Physiotherapy Ireland

Physiotherapy Ireland

Physiotherapy Ireland 2012 Vol. 33 No.1

2012 Vol. 33 No.1

Irish Society of Chartered Physiotherapists RCSI, 123 St. Stephen's Green, Dublin 2, Ireland. Telephone: +353 1 402 2148 Fax: +353 1 402 2160

www.iscp.ie

Physiotherapy Ireland. 2012;33(1)

Physiotherapy Ireland Editor-in-Chief JG McVeigh PhD DipOrthMed BSc(Hons) MCSP Health and Rehabilitation Sciences Research Institute School of Health Sciences University of Ulster, Jordanstown, Northern Ireland Email: [email protected] Musculoskeletal Editors Garrett Coughlan PhD BSc MISCP Medical Department Coordinator and National U-20's Team Physiotherapist IRFU Medical Department 10-12 Lansdowne Road, Dublin Republic of Ireland Email: [email protected] Kieran O'Sullivan M Manip Ther B Physio(Hons) MISOM SMISCP Department of Physiotherapy University of Limerick, Limerick Republic of Ireland Email: [email protected] Review Editors Eamonn Delahunt PhD BSc MISCP School of Public Health, Physiotherapy & Population Science University College Dublin, Dublin Republic of Ireland Email: [email protected] Diarmaid Fitzgerald PhD BSc (Hons) MISCP Gait Laboratory Central Remedial Clinic Vernon Ave Clontarf, Dublin Republic of Ireland Email: [email protected] Book Review Editor Karen McCreesh M Manip Ther B Physio (Hons) MMACP MISCP Department of Physiotherapy, University of Limerick Republic of Ireland Email: [email protected] Brona Fullen, BSc, Grad Dip Healthcare(Acup), PhD, MISCP School of Public Health, Physiotherapy & Population Science University College Dublin, Dublin Republic of Ireland Email: [email protected]

This journal is a member of and subscribes to the principles of the Committee on Publication Ethics www.publicationethics.org.

Statistical Consultant Dr Conor Gissane Senior Lecturer Directorate of Sports Rehabilitation St Mary's University College, Middlesex United Kingdom International Editorial Board Professor Jeff Basford Professor in Physical Medicine & Rehabilitation Department of Physical Medicine & Rehabilitation Mayo Clinic, Rochester, Minnesota USA Professor Wim Dankaerts Musculoskeletal Research Unit Department of Rehabilitation Sciences Faculty of Kinesiology and Rehabilitation Sciences University of Leuven, Tervuursevest 101 Belgium Dr Daniel Tik-Pui Fong Research Assistant Professor Department of Orthopaedics and Traumatology Prince of Wales Hospital Faculty of Medicine, The Chinese University of Hong Kong Hong Kong Professor Gwendolen Jull Professor of Physiotherapy School of Health and Rehabilitation Sciences The University of Queensland, St Lucia 4072 Australia Professor Dennis Martin Professor of Rehabilitation Director of the Centre for Rehabilitation Sciences Teesside University Middlesbrough, Tees Valley United Kingdom Dr Borja Sañudo Corrales Department of Physical Education and Sport Faculty of Educational Sciences University of Seville, Seville Spain Professor James Selfe Professor of Physiotherapy School of Public Health and Clinical Sciences Brook Building University of Central Lancashire, Preston United Kingdom

Irish Society of Chartered Physiotherapists RCSI,123 St. Stephen's Green, Dublin 2, Ireland. Telephone: +353 1 402 2148 Fax: +353 1 402 2160 Web: www.iscp.ie and www.physicaltherapy.ie

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2 | www.physicaltherapy.ie


Contents Editorial McVeigh JG. Pain management and the undergraduate curriculum – is it a case of ‘could do better’?

4

Invited commentary Vicenzino B, McPoil T.The role of physiotherapists in implementing in-shoe foot orthoses in managing overuse musculoskeletal injuries: using patellofemoral pain as an example.

