Diercks R, Bron C, Dorrestijn O, Meskers C, Naber R, de Ruiter T, Willems J, Winters J, van der Woude HJ [Netherlands Orthopedic Society, Koninklijk Nederlands Genootschap voor Fysiotherapie, Netherlands Association of General Practitioners, Netherlands Society of Rehabilitation Medicine, Netherlands Association of Occupational Medicine, Netherlands Society of Radiology]
Acta Orthopaedica 2014;85(3):314-322

Practice guideline

Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better. A working group formed from a number of Dutch specialist societies, joined by the Dutch Orthopedic Association, has produced a guideline based on the available scientific evidence. This resulted in a new outlook for the treatment of subacromial pain syndrome. The important conclusions and advice from this work are as follows:
(1) the diagnosis SAPS can only be made using a combination of clinical tests.
(2) SAPS should preferably be treated non-operatively.
(3) Acute pain should be treated with analgetics if necessary.
(4) Subacromial injection with corticosteroids is indicated for persistent or recurrent symptoms.
(5) Diagnostic imaging is useful after 6 weeks of symptoms. Ultrasound examination is the recommended imaging, to exclude a rotator cuff rupture.
(6) Occupational interventions are useful when complaints persist for longer than 6 weeks.
(7) Exercise therapy should be specific and should be of low intensity and high frequency, combining eccentric training, attention to relaxation and posture, and treatment of myofascial trigger points (including stretching of the muscles) may be considered.
(8) Strict immobilization and mobilization techniques are not recommended.
(9) Tendinosis calcarea can be treated by shockwave (ESWT) or needling under ultrasound guidance (barbotage).
(10) Rehabilitation in a specialized unit can be considered in chronic, treatment resistant SAPS, with pain perpetuating behavior. (11) There is no convincing evidence that surgical treatment for SAPS is more effective than conservature management.
(12) There is no indication for the surgical treatment of asymptomatic rotator cuff tears. 

1. Lukas Gebremariam1, 
2. Elaine M Hay2, 
3. Renske van der Sande1, 
4. Willem D Rinkel3, 
5. Bart W Koes1, 
6. Bionka M A Huisstede1,3

Author affiliations
Background 
The subacromial impingement syndrome (SIS) includes the rotator cuff syndrome, tendonitis and bursitis of the shoulder. Treatment includes surgical and non-surgical modalities. Non-surgical treatment is used to reduce pain, to decrease the subacromial inflammation, to heal the compromised rotator cuff and to restore satisfactory function of the shoulder. To select the most appropriate non-surgical intervention and to identify gaps in scientific knowledge, we explored the effectiveness of the interventions used, concentrating on the effectiveness of physiotherapy and manual therapy.
Methods 
The Cochrane Library, PubMed, EMBASE, PEDro and CINAHL were searched for relevant systematic reviews and randomised clinical trials (RCTs). Two reviewers independently extracted data and assessed the methodological quality. A best-evidence synthesis was used to summarise the results.
Results 
Two reviews and 10 RCTs were included. One RCT studied manual therapy as an add-on therapy to self-training. All other studies studied the effect of physiotherapy: effectiveness of exercise therapy, mobilisation as an add-on therapy to exercises, ultrasound, laser and pulsed electromagnetic field. Moderate evidence was found for the effectiveness of hyperthermia compared to exercise therapy or ultrasound in the short term. Hyperthermia and exercise therapy were more effective in comparison to controls or placebo in the short term (moderate evidence). For the effectiveness of hyperthermia, no midterm or long-term results were studied. In the midterm, exercise therapy gave the best results (moderate evidence) compared to placebo or controls. For other interventions, conflicting, limited or no evidence was found.
Conclusions 
​Some physiotherapeutic treatments seem to be promising (moderate evidence) to treat SIS, but more research is needed before firm conclusions can be drawn.

