-ESWT (rESWT) (n = 54) or ABI (n = 48), with minimum 3-month follow-up and 96% (98/102) having 6-month follow-up. Mean age 49.5 years and mean duration of symptoms 37.5 months before treatment.INTERVENTIONS:Patients received either 3 sessions of radial ESWT (one session per week for 3 weeks), or a single ultrasound-guided dry needling and ABI (3 mL whole autologous blood). All patients received standardized after-care, including progressive structured home exercise program of flexibility, strengthening, and proprioception exercises.MAIN OUTCOME MEASURES:0 to 10 numerical rating scale (NRS) for self-reported "average pain" and "average stiffness" values. Secondary outcome measures included assessments of local foot function [including Manchester-Oxford Foot Questionnaire (MOXFQ), revised-Foot Function Index] as well as markers of mental health functioning (HAD), global health (EQ-5D-5L), and physical activity (International Physical Activity Questionnaire).RESULTS:This study demonstrated statistically significant improvements in self-reported measures of pain and local foot function after either procedure at 6 weeks, 3 months, and 6 months, but no statistically significant differences were seen between groups at any time-period studied. At 6 months, the average pain using a 0 to 10 NRS was improved from 6.8 ± 1.8 to 4.0 ± 2.7 (P < 0.001) after ESWT and from 7.1 ± 1.6 to 3.8 ± 2.7 (P < 0.001) after ABI. At 6 months, significant improvements were seen following either group using a number of different validated patient-rated outcome measures assessing local foot pain and function, eg, the total score for MOXFQ improved from 56.1 ± 12.8 to 42.5 ± 16.6 (P < 0.001) after ESWT and from 58.8 ± 13.2 to 44.2 ± 19.2 (P < 0.001) after ABI. However, measures of physical activity or wider aspects of patient functioning did not consistently improve from baseline values to follow-up periods.CONCLUSIONS:Patients with chronic plantar fasciitis improved to statistically significant extent after either rESWT or ABI procedures, with no significant differences seen between groups. The lack of randomization in this pragmatic study is noted, which may have influenced the outcome seen. Potentially larger and more robust studies are required to investigate this treatment comparison further.

Background: Investigating outcomes following radial-extra-corporeal-shockwave-therapy (rESWT) in pa-tients with chronic plantar fasciopathyMethods: This double-blinded RCT in a single NHS Sports medicine clinic recruited 117 patients with chronic plantar fasciopathy randomised equally to either 3 sessions of rESWT or "minimal-dose" respec-tively. Mean age 51.7 +/- 9.6 years, 66 % female, symptom duration: 32.6 +/- 30.8 months. Results: "Average pain" improved by 50 % at 6-months, (> 1/3 at interim time-points). Statistically sig-nificant within-group improvements were identified in pain, local function, and "ability" PROMs in both groups. Fewer benefits in activity levels or mood. No between-group differences were seen at the interim or final time-points.Conclusion: 3 sessions of "recommended-dose" rESWT is non-superior to "minimal-dose" rESWT in pa-tients with chronic plantar fasciopathy. rESWT may be ineffective in the treatment of patients with chronic plantar fasciopathy, "minimal-dose" rESWT may be sufficient for a therapeutic effect, or a greater number of treatment sessions may be required for benefit. Level of evidence: Level I - Randomised controlled trial (c) 2022 The Authors. Published by Elsevier Ltd on behalf of European Foot and Ankle Society.This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).

Objective. Do any measures at baseline predict response from radial Extracorporeal Shockwave Therapy (rESWT) for patients with GTPS? Methods. Setting: single UK NHS Sports Medicine Clinic. Patients: 260 patients following rESWT for GTPS. Mean age 60.0 +/- 11.9 years, 81% female, mean duration of symptoms 44.5 +/- 44.7 months (range: 3 months-20years). Interventions: participants received three sessions of rESWT plus structured home exercise programme (flexibility, strength, and balance). Main outcome measures: follow-up was 3-months, and 6-months. Outcome measures of self-reported "average pain", "worst pain", and VISA-G score. Baseline PROMS (Non-Arthritic Hip score, and Oxford Hip Score), pain (painDETECT, S-LANSS, CSI), "ability" (ODI, MSK-HQ), mood (HADS). Results. Improvement in "average pain" of 30% at 3-months, and 37% at 6-months. VISA-G improved by more than 10% points at 3-months and 6-months. Several weak or very-weak correlations were identified, but no single baseline variable corelated strongly to the improvements seen at follow-up time-points. Conclusions. There were clinical and statistically-significant improvements seen following rESWT for patients with GTPS, even in those with very long duration of symptoms, irrespective of age or symptom duration. There was a statistically significant difference for gender (greater benefit in female patients) which did not reach clinical significance. Greatest improvements in self-reported pain were seen in those with the worst baseline symptoms, particularly with variables more sensitive to non-arthritic hip pain (NAHS, VISA-G) than "arthritic pain" measures (OHS). Baseline measures such as Oswestry Disability Inventory or the MSK-HQ have weak correlations to improvements in some factors seen, with fewer correlations seen for markers of chronic, neuropathic, or centralised pain, or mood.