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Original Research Lynch E, Barry S.The effectiveness of ice water immersion in the treatment of delayed onset muscle soreness in the lower leg

9

Theobald G, Parry, S, Richards J,Thewlis, D,Tootill, Selfe J. Biomechanical effects of different treatment modalities used in knee pain during cycling

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Lowther D, O’Connor A, Clifford A. M, O’Sullivan K.The relationship between lower limb flexibility and injury in male Gaelic footballers

22

Chohan A, Erande R, Callaghan M, Richards J, Selfe J.The relationship between vibratory perception and joint position sense testing at the knee

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Review Rainsford G. The use of neuromuscular electrical stimulation as an adjunctive therapy for muscle strengthening in knee rehabilitation

36

Book Reviews

42

Abstracts

44

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Editorial: Pain management and the undergraduate curriculum – is it a case of ‘could do better’? McVeigh JG1 1. School of Health Sciences, University of Ulster, Shore Road, Newtownabbey, Northern Ireland.

There is an old adage that says a society should be judged by how it treats the most vulnerable. It is interesting to apply this concept to the area of pain management. There is perhaps nothing as distressing as a child in pain; the helpless suffering of children touches us at a deeply human level and, I would argue, represents a profound failure of the healthcare system to address the needs of a very vulnerable group. A recent publication by King et al1 suggests that chronic persistent or recurrent pain in children is ‘overwhelmingly prevalent’ and represents a major health concern for this population. In their review of epidemiological studies, King et al1 found that the prevalence of headache in children ranged from 8-83%, abdominal pains from 4-53%; and for conditions that physiotherapists are perhaps more associated with , the prevalence rates were: back pain 14 – 24%, musculoskeletal pain 4 – 40%, multiple pains 4 – 49%, and general pain 5 – 88%. Because of the wide variation in reported prevalence rates it is difficult to make generalisations, however, chronic pain in children increased with age, tended to affect girls more than boys, and was associated with psychosocial variables including anxiety, depression and low self-esteem. Most worryingly, these authors suggested that the prevalence of chronic pain in children had increased in the last number of decades. When pain in children becomes chronic or persistent, it can signal long term future health problems.2 Children with pain often become adults with pain; it is well recognised that pain during infancy causes longlasting changes in pain processing that extend well into childhood and adulthood.3 Another recent study exploring pain in an extremely vulnerable group, by Maria Walsh and colleagues at the National University of Ireland4 reported the prevalence and impact of chronic pain in adults with intellectual disability in Ireland (n = 753). These authors found that the overall prevalence of chronic pain in those with intellectual disability was 15.4%, and again the prevalence among females (20.1%) was higher than males (13.4%); Walsh et al4 cautioned that these figures may even represent an under estimation of the problem. Among the most frequent causes of pain in this population was arthritis and musculoskeletal pain, and with respect to management, massage (29.8%) and physiotherapy (21%), featured among the most common treatments. For those with intellectual disability to have to carry the burden of chronic pain (and almost one third of cases had moderate to severe pain) in addition to the other challenges that their condition brings, is an appalling situation. When pain management in the elderly is considered, a similar story emerges to that of other vulnerable groups;