André E. Bussières, DC, PhDCorrespondence information about the author DC, PhD André E. BussièresEmail the author DC, PhD André E. Bussières, Gregory Stewart, BPE, DC, Fadi Al-Zoubi, PT, MSc, Philip Decina, DC, Martin Descarreaux, DC, PhD, Jill Hayden, DC, PhD, Brenda Hendrickson, BN, MN, Cesar Hincapié, DC, PhD, Isabelle Pagé, DC, MSc, Steven Passmore, DC, PhD, John Srbely, DC, PhD, Maja Stupar, BSc, DC, PhD, Joel Weisberg, BSc, DC, Joseph Ornelas, DC, PhD
Objective
The objective was to develop a clinical practice guideline on the management of neck pain–associated disorders (NADs) and whiplash-associated disorders (WADs). This guideline replaces 2 prior chiropractic guidelines on NADs and WADs.
Methods
Pertinent systematic reviews on 6 topic areas (education, multimodal care, exercise, work disability, manual therapy, passive modalities) were assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR) and data extracted from admissible randomized controlled trials. We incorporated risk of bias scores in the Grading of Recommendations Assessment, Development, and Evaluation. Evidence profiles were used to summarize judgments of the evidence quality, detail relative and absolute effects, and link recommendations to the supporting evidence. The guideline panel considered the balance of desirable and undesirable consequences. Consensus was achieved using a modified Delphi. The guideline was peer reviewed by a 10-member multidisciplinary (medical and chiropractic) external committee.
Results
​For recent-onset (0-3 months) neck pain, we suggest offering multimodal care; manipulation or mobilization; range-of-motion home exercise, or multimodal manual therapy (for grades I-II NAD); supervised graded strengthening exercise (grade III NAD); and multimodal care (grade III WAD). For persistent (>3 months) neck pain, we suggest offering multimodal care or stress self-management; manipulation with soft tissue therapy; high-dose massage; supervised group exercise; supervised yoga; supervised strengthening exercises or home exercises (grades I-II NAD); multimodal care or practitioner’s advice (grades I-III NAD); and supervised exercise with advice or advice alone (grades I-II WAD). For workers with persistent neck and shoulder pain, evidence supports mixed supervised and unsupervised high-intensity strength training or advice alone (grades I-III NAD).
Conclusions
A multimodal approach including manual therapy, self-management advice, and exercise is an effective treatment strategy for both recent-onset and persistent neck pain.

Oliveira HAV, Jones A, Moreira E, Jennings F, Natour J
The Journal of Rheumatology 2015 May;42(5):870-878
clinical trial
8/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*
OBJECTIVE: To assess the effectiveness of total contact insoles (TCI) in patients with plantar fasciitis (PF).
METHODS: A double-blind randomized controlled trial was carried out with intention-to-treat analysis. Seventy-four patients were randomly allocated to use a TCI made of ethylene vinyl acetate (study group, n = 37) or a flat insole (control group, n = 37). The following assessment tools were used: visual analog scale for pain while walking and at rest, Medical Outcomes Study Short Form-36 (SF-36) for quality of life, Foot Function Index and Foot Health Status Questionnaire for foot function, 6-min walk test (6MWT), and baropodometer FootWalk Pro for plantar pressure analysis. The groups were evaluated by a blinded assessor at baseline and after 45, 90, and 180 days.
RESULTS: The groups were homogeneous for the majority of variables at baseline. The over-time comparisons show a statistical difference between the groups for pain while walking (p = 0.008) and the 6MWT (p = 0.010). Both groups showed significant improvements in pain at rest, foot function, and some quality of life variables (physical functioning, bodily pain, vitality, and social functioning), with no significant statistical differences between them. The baropodometer recorded no changes from the use of the insoles.
CONCLUSION: A TCI can be used to reduce pain while walking and to increase walking distance in individuals with PF. 

By Matthew Walsh, PT | Athletic Training, Physical Therapy | December 14, 2016
A runner’s ability to maintain a relaxed posture and fluid running form requires a complex interaction of mileage, intensity, postural awareness, strength, stability, and mobility. Devoting time to training each of these components can be a catalyst to improving running economy, reducing injury risk, and increasing speed.
The Fundamental 5The series of running-specific motions outlined below aims to challenge balance and control. The five exercises focus on building a runner’s postural awareness. Successful runners train this ability to maintain great body shape/postural alignment and control, through all the phases of a running cycle and even when they are fatigued.
Shown in the video below are the most basic exercise forms for the fundamental 5. Once mastered, volume can be added, then load, and finally greater complexity and speed. This is an adjunct, not a substitute, to regular training, dynamic warm-ups, lifting and mobility programs. Make sure patients pay close attention to form as quality is critical to success.

1. Runner’s MarchBegin with tall posture, drive knees up high, tighten the glut on the stance leg, and keep chest up and forward. Hold for 2 seconds and then return the leg to the start position slowly. See a Video Demonstration
2. Runner’s TouchStart with the march posture, reach down and forward until a light hamstring stretch is felt. Keep the back flat and abs lightly drawn in while holding the stance leg almost fully straight at the knee. See a Video Demonstration
3. Runner’s ClimbStart again with the march posture and then lean forward placing a foot on a regular-sized step or block. In one smooth motion, step up by engaging glutes, staying tall and driving a leg up as high as possible. Hold for 2 seconds and lower back down to the start position slowly. See a Video Demonstration
4. Swinging Kick and FlicksSwing the free leg up until there’s a light hamstring stretch, keep the spine tall, and the arms swing opposite mimicking running sequence. Let the leg flick up behind as the thigh sweeps back while keeping the stance leg steady. See a Video Demonstration
5. Runner’s LungeStart with the march posture, fall slowly down into a lunge, then drive up to the march posture in one clean fluid knee drive. See a Video Demonstration

Start with 5 repetitions of each motion and keep repeating the cycle for a total of 8-10 minutes. After two weeks, if your patient feels dialed in, then increase their duration from 10 to 15 minutes for the remaining two weeks. Try to make it a one month challenge.
Changes and AdaptionMost patients see clear changes in form and efficiency after one month on this program. If it’s really hard at first, try reducing repetitions or instructing patients to use a stick to assist in balance. Remember to remind patients that if anything is painful, poorly controlled or just plain doesn’t feel right, back off and request modification.

