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Purpose: Individuals with Lateral Epicondyle Tendinopathy (LET) commonly experience gripping deficits, which are marked by pain and altered motor control of the forearm extensors and flexors. Although delayed activation of the anconeus muscle during rapid wrist extension has been observed in LET, its role during gripping is not well understood. This study aimed to investigate anconeus activation and its relation to forearm muscle activity during gripping in individuals with LET., Methods: Eleven participants with LET and 11 healthy, age-, sex-, and limb-matched controls performed steady-state isometric gripping at 15% and 30% of their maximum voluntary contraction (MVC). Surface electromyography was recorded from anconeus and six forearm muscles. Standard clinical assessments for LET were conducted to evaluate the severity of the condition., Results: Participants with LET exhibited increased relative activation of anconeus compared the forearm flexors, but not with the extensors, during both 15% and 30% MVC gripping. Additionally, the LET group demonstrated an increased coactivation ratio between anconeus and extensor carpi radialis brevis, as well as the flexor digitorum superficialis (FDS) during 15% MVC. At 30% MVC, this increased coactivation was observed between anconeus and all three flexors (FDS, flexor carpi radialis, flexor carpi ulnaris). Lower anconeus activation was associated with greater LET-related disability, while higher anconeus activation was associated with increased anconeus tenderness., Conclusion: This study presents novel evidence of an adaptive motor pattern in LET, characterized by increased relative activation and coactivation of the anconeus muscle depending on grip force. Signs of maladaptive motor patterns emerge when grip force becomes painful. These findings enhance our understanding of anconeus dysfunction in LET and the gripping deficits that accompany it, offering new insights into potential management strategies for this condition., Level of Evidence: Basic Science Study; Kinesiology., (Copyright © 2024. Published by Elsevier Inc.)

The experience of pain that is induced by extremely cold temperatures can exert a modulatory effect on motor cortex circuitry. Although it is known that immersion of a single limb in very cold water can increase corticomotor excitability it is unknown how afferent input to the cortex shapes excitatory and inhibitory processes. Therefore, the purpose of this study was to examine motor-evoked potentials (MEP), short-latency afferent inhibition (SAI) and long-latency afferent inhibition (LAI) in response to immersion of a single hand in cold water. Transcranial magnetic stimulation (TMS) was used to assess MEPs, and peripheral nerve stimulation of the median nerve paired with TMS was used to measure SAI and LAI in motor circuits of the ipsilateral hemisphere. Measurements were obtained from electromyography (EMG) of the first dorsal interosseous (FDI) at baseline, during cold-water immersion, and during recovery from cold-water immersion. The intervention caused unconditioned MEPs to increase during exposure to the cold stimulus (P = 0.008) which then returned to baseline levels once the hand was removed from the cold water. MEP responses were decoupled from SAI responses, where SAI was reduced during exposure to the cold stimulus (P = 0.005) and remained reduced compared to baseline when the hand was removed from the cold water (P = 0.002). The intervention had no effect on LAI. The uncoupling of SAI from MEPs during the recovery period suggests that the mechanisms underlying the modulation of corticospinal excitability by sensory input may be distinct from those affecting intracortical inhibitory circuits. HIGHLIGHTS: What is the central question of this study? Does immersion of a limb in very cold water influence corticospinal excitability and the level of afferent inhibition exerted on motor cortical circuits? What is the main finding and its importance? In additional to perception of temperature, immersion in 6°C water also induced perceptions of pain. Motor evoked potential (MEP) amplitude increased during immersion, and short-latency afferent inhibition (SAI) of the motor cortex was reduced during immersion; however, these responses differed after the limb was removed from the cold stimulus, as MEPs returned to normal levels while SAI remained suppressed., (© 2024 The Author(s). Experimental Physiology published by John Wiley & Sons Ltd on behalf of The Physiological Society.)