pain is present in 25% to 50% of community-dwelling elderly people, for those in long-term care, the prevalence is even higher, with as much as 80% reporting daily pain.5 Pain assessment and treatment in the elderly is complicated by a number of factors, the reluctance or inability of many older people to report their pain, the high incidence of dementia among those in residential care is a particular problem, and pain management is often complicated by other concomitant medical problems in the older adult.6 The literature on the management of pain in vulnerable people does not reflect well on healthcare professionals and indeed the history of poor pain management in children is well recognised. Post-operative pain in children is often undertreated and a large proportion of children experience moderate to severe pain post operatively.7 Children have been treated with much less analgesia post-operatively than the recommended amounts7 and it was common to use non-opioid, oral analgesia rather than intravenous morphine even after major surgery in children.8 It should be noted that inadequately treated pain, particularly in the neonatal period, results in increased morbidity and mortality.9 For children with chronic musculoskeletal pain there is strong evidence to support psychological and physical interventions, particularly exercise, but recognition, early treatment and access to services remain a major barrier to successful outcomes.2 Some of the proposed explanations for poor pain management in children have been; that children suffer less pain than adults,7 neonates do not feel pain due to the under development of the nervous system10 (in fact, the converse of this is now believed to be the case, the underdevelopment of the nervous system in neonates and very young children results in an inability to localise pain and consequently more widespread pain and more peripheral and central sensitization). The belief that administering opiates to children with severe abdominal will lead to management errors has also been expressed as a reason for withholding appropriate analgesia.11 All of these explanations have been demonstrated to be erroneous, yet pain management in children remains suboptimal.12 In the elderly a similar situation exists; pain in older patients is frequently inadequately managed or left untreated, sadly this is even more frequently the case in those with dementia or cognitive impairment and cancer.13, 14 The consequences of poorly controlled pain in older adults are further cognitive deterioration, depression and mood disturbance, sleeplessness, reduced activities of daily living, and of course decreased quality of life.6 Indeed poor pain management in elderly populations is seen as a


contributory factor to increased mortality.15 One of the reasons cited for poor pain management in vulnerable groups is the difficulty associated with pain assessment in those with cognitive or communication challenges; whilst this undoubtedly does contribute to the problem, factors such as knowledge deficits, inappropriate or outdated beliefs about pain management and a mismatch between knowledge and understanding and clinical practice are also reported in the literature.12,16 Ineffective pain management skills and inappropriate understanding and beliefs about pain by therapists, nurses and medical staff have been directly linked to inadequate undergraduate education about pain.17 Although pain management is seen as a core component of physiotherapy practice, paradoxically, undergraduate education in this area is often unsatisfactory.18 A recent UK survey of undergraduate pain teaching in 70 undergraduate programmes including: physiotherapy, occupational therapy, nursing, midwifery, medicine, dentistry, pharmacy and veterinary science found that the average pain content in the curriculum was just 12 hours.18 Physiotherapy undergraduates received the highest input averaging 37.5 hours with nursing (all branches) averaging just 10.2 hours; occupational therapy and medicine had a similar amount of pain education with 14 and 13 hours respectively. Typically where pain featured in the programme the content was fragmented across the curriculum; while it could be argued that this would allow the pain content to be revisited and built upon over the duration of the course; there is also the possibility that students may find it difficult to integrate complex material if it appears sporadically throughout the curriculum. Briggs et al18 also reported that interprofessional education around pain was rare. Similar problems have been reported for undergraduate healthcare programmes in Canada and have been successfully addressed using an inter-professional curriculum based on that proposed by the International Associations for the Study of Pain.17 Those physiotherapy programmes that have developed a comprehensive, interprofessional pain education programme should be applauded, but perhaps for the rest of us it’s a case of ‘could do better’.

REFERENCES 1. King S, Chambers CT, Huguet A, Macnevin RC, McGrath PJ, Parker L, Macdonald AJ. The epidemiology of chronic pain in children and adolescents revisited: A systematic review. Pain. 2011 Dec;152(12):2729-38. 2. Clinch J, Eccleston C. Chronic musculoskeletal pain in children: assessment and management. Rheumatology (Oxford). 2009 May;48(5):466-74.