The overarching BASEM Annual conference 2022 theme is Elite, Olympic and Paralympic Sport and Exercise in Medicine and Health, with conference straplines of ‘Hot topics and lessons from the Tokyo Olympics during a universal crisis, health impact of a lifetime in elite Paralympic and Olympic sport, and the national and European initiatives in physical activity promotion and exercise prescription.’ A consensus statement by Jones et al reinforces the understanding that the benefits of physical activity outweigh any risks in people living with long-term conditions (see page 425) . [...]a couple of articles consider several important issues related to equity, diversity and inclusion in sport, an area in which there are initiatives to improve representation by both BASEM and the BJSM.

BackgroundChronic tendinopathy is a significant burden in physically active populations. High-volume image-guided injection (HVIGI) proposes to strip away associated neovascularity, disrupt painful nerve ingrowth and facilitate rehabilitation.MethodsThe objective was to investigate the efficacy of HVIGI with and without steroid relative to placebo. The study design was a three-arm block randomised control trial in a tertiary rehabilitation centre. Sixty-two participants were recruited between 25 May 2016 and 5 March 2020. Participants were men aged 18–55 with, Achilles or patellar tendinopathy of at least 6-months chronicity who had not improved with conservative management including shockwave, Ultrasound (US) evidence of neovascularisation, tendon thickening and echogenic changes.Participants were randomly assigned to control (3ml subcutaneous 0.5% Bupivacaine) or HVIGI (10 ml 0.5% Bupivacaine and 30 ml normal saline US guided between tendon and underlying fatpad) or HVIGI with steroid (0.25 ml 100 mg/ml hydrocortisone). Clinicians and assessors were blinded. All participants were supervised through a pain-guided progressive loading programme for 6-months post injection. The primary outcome measures were the Victoria institute of sport assessments for Achilles and patellar tendinopathy (VISA-A and VISA-P) and visual analogue scale (VAS)-pain at 6-months.ResultsVISA improved by 22.8 ((95% CI) 10.4 to 35.3, effect size (ES) 1.51) in control (n=21), 18.6 (9.1 to 28.0, ES 1.31) in HVIGI (n=21) and 18.5 (3.4 to 33.6, ES 0.88) in HVIGI with steroid (n=20) groups. VAS-pain improved by 15 ((IQR) -38.75 to 8, ES 0.39) in control, 13 in HVIGI (-34.0 to 3.75, ES 0.47) and 27 (-38.0 to-1.0, ES 0.54) in HVIGI with steroid groups. Main effects for time were significant (p<0.001) but not group (p≥0.48) with no group-time interaction (p=0.71). One participant was lost to follow-up from each group for whom multiple imputation was used. No adverse events occurred.ConclusionsData does not demonstrate superiority of HVIGI over control injection. Pain-guided progressive loading remains the mainstay of treatment.