Background: Understanding the true effects of exercise in the treatment of lateral elbow tendinopathy (LET) is hampered by insufficient information or a lack of standardisation in defining, measuring, reporting and analysis of exercise adherence., Objectives: This scoping review aimed to explore both the quantity and scope of reporting of exercise adherence in published studies of participants with LET., Method: Six databases were searched to identify original research studies written in English, investigating therapeutic exercise for LET. Eligible studies were first searched for terms related to exercise adherence. If provided, information on the terminology, definition, measurement, results and analysis of adherence were collated and summarised. Recommendations for standardized reporting of exercise adherence were developed., Results: 104 studies were identified, of which 74 (71%) did not report adherence or related terms. Reference to exercise compliance or adherence occurred in 17 and 13 studies respectively. Adherence was most commonly defined as the frequency or percentage of exercise sessions completed compared to the recommendation and measured by self-reported diary. Few studies defined a threshold for adherence, provided comprehensive reporting of results or analysis of exercise adherence., Conclusion: Reporting of exercise adherence in studies of LET was limited in both quantity and scope. Recommendations are made to improve the quality and consistency of reporting in future studies., Competing Interests: Declaration competing of interest None., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background and Objectives: People with diabetic peripheral neuropathy (DPN) report fluctuating foot symptoms. This study used ecological momentary assessment to: (1) compare foot symptoms between days, time points and periods with/without preceding physical activity or pain medication; and (2) determine relationships between symptoms and endogenous pain modulation., Method: Ten low-active Australian adults with probable DPN underwent temporal summation of pain (TSP) and conditioned pain modulation (CPM) then completed mobile phone surveys five times daily for seven days, where they recorded the intensity of six foot symptoms and whether they performed physical activity or consumed pain medication in the preceding three hours.  RESULTS: All foot symptoms except numbness were greater in periods following physical activity, whereas periods following pain medication showed greater shooting pain. TSP showed very large correlations with sensitivity to touch, burning pain, shooting pain and prickling/tingling.  DISCUSSION: General practitioners should be aware that physical activity might exacerbate symptoms of DPN when encouraging their patients to be active.

Purpose: The purpose of the study was to examine the effects of acute mood modulation on treadmill walking duration during experimental pain application., Methods: This was a repeated measure, within-subject study design. 30 healthy individuals (Males: Females 16:14; age 22.9 ± 2.5 years; height 170.9 ± 9.5 cm; body mass 68.4 ± 14.6 kg) attended a familiarization session and three experimental sessions, whereby they simultaneously viewed emotionally evoking stimulus from the International Affective Picture System (IAPS) and performed two treadmill walking tests (maximum 10 min duration) with a fixed nociceptive input applied to the thigh (pressure cuff). The primary outcome was treadmill walking duration during pain application to achieve a fixed pain score. During walking, mood (Self-Assessment Manikin: SAM 0-9) and pain (numerical rating scale: NRS 0-10) were measured., Results: Mood valence scores were significantly different in all conditions (p < 0.001), negative (2.4 ± 0.3), neutral (4.9 ± 0.6) and positive (6.6 ± 0.3). There was a significant difference (p = 0.04) in the treadmill walking duration for different mood states. For the primary outcome, post hoc analysis found differences between the negative and positive mood conditions for the treadmill walking durations to reach pain scores of 3 (negative: 224 ± 49 s; positive: 259 ± 60s, effect size [ES]: 0.80), 4 (negative: 262 ± 59 s; positive: 326 ± 90s, ES: 0.92), 5 (negative: 313 ± 86 s; positive: 385 ± 113 s, ES: 0.90), 6 (negative: 367 ± 106 s; positive: 447 ± 113 s, ES: 1.04) and 7 (negative: 423 ± 114 s; positive: 521 ± 110 s, ES: 1.02). There was no significant difference in the treadmill walking duration between the neutral vs negative mood and neutral vs positive mood conditions., Conclusion: These results highlight the potential psychophysiological impacts on the pain experience in healthy individuals and encourages pursuit in strategies to minimize pain-limited exercise, a highly prevalent issue in the chronic pain population., Significance: Walking-based rehabilitation, designed to improve physical activity, has been shown to improve pain and disability. However active participation and adherence in walking-based rehabilitation has shown to be jeopardized by pain and pain-related cognitive and behavioural adaptations. This study examined the effect of a shift in mood on pain perception and treadmill walking tolerance. We found that with a worse mood, individuals were less tolerant of pain and walked on the treadmill for a shorter duration. These results suggest that factors which improve mood should be combined with walking-based training to improve tolerance., (© 2023 The Authors. European Journal of Pain published by John Wiley & Sons Ltd on behalf of European Pain Federation - EFIC ®.)