3. Low LA, Schweinhardt P. Early life adversity as a risk factor for fibromyalgia in later life. Pain Res Treat. 2012. Epub 2011 Oct 12. 4. Walsh M, Morrison TG, McGuire BE. Chronic pain in adults with an intellectual disability: prevalence, impact, and health service use based on caregiver report. Pain. 2011 Sep;152(9):1951-7. 5. Gianni W, Madaio RA, Di Cioccio L, D’Amico F, Policicchio D, Postacchini D, Franchi F, Ceci M, Benincasa E, Gentili M, Zuccaro SM. Prevalence of pain in elderly hospitalized patients. Arch Gerontol Geriatr. 2010 Nov-Dec;51(3):273-6 6. Zwakhalen SM, Hamers JP, Abu-Saad HH, Berger MP.Pain in elderly people with severe dementia: a systematic review of behavioural pain assessment tools. BMC Geriatr. 2006 Jan 27;6:3. 7. Shrestha-Ranjit JM, Manias E. Pain assessment and management practices in children following surgery of the lower limb. J Clin Nurs. 2010 Jan;19(1-2):11828. 8. Cunliffe M, Roberts SA. Pain management in children. Current Anaesthesia & Critical Care. 2004;15: 272– 283 9. Zempsky WT, Schechter NL. What’s new in the management of pain in children. Pediatr Rev. 2003 Oct;24(10):337-48. 10. Lloyd-Thomas AR. Modern concepts of paediatric analgesia. Pharmacol Ther. 1999 Jul;83(1):1-20. 11. Kim MK, Galustyan S, Sato TT, Bergholte J, Hennes HM. Analgesia for children with acute abdominal pain: a survey of pediatric emergency physicians and pediatric surgeons. Pediatrics. 2003 Nov;112(5):11226. 12. Twycross A. Managing pain in children: where to from here? J Clin Nurs. 2010 Aug;19(15-16):2090-9. 13. Buffum MD, Hutt E, Chang VT, Craine MH, Snow AL. Cognitive impairment and pain management: review of issues and challenges. J Rehabil Res Dev. 2007;44(2):315-30. 14. Bernabei R, Gambassi G, Lapane K, Landi F, Gatsonis C, Dunlop R, Lipsitz L, Steel K, Mor V. Management of pain in elderly patients with cancer. SAGE Study Group. Systematic Assessment of Geriatric Drug Use via Epidemiology. JAMA. 1998 Jun 17;279(23):187782. 15. Catananti C, Gambassi G. Pain assessment in the elderly. Surg Oncol. 2010 Sep;19(3):140-8 16. Lui, L. Y., So, W. K. and Fong, D. Y. (2008), Knowledge and attitudes regarding pain management among nurses in Hong Kong medical units. Journal of Clinical Nursing, 17: 2014–2021. 17. Watt-Watson J, Hunter J, Pennefather P, Librach L, Raman-Wilms L, Schreiber M, Lax L, Stinson J, Dao T, Gordon A, Mock D, Salter M. An integrated undergraduate pain curriculum, based on IASP curricula, for six health science faculties. Pain. 2004 Jul;110(1-2):140-8. 18. Briggs EV, Carr EC, Whittaker MS. Survey of undergraduate pain curricula for healthcare professionals in the United Kingdom. Eur J Pain. 2011 Sep;15(8):789-95.

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Invited Commentary

The role of physiotherapists in implementing in-shoe foot orthoses in managing overuse musculoskeletal injuries: using patellofemoral pain as an example. Vicenzino B,1 McPoil T2 1. 2.

Professor in Sports Physiotherapy and Head of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia. Professor in Physical Therapy, School of Physiotherapy, Regis University, Colorado, USA, and Honorary Professor in Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Queensland, Australia. Correspondence to: Professor Bill Vicenzino, email: [email protected]

Contemporary physiotherapy tends to consist of a combination of reasoned therapeutic strategies: usually focusing on advice, education and exercise with the addition of various adjunctive therapeutic strategies such as external physical devices (e.g., braces, orthoses, tape), joint and soft tissue manual therapy (e.g., mobilization with movement, massage, manipulation) and possibly the judicious use of electro-physical agents (e.g., functional electrical stimulation, acupuncture or dry needling, therapeutic ultrasound) (Figure 1). The combination of these strategies for any one individual patient will depend on the clinical assessment and identification of other associated factors, often multifactorial in nature. An example of the superior efficacy of multimodal physiotherapy has recently been highlighted in a systematic review1 of the efficacy of non-operative management of patellofemoral pain (PFP) in which hip and knee exercises, knee taping and manual therapy along with in-shoe foot orthoses were superior to a minimalist intervention (flat shoe insert and low level balance exercises) or in-shoe foot orthoses only over the short and longer term (>26 weeks). The relative contribution of orthoses in PFP in a multimodal physiotherapy program, might be ascertained from studies demonstrating the efficacy of orthoses alone beyond a flat placebo insert or Figure 1: Components of management strategies highlighting external physical devices and the linkage with assessment and associated factors.