Background: Chronic Achilles and patellar tendinopathy are a significant burden in physically active populations. High-volume image-guided injection (HVIGI) proposes to strip away associated neovascularity, disrupt painful nerve ingrowth, and facilitate rehabilitation. Purpose: To investigate the efficacy of HVIGI with and without steroid relative to placebo. Study Design: Randomized controlled trial; Level of evidence, 1. Methods: A total of 62 participants were recruited between May 25, 2016, and March 5, 2020. Participants were men aged 18 to 55 years with Achilles or patellar tendinopathy of at least 6-month chronicity that had not improved with nonoperative management (including physical therapy and shockwave therapy), with ultrasound evidence of neovascularization, tendon thickening, and echogenic changes. They were assigned to the following groups: control (3 mL of subcutaneous 0.5% bupivacaine), HVIGI (10 mL of 0.5% bupivacaine and 30 mL of normal saline, ultrasound-guided between tendon and underlying fat pad), or HVIGI with steroid (HVIGIwSteroid; 0.25 mL of 100 mg/mL hydrocortisone). Clinicians and assessors were blinded. All participants were supervised through a pain-guided progressive loading program for 6 months postinjection. The main outcome measures were the Victoria Institute of Sport Assessments (VISA) for Achilles and patellar tendinopathy and the visual analog scale (VAS) for pain at 6 months postinjection. Results: The VISA score improved by a mean of 22.8 points (95% CI, 10.4-35.3 points; effect size [ES], 1.51) in the control group (n = 21), 18.6 points (95% CI, 9.1-28.0 points; ES, 1.31) in the HVIGI group (n = 21), and 18.5 points (95% CI, 3.4-33.6 points; ES, 0.88) in the HVIGIwSteroid group (n = 20). VAS pain improved by a mean of 15 points (interquartile range [IQR], –38.75, 8 points; ES, 0.39) in controls, 13 points (IQR,–34.0, 3.75 points; ES, 0.47) in the HVIGI group, and 27 points (IQR,–38.0, –1.0 points; ES, 0.54) in the HVIGIwSteroid group. The main effects were significant for time ( P < .001) but not group ( P ≥ .48), with no group × time interaction ( P = .71). One participant was lost to follow-up from each group, multiple imputation was used for missing data points. No adverse events occurred. Conclusion: Study findings did not demonstrate superiority of HVIGI over control injection. Registration: EU Clinical Trials Register (EudraCT: 2015-003587-36).

BACKGROUND:Patella tendinopathy is a common condition in a number of sports and can have a significant impact on activity and quality of life. Whilst rehabilitation leads to improvements in the majority of cases, a number of adjunct treatments are available for resistant cases with limited evidence supporting the use of one treatment over another.Hypothesis/Purpose: To compare the outcomes for patients with chronic patella tendinopathy, following either radial-Extra-Corporeal Shockwave Therapy (r-ESWT) or Autologous Blood Injection (ABI).STUDY DESIGN:Prospective cohort study.METHODS:28 consecutive patients with chronic patella tendinopathy, treated with radial-ESWT (n = 14) or ABI (n = 14), with minimum three-month follow-up. Mean age 34.2 years, mean duration of symptoms 32.8 months. Patients received either three sessions of radial-Extra-Corporeal Shockwave Therapy (one session per week for 3 weeks), or two ultrasound-guided Autologous Blood Injections (2 injections performed 2-4 weeks apart). All patients received standardised after-care, including continuation of a structured home exercise programme of flexibility and progressive loading (eccentric strengthening) exercises. Main Outcome Measures were Victoria Institute of Sport - Patella questionnaire (VISA-P), plus 0-10 Visual Analogue Scale (VAS) for self-reported levels of "average pain".RESULTS:There were statistically significant improvements in self-reported measures of pain/function following either procedure at 6-weeks and at 3-months, but only in the ABI group at 6-months. At 3-months: VISA-P was improved from 32.4% ± 11.7%-60.0% ± 20.7% (p < 0.01) in the ABI group, and from 34.2% ± 14.6%-48.9% ± 17.8% (p < 0.001) in the r-ESWT group.CONCLUSIONS:Patients with chronic patella tendinopathy improved at 6-weeks and 3-months following either ABI or r-ESWT procedure, with significant benefits at 6-months seen only in the ABI group. Between group analysis demonstrated improved outcomes favouring ABI compared to r-ESWT at the 6-month timepoint using VISA-P, and at all time-points using VAS as outcome measures. The small sample sizes in this pragmatic study are however noted, which limit interpretation, and larger more robust studies are required to investigate this further. This pragmatic prospective cohort study demonstrates improvements following either r-ESWT or ABI procedures, with results potentially favouring ABI over r-ESWT for patients with chronic patella tendinopathy.