Background and Objectives: People with diabetic peripheral neuropathy (DPN) report difficulty exercising. This study tested an innovative intervention to promote physical activity self-management and its impact on foot symptoms., Method: Ten adults with DPN not meeting exercise guidelines consented to four weekly sessions involving exercise tasters, behaviour change counselling and Physical Activity Intelligence (PAI) self-monitoring, with a goal to maintain daily PAI scores ≥100. Foot symptoms were assessed using repeated mobile phone surveys at 0 and 12 weeks., Results: Participants attended a mean 3.5 sessions and achieved 100 PAI on 53% and 15% of days during Weeks 2-4 and 5-12, respectively. No major adverse events and large reductions in aching (P=0.02) and burning pain (P=0.03) in the feet were recorded., Discussion: The PAI eHealth intervention was feasible and safe and might reduce foot symptoms. More work is needed to support self-directed exercise maintenance.

Pancreatic ductal adenocarcinoma (PDAC) is a disease that remains refractory to existing treatments including the nucleoside analogue gemcitabine. In the current study we demonstrate that an organometallic nucleoside analogue, the ferronucleoside 1-(S,Rp), is cytotoxic in a panel of PDAC cell lines including gemcitabine-resistant MIAPaCa2, with IC50 values comparable to cisplatin. Biochemical studies show that the mechanism of action is inhibition of DNA replication, S-phase cell cycle arrest and stalling of DNA-replication forks, which were directly observed at single molecule resolution by DNA-fibre fluorography. In agreement with this, transcriptional changes following treatment with 1-(S,Rp) include activation of three of the four genes (HUS1, RAD1, RAD17) of the 9-1-1 check point complex clamp and two of the three genes (MRE11, NBN) that form the MRN complex as well as activation of multiple downstream targets. Furthermore, there was evidence of phosphorylation of checkpoint kinases 1 and 2 as well as RPA1 and gamma H2AX, all of which are considered biochemical markers of replication stress. Studies in p53-deficient cell lines showed activation of CDKN1A (p21) and GADD45A by 1-(S,Rp) was at least partially independent of p53. In conclusion, because of its potency and activity in gemcitabine-resistant cells, 1-(S,Rp) is a promising candidate molecule for development of new treatments for PDAC., (© The Author(s) 2022. Published by Oxford University Press.)