adoption of a wait and see policy, with numbers needed to treat in the order of 4 and 2, respectively.2,3 There anecdotally appears reluctance for physiotherapists to prescribe and fit in-shoe foot orthoses for conditions such as PFP, which is difficult to understand, given the (i) level of expertise a physiotherapist has in the management of musculoskeletal pain and injury, and (ii) evidence of efficacy of the inclusion of external physical devices for other ankle and foot conditions. The reluctance appears rather unfounded when considered against the utilization of external physical devices in ankle problems such as recurrent ankle sprain (chronic ankle problems or functional ankle instability). In the circumstance of a recurrent ankle sprain, there is high level evidence in support of the use of braces and tape in the prevention of ankle injury, especially after an initial injury4,5 and it would be difficult to understand a physiotherapist not being confident in recommending and implementing these strategies in managing a patient from experiencing recurrent ankle sprains. So why is it that physiotherapists appear reluctant to use an in-shoe foot orthosis in the management of overuse injuries of the lower limb (e.g., PFP)? The apparent hesitancy of physiotherapists to prescribe and fit in-shoe foot orthoses might arise for a number of reasons. One such reason might be the difficulty in understanding and consistently performing certain evaluations of posited intrinsic deformities as a basis for posting/wedging orthoses. Another is likely a function of the complexity of the structure and function of the foot and ankle along with its relationship to musculoskeletal conditions (pain and injury) of the lower limb, much of which is speculative and in need of systematic and rigorous evaluation (e.g., PFP6). In addition, there has been traditionally a level of obfuscation surrounding in-shoe foot orthoses, which a cynic might attribute to a turf protection approach of those who promote their use. PFP is clinically considered to have a character typical motion pattern whereby there is an associated increased foot pronation, internal lower limb rotation and hip adduction. This is largely a clinical notion in need of scientific scrutiny.6 However, there are several studies that show associations between abnormal foot posture/motion and PFP. Barton et al6 reported similar movement patterns


in a lower limb kinematic study of 26 PFP and 20 control participants, while McPoil et al7 showed that greater mid foot width and smaller arch height in weight bearing compared to non weight bearing was associated with PFP (43 PFP, 86 control). Interestingly, two prospective studies by the Belgian group8,9 have shown that thigh muscle tightness and plantar pressure distribution indicating pronation was predictive of those who would develop PFP. Not surprisingly, in-shoe foot orthoses are frequently used clinically in the management of PFP. Vicenzino10 proposed a clinical reasoning approach to assist the practitioner in determining the probability of success or failure associated with in-shoe foot orthoses. In brief the approach uses a physical manipulation (usually anti-pronation taping11) to (i) alter motion during a physical activity with which the patient has difficulty (pain and limited capacity as ascertained in clinical assessment of a physical function with an hypothesized pathomechanics, Figure 1) and (ii) improve the amount of activity possible before pain onset10. This clinical reasoning process has been termed the Treatment Direction Test (TDT, Figure 1). While using the TDT in this way will provide insight for the practitioner into the likelihood of success or failure with fitting of an orthosis, Meier et al12 have suggested that the anti-pronation tape can be used to determine the amount of posting (inversion angulation of the plantar foot insert). Meier et al12 demonstrated this approach in a series of cases, reporting that pain severity and Foot and Ankle Ability Measure were substantially improved after 4 weeks of wearing orthoses. The tape in all patients had improved their painful physical activity. That is, the antiproantion taping technique not only helps the practitioner in deciding if an orthosis might be useful, but also to what extent it ought to change foot posture. The TDT is in need of validation through research. Barton et al,13 in a preliminary study of 52 patients with PFP, has provided evidence of a prefabricated anti-pronation foot orthosis’ ability to significantly improve function (measured by single leg squats, single leg rising from sitting, pain free step downs) immediately after application. While the insertion of an orthosis in the clinic to judge the immediate effects is akin to the taping technique, it is rather an expensive option as a trial in the field whereby the taping technique can be used to confirm the clinical findings of an immediate effect in the patient’s real environment and participation. Nevertheless, Barton et al13 study supports the ability of a physical manipulation to immediately change function, which is the first stage of a positive TDT. Whilst it is widely believed that the prescription of a foot orthosis requires the foot to be measured and certain parameters determined in order for the orthosis to be effect, there is little evidence in support of such a notion.14 In the largest RCT of foot orthosis in the management of PFP undertaken to date the orthoses were fitted on the basis of comfort (at orthosis-foot interface) and performance (i.e., replication of the TDT in clinic and in the field),15 not any measures of foot posture/function. This study showed that randomly applied orthoses, which were fitted on the basis of comfort and performance, but not foot type, were superior to a flat insert in the short

