Journal of Orthopaedic & Sports Physical Therapy最新文献

SYNOPSIS: Pain near the posteromedial tibia is common in running and jumping athletes. This problem has had many names, with "shin splints" and "medial tibial stress syndrome" (MTSS) the most common. The term shin splints is nonspecific and nondescript, and has never gained clinical traction. Similarly, the clinical use of MTSS with athletes and coaches is often met with confusion as "tibial stress" is frequently misinterpreted as indicating a bone stress injury. With no conclusive evidence regarding the pathophysiology of MTSS, we advocate renaming it "Load Induced Medial-Leg Pain" (LIMP). LIMP avoids the use of "tibial stress," which is problematic due to the unknown pathology of the condition and its confusion with bone stress injury. Using the term LIMP instead of MTSS gives clinicians, researchers, and athletes a clearer, more accurate way to approach managing exercise-related lower leg pain. J Orthop Sports Phys Ther 2025;55(10):1-2. Epub 18 August 2025. doi:10.2519/jospt.2025.13411.

OBJECTIVE: To evaluate the efficacy of high-velocity low-amplitude thrust (HVLAT) manipulations in patients with cervical, thoracic, and lumbar radiculopathy. DESIGN: Intervention systematic review. LITERATURE SEARCH: Five electronic databases were searched from inception to May 2024. STUDY SELECTION CRITERIA: Randomized controlled trials comparing HVLAT to different interventions in patients with cervical, thoracic, or lumbar radiculopathy were eligible, if they reported outcomes related to pain intensity, disability, range of motion, and/or health-related quality of life. DATA SYNTHESIS: Data were pooled using a random-effects model. Heterogeneity was assessed using the I² statistic. The risk of bias (RoB) was assessed with the revised Cochrane RoB tool (RoB 2). The certainty of evidence was rated using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. RESULTS: Eleven trials (N = 991) were included. HVLAT was associated with significant pain reduction compared to sham HVLAT (mean difference [MD], -1.20; 95% confidence interval [CI]: -1.90, -0.50) and to nonrecommended interventions (MD, -1.16; 95% CI: -1.54, -0.77) in both cervical and lumbar radiculopathy. HVLAT was associated with reduced pain compared to conventional physical therapy alone (MD, -1.26; 95% CI: -2.20, -0.32) at short- and medium-term follow-up. There were no differences at long-term follow-up. The overall RoB was high; the certainty of evidence ranged from very low to moderate. CONCLUSION: HVLAT could reduce pain and disability in patients with cervical and lumbar radiculopathy in the short term and medium term compared with sham HVLAT interventions, conventional physical therapy alone, and spinal mobilization, but not if compared to spinal mobilization with leg movement. J Orthop Sports Phys Ther 2025;55(10):1-12. Epub 11 September 2025. doi:10.2519/jospt.2025.13103.

An infographic created by the JOSPT Knowledge Mobilization team to disseminate key research messages for clinicians. J Orthop Sports Phys Ther 2025;55(10):623. doi:10.2519/jospt.2025.9001.

OBJECTIVE: To describe the injury type (index/recurrent), location (medial head/lateral head), mechanism, player demographics, and prognosis (recovery/recurrence) in gastrocnemius injuries affecting elite male players. DESIGN: Longitudinal cohort. METHODS: Injury data from 2014 to 2023 were extracted from the Soft Tissue Injury Registry of the Australian Football League. Data items were injury type and circumstances, player demographics, and prognostic outcomes (functional milestones and recurrence). Demographics, injury characteristics, and prognoses were described. Recovery (time to return to play) was compared (survival analysis) for injury type (index vs recurrent), location (medial head vs lateral head), mechanism, intrinsic factors, and training history. RESULTS: Eighty-two magnetic resonance imaging-confirmed gastrocnemius injuries were included (68 index, 14 recurrent). Medial head injuries were most prevalent (78%). The median (interquartile range) time to reach functional milestones was 3 days (3) to walk pain free, 14 days (11) to run at >90% of the maximum speed, 14 days (15.5) to return to full training, and 19 days (16) to return to play. A recent change in loading prior to injury (P = .02), a running-related mechanism (P = .03), and older age (P = .01) resulted in longer recovery. Acceleration was the most common running injury mechanism, occurring in 13 cases. Twenty-nine injuries lacked a specific inciting mechanism. Recurrences occurred <6 months after the index injury in 79% (n = 11) of cases. CONCLUSION: Gastrocnemius injuries predominantly affected the medial head. More than 1 in 6 cases were recurrent. J Orthop Sports Phys Ther 2025;55(10):1-8. Epub 8 September 2025. doi:10.2519/jospt.2025.13526.

