Articles of Interest

Ankle/Foot

Plantar fascia stretches for plantar fasciitis
Specific non-weight bearing stretches for the plantar fascia are more beneficial than standard achillies tendon stretches in the short term treatment of plantar fasciitis.
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Plantar Fasciitis and the Windlass mechanism: Biomechanical Link to Clinical Practice
Clinicians' understanding of the biomechanical causes of plantar fasciitis should guide the decision-making process concerning the evaluation and treatment of heel pain. Use of this approach may improve clinical outcomes because intervention does not merely treat physical symptoms but actively addresses the influences that resulted in the condition.
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Stretching improves ankle range of motion
Calf muscle stretching provides a small and statistically significant change in ankle range of motion. However it is uncertain if this change is clinically significant.
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The rehabilitation of an injury to an ankle ligament.
A combination of strength training and proprioception (balance) training shortens rehabilitation time and helps prevent secondary or recurring injury.
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Complementary Therapy

A Randomised Trial of Chiropractic and Medical Care for Patients with Low Back Pain
This study suggests that whilst people may believe chiropractic is more effective for managing low back pain this does not appear to be the case. Physical therapy was shown to be more effective than medical care alone in some cases but was not directly compared to chiropractic. The evidence of ongoing pain at 18 months highlights the need for further research into the most effective models of care.
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Adverse Reactions to Chiropractic Care in the UCLA Neck Pain Study
Neck manipulation has long been used for neck pain, often being touted as remarkably safe and comfortable. However this study shows that 3/10 patients receiving manipulation for neck pain have adverse reactions to this treatment. Mobilization of neck joints were shown to be significantly less likely to have an adverse reaction. Given the lack of evidence for manipulation over mobilization for treating neck pain, this study recommends using mobilization as a more appropriate therapy, particularly patients with more severe pain.
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Bipolar Permanent Magnets for the Treatment of Chronic Low Back
Based on the findings from this study, magnets provided no greater relief for chronic low back pain.
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Chiropractic spinal manipulation for low back painThis article shows that the effectiveness of chiropractic spinal manipulation is uncertain. It also recommends that osteoporosis should be reguarded as a contraindication for chiropractic manipulation.
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Clinical Utility of Surface EMG Based on the lack of evidence with the studies up to this point, SEMG is considered unacceptable as a clinical tool in the diagnosis of low back pain. People with low back pain should be wary of any claims made by clinicians regarding their condition based on findings obtained from surface electromyography (SEMG).
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Effect of Magnetic vs. Sham ? magnetic Insoles on Plantar heel pain
Magnets have become a popular treatment for many musculoskeletal conditions despite little scientific support for therapeutic benefit. Based on the evidence from this article, magnets provided no greater relief from plantar fasciitis.
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Effectiveness of foot orthoses
The results are generally good 78% of recipients of foot orthoses agreed or strongly agreed that they had gained some relief. A wide range of symptoms were treated but the sample is too small to produce a valid analysis of trends.
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Glucosamine and Chondroitin for Treatment of Osteoarthritis
According to these earlier studies, pain associated with osteoarthritis of the hip or knee appears to improve with Glucosamine and Chondroitin supplements. Shortcomings found in these studies however raises the question of how accurate the early findings are. As better studies are completed the true effectiveness of these preparations should become clearer (please refer to other references contained in this section).
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Glucosamine therapy for treating OA
Glucosamine is safe but does not appear to improve pain and functional limitation associated with OA as much as previously thought, if at all.
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Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis
Glucosamine and Chondroitin Sulfate preparations when taken alone or in combination do not effectively reduce pain levels for those people suffering osteoarthritis of the knee. This study suggests that these supplements are more effective for those suffering moderate to severe pain, but this requires further research.
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Homeopathic arnica for prevention of pain and bruising
The results of this double -blind, placebo-controlled, randomized trail do not support the routine use of homeopathic arnica for preventing or reducing postoperative complications such as bruising, swelling and pain.
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Homoeopathic Arnica
Homeopathic arnica failed to show any advantage compared with placebo in reducing post-operative pain, bruising, and swelling in patients having elective hand surgery.
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Some observations on the pharmacology of deep-heat, a topical rubifacient
This article examines the effect the ‘deep-heat’ has on normal tissue. There was found to be an erythematous response and an increase in venous blood oxygen levels. The active ingredients also acted on the clotting system to make cells more resistant to clotting factors. This study is limited in that it doesn’t show any effects to tissues deeper than the skin.
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The Use of Ice in the Treatment of Acute Soft-Tissue Injury
This study reviews the efficacy of icing in the treatment of acute soft-tissue injury. Many studies have been conducted examining its efficacy with mixed results. Conclusions were drawn suggesting ice must be applied as early as possible in acute inflammatory phase, and be combined with exercise outside of this phase. Further studies that use ice in this manner are required to prove its efficacy.
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Intermittent Ice application vs Standard Ice application
Intermittent ice application may enhance the therapeutic effects of ice after soft tissue injury. However at the moment these effects are limited to pain relief in the early stages of rehabilitation.
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Therapeutic Magnets
A well designed study concluding that a nil thermal effect was observed with magnet treatment over a time period, contradicting one of the fundamental claims made my magnet advocates.
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Topical NSAIDs for Musculoskeletal Conditions. A Review of The Literature
This review examines the efficacy of topically applied non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of musculoskeletal conditions. It suggests that the local concentrations of NSAID in tissues under the area of application are equal to that gained using oral NSAIDs. The systemic levels of the active ingredients, however, are much lower than using the oral form, therefore reducing the risk of systemic reactions such as hearing loss, upper gastrointestinal bleeding, asthma and renal impairment. There is associated risk of cutaneous irritation. Rubbing the affected area may contribute to some of the effects gained and often topically applied NSAIDs are used as adjuncts to other therapy therefore their effects as sole intervention are not often examined.
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Whole body vibration exercise
There are now many outlets throughout New Zealand that offer Whole Body Vibration training. This review has found that there is no conclusive evidence that Whole Body Vibration is effective for strength and cardiovascular training for fit and healthy subjects. It is, however relatively safe for short periods of training and may be effective for elderly populations, particularly those with osteoporosis.
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Elbow