term (NNT=4). In a follow up analysis of the RCT, a clinical prediction rule for success with orthosis revealed that mid foot width was in part predictive of success.16 A recent study of orthoses in PFP by Mills et al3 showed a superior effect with orthoses in those who had >11.25mm increase in mid foot width when going from a non supported seated position to standing [the NNT went from 2 to 1 in this subgroup of mobile feet]. An interesting finding reported by Mills et al3 is that the perceived global rating of change seemed to reflect changes in function not pain. Barton et al, 13 in the study of the immediate effect of orthoses in 52 PFP sufferers, showed that those who have a more pronated foot in standing (measured by the Foot Posture Index,17 which correlates with the mid foot width measure18) gain greater benefits in function when an anti-pronation orthosis is worn. Taken together these two studies tend to indicate that function rather than pain is a target of in-shoe foot orthoses in the management of PFP. Thus, there is now a few studies that have shown those with more pronation have a better chance of success, which provides some direction to physiotherapists in optimizing outcomes when using in-shoe foot orthoses for PFP. In summary, there is high quality evidence of the efficacy of in-shoe foot orthoses in PFP, which improves when patients with greater pronation are targeted. That this excessive pronation can be readily measured by reliable methods (e.g., Foot Posture Index, mid foot width) should instill confidence in the physiotherapist to use inshoe foot orthoses. The application of a TDT approach further improves and underpins the confidence with which the physiotherapist can selectively identify patients that have a high likelihood of success with foot orthoses. Finally a physiotherapist must consider that in-shoe foot orthoses are only one intervention to consider amongst a number of others (e.g., specific therapeutic exercise (of the hip, thigh and leg), advice and education on training (e.g., periodization cycle, overall work load and type), equipment (e.g., shoes in runners or bike set up for cyclists with PFP) and environment (e.g., surfaces run on and ambient conditions) that can be used in the management of overuse injuries such as PFP. The exciting part of physiotherapy is deciding which one of these multiple physiotherapy modalities or combination thereof will optimally resolve the patient’s presenting condition.