OBJECTIVE: To explore factors that influence patient preferences for recommended physical therapies for low back pain. DESIGN: Discrete choice experiment. METHODS: Respondents were randomized to a block of 12 choice tasks and asked to choose between two physical therapies or no treatment. Characteristics of the physical therapies varied between choice tasks and included type (exercise, advice and education, or clinician-directed treatment), effectiveness, time for symptoms to improve, costs, risk of side effects, and treatment duration. Choices were analyzed using a mixed logit model. Latent class analysis examined preference heterogeneity. To measure decision trade-offs, we estimated the smallest worthwhile effect and the "willingness to pay" value. RESULTS: A total of 697 Australians reporting a history of low back in the last year completed all choice tasks. Respondents showed a strong preference for taking any nonpharmacologic care option over no treatment (OR = 17.24; 95% CI [12.89, 22.58]). This preference was present at any level of effectiveness (smallest worthwhile effect = 0%). Respondents preferred physical therapies with higher effectiveness, quicker symptom improvement, lower out-of-pocket expenses, reduced side effects, and shorter duration. Respondents were willing to pay up to A$355 per month for physical therapies over no treatment. Older and less-educated respondents had weaker preferences for physical therapies. CONCLUSION: Respondents had a strong preference for any recommended physical therapies over no treatment for low back pain, even when effects were very small. Clinicians should discuss likely effectiveness, time for improvement, side effects, and treatment duration when supporting patients to choose between recommended physical therapies. J Orthop Sports Phys Ther 2025;55(9):602-610. Epub 30 July 2025. doi:10.2519/jospt.2025.13409.

OBJECTIVE: To explore the effect of the WalkBack intervention on the duration and severity of low back pain in participants who reported a recurrence. DESIGN: Secondary exploratory analysis of the WalkBack randomized controlled trial. METHODS: The WalkBack trial compared an individualized and progressive walking plus education program delivered by physiotherapists, to a no-treatment control group for preventing new recurrences of low back pain. In this study, we analyzed the first recurrence of low back pain (n = 596). The primary outcome for this analysis was the duration of the recurrence (time to recovery in days). The secondary outcomes were the level of interference with daily activity caused by the recurrence, and pain intensity (average and worst). Survival analysis, linear, and ordinal regression were used to compare outcomes between groups. RESULTS: Walking plus education was associated with a shorter duration of pain recurrence compared to control: median time to recovery 3 days (95% confidence interval [CI]: 3, 4) versus 4 days (95% CI: 4, 5); hazard ratio 1.30 (95% CI: 1.10, 1.53; P = .002). There was no between-group difference in interference with daily activity or average pain intensity. The intervention group reported lower worst pain intensity on average than the control group (-0.34 on a numerical pain-rating scale from 0 to 10; 95% CI: -0.65, -0.03; P = .03). CONCLUSION: Participants who received a tailored and progressive walking plus education program reported shorter and milder back pain recurrences than participants in the control group. However, the benefits were small and of uncertain clinical relevance. J Orthop Sports Phys Ther 2025;55(9):1-6. Epub 6 August 2025. doi:10.2519/jospt.2025.13361.

OBJECTIVE: To evaluate the efficacy of heel lifts in people with midportion Achilles tendinopathy. DESIGN: This was a parallel-group randomized, sham-controlled, participant- and assessor-blinded trial conducted at a single center (Victoria University, Institute for Health and Sport, Melbourne, Australia). METHODS: One hundred and eight participants (38 females and 70 males; mean age, 48 years; standard deviation, 10 years) with midportion Achilles tendinopathy, diagnosed clinically and confirmed by ultrasound, were randomly allocated to either a heel lift (n = 54) or sham intervention (n = 54) group. The primary outcome was pain intensity (11-point numerical rating scale) at 12 weeks. Differences between groups were analyzed using an intention-to-treat approach with analysis of covariance. RESULTS: There was 100% follow-up of participants at 12 weeks. Pain intensity reduced by a mean of 3.7 points in the heel lifts group and 2.5 points in the sham intervention group. On average, there was a significant between-group difference in favor of heel lifts for reducing pain intensity (adjusted mean difference, -0.9; 95% confidence interval [CI]: -1.7, -0.2; P = .02), which approximated, but did not meet the predetermined minimum important difference of 1.5 points. The primary analysis was not robust to sensitivity analysis when controlling for expectation (adjusted mean difference -0.7; 95% CI: -1.5, 0.0; P = .06). CONCLUSION: In adults with midportion Achilles tendinopathy, heel lifts demonstrated greater efficacy than a sham intervention for reducing pain intensity at 12 weeks, but this benefit was small and may not be clinically meaningful. These results do not support the use of heel lifts for the primary management of Achilles tendinopathy. J Orthop Sports Phys Ther 2025;55(9):1-10. Epub 1 August 2025. doi:10.2519/jospt.2025.13422.

