The power of exercise + the power of the internet = #PEPA16

1- Ann Gates Gym Ball (3)

Ann Gates a.k.a. @exerciseworks

I have a lot to share this morning, but I am writing an intro to a guest blog post…and so I shall be brief.

I’ve got ‘exercise on the brain’ of late.  We’re only three weeks away from the beginning of the American College of Sports Medicine (ACSM) Annual Meeting and the coincident 7th World Congress on Exercise is Medicine taking place in Boston, which I’ll be attending.  Here at CJSM, we just released our May issue which features a couple of highly discussed research studies:  a meta-analysis on physical activity and the risk of lung cancer and an RCT on the effect of rock climbing on low back pain.

And to top it off, I’ve ‘met’ Ann Gates, founder and CEO of Exercise Works, aka @exerciseworks for those of you, like me, who have followed that Twitter handle for years. Last week I noticed on that feed an announcement that Exercise Works would hold a MOOC this summer — ‘Physiotherapy, Exercise and Physical Activity’ #PEPA16. And it starts July 4 2016.

What is a MOOC you say? What exactly will go on in #PEPA16?

Let’s hear from Ann.

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#PEPA16? It sounds like a rock group… but it’s a mission.

It’s a passion. It’s an opportunity to support health care professionals interested in exercise medicine and disease: from Africa to Afghanistan, doctors to community outreach workers, and to embed physical activity into making every contact count, every consult.

So what’s a MOOC, and what’s happening this summer? A MOOC is a massive, open online, course run by expert educational organizations (in this case Physiopedia). It’s also a unique opportunity to learn, participate, contribute, engage, and share on a global scale! The excitement of it all is that the course has been designed and evaluated to deliver high quality learning outcomes on the role of physical activity in health. It provides a global, level playing field, to gain knowledge on the health benefits of exercise and chronic disease prevention and treatment. It’s also the final part (phew!) of my three year project to change the way we educate health care professionals in prevention medicine (in this case using exercise as a medicine).

I set out in 2014, to disrupt the way in which physical activity medical education is delivered. I wanted most of all to open up the opportunities to all, and to deliver learning and implementation science of physical activity opportunities, into everyday patient care. We’ve achieved this for doctors and health care professionals in the UK- but I wanted to take this global, and provide educational support for all, in any country, for any health care professional interested in learning more about the benefits of physical activity in health.

So, #PEPA16 is the result. A global, online, “rocking”, opportunity to care and share the knowledge, that indeed, exercise is best medicine! Join us, this summer, and please register here.

What’s in the #PEPA16 MOOC Resources? Read more of this post

Patellofemoral pain syndrome – is this a top down or bottom up problem…or both? Guest blog by Simon Lack

Patellofemoral pain syndrome (PFPS) has a high prevalence within the sporting population, with one study of 2159 presentations to sports medicine clinics, reporting 5.4% incidence of PFPS, accounting for 25% of those presenting with knee pain (1).  Despite a more traditional approach to management having been well researched in a high quality RCT (2), the problem has been shown to have a high recurrence.  In a quest to unravel the mystery of long-term successful treatment outcomes, researchers have started looking above and below the knee to potentially identify more effective solutions.

Arguably started by the work of Lee et al (3) that identified that changes in femoral rotation angles have significant consequences for patellofemoral joint loading, in combination with consistently reported weakness of hip musculature in PFPS populations (4), multiple studies have looked to modify top down control through strengthening of the hip rotator muscles.  The outcomes of these studies have shown significant reductions in symptoms and increases in function particularly in weaker individuals.  In addition, better outcomes have been reported if a proximal strengthening programme is started prior to functional strengthening compared with an initial local knee-strengthening programme (5). Thus, a case is emerging in favour of a top-down treatment mechanism.

Distal to the knee a growing body of evidence supporting the use of foot orthoses in PFPS management has started to be established.  A high quality RCT that compared six weeks of physiotherapist intervention with off the shelf foot orthoses, flat inserts, multimodal physiotherapy (patellofemoral joint mobilisation, patellar taping, quadriceps muscle retraining, and education), or foot orthoses plus physiotherapy, demonstrated orthoses to be superior to flat inserts, with their use resulting in comparable outcomes to multimodal physiotherapy (6).

Further more, evidence suggests foot orthoses have the ability to change pain immediately within this population of patients (7), with a further reduction of pain experienced following a 12/52 period of orthotic wear (8).  Interventions that have the capacity to reduce pain symptoms immediately, pose a valuable tool in facilitating normal movement patterns, maximising function and minimising detrimental pain inhibition.  Hence, further emerging evidence for a bottom-up treatment mechanism.

What do you think predicts treatment success in PFPS, and why ?

Simon Lack is a Physiotherapist and current PhD student at Queen Mary University, London, currently studying the interaction of hip and foot biomechanics in the presentation and management of patellofemoral pain.

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References

1.Devereaux MD, Lachmann SM. Patello-femoral arthralgia in athletes attending a Sports Injury Clinic. Br J Sports Med. 1984 Mar;18(1):18-21.

2. Crossley K, Bennell K, Green S, Cowan S, McConnell J. Physical therapy for patellofemoral pain: a randomized, double-blinded, placebo-controlled trial. Am J Sports Med. [Clinical Trial Multicenter Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2002 Nov-Dec;30(6):857-65.

3. Lee TQ, Morris G, Csintalan RP. The influence of tibial and femoral rotation on patellofemoral contact area and pressure. J Orthop Sports Phys Ther. [Research Support, Non-U.S. Gov’t Research Support, U.S. Gov’t, Non-P.H.S. Review]. 2003 Nov;33(11):686-93.

4. Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. Aust J Physiother. 2009;55(1):9-15.

5. Dolak KL, Silkman C, Medina McKeon J, Hosey RG, Lattermann C, Uhl TL. Hip strengthening prior to functional exercises reduces pain sooner than quadriceps strengthening in females with patellofemoral pain syndrome: a randomized clinical trial. J Orthop Sports Phys Ther. 2011 Aug;41(8):560-70.

6. 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. [Comparative Study Randomized Controlled Trial Research Support, Non-U.S. Gov’t]. 2008;337:a1735.

7. 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. 2010 Jul 20.

8. Barton CJ