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REFERENCES: 1. Collins N, Bisset L, Crossley K, Vicenzino B. Efficacy of nonsurgical interventions for anterior knee pain. Sports Med. 2011 Nov. 4;:1–23. 2. Collins N, Crossley K, Beller E, Darnell R, McPoil T, Vicenzino B. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: randomised clinical trial. BMJ. 2008 Oct 24;337:a1735–a1735. 3. Mills K, Blanch P, Dev P, Martin M, Vicenzino B. A randomised control trial of short term efficacy of inshoe foot orthoses compared with a wait and see policy for anterior knee pain and the role of foot mobility. Br J Sports Med. 2011 Sep. 18; [Epub ahead of print] 4. Gross MT, Liu H-Y. The role of ankle bracing for prevention of ankle sprain injuries. J Orthop Sports Phys Ther. 2003 Oct. 1;33(10):572–577. 5. Dizon JMR, Reyes JJB. A systematic review on the effectiveness of external ankle supports in the prevention of inversion ankle sprains among elite and recreational players. J Sci Med Sport. 2010 May;13(3):309–317. 6. Barton CJ, Levinger P, Menz HB, Webster KE. Kinematic gait characteristics associated with patellofemoral pain syndrome: a systematic review. Gait Posture. 2009 Nov.;30(4):405–416. 7. McPoil TG, Warren M, Vicenzino B, Cornwall MW. Variations in foot posture and mobility between individuals with patellofemoral pain and those in a control group. J Am Podiatr Med Assoc. 2011 Jun.;101(4):289–296. 8. Witvrouw E, Lysens R, Bellemans J, Cambier D, Vanderstraeten G. Intrinsic risk factors for the development of anterior knee pain in an athletic population. A two-year prospective study. Am J Sports Med. 2000;28(4):480–489. 9. Thijs Y, Van Tiggelen D, Roosen P, De Clercq D, Witvrouw E. A prospective study on gait-related intrinsic risk factors for patellofemoral pain. Clin J Sport Med. 2007 Nov.;17(6):437–445. 10. Vicenzino B. Foot orthotics in the treatment of lower limb conditions: a musculoskeletal physiotherapy perspective. Man Ther. 2004 Oct. 31;9(4):185–196. 11. Franettovich M, Chapman A, Blanch P, Vicenzino B. A physiological and psychological basis for antipronation taping from a critical review of the literature. Sports Med. 2008;38(8):617-31. 12. Meier K, McPoil T, Cornwall M, Lyle T. Use of Antipronation Taping to Determine Foot Orthoses Prescription: A Case Series. Res Sports Med. 2008 Oct. 1;16(4):257–271. 13. Barton CJ, Menz HB, Crossley KM. The immediate effects of foot orthoses on functional performance in individuals with patellofemoral pain syndrome. Br J Sports Med. 2011 Mar.;45(3):193–197. 14. McPoil TG, Hunt GC. Evaluation and management of foot and ankle disorders: present problems and future directions. J Orthop Sports Phys Ther. 1995 Jun. 1;21(6):381–388.


15. Vicenzino B, Collins N, Crossley K, Beller E, Darnell R, McPoil T. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: a randomised clinical trial. BMC Musculoskelet Disord. 2008 Feb. 27;9(1):27. 16. Vicenzino B, Collins N, Cleland J, McPoil T. A clinical prediction rule for identifying patients with patellofemoral pain who are likely to benefit from foot orthoses: a preliminary determination. Br J Sports Med. 2010 Sep.;44(12):862–866. 17. Redmond AC, Crane YZ, Menz HB. Normative values for the Foot Posture Index. J Foot Ankle Res. 2008;1(1):6. 18. Cornwall MW, McPoil TG. Relationship between static foot posture and foot mobility. J Foot Ankle Res. 2011;4:4.


The effectiveness of ice water immersion in the treatment of delayed onset muscle soreness in the lower leg Lynch E1, Barry S1 1.

Faculty of Health and Life Sciences, Coventry University, Coventry, UK, CV1 5FB

ABSTRACT Background: The current evidence base pertaining to the use of ice water immersion in the treatment and prevention of delayed onset muscle soreness (DOMS) remains inconsistent and controversial. Although little scientific support exists, many athletes continue to acknowledge it as an important treatment modality in DOMS management.The purpose of this study is to determine the effectiveness of ice water immersion in the treatment of DOMS induced in the lower leg in a group of untrained volunteers. Method: An experimental inter-subject design was employed, using convenience sampling, to recruit 16 untrained volunteers (11 females, 5 males). Each performed a bilateral DOMS inducing protocol, in the plantar flexors, to exhaustion. Each leg was then randomly assigned to a control (no treatment) or intervention (ice immersion) group. The ice protocol consisted of a 10 minute water immersion, superior to the knee joint, at 10˚C. Range of movement (ROM), using a standard plastic goniometer, and soreness, using a Visual Analogue Scale (VAS), were assessed. Measurements were taken prior to, and 48 hours post exercise. Results were analyzed using a related t-test. Results: Statistical analysis of the results was performed using SPSS 14.0, where p