A trial of treatment options for tennis elbow.
This study shows that physio or steroid injections are best in the short term. In the long term physio and 'wait and see' are similar but both have better results than the steroid injection. Research is needed to assess the effects of physiotherapy after a steroid injection.
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Hip/Pelvis

Transverse abdominis (deep abdominals) decreases sacroiliac joint (SIJ) laxity.
PLUS rehab comment: This study shows that transversus abdominis contraction decreases sacroiliac joint laxity. These findings are important for patients and therapists to be aware of as training the transversus abdominals can treat sacroiliac joint (SIJ) and low back pain.
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Knee/Thigh

Exercise for jumper's knee (Patella tendonosis)
Eccentric, but not concentric quadriceps training on a decline board seems to reduce pain in jumper's knee.
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Knee control during single limb squat
Resisted single limb squats may help to simultaneously strengthen quadriceps and facilitate co-activation of the hamstrings. This reduces the strain on the anterior cruciate ligament (ACL, inside the knee) and may help improve control of the knee when active.
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The effect of taping on patellofemoral pain
Taping of the patella (kneecap) seems to reduce pain in people with patellofemoral pain syndrome. However there is no strong evidence to identify why it reduces pain.
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Lower back/Lumbar spine

A clinical rule for lumbar manipulation
This article demonstrates that the use of a clinical prediction rule can predict which patients with lower back pain will benefit from manipulation. This will help to ensure that the treatment that you recieve here will be as beneficial as possible, by using the latest evidence to help guide our treatment decisions.
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Bed rest does not reduce low back pain intensity or sciatica.
This systematic review shows that bed rest does not appear to have any positive effect on low back pain intensity and may even have a negative effect on the low back. Therapists need to be aware of when educating patients on bed rest. It is also important for patients to be aware of so that they can be thoroughly informed when deciding on whether or not to choose bed rest as a treatment for acute low back pain and sciatica.
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Daily spinal loading as a risk factor for low back pain
This study shows that increased loading of the spine in the flexed (bent forward) position is associated with acute low back pain. The longer you are bending forward for the more likely you are to get a sore back.
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Gynecologic surgery and low back pain
Physiotherapy may be indicated post gynecologic surgery to strengthen abdominal and pelvic muscles to prevent possible future low back pain.
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Loading of the lumbar spine during bending
The load on the spine increases as a healthy individual bends forward. The load increases by a greater amount if weight is added to the individual eg. if they are holding something.
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Low back pain and Endometriosis
Endometriosis is a diagnosis that should be considered with young women who experience low back pain.
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Manipulation and outcome for patients with low back pain.
This study shows that patients who have their lower back manipulated are not more likely to have reduced low back pain or lumbopelvic range of movement.
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Stabilizing exercises reduce long-term effects of low back pain.
This research shows that rehabilitating the multifidus and transversus abdominis (core stabilisers) after an episode of low back pain may reduce low back pain recurrence.
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Trunk strengthening for people with chronic low back pain Neck/Cervical Spine
Trunk strengthening is effective for reducing pain and improving function in patients with non-specific chronic low back pain and after lumbar disc surgery. More intensive programmes and those that include motivational strategies appear to be of greater benefit than less intensive.
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Neck/Cervical Spine