Objectives: To develop a core outcome set for lateral elbow tendinopathy (COS-LET) and to provide guidance for outcome evaluation in future studies., Methods: We implemented a multi-stage mixed-methods design combining two systematic reviews, domain mapping of outcome measurement instruments to the core domains of tendinopathy, psychometric analysis of instruments, two patient focus groups and a Delphi study incorporating two surveys and an international consensus meeting. Following the OMERACT guidelines, we used a 70% threshold for consensus., Results: 38 clinicians/researchers and 9 patients participated. 60 instruments were assessed for inclusion. The only instrument that was recommended for the COS-LET was Patient Rated Tennis Elbow Evaluation (PRTEE) for the disability domain. Interim recommendations were made to use: the PRTEE function subscale for the function domain; PRTEE pain subscale items 1, 4 and 5 for the pain over a specified time domain; pain-free grip strength for the physical function capacity domain; a Numerical Rating Scale measuring pain on gripping for the pain on activity/loading domain; and time off work for the participation in life activities domain. No recommendations could be made for the quality-of-life, patient rating of condition and psychological factors domains., Conclusions: The COS-LET comprises the PRTEE for the disability domain. Interim-use recommendations included PRTEE subscales, time off work, pain-free grip strength and a Numerical Rating Scale measuring pain on gripping. Further work is required to validate these interim measures and develop suitable measures to capture the other domains., Competing Interests: Competing interests: MB and JPE contributed equally and share first authorship. MB, JPE, AW, JP, VJ, VV, LMB and BV declare that they have no competing interests. The core outcome set for lateral elbow tendinopathy (COS-LET) consensus group has no competing interests except for Joy MacDermid, who is the author of the Patient Rated Tennis Elbow Evaluation (PRTEE). Her responses were removed from survey and consensus voting related to the use of the PRTEE in the COS-LET., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY. Published by BMJ.)

New Findings: What is the central question of this study? How does single limb cold water immersion affect corticomotor function and intracortical circuitry in the motor cortex of each cerebral hemisphere? What is the main finding and its importance? Immersion of a single limb in very cold water caused an increase in corticomotor excitability and intracortical facilitation, and a decrease in intracortical inhibition, in the motor cortex of both hemispheres. These findings provide evidence that intense sensory stimuli induce widespread changes in motor circuitry in the contralateral, as well as the ipsilateral, hemisphere., Abstract: Although responses to noxious stimuli have been extensively studied for the contralateral hemisphere, little is known about how the ipsilateral hemisphere may be affected. Therefore, this study examined how exposing a single limb to noxious cold stimuli affects motor output arising from both the contralateral and ipsilateral hemisphere. A total of 17 healthy adults participated in three experiments. Single- and paired-pulse TMS protocols were used to identify how immersing a single upper limb in cold water (4.0 ± 0.5 °C) affects inhibitory and facilitatory circuits in the primary motor cortex (M1) of the contralateral (experiment 1) and ipsilateral (experiment 2) hemisphere. The third experiment used a reaction time task to assess the functional consequences of acute adaptations in the ipsilateral M1. The target muscle in all experiments was the extensor carpi radialis brevis (ECRB). Immersion of a single limb in cold water increased self-perception of pain and temperature, and increased EMG amplitude of the immersed limb. During immersion, motor evoked potentials and intracortical facilitation increased, whereas short interval intracortical inhibition decreased, for both the ipsilateral M1 and contralateral M1. Activity in the ipsilateral hemisphere to the limb immersed in cold water also slowed reaction time for the non-immersed limb. Our findings suggest that altered motor responses from single limb cold water immersion are not restricted to a single hemisphere. Instead, widespread activation of somatosensory systems influences inhibitory and facilitatory circuits in the primary motor cortex of each hemisphere., (© 2019 The Authors. Experimental Physiology © 2019 The Physiological Society.)

Objectives: To investigate forearm muscle activity in individuals with lateral epicondylalgia (LE) when gripping at different wrist postures, and investigate the association between muscle activity and clinical characteristics of LE., Methods: Eleven LE and 11 healthy participants performed isometric handgrips at 15% and 30% of maximum grip force (MVC). Gripping was performed in wrist extension, wrist flexion, and wrist neutral. Surface electromyography was collected from six forearm muscles. Standard clinical and tendon structural measures for LE were obtained., Results: LE group had reduced magnitude of extensor carpi radialis brevis (ECRB) with increased contribution of extensor carpi ulnaris (ECU) during 15% MVC. However, during 30% MVC the LE group had reduced flexor carpi radialis and flexor digitorum superficialis activity, which was coupled with increased contribution from extensor digitorum communis (EDC) and ECU. Although ECRB and ECU activity differed in wrist flexion compared to other wrist postures for controls, different wrist posture had no effect on forearm muscle activation in LE. Pain and disability, and tendon thickness had significant associations with EDC and ECRB activity respectively in LE., Conclusion: Individuals with LE use different neuromuscular strategies when gripping with different wrist postures which appears to be dependent on the level of grip force.