OBJECTIVE: To systematically synthesize and summarize findings from qualitative studies exploring the perceptions and experiences of individuals living with frozen shoulder. DESIGN: Systematic review of qualitative studies. LITERATURE SEARCH: The search strategy was conducted in June and updated in November 2024. We searched the following databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Cochrane Library, EMBASE, PEDro (Physiotherapy Evidence Database), PsycINFO, MEDLINE (Medical Literature Analysis and Retrieval System Online), Scopus, SPORTDiscus, and Web of Science. STUDY SELECTION CRITERIA: We included qualitative primary studies or mixed-methods studies that (1) clearly identified qualitative data; (2) were published in English or Italian; (3) involved participants aged ≥16 years; and (4) investigated participants' experiences living with frozen shoulder, regardless of phase, intervention type, or publication date. DATA SYNTHESIS: Sandelowski and Barroso's methodology was followed for meta-synthesis and meta-summary. The Confidence in the Evidence from Reviews of Qualitative Research approach evaluated the certainty of the results. RESULTS: Nine studies, comprising 116 participants, were included. One hundred fifty-seven target findings were extracted, analyzed, synthesized, and grouped into 12 categories and 5 main themes: (1) "I cannot recognize my body," (2) "Frozen shoulder is hindering my life," (3) "Frozen shoulder is affecting my psychological well-being," (4) "Navigating recovery," and (5) "Regaining control of my life after frozen shoulder." The critical appraisal indicated moderate methodological quality, and there was a moderate level of confidence that the findings effectively captured the patient experience of frozen shoulder. CONCLUSION: Frozen shoulder affects people's physical function, emotional well-being, and daily life, underscoring the need for a patient-centered approach. Integrating these perspectives into clinical practice can enhance health care strategies and support recovery. J Orthop Sports Phys Ther 2025;55(9):1-16. Epub 30 July 2025. doi:10.2519/jospt.2025.13432.

OBJECTIVE: To summarize the perceptions and experiences of patients living with whiplash-associated disorders (WADs). DESIGN: Qualitative evidence synthesis. LITERATURE SEARCH: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, Embase, Physiotherapy Evidence Database (PEDro), PsycINFO, MEDLINE, Scopus, SPORTDiscus, and Web of Science databases were searched up to June 2024 and updated in October 2024. STUDY SELECTION CRITERIA: Inclusion criteria were (1) qualitative primary studies or mixed methods studies with clear identification of participants and findings from the qualitative methods, (2) published in English or Italian, (3) included participants aged ≥16 years, and (4) focused on participants' experiences with a diagnosis of WAD. DATA SYNTHESIS: Metasummary and metasynthesis processes were conducted following Sandelowski and Barroso's methodology. The confidence of the findings was evaluated using the Grading of Recommendations Assessment, Development, and Evaluation Confidence in Evidence from Reviews of Qualitative Research (GRADE-CERQual) approach. RESULTS: Eighteen studies were included, comprising a total of 349 participants. Overall, 330 target findings were collected, analyzed, and grouped into 15 categories attributable to 5 main themes: (1) "WAD changed my body," (2) "WAD destabilized my daily life," (3) "WAD has consumed my thoughts," (4) "The recovery journey from WAD," (5) "Life goes on after WAD." The methodological quality of all studies revealed only minor concerns. The GRADE-CERQual assessment indicated moderate confidence in the findings, due to serious concerns regarding their relevance to the patient experience of WAD. CONCLUSION: People with WAD experienced a wide range of interconnected physical, emotional, cognitive, and social challenges. Addressing these multifaceted needs through a biopsychosocial approach can guide more effective management strategies and improve long-term outcomes for patients with WAD. J Orthop Sports Phys Ther 2025;55(9):1-19. Epub 25 July 2025. doi:10.2519/jospt.2025.13156.

Synopsis: Identifying pain descriptors provides a way to tailor pain management based on presumed underlying mechanisms. The aim is to use mechanistic pain descriptors (nociceptive, neuropathic, and nociplastic pain) to guide clinical practice into an era of personalized medicine for people with pain. Clinicians should understand the concept of descriptors to improve their understanding of a mechanism-based management of chronic pain. Nonetheless, all treatment of individuals suffering from chronic pain should be holistic (ie, person-centered). Nociplastic pain already serves as an evidence-based explanation that can help make sense of pain without any known pathology, but is not ready to be considered as a target for treatment in itself, based on the current level of evidence. To summarize, treatment outcomes may improve when treatments are matched to patients according to mechanistic descriptors. Current research initiatives are working on bring this closer to the clinic. J Orthop Sports Phys Ther 2025;55(9):1-6. Epub 29 July 2025. doi:10.2519/jospt.2025.13335.