Clinical prediction rule for thoracic manipulation
This article demonstrates that the use of a clinical prediction rule can predict which patients with neck pain will benefit from thoracic manipulation. This will help to ensure that the treatment that you recieve here will be as beneficial as possible, by using the latest evidence to guide our treatment decisions.
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Other

Physiotherapy and osteoporosis
In children and adolescents high impact activities should be prescribed to maximise peak bone mass. Small increases in bone mass can be achieved in the middle adult years through structured weight training and weight-bearing exercise. In the elderly conservation of bone mass is most important along with reducing falls, promoting extended postures reducing pain and maximising mobility and function.
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Effective Physiotherapy
Early provision of reassurance and advice to return to activity can prevent chronic disability associated with back pain. Massage and electrotherapy are not useful for chronic pain but exercise can reduce disability. Tailored exercise programmes reduce the risk of falls in the elderly.
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Exercise and Postmenopausal Women.
The research found physical activity such as walking (on average 3.5 days/week for 176 mins/week) can significantly reduce body weight, body fat, intra-abdominal fat and subcutaneous fat in postmenopausal women. Therapists should be aware of this when advising patients on lifestyle changes.
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Muscle activation and spinal load with different types of push-up
Dynamic push-ups (clap, and moving hands) as well as one arm push-ups place the greatest load on the spine, however they also result in the most muscle activity. Press-ups on balls work the abdominals moderately well with less spinal compression. It was also found that skilled individuals activated their muscles more effectively than unskilled.
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Outcome measures

One-leg stance in healthy young and elderly adults
One-leg stance is one outcome measure that can be used to assess balance in young and elderly adults. The first 5 seconds of one-leg stance are crucial in assessing the ability to balance successfully.
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Performance Measures Provide Assessment of Pain and Function in People with Advanced OA
This article found that in patients with OA of the Hip and Knee, the 6 minute walk test and Timed Up and Go measures were more consistent in measuring pain and function of these patients than self reported measures. This indicates that the use of these measures may give a more distinct method of assessing these attributes than can be obtained by self reports alone.
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Six Minute Walk Test
The six minute walk is a self paced sub maximal measure of functional capacity. Most activities of daily living are performed at sub maximal levels of exertion; the 6 minute walk may better reflect the functional exercise level for daily physical activities.
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Submaximal Exercise Testing: Clinical Application and Interpretation
Despite the known limitations associated with predictive submaximal testing it is a more valid approach than maximal testing, within the rehabilitation setting. As long as an appropriate test is selected and procedures are standardized, valid and reliable results can be obtained which helps physiotherapists determine an appropriate level of exercise as part of a rehabilitation programme.
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Pain Relief

Hot packs more effective than painkillers for low back pain
This study shows that hot packs are more effective for pain relief than the analgesics (painkillers) acetaminophen and ibuprofen. This extremely important for patients to be aware of when deciding on the pain relief mechanism for their low back pain.
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Pain relief in soft-tissue injuries.
This research shows soft-tissue injuries (such as muscles and ligaments) should be treated with a physical means such as R.I.C.E and early mobilisation rather than medication.
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Sports

Post match recovery after rugby
Contrast water therapy (hot and cold), compression garments and low intensity active exercise enhance recovery rate and magnitude more than passive recovey i.e. doing nothing.
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Rubber tubing resistance excercises for throwing athletes
Performing the 7 excercises described in this study results in activation of the muscles involved in throwing. Performing these exercises as a warm up before throwing, or engaging in other over head athletic activity could be beneficial.
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Warming up increases proprioception (awareness of joint position).
This research shows that knee joint proprioception (awareness of joint position) increased after warming up. This highlights the importance of warming up as proprioception can influence balance.
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Ultrasound/Physical agents

Therapeutic ultrasound for treating patellofemoral pain syndrome.
This article shows that there is no evidence for the use of ultrasound therapy on acute ankle sprains and that there is no difference between true and sham ultrasound after a 7-14 day follow up.
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Therapeutic ultrasound for treating patellofemoral pain syndrome.
This review shows that ultrasound does not have a clinically significant effect on reducing patellofemoral pain syndrome.
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Ultrasound in musculoskeletal disorders
As yet there seems to be little evidence to support the evidence of ultrasound therapy to treat musculoskeletal disorders.
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