Donnell-Fink LA, Klara K, Collins JE, Yang HY, Goczalk MG, Katz JN, Losina E
PLoS ONE 2015 Dec;10(12):e0144063
systematic review
OBJECTIVE: Individuals frequently involved in jumping, pivoting or cutting are at increased risk of knee injury, including anterior cruciate ligament (ACL) tears. We sought to use meta-analytic techniques to establish whether neuromuscular and proprioceptive training is efficacious in preventing knee and ACL injury and to identify factors related to greater efficacy of such programs. METHODS: We performed a systematic literature search of studies published in English between 1996 and 2014. Intervention efficacy was ascertained from incidence rate ratios (IRRs) weighted by their precision (1/variance) using a random effects model. Separate analyses were performed for knee and ACL injury. We examined whether year of publication, study quality, or specific components of the intervention were associated with efficacy of the intervention in a meta-regression analysis.
RESULTS: Twenty-four studies met the inclusion criteria and were used in the meta-analysis. The mean study sample was 1,093 subjects. Twenty studies reported data on knee injury in general terms and 16 on ACL injury. Maximum Jadad score was 3 (on a 0 to 5 scale). The summary incidence rate ratio was estimated at 0.731 (95% CI 0.614 to 0.871) for knee injury and 0.493 (95% CI 0.285 to 0.854) for ACL injury, indicating a protective effect of intervention. Meta-regression analysis did not identify specific intervention components associated with greater efficacy but established that later year of publication was associated with more conservative estimates of intervention efficacy.
CONCLUSION: The current meta-analysis provides evidence that neuromuscular and proprioceptive training reduces knee injury in general and ACL injury in particular. Later publication date was associated with higher quality studies and more conservative efficacy estimates. As study quality was generally low, these data suggest that higher quality studies should be implemented to confirm the preventive efficacy of such programs. 

Immediate effects of hip mobilization with movement in patients with hip osteoarthritis: A randomised controlled trial

Carlos Beselga, Francisco Neto, Francisco Alburquerque-Sendín, Toby Hall, Natália Oliveira-Campelo

PlumX Metrics
DOI: http://dx.doi.org/10.1016/j.math.2015.10.007
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Highlights

• •Immediate effects of hip MWM and placebo were evaluated in patients with hip OA.
• •MWM decreased pain, improved ROM, and physical function greater than placebo.
• •These results direct future studies to investigate long-term efficacy.

Background
Mobilization with movement (MWM) has been shown to reduce pain, increase range of motion (ROM) and physical function in a range of different musculoskeletal disorders. Despite this evidence, there is a lack of studies evaluating the effects of MWM for hip osteoarthritis (OA).
Objectives
To determine the immediate effects of MWM on pain, ROM and functional performance in patients with hip OA.
DesignRandomized controlled trial with immediate follow-up.
Method
Forty consenting patients (mean age 78 ± 6 years; 54% female) satisfied the eligibility criteria. All participants completed the study. Two forms of MWM techniques (n = 20) or a simulated MWM (sham) (n = 20) were applied. Primary outcomes: pain recorded by numerical rating scale (NRS). Secondary outcomes: hip flexion and internal rotation ROM, and physical performance (timed up and go, sit to stand, and 40 m self placed walk test) were assessed before and after the intervention.
Results
​For the MWM group, pain decreased by 2 points on the NRS, hip flexion increased by 12.2°, internal rotation by 4.4°, and functional tests were also improved with clinically relevant effects following the MWM. There were no significant changes in the sham group for any outcome variable.
Conclusions
Pain, hip flexion ROM and physical performance immediately improved after the application of MWM in elderly patients suffering hip OA. The observed immediate changes were of clinical relevance. Future studies are required to determine the long-term effects of this intervention.

Systematic review of the literature of low-level laser therapy (LLLT) in the management of neck pain

• Roberta T. Chow MB BS (Hons), FRACGP, M Appl Sci,
  Les Barnsley B Med (Hons), PhD, Grad Dip Epi, FRACP, FAFRM [RACP
• First published: 13 June 2005Full publication history
• DOI: 10.1002/lsm.20193  View/save citation
• Cited by (CrossRef): 48 articlesCheck for updates
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• Roberta T. Chow is a General Practitioner and Les Barnsley is an Assistant Professor.