Objective: To investigate the outcomes following 3 weekly sessions of radial extracorporeal shockwave therapy (rESWT) in patients with chronic greater trochanteric pain syndrome (GTPS) presenting to an NHS Sports Medicine Clinic in the United Kingdom. Design: Double-blinded randomized controlled trial. Setting: A single NHS Sports Medicine Clinic, in the United Kingdom. Patients: One hundred twenty patients in an NHS Sports Medicine clinic presenting with symptoms of GTPS who had failed to improve with a minimum of 3 months of rehabilitation were enrolled in the study and randomized equally to the intervention and treatment groups. Mean age was 60.6 ± 11.5 years; 82% were female, and the mean duration of symptoms was 45.4 ± 33.4 months (range, 6 months to 30 years). Interventions: Participants were randomized to receive either 3 sessions of ESWT at either the “recommended”/“maximally comfortably tolerated” dose or at “minimal dose.” All patients received a structured home exercise program involving flexibility, strength, and balance exercises. Main Outcome Measures: Follow-up was at 6 weeks, 3 months, and 6 months. Outcome measures included local hip pain, validated hip PROMs (Oxford hip score, non-arthritic hip score, Victorian Institute of Sport assessment questionnaire), and wider measures of function including sleep (Pittsburgh sleep quality index) and mood (hospital anxiety and depression scale). Results: Results were available for 98% of patients at the 6-month period. There were statistically significant within-group improvements in pain, local function, and sleep seen in both groups. However, fewer benefits were seen in other outcome measures, including activity or mood. Conclusion: There were no time × group interaction effects seen between the groups at any time point, indicating that in the 3 sessions, the “recommended-dose” rESWT had no measurable benefit compared with “minimal dose” rESWT in this group of patients with GTPS. The underlying reason remains unclear; it may be that rESWT is ineffective in the treatment of patients with chronic GTPS, that “minimal dose” rESWT is sufficient for a therapeutic effect, or that a greater number of treatment sessions are required for maximal benefit. These issues need to be considered in further research.

Objectives Identifying the prevalence of neuropathic pain components in patients with chronic tendinopathy conditions using the Self-Administered Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS) questionnaire.Methods Patients with chronic tendinopathy and ‘tendon-like’ conditions treated within a single hospital outpatient clinic specialising in tendinopathy were identified. Pain scores, plus global function patient-reported outcome measures (5-Level version of EuroQol-5 Dimension and Musculoskeletal Health Questionnaire (MSK-HQ)), were completed and compared with the S-LANSS questionnaireResults 341 suitable patients with chronic tendinopathy and potentially similar conditions were identified. Numbers: lateral elbow tendinopathy (39), greater trochanteric pain syndrome (GTPS; 112), patellar tendinopathy (11), non-insertional Achilles tendinopathy (40), insertional Achilles tendinopathy (39), plantar fasciopathy (100). 68% were female, with a mean age of 54.0±11.3 years and a mean symptom duration of 38.1±33.7 months.There was a mean S-LANSS score of 11.4±6.4. Overall, 47% of patients scored 12 or greater points on S-LANSS, indicating the possible presence of neuropathic pain. The highest proportion was in patients with plantar fasciopathy (61%), the lowest in those with GTPS (33%). Weak correlations were found between the S-LANSS score and MSK-HQ score, the numerical rating scale (0–10) values for ‘average pain’ and for ‘worst pain’, but not with the MSK-HQ %health value.Conclusion S-LANSS identified nearly half of patients with chronic tendinopathy as possibly having a neuropathic pain component. This is of unclear clinical significance but worth further study to see if/how this may relate to treatment outcomes. These results are from a single hospital clinic dealing with patients with chronic tendinopathy, without a control group or those with shorter symptom duration. However, this reinforces the probability of neuropathic pain components in at least some patients with chronic tendinopathy.

Introduction Ankle sprain is a common injury that can have long-term sequelae resulting in pain, swelling and a reduction of physical activity participation. Previous research has shown a laterally deviated centre of pressure (COP) during running gait increases the risk of lateral ankle sprain. As a method of altering COP, electrical stimulation has been considered. Method A group of 14 healthy males were randomly allocated to case control groups which were single blinded. The intervention involved an 8-week training programme of functional electrical stimulation to the peroneal muscles during treadmill running, with a sham control group. Outcomes were COP position and star excursion balance test. Statistical analysis was through SPSS using a combination of MANOVA, T-tests and Wilcoxon signed rank Results There was a significant difference in the results post intervention at max pressure for intervention M = 0.7(±0.7) and control M = −6.0 (±4.6) conditions; t(6) = −2.9, p < 0.05 Conclusion It has been demonstrated that FES can alter COP during max pressure in running gait after an 8-week training programme, although carry over effect appears limited and further testing is required.