It is largely unknown how the CNS regulates multiple muscle systems in the presence of pain. This study used muscle synergy analysis to investigate multiple forearm muscles in individuals with chronic elbow pain during the development of grip force. Eleven individuals with chronic elbow pain and 11 healthy age-matched control subjects developed grip force to 15% and 30% of maximum voluntary contraction (MVC). Surface electromyography was obtained from six forearm muscles during force development before nonnegative matrix factorization was performed. The relationship between muscle synergies and standard clinical tests of elbow pain were examined by linear regression. During grip force development to 15% MVC the pain group had a lower number of forearm muscle synergies, increased similarity in spatial activation patterns, increased cocontraction of forearm flexors, and a greater magnitude of muscle weightings across the forearm when performing the task. During the 30% MVC grip the numbers of muscle synergies were the same for both groups; however, the pain group had lower activation and reduced variability in the timing of peak activation. The timing of peak activation was delayed in the pain group regardless of the task, and performing the grip in different wrist postures did not affect muscle synergy characteristics in either group. Although localized pain causes direct dysfunction of an affected muscle, this study provides evidence that the timing and amplitude of agonist and antagonist muscle activity are also affected with chronic pain. NEW & NOTEWORTHY Muscle activation patterns of individuals with chronic elbow pain are simplified compared with healthy individuals. This is apparent as individuals with pain exhibit fewer forearm muscle synergies, and increased similarity of activation patterns between forearm muscles, when performing pain-free isometric gripping. As such, even during pain-free tasks it is possible to observe changes in motor control in people with chronic pain., (Copyright © 2017 the American Physiological Society.)

Background: Individuals with lateral epicondylalgia (LE) have delayed upper limb reaction time (RT); however, it is unknown if the mechanisms of this dysfunction are related to neural processing or the affected forearm muscles. The aim of this study was to examine the timing of processes that occur before and after forearm muscles are activated during the RT task., Methods: Eleven LE (42 ± 11 yr) and 11 healthy controls (42 ± 11 yr) performed rapid wrist extension in response to an audio cue. Intramuscular EMG was obtained from extensor carpi radialis brevis (ECRB), extensor digitorum communis (EDC), extensor carpi ulnaris (ECU), and anconeus. Premotor time (PMT) was the duration from an audio cue to the onset of muscle activity, and motor time (MT) was the onset of muscle activity to the onset of wrist extension. Standard clinical assessments of LE were also performed., Results: RT was significantly slower (33; 95% CI, 1-66 ms) in the LE group. There were no group differences in PMT and the order of muscle activation. Instead, the MT of ECRB (18; 95% CI, 6-31 ms), EDC (12; 95% CI, 1-23 ms), ECU (28; 95% CI, 9-46 ms), and anconeus (33; 95% CI, 11-56 ms) showed significant delay in LE group. Regression analyses revealed that the duration of LE could predict RT, ECRB, and anconeus PMT, whereas cold pain threshold predicted ECRB MT., Conclusions: Delayed RT in LE was predominantly caused by deficits in ECRB and EDC MT. This study provides preliminary evidence that in the people with longer LE symptoms, duration appeared to have faster RT, although confirmation of this finding is required before firm conclusions can be drawn.