Background and Objectives
Low-level laser therapy (LLLT) is widely used in the treatment of musculoskeletal pain. However, there is controversy over its true efficacy. We aimed to determine the efficacy of LLLT in the treatment of neck pain through systematically reviewing the literature.
Study Design/Materials and Methods
A search of computerized bibliographic databases covering medicine, physiotherapy, allied health, complementary medicine, and biological sciences was undertaken undertaken from date of inception until February 2004 for randomized controlled trials of LLLT for neck pain. A comprehensive list of search terms was applied and explicit inclusion criteria were developed a priori. Twenty studies were identified, five of which met the inclusion criteria.
Results
Significant positive effects were reported in four of five trials in which infrared wavelengths (λ = 780, 810–830, 904, 1,064 nm) were used. Heterogeneity in outcome measures, results reporting, doses, and laser parameters precluded formal meta-analysis. Effect sizes could be calculated for only two of the studies.
Conclusions
​This review provides limited evidence from one RCT for the use of infrared laser for the treatment of acute neck pain (n = 71) and chronic neck pain from four RCTs (n = 202). Larger studies are required to confirm the positive findings and determine the most effective laser parameters, sites and modes of application. © 2005 Wiley-Liss, Inc.

Effects of taping on pain and function in patellofemoral pain syndrome: a randomized controlled trial
Whittingham M, Palmer S, Macmillan F
The Journal of Orthopaedic and Sports Physical Therapy 2004 Sep;34(9):504-510
OBJECTIVES: To investigate the effectiveness of daily patella taping and exercise on pain and function in individuals with patellofemoral pain syndrome.
BACKGROUND: Patella taping and muscle-strengthening programs are commonly used to treat patellofemoral pain syndrome. There is, however, little evidence for the effectiveness of these approaches.
METHODS AND MEASURES: Twenty-four men and 6 women aged 17 to 25 years (mean +/- SD, 18.7 +/- 1.2 years) participated in the study. Subjects were randomly and exclusively assigned to 1 of 3 treatment groups: patella taping combined with a standardized exercise program, placebo patella taping and exercise program, or exercise program alone (n = 10 in each group). Taping was applied and exercises performed on a daily basis for 4 weeks. Outcome measures were visual analog scales for pain and the functional index questionnaire, recorded at weekly intervals by a therapist who was blinded to group allocation.
RESULTS: Separate mixed-model ANOVAs, with repeated measures on time, indicated statistically significant improvements in pain and function over time for all groups (p < 0.01) and also significant differences between groups for all measures (p < 0.01). Separate independent samples t tests showed that the group receiving taping and exercises had better pain and function scores following treatment than the placebo taping-and-exercise group and the exercise-alone group. There were no significant differences between the placebo taping-and-exercise group and exercise-alone group at any time point.
CONCLUSIONS: These findings indicate that over a period of 4 weeks a combination of daily patella taping and exercises was successful in improving pain and function in individuals with patellofemoral pain syndrome. The combination of patella taping and exercise was superior to the use of exercise alone

Activity- versus structural-oriented treatment approach for frozen shoulder: a randomized controlled trial [with consumer summary]
Horst R, Maicki T, Trabka R, Albrecht S, Schmidt K, Metel S, von Piekartz H
Clinical Rehabilitation 2017 May;31(5):686-695
clinical trial

OBJECTIVE: To compare the short- and long-term effects of a structural-oriented (convential) with an activity-oriented physiotherapeutic treatment in patients with frozen shoulder. 
SUBJECTS: We included patients diagnosed with a limited range of motion and pain in the shoulder region, who had received a prescription for physiotherapy treatment, without additional symptoms of dizziness, a case history of headaches, pain and/or limited range of motion in the cervical spine and/or temporomandibular joint.
INTERVENTIONS: The study group received treatment during the performance of activities. The comparison group was treated with manual therapy and proprioceptive neuromuscular facilitation (conventional therapy). Both groups received 10days of therapy, 30minutes each day.
MAIN MEASURES: Range of motion, muscle function tests, McGill pain questionnaire and modified Upper Extremity Motor Activity Log were measured at baseline, after two weeks of intervention and after a three-month follow-up period without therapy.
​RESULTS: A total of 66 patients were randomized into two groups: The activity-oriented group (n = 33, mean 44years, SD 16years) including 20 male (61%) and the structural-oriented group (n = 33, mean 47years, SD 17years) including 21 male (64%). The activity-oriented group revealed significantly greater improvements in the performance of daily life activities and functional and structural tests compared with the group treated with conventional therapy after 10days of therapy and at the three-month follow-up (p < 0.05).
CONCLUSIONS: Therapy based on performing activities seems to be more effective for pain reduction and the ability to perform daily life activities than conventional treatment methods.