Christian J Barton

Bio: Christian J Barton is an academic researcher from La Trobe University. The author has contributed to research in topics: Patellofemoral pain syndrome & Medicine. The author has an hindex of 39, co-authored 160 publications receiving 4807 citations. Previous affiliations of Christian J Barton include Centre College & Charles Sturt University.

Achilles and patellar tendinopathy loading programmes : a systematic review comparing clinical outcomes and identifying potential mechanisms for effectiveness.

Abstract: Achilles and patellar tendinopathy are overuse injuries that are common among athletes Isolated eccentric muscle training has become the dominant conservative management strategy for Achilles and patellar tendinopathy but, in some cases, up to 45 % of patients may not respond Eccentric-concentric progressing to eccentric (Silbernagel combined) and eccentric-concentric isotonic (heavy-slow resistance; HSR) loading have also been investigated In order for clinicians to make informed decisions, they need to be aware of the loading options and comparative evidence The mechanisms of loading also need to be elucidated in order to focus treatment to patient deficits and refine loading programmes in future studies The objectives of this review are to evaluate the evidence in studies that compare two or more loading programmes in Achilles and patellar tendinopathy, and to review the non-clinical outcomes (potential mechanisms), such as improved imaging outcomes, associated with clinical outcomes Comprehensive searching (MEDLINE, EMBASE, CINAHL, Current Contents and SPORTDiscus™) identified 403 studies Two authors independently reviewed studies for inclusion and quality The final yield included 32 studies; ten compared loading programmes and 28 investigated at least one potential mechanism (six studies compared loading programmes and investigated potential mechanisms) This review has identified limited (Achilles) and conflicting (patellar) evidence that clinical outcomes are superior with eccentric loading compared with other loading programmes, questioning the currently entrenched clinical approach to these injuries There is equivalent evidence for Silbernagel combined (Achilles) and greater evidence for HSR loading (patellar) The only potential mechanism that was consistently associated with improved clinical outcomes in both Achilles and patellar tendon rehabilitation was improved neuromuscular performance (eg torque, work, endurance), and Silbernagel-combined (Achilles) HSR loading (patellar) had an equivalent or higher level of evidence than isolated eccentric loading In the Achilles tendon, a majority of studies did not find an association between improved imaging (eg reduced anteroposterior diameter, proportion of tendons with Doppler signal) and clinical outcomes, including all high-quality studies In contrast, HSR loading in the patellar tendon was associated with reduced Doppler area and anteroposterior diameter, as well as greater evidence of collagen turnover, and this was not seen following eccentric loading HSR seems more likely to lead to tendon adaptation and warrants further investigation Improved jump performance was associated with Achilles but not patellar tendon clinical outcomes The mechanisms associated with clinical benefit may vary between loading interventions and tendons There is little clinical or mechanistic evidence for isolating the eccentric component, although it should be made clear that there is a paucity of good quality evidence and several potential mechanisms have not been investigated, such as neural adaptation and central nervous system changes (eg cortical reorganization) Clinicians should consider eccentric-concentric loading alongside or instead of eccentric loading in Achilles and patellar tendinopathy Good-quality studies comparing loading programmes and evaluating clinical and mechanistic outcomes are needed in both Achilles and patellar tendinopathy rehabilitation

The effectiveness of neuromuscular warm-up strategies, that require no additional equipment, for preventing lower limb injuries during sports participation: a systematic review

Abstract: Lower limb injuries in sport are increasingly prevalent and responsible for large economic as well as personal burdens In this review we seek to determine which easily implemented functional neuromuscular warm-up strategies are effective in preventing lower limb injuries during sports participation and in which sporting groups they are effective Seven electronic databases were searched from inception to January 2012 for studies investigating neuromuscular warm-up strategies and injury prevention The quality of each included study was evaluated using a modified version of the van Tulder scale Data were extracted from each study and used to calculate the risk of injury following application of each evaluated strategy Nine studies were identified including six randomized controlled trials (RCT) and three controlled clinical trials (CCT) Heterogeneity in study design and warm-up strategies prevented pooling of results Two studies investigated male and female participants, while the remaining seven investigated women only Risk Ratio (RR) statistics indicated 'The 11+' prevention strategy significantly reduces overall (RR 067, confidence interval (CI) 054 to 084) and overuse (RR 045, CI 028 to 071) lower limb injuries as well as knee (RR 048, CI 032 to 072) injuries among young amateur female footballers The 'Knee Injury Prevention Program' (KIPP) significantly reduced the risk of noncontact lower limb (RR 05, CI 033 to 076) and overuse (RR 044, CI 022 to 086) injuries in young amateur female football and basketball players The 'Prevent Injury and Enhance Performance' (PEP) strategy reduces the incidence of anterior cruciate ligament (ACL) injuries (RR 018, CI 008 to 042) The 'HarmoKnee' programme reduces the risk of knee injuries (RR 022, CI 006 to 076) in teenage female footballers The 'Anterior Knee Pain Prevention Training Programme' (AKP PTP) significantly reduces the incidence of anterior knee pain (RR 027, CI 014 to 054) in military recruits Effective implementation of practical neuromuscular warm-up strategies can reduce lower extremity injury incidence in young, amateur, female athletes and male and female military recruits This is typically a warm-up strategy that includes stretching, strengthening, balance exercises, sports-specific agility drills and landing techniques applied consistently for longer than three consecutive months In order to optimize these strategies, the mechanisms for their effectiveness require further evaluation