This study observed the effect of visual feedback on between-limb force variability relationships in young and older adults. Abduction force was examined in healthy young (n = 15, 25 ± 4 years) and older adults (n = 18, 71 ± 6 years) during simultaneous isometric contractions of both index fingers. Target forces ranged from 5% to 30% maximum voluntary contraction (MVC), where force variability and first dorsal interosseus activity were measured while (1) subjects viewed visual targets for both index fingers, (2) a visual target was provided for the dominant index finger only, and (3) visual targets were removed for both index fingers during bilateral isometric contractions. When subjects were provided with bilateral visual feedback during simultaneous contractions at low forces (5% and 10% MVC), older adults produced greater force variability than younger subjects (p = 0.002). However, when bilateral visual feedback was removed, age-related differences in variability were no longer present. Between-limb force variability differences existed at higher force outputs (20% and 30% MVC) when visual feedback was removed for the nondominant limb during bilateral isometric index finger abduction (p = 0.002). The control of bilateral force variability is compromised in older adults when visuomotor processes are engaged. However, age-related differences in force variability are abolished when no task-related visual feedback is available, and isometric contractions are based on internally guided feedback., (Copyright © 2016 Elsevier Inc. All rights reserved.)

Objective: The purposes of this study were to determine whether there were differences in mean values or reliability for 2 frequently used protocols for pressure pain threshold (PPT) and to calculate how large a difference in PPT is necessary to be 95% confident that a real change has occurred., Methods: Thirteen participants (8 females) aged 22.3 (±2.3) years from a university community were included. Two testers evaluated participants using 2 protocols, in which PPT was measured 3 times at 8 different body locations. The "cluster protocol" consisted of 3 successive measurements at each location with a 30-second rest between each measurement. The "circuit protocol" consisted of 1 measurement taken at each anatomical location until "the circuit" was complete and then repeated a total of 3 times., Results: A 2-way analysis of variance did not reveal significant differences between protocols at any body location (P = .46-.98). Intertester reliability was good to excellent for all locations (intraclass correlation coefficient, 0.84-0.96), and limits of agreement ranged from 108 to 223 kPa., Conclusions: Either the cluster or circuit protocol can be used to measure PPT in clinical or research setting. A difference of 160 kPa is considered sufficient to indicate a real difference between repeated measures of PPT regardless of protocol used for testing., (Copyright © 2015 National University of Health Sciences. Published by Elsevier Inc. All rights reserved.)

This study examined how force tremor and muscle activity are altered between limbs when a visual target is removed for one limb during bilateral index finger abduction. Isometric index finger abduction force was examined in healthy adults (23 ± 4 years) when both index fingers abducted simultaneously. Abduction forces ranged from 5 to 20% maximum voluntary contraction, and these target forces were displayed on a PC monitor in front of the subject. Force tremor and first dorsal interosseous (FDI) activity were first collected while subjects viewed visual targets for both index fingers and then when the visual target was removed for the non-dominant index finger. Subjects successfully matched the force amplitudes generated for both limbs regardless of visual condition. When the visual target was removed for one limb, force tremor increased in this limb (p < 0.01). Different power spectral profiles were evident for each FDI EMG when targets were available for both limbs (p < 0.05); however, when one target was removed, the pattern of FDI EMG for the limb without a visual target closely reflected FDI EMG for the limb which had the visual target. The CNS actively modulates muscle activity in each limb to perform visually guided isometric contractions. Given that the goal was to match force output with both limbs, the requirements of the task must be established from the limb that had a visual target, and a copy of those motor commands appears to have been sent to the FDI of the limb without a visual target.

