Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect?

This document is the Accepted Manuscript version of the following article: Parle PJ, Riddiford-Harland DL, Howitt CD, et al. 'Acute rotator cuff tendinopathy: does ice, low load isometric exercise, or a combination of the two produce an analgaesic effect?.' Br J Sports Med 2017;51:208-209, doi: http://dx.doi.org/10.1136/bjsports-2016-096107.Rotator cuff tendinopathies are the most commonly diagnosed musculoskeletal shoulder conditions and are associated with pain, weakness and loss of function.1 Tendon swelling may be associated with tendinopathy and may result from acute overload.2–3 An increase in tendon cells (tenocytes) and upregulation of large molecular weight proteoglycans, such as aggrecan, may increase tendon water content.2 There is uncertainty as to whether the swelling is related to the pain or is instead an observed but unrelated phenomenon. Weakness detected clinically may be due to pain inhibition.4–5 Early treatment of acute rotator cuff tendinopathy involves patient education and relative rest, and may include non-steroidal anti-inflammatory drugs (NSAIDs) to reduce pain, swelling and inflammation. Subacromial corticosteroid injections are also used to achieve the same purpose. These techniques show low to moderate evidence of reducing short-term pain but they do not improve function.6 The medications have side effects such as gastrointestinal tract complaints,7 and corticosteroids may damage tendon tissue.8 Identifying alternative ways to control pain and inflammation may be warranted. Two clinical procedures to manage RC tendinopathy include ice wraps and isometric exercise, however, there are no empirical data supporting their use. This pilot study, conducted at the Illawarra Sports Medicine Clinic, NSW, Australia, was designed to test (1) the short term analgaesic effect of these interventions and (2) the feasibility of a larger clinical trial for adults diagnosed with acute rotator cuff tendinopathy (<12 weeks).Peer reviewe

What is the effect of a physical activity program on foot structure & function in overweight & obese children?

It has been speculated that the higher peak pressures typically generated beneath the feet of overweight/obese children may result in excessive discomfort of these children’s developing feet (Mickle et al. 2006, Dowling et al. 2001), in turn, acting as a deterrent to them participating in physical activity. Apart from perpetuating the cycle of obesity via decreased energy expenditure, physical inactivity in young children can restrict opportunities for these children to develop basic motor skills and, possibly, proper musculoskeletal development. We postulated that an intervention designed to improve fundamental movement skill (FMS) performance in overweight and obese young children may influence development of the children’s base of support, the feet, during locomotor skills. Therefore, the aim of the present study was to examine the effects of a FMS intervention program on foot structure and function in young overweight and obese children

Foot structure in obese children: Implications for footwear design

Abstract of paper presented at 19th Annual Scientific Meeting of the Australian and New Zealand Obesity Society, Adelaide, Australia, 19-22 October, 2011

Effects of a physical activity program on plantar pressures in overweight and obese children: RCT findings at 12 months follow-up

Abstract of paper that presented at the 2012 Australian & New Zealand Obesity Society Annual Scientific Meeting, Aucklan, New Zealand, 18-20 October

Does participation in a physical activity program impact upon the feet of overweight and obese children?

Objectives: To investigate the effect of a weight-bearing physical activity program on foot structure and plantar pressures generated by overweight/obese children. Design: Descriptive study. Methods: Measurements were collected for a sample of children participating in an obesity treatment trial (mean±SD 8.5±1.1 y, 29.4% boys, 2.63±0.61 body mass index z-score). Children were randomised to physical activity (physical activity; n=24) and no physical activity (no physical activity; n=10) groups. Foot structure was characterised using anthropometry, an emed® AT-4 system quantified pressure distributions and Actigraph accelerometers objectively measured physical activity. Results: After 6 months there was a significant decrease in body mass index z-score (physical activity: p = 0.002, no physical activity: pConclusions: Although changes to foot structure and function in overweight/obese children could not be attributed to participating in the physical activity program, their developing feet may still be at risk of pain and discomfort due to higher plantar pressures and pressure-time integrals. Further research investigating ways to reduce plantar pressures generated by overweight/obese children while they are physically active is warranted

Lower activity levels are related to higher plantar pressures in overweight children

PURPOSE: This study aimed to establish whether the peak plantar pressures generated by overweight and obese school-age children during walking were associated with their objectively measured physical activity. METHODS: Physical activity levels of a subset of 73 overweight/obese children from a randomized controlled trial (mean ± SD: age, 8.3 ± 1.1 yr; 47 girls; body mass index z-score, 2.7 ± 0.7) were objectively measured using accelerometers. Plantar pressure distributions were also quantified as the participants walked over a pressure platform. Pearson product moment correlation coefficients were calculated to determine the strength of the relations between the peak plantar pressures generated during walking and the physical activity levels for overweight/obese children. RESULTS: Peak pressures generated beneath the forefoot during walking were inversely correlated with time spent in different intensity levels of physical activity. Moderate-intensity (r = -0.321, P = 0.007), vigorous-intensity (r = -0.326, P = 0.006), and moderate- to vigorous-intensity (r = -0.342, P = 0.004) physical activity were significantly correlated with middle forefoot pressure and with lateral forefoot pressure (r = -0.248, P = 0.040; r = -0.264, P = 0.028; r = -0.267, P = 0.027, respectively). Lateral midfoot (r = -0.244, P = 0.044) and second toe (r = 0.227, P = 0.021) pressure were also significantly correlated with vigorous-intensity activity. CONCLUSIONS: Those children who generated higher pressures beneath their forefoot and midfoot during walking had lower levels of physical activity. Further research is required to determine the long-term effects of excessive body mass on participation in physical activity and whether the walking plantar pressure patterns associated with reduced physical activity are related to foot pain or discomfort