2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)

Abstract: Patellofemoral pain affects physically active and sedentary individuals, accounting for 11–17% of knee pain presentations to general practice1 ,2 and 25–40% of all knee problems seen in a sports injury clinic.3 ,4 Patellofemoral pain is characterised by anterior knee pain associated with activities such as squatting, rising from sitting and stair ambulation. While traditionally viewed as self-limiting, increasing research data suggest that patellofemoral pain is often recalcitrant and can persist for many years,5–8 and may cause a decline in sports participation.8 ,9 Despite its high prevalence among active individuals9–12 and frequent presentations for treatment, there are few published guidelines to help clinicians choose the appropriate evidence-based treatment for patellofemoral pain. The most recent and relevant paper from Barton and colleagues13 combined systematic review findings with qualitative interviews from expert clinicians to provide a clinically relevant synthesis, covering the literature up to September 2013. At the International Patellofemoral Pain Research Retreat in Manchester 2015, we held a consensus meeting to update the current evidence base and produce consensus-based recommendations regarding treatment for patellofemoral pain. All retreat registrants were active researchers in patellofemoral pain and presented their research findings. Many of the world leading researchers (eg, 8 out of the top 10 researchers with the highest number of publications, when the term ‘patellofemoral pain’ was searched in Scopus, February 2016) were in attendance and contributed to the consensus meeting. The consensus meeting during the retreat resulted in recommendations, based on evidence published between January 2010 and June 2015. These recommendations should be combined with information gathered from individual patients, regarding their preferences, experiences, presentation and values, along with the values, expertise and skills of individual practitioners to create a patient-centred treatment approach. ### Literature review CJB searched EMBASE, MEDLINE, CINAHL and Current Contents for systematic reviews …

2018 Consensus statement on exercise therapy and physical interventions (orthoses, taping and manual therapy) to treat patellofemoral pain: recommendations from the 5th International Patellofemoral Pain Research Retreat, Gold Coast, Australia, 2017.

Abstract: Patellofemoral pain affects a large proportion of the population, from adolescents to older adults, and carries a substantial personal and societal burden. An international group of scientists and clinicians meets biennially at the International Patellofemoral Research Retreat to share research findings related to patellofemoral pain conditions and develop consensus statements using best practice methods. This consensus statement, from the 5th International Patellofemoral Research Retreat held in Australia in July 2017, focuses on exercise therapy and physical interventions (eg, orthoses, taping and manual therapy) for patellofemoral pain. Literature searches were conducted to identify new systematic reviews and randomised controlled trials (RCTs) published since the 2016 Consensus Statement. The methodological quality of included systematic reviews and RCTs was graded using AMSTAR and PEDro, respectively. Evidence-based statements were developed from included papers and presented to a panel of 41 patellofemoral pain experts for consensus discussion and voting. Recommendations from the expert panel support the use of exercise therapy (especially the combination of hip-focused and knee-focused exercises), combined interventions and foot orthoses to improve pain and/or function in people with patellofemoral pain. The use of patellofemoral, knee or lumbar mobilisations in isolation, or electrophysical agents, is not recommended. There is uncertainty regarding the use of patellar taping/bracing, acupuncture/dry needling, manual soft tissue techniques, blood flow restriction training and gait retraining in patients with patellofemoral pain. In 2017, we launched the International Patellofemoral Research Network (www.ipfrn.org) to consolidate and grow our patellofemoral research community, facilitate collaboration and disseminate patellofemoral pain knowledge to clinicians and the general public. The 6th International Patellofemoral Research Retreat will be held in Milwaukee, Wisconsin, USA, in October 2019.

The Answer Is 17 Years, What Is the Question

Abstract: This study aimed to review the literature describing and quantifying time lags in the health research translation process. Papers were included in the review if they quantified time lags in the development of health interventions. The study identified 23 papers. Few were comparable as different studies use different measures, of different things, at different time points. We concluded that the current state of knowledge of time lags is of limited use to those responsible for R&D and knowledge transfer who face difficulties in knowing what they should or can do to reduce time lags. This effectively ‘blindfolds’ investment decisions and risks wasting effort. The study concludes that understanding lags first requires agreeing models, definitions and measures, which can be applied in practice. A second task would be to develop a process by which to gather these data.