Study Design: Repeated-measures, crossover, double-blinded randomized controlled trial., Objectives: To compare the immediate effectiveness of 2 types of counterforce braces in improving pain-free grip strength, pressure pain threshold, and wrist angle during a gripping task in individuals with lateral epicondylalgia., Background: Sports medicine management of lateral epicondylalgia often includes application of a counterforce brace, but the comparative effectiveness of different braces is unclear. The most common brace design consists of a single strap wrapped around the proximal forearm. A variation of this brace is the use of an additional strap that wraps above the elbow, which aims to provide further unloading to the injured tissue., Methods: Pain-free grip strength, pressure pain threshold, and wrist angle during a gripping task were measured on 34 participants with a clinical diagnosis of lateral epicondylalgia (mean ± SD age, 47.8 ± 8.5 years). Measurements were made without a brace, as well as immediately before and after the application of 2 types of counterforce braces. Each condition was tested during a separate session, with a minimum of 48 hours between sessions. Analysis-of-variance models were used to test the differences within and between conditions., Results: Pain-free grip strength (17.2 N; 95% confidence interval: 7.5, 26.8) and pressure pain threshold (42.2 kPa; 95% confidence interval: 16.5, 68.0) significantly improved on the affected side immediately following the intervention conditions as well as the control condition. There was no significant difference between braces or the control condition for any outcome., Conclusion: Both types of counterforce braces had an immediate positive effect in participants with lateral epicondylalgia, without differences between interventions and similar to a no-brace control condition. Therefore, while the use of a brace may be helpful in managing immediate symptoms related to lateral epicondylalgia, the choice of which brace to use may be more a function of patient preference, comfort, and cost. Further research is required to investigate the comparative longer-term and clinical effects of the 2 braces., Trial Registration: ACTRN12609000354280 ( www.anzctr.org.au).

This study examined how regulating force tremor in a single limb is altered when the opposite limb is actively engaged in a force generating task. Index finger abduction force and first dorsal interosseous (FDI) activity were assessed in thirteen healthy subjects, at target forces from 5% to 60% MVC for the non-dominant limb (unilateral task), and again when the dominant limb simultaneously generated a submaximal abduction force (bilateral task). When the non-dominant limb generated force at 20% MVC, tremor was greater during the bilateral task compared with the unilateral task; a finding reflected in the amplitude of peak power of force. Bilateral responses were also examined during a prolonged 60% MVC unilateral contraction. Force tremor and muscle activity amplitude increased while the frequency of activity decreased for the contracting limb. Additionally, force tremor significantly decreased towards the end of the prolonged contraction in the contralateral limb. Overall, it appears that the process of performing isometric contractions invokes tremor-related changes in the opposite limb at selective force targets, and performing prolonged unilateral contractions invokes tremor-related changes in the opposite limb when it is at rest., (Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.)

The purpose of this study was to investigate whether neuromuscular adaptations at the site of injury or neural adaptation remote to the injury are affected in individuals with chronic ankle instability (CAI). Electromyography data were collected from the peroneus longus (PL) and tibialis anterior during an ankle joint reaction time task in 12 participants with unilateral CAI and 12 healthy control participants. Following an auditory cue, time to onset of muscle activity (pre-motor time) and time from onset of muscle activity to movement (motor time) were measured during rapid ankle eversion and dorsiflexion. Reaction time for ankle eversion on the affected side was significantly slower in the CAI group than the control group, due to significantly slower motor time for the PL. Changes in motor time for the affected PL in participants with CAI may be attributed to a combination of factors associated with local tissue changes., (Copyright © 2011 Elsevier Ltd. All rights reserved.)

