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COURSE ADVERTISEMENT
Other conditions that this Nimbus will benefit include:
Metatarsalgia: Pain in the plantar region of the forefoot. This condition causes mechanical over load of the metatarsals, affecting normal gait. Increase cushioning at forefoot will help relieve forefoot pain.
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Sesamoiditis: Pain affecting the sesamoids. Conservative management allows the propulsive phase of gait to be unrestricted to allow foot to move in the correct alignment. Nimbus lite has a wider base at the forefoot, with an unrestricted propulsive phase allowing a smooth transition required to help manage this pain.
Heel spur syndrome: A bony overgrowth from the calcaneal tuberosity. Symptoms vary among individuals, although most include a dull ache in heel throughout the day, with associated inflammation. Nimbus offers an effective gradient pitch to shift peak forces away from heel, along with a highly absorbent plantar cushioning to relive pressure with reduce pain.
Underpronation: Excessive supination, caused by a high arch and muscle weakness. Stress occurs to the outside side of foot, predisposing to sprained ankles and often leading to other additional foot complications. Nimbus provides, cushioning, flexibility to allow the foot to pronate to aid this biomechanical complication.
Anthony Ng
B.Sc (Pod), B.Ed, Dip Tch
Integrating pelvic health into musculoskeletal physiotherapy practice.
Location Auckland, Wellington, and Christchurch
Dates Auckland 3 July 2021 Wellington 31 July 2021 Christchurch 30 October 2021
Dr Melissa Davidson Specialist Physiotherapist in Pelvic Health Registered with the Physiotherapy Board of New Zealand under Specialist Scope of Practice
Brief summary of content
• Do you want to learn more about pelvic health but you aren't ready yet to do internal examinations? • Do you want to advance your knowledge of both women's and men's health? • Do you feel you are missing a piece of the puzzle when it comes to patient care? • Do you treat both female and male patients for general musculoskeletal issues? This course will cover common conditions and issues for both women and men that you see in the clinic. The course covers: • How to complete a basic screening for pelvic health conditions • How to externally palpate the superficial pelvic floor muscles safely through clothing with patient consent • Return to exercise for post-partum women • DRAM management • Recurrent back, hip, and groin injuries and their relationship to the pelvic floor • Post-prostate surgery return to exercise • Pelvis fracture rehab – addressing the bottom of the pelvis • Adjusting programmes of care to account for pelvic health conditions • How to initiate training of the pelvic floor muscles • Respiratory conditions and the pelvic floor • Pelvic girdle pain during pregnancy • Sportswomen and hormones • When to refer onwards to a pelvic floor or women’s and men’s pelvic health physiotherapist who completes internal examinations as part of their standard assessment and treatment
Cost Auckland $300 Wellington $340 Christchurch $340
Registration and information contact details. Full course details and how to register is on www.drmelissadavidson.com
Marinus Winters , Sinéad Holden, Carolina Bryne Lura, Nicky J Welton, Deborah M Caldwell, Bill T Vicenzino , Adam Weir, Michael Skovdal Rathleff.
British Journal of Sports Medicine 2021: 55:369-377. doi:10.1136/bjsports-2020-102819
By Karen Carmichael
Abstract:
Objective:
To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP). Design a living systematic review with network meta-analysis (NMA).
Data sources:
Sensitive search in seven databases, three grey literature resources and four trial registers.
Eligibility criteria:
Randomised controlled trials evaluating any treatment for PFP with outcomes ’any improvement’, and pain intensity.
Data extraction:
Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V.2. We used Grading of Recommendations, Assessment, Development and Evaluation to appraise the strength of the evidence.
Primary outcome measure:
Results:
Twenty-two trials (with forty-eight treatment arms) were included, of which approximately 10 (45%) were at high risk of bias for the primary outcome. Most comparisons had a low to very low strength of the evidence. All treatments were better than wait and see for any improvement at 3 months (education (OR 9.6, 95% credible interval (CrI): 2.2 to 48.8); exercise (OR 13.0, 95% CrI: 2.4 to 83.5); education+orthosis (OR 16.5, 95% CrI: 4.9 to 65.8); education+exercise+patellar taping/mobilisations (OR
25.2, 95% CrI: 5.7 to 130.3) and education+exercise+patellar taping/ mobilisations+orthosis (OR 38.8, 95% CrI: 7.3 to 236.9)). Education+exercise+patellar taping/ mobilisations, with (OR 4.0, 95% CrI: 1.5 to 11.8) or without orthosis (OR 2.6, 95% CrI: 1.7 to 4.2), were superior to education alone. At 12 months, education or education+any combination yielded similar improvement rates.
Summary/conclusion.
Education combined with a physical treatment (exercise, orthoses or patellar taping/mobilisation) is most likely to be effective at 3 months. At 12 months, education appears comparable to education with a physical treatment. There was insufficient evidence to recommend a specific type of physical treatment over another. All treatments in our NMA were superior to wait and see at 3 months, and we recommend avoiding a wait-and-see approach.
The idea behind this paper was to create a “living systematic review” using network meta-analysis (NMA), to keep up to date with the research into the most effective treatment strategies for patella-femoral pain. The question the paper sought to answer was: “Which treatment(s)/treatment category is most likely to be effective for patella-femoral pain (PFP) on any improvement (measured by a Global rating of change Scale) and patient-rated pain (measured by a pain scale)?” Using a NMA allows them to update the systematic review as new research comes out.
The minimum criteria for inclusion were studies describing patients with retropatellar or peri patella pain, of at least 6-week duration and a non-traumatic onset. Patella dislocations, patellofemoral OA, patellar tendionopathy, Osgood-Schlatters, ITB and Sinding-Larsen-Johanssson were all
excluded. There were no age restrictions.
Studies measuring the treatment effect after a minimum of 6 weeks were included.
Treatment was put into several different categories including:
• Education • Education+exercise therapy + Patellar taping/ mobilisations • Education + orthotics • Education + exercise therapy + patellar treatments + orthosis • Wait and see • Exercise Therapy
A definition of each of the categories was outlined in the paper.
22 Randomised Controlled trials were included in the review. Eleven of the RCT’s used a global rating of change scale and nineteen trials used a worst pain scale or measured pain during a specific activity. Altogether 1472 patients with PFP were included. There was a high risk of bias in most of the studies. Most of the certainty for evidence was rated low to very low.
It was reassuring to see that all treatments were better than a wait and see approach at 3 months. Education + exercise + patella taping/ mobilisations, either with or without orthosis was the best combination of treatments for PFP at 3 months.
Unfortunately, the pooled findings for “worst pain” showed that none of the treatments was superior to a wait and see approach.
At 12 months, Education combined with modalities were better than education alone. For pain descending stairs at both 3 and 12 months a programme of hip, knee and trunk exercises was superior to hip and knee exercises alone (and superior to arthroscopy at 12 months).
It is interesting to see that a global rating of change found significant differences between treatment regimes, but “worst pain” did not. This means reported outcomes can have a bearing on study findings. In this review they asked 7 people with PFP what outcome measure was more important to them, and 6 out of 7 preferred the global rating of change. It is also easier to compare studies if a “gold -standard” outcome measure is used, and perhaps more research is needed for this in PFP.
As with any studies there are several flaws and limitations. Quality of studies included in the review and inherent bias in studies are an issue. The treatment groupings are quite broad, other studies have found conflicting results – notably with the education alone. The type of education given needs to be defined.
The clinical message from this paper is overall reassuring that treatment for PFP is generally better than a wait and see approach on a global change scale and there are several modalities that can be used. As always clinical judgement is needed to evaluate what is likely to be best for your client. Education in combination with a physical treatment (exercise, othoses or patella taping/mobilisation) is likely to be effective at 3 months.
A full set of references is available on request.
RESEARCH REQUEST
Experiencing and living with a shoulder dislocation
We are seeking participants for a research study exploring experiences of people with a shoulder dislocation. We ask them to share their experiences about the injury, health care, and how they manage potential recurrences and fear or anxiety about recurrence.
We are inviting individuals who have had a traumatic shoulder dislocation within the past 6 months to 5 years and are between 16 and 35 years old. Participants will be asked to complete an electronic questionnaire and attend an interview with the researchers (in person, or by Zoom/ Skype or telephone).
Researchers: A/Prof Gisela Sole, Dr Margie Olds The study is supported by a grant from the NZ Manipulative Physiotherapy Association. Approved by the University of Otago Human Ethics Committee (Health)
Please find information here:
https://www.otago.ac.nz/physio/research/ otago824639.html
Or contact Gisela Sole, Gisela.sole@otago.ac.nz
