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 Answer Is 17 Years, What Is the Question

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...

https://www.jospt.org/doi/pdf/10.2519/jospt.2010.3337

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

Foundations of Clinical Research: Applications to Practice, 2nd Edition, Leslie Gross Portney, Mary P. Watkins. Prentice Hall, Upper Saddle River, NJ (2000), 752 pages. $60

### 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 …

https://bjsm.bmj.com/content/bjsports/48/4/287.full.pdf

Overuse Injuries and Burnout in Youth Sports: APositionStatementfromtheAmericanMedicalSocietyfor Sports Medicine

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.

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

‘It’s not hands-on therapy, so it’s very limited’: Telehealth use and views among allied health clinicians during the coronavirus pandemic

Running is often perceived as bad for your knees.1 In particular, concern exists regarding the development and progression of knee osteoarthritis due to long-term exposure to running.1

Despite these fears, recreational running does not have negative consequences on knee joint articular cartilage in runners without symptomatic knee osteoarthritis2 3 and may actually be beneficial for long-term joint health4 (see figure 1). Only 3.5% (95% CI 3.4% to 3.6%) of recreational (amateur) runners have osteoarthritis (knee or hip) compared with 10.2% (95% CI 9.9% to 10.6%) of sedentary individuals.4 However, a dose–response relationship may be present; 13.3% (95% CI 11.6% to 15.2%) of elite or ex-elite runners (competitive professional athletes of an international level) had osteoarthritis, a higher rate than seen in recreational …

https://bjsm.bmj.com/content/bjsports/early/2021/11/23/bjsports-2021-104342.full.pdf

Infographic. Running Myth: recreational running causes knee osteoarthritis

Strong evidence supports the proximal combined with quadriceps strengthening for patellofemoral pain (PFP) rehabilitation. However, most reported rehabilitation programs do not follow specific exercise prescription recommendations or do not provide adequate details for replication in clinical practice. Furthermore, people with PFP have power deficits in hip and knee muscles and it remains unknown whether the addition of power exercises would result in superior or more consistent outcomes. Therefore, this study is designed to verify whether the benefits of a rehabilitation program addressing proximal and knee muscles comprising power and strength exercises are greater than those of a program consisting of strength exercises only. This study will be a randomized controlled trial that will be conducted at university facilities. A minimum of 74 people with PFP between the ages of 18 and 45 years will be included. The experimental group will engage in a 12-week resistance training program focusing on proximal and knee muscles using power and strength exercises. The control group will engage in a 12-week resistance training program focusing on proximal and knee muscles using strength exercises only. Primary outcomes will be pain intensity and physical function; and secondary outcomes will be kinesiophobia, self-reported improvement, quality of life, peak hip and knee torque, and hip and knee rate of force development. The primary outcomes will be evaluated at baseline, and after 6 weeks, 12 weeks, 3 months, 6 months, and 1 year. The secondary outcomes will be evaluated at baseline and immediately after the interventions. Therapists and participants will not be blinded to group allocation. This randomized clinical trial will investigate if adding power exercises to a progressive resistance training may lead to more consistent outcomes for PFP rehabilitation. The study will provide additional knowledge to support rehabilitation programs for people with PFP. ClinicalTrials.gov
 NCT 03985254. Registered on 26 August 2019.

/pdf/adding-muscle-power-exercises-to-a-strength-training-program-12n1klwbio.pdf

Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial.


 Objective To develop a Best Practice Guide for managing people with plantar heel pain (PwPHP)Design a mixed methods designData sources Medline, Embase, CINAHL, SportsDiscus, Cochrane Central Register of Controlled Trials (CENTRAL), trial registries, reference lists, and citation tracking. Semi-structured interviews with world experts and a patient survey.Eligibility criteria RCTs evaluating any intervention for PwPHP in any language were included subject to strict quality criteria. Trials with a sample size greater than 38 were considered for proof of efficacy. International experts were interviewed using a semi-structured approach and PwPHP surveyed online.Results Forty PwPHP completed the survey and 14 experts were interviewed resulting in 7 themes and 38 sub-themes. Fifty-one eligible trials enrolled 4351 participants, with 10 interventions suitable to determine proof of efficacy. There was good agreement between the interview data and systematic review findings about taping (SMD: -0.47, 95% CI -0.88 to -0.05) and stretching (SMD: 1.21, 95% CI 0.78 to 1.63) for first step pain in the short term, with clinical reasoning guidance to combine these interventions with education and footwear advice as a core approach. There was good agreement to stepped care with focussed shockwave for first step pain in the short term (OR: 1.72, 95% CI 1.14 to 2.61), medium term (SMD -1.31, 95% CI -2.01 to – 0.61) and long term (SMD -1.67, 95% CI -2.45 to -0.88) and radial shockwave for first step pain in the short term (OR: 1.66, 95% CI 1.00 to 2.76) and long term (OR: 1.78, 95% CI 1.07 to 2.96). Good agreement for stepped care was also revealed for custom foot orthoses for pain in the short term (SMD: -0.41, 95% CI -0.74 to – 0.07) and medium term (SMD: -0.55, 95% CI -1.02 to -0.09).ConclusionA best practice guide was formulated based on robust evidence, with application guided by expert reasoning and patients’ perspectives.Systematic review registration Prospero CRD42018102227

/pdf/management-of-plantar-heel-pain-a-best-practice-guide-16tfebc62r.pdf

Christian J Barton

Papers

‘It’s not hands-on therapy, so it’s very limited’: Telehealth use and views among allied health clinicians during the coronavirus pandemic

Infographic. Running Myth: recreational running causes knee osteoarthritis

Adding muscle power exercises to a strength training program for people with patellofemoral pain: protocol of a randomized controlled trial.

Management of plantar heel pain: a best practice guide synthesising systematic review with expert clinical reasoning and patient values

The effectiveness and dose-response relationship of extracorporeal shock wave therapy in lower limb tendinopathy: A systematic review