Anterior knee pain is a chronic condition that presents frequently to sports medicine clinics, and can have a long-term impact on participation in physical activity. Conceivably, effective early management may prevent chronicity and facilitate physical activity. Although a variety of nonsurgical interventions have been advocated, previous systematic reviews have consistently been unable to reach conclusions to support their use. Considering a decade has lapsed since publication of the most recent data in these reviews, it is timely to provide an updated synthesis of the literature to assist sports medicine practitioners in making informed, evidence-based decisions. A systematic review and meta-analysis was conducted to evaluate the evidence for nonsurgical interventions for anterior knee pain. A comprehensive search strategy was used to search MEDLINE, EMBASE, CINAHL and Pre-CINAHL, PEDro, PubMed, SportDiscus, Web of Science, BIOSIS Previews, and the full Cochrane Library, while reference lists of included papers and previous systematic reviews were hand searched. Studies were eligible for inclusion if they were randomized clinical trials that used a measure of pain to evaluate at least one nonsurgical intervention over at least 2 weeks in participants with anterior knee pain. A modified version of the PEDro scale was used to rate methodological quality and risk of bias. Effect size calculation and meta-analyses were based on random effects models. Of 48 suitable studies, 27 studies with low-to-moderate risk of bias were included. There was minimal opportunity for meta-analysis because of heterogeneity of interventions, comparators and follow-up times. Meta-analysis of high-quality clinical trials supports the use of a 6-week multimodal physiotherapy programme (standardized mean difference [SMD] 1.08, 95% CI 0.73, 1.43), but does not support the addition of electromyography biofeedback to an exercise programme in the short-term (4 weeks: SMD -0.21, 95% CI -0.64, 0.21; 8-12 weeks: SMD -0.22, 95% CI -0.65, 0.20). Individual study data showed beneficial effects for foot orthoses with and without multimodal physiotherapy (vs flat inserts), exercise (vs control), closed chain exercises (vs open chain exercises), patella taping in conjunction with exercise (vs exercise alone) and acupuncture (vs control). Findings suggest that, in implementing evidence-based practice for the nonsurgical management of anterior knee pain, sports medicine practitioners should prescribe local, proximal and distal components of multimodal physiotherapy in the first instance for suitable patients, and then consider foot orthoses or acupuncture as required.

Objectives: To evaluate the time course of sensorimotor deficits in lateral epicondylalgia (LE; tennis elbow) and how these deficits may be influenced by common conservative treatments., Design: Single-blind randomized controlled trial., Setting: University laboratory, Australia., Participants: A total of 198 participants with unilateral LE of a minimum 6 weeks duration and normative data from a group of 40 healthy participants., Interventions: Participants with LE were randomly assigned to physical therapy, corticosteroid injection, or a wait-and-see approach with ergonomic advice., Main Outcome Measures: Upper-limb reaction time (simple, 1-choice and 2-choice reaction time) and speed of movement were assessed at baseline and 6 and 52 weeks of follow-up., Results: Patients with LE exhibited delayed reaction times (P<.001) and slower movement speeds (P<.001) for both the affected and unaffected arm at baseline, compared with normative data. Despite some improvement over time, significant bilateral deficits remained compared with healthy participants, with no significant differences between the affected and unaffected arm. Overall, there was no significant difference between the 3 treatment groups over time., Conclusions: Sensorimotor deficits remain relatively unchanged over time and are present bilaterally in patients with unilateral LE. Treatment did not influence the time course of the sensorimotor deficits. This prompts conjecture as to the relationship and clinical relevance of sensorimotor deficits in LE. It should be noted that treatment evaluated in this study did not specifically target sensorimotor function, and further investigation into the significance of sensorimotor deficits in patients with LE is required.

Objective: To evaluate impairments in motor function of the upper limb in unilateral lateral epicondylalgia., Design: Assessor-blinded, case-controlled study., Setting: University laboratory., Participants: Forty participants with lateral epicondylalgia and 40 age- and sex-matched controls were recruited from the general community., Interventions: Not applicable., Main Outcome Measures: Wrist posture adopted during a grip test, grip strength force, as well as upper-limb reaction times and speed of movement., Results: Participants with unilateral lateral epicondylalgia adopted wrist postures that were on average 11 degrees less extended, bilaterally, than controls (P<.000). This was paralleled by increased upper-limb reaction times and reduced speed of movement (mean differences, 2%-15%) in both affected and unaffected limbs. Pain-free grip strength was reduced on the involved side (mean difference, 170N; 95% confidence interval, 144-195N)., Conclusions: Motor deficits may be modifiable through exercise and postural retraining. Although further work is required to evaluate the clinical efficacy of such an approach, health care practitioners have an emerging evidence base on which to base their management of lateral epicondylalgia.