The Influence of Abnormal Hip Mechanics on Knee Injury: A Biomechanical Perspective

Abstract: Synopsis During the last decade, there has been a growing body of literature suggesting that proximal factors may play a contributory role with respect to knee injuries. A review of the biomechanical and clinical studies in this area indicates that impaired muscular control of the hip, pelvis, and trunk can affect tibiofemoral and patellofemoral joint kinematics and kinetics in multiple planes. In particular, there is evidence that motion impairments at the hip may underlie injuries such as anterior cruciate ligament tears, iliotibial band syndrome, and patellofemoral joint pain. In addition, the literature suggests that females may be more disposed to proximal influences than males. Based on the evidence presented as part of this clinical commentary, it can be argued that interventions which address proximal impairments may be beneficial for patients who present with various knee conditions. More specifically, a biomechanical argument can be made for the incorporation of pelvis and trunk stability, as we...

Overuse Injuries and Burnout in Youth Sports: APositionStatementfromtheAmericanMedicalSocietyfor Sports Medicine

Abstract: ### Background Youth sport participation offers many benefits including the development of self-esteem, peer socialisation and general fitness. However, an emphasis on competitive success, often driven by goals of elite-level travel team selection, collegiate scholarships, Olympic and National team membership and even professional contracts, has seemingly become widespread. This has resulted in an increased pressure to begin high-intensity training at young ages. Such an excessive focus on early intensive training and competition at young ages rather than skill development can lead to overuse injury and burnout. ### Purpose To provide a systematic, evidenced-based review that will (1) assist clinicians in recognising young athletes at risk for overuse injuries and burnout; (2)delineate the risk factors and injuries that are unique to the skeletally immature young athlete; (3) describe specific high-risk overuse injuries that present management challenges and/or can lead to long-term health consequences; (4) summarise the risk factors and symptoms associated with burnout in young athletes; (5)provide recommendations on overuse injury prevention. ### Methodology Medical Subject Headings (MeSHs) and text words were searched on 26 March 2012 from MEDLINE, CINAHL and PsycINFO. The search yielded 953 unique articles. Additional articles were found using cross-referencing. The process was repeated on 10 July 2013 to review any new articles since the original search. Screening by the authors yielded a total of 208 relevant sources that were used for this article. Recommendations were classified using the Strength of Recommendation Taxonomy (SORT) grading system. ### Definition of overuse injury Overuse injuries occur due to repetitive submaximal loading of the musculoskeletal system when rest is not adequate to allow for structural adaptation to take place. Injury can involve the muscle-tendon unit, bone, bursa, neurovascular structures and the physis. Overuse injuries unique to young athletes include apophyseal injuries and physeal stress injuries. ### Epidemiology It is estimated that 27 million US youth between 6 and 18 years of age participate in …

How the Read a Paper: The Basics of Evidence Based Medicine

Abstract: Do you need to read published papers? Or are you a scientific paper non-reader or recluse? This book (very thoughtfully) starts off by asking whether you need to read this book—how many textbooks actually ask you whether you need to use/read/buy it? The need for such a book is certainly there, as this excellent little book is intended to help existing readers read, and actually interpret, medical papers better. Current non-readers and scientific recluses may even be encouraged to open medical journals for once! The book provides an excellent practical and pragmatic approach to critical analysis of much of the uninspiring and unread published literature (which often makes you wonder how it got into print in the first place!). There is a systematic discussion on evidence-based medicine and a thoughtful practical section on how to search the medical literature. Despite the age of the Internet and computerised databases, even the most experienced Medline surfer often only manages to find approximately a third of the published material on a particular subject—handy tips are provided to improve searches, to increase one’s gain and to reduce eye strain or repetitive strain injury from a long, tiring session at the Medline computer terminal. The book describes the various sections of a published paper, including appraisal of the nature of the study and statistics for the non-statistician. It then discusses what you would hope to gain from reading a particular paper, including papers that report drug trials, diagnostic screening tests, systematic reviews and guidelines. It also has information on economic analyses and qualitative research. Finally, it gives some examples of how to implement evidence-based findings. Since much of clinical medicine is still not evidence-based, perhaps this goes some way to rectify this appalling state of affairs. I also found the Appendix with a checklist for finding, appraising and implementing evidence fairly helpful. Readers of this excellent book who are like me — struggling to understand much of the published literature and also to produce an intelligible published paper every so often—this book not only helps you read a paper but tries to make you a better paper writer as well. Perhaps my understanding of evidence-based medicine will improve after reading this book, and make me a better teacher and researcher. Perhaps it will make me reject more of the papers submitted to the journal I help edit! At the cost of £14.95, this book is an absolute bargain and it fulfils its advertised aim of being a compressed introduction to the usefulness and potential applications of evidence-based medicine in the clinical setting. I recommend it wholeheartedly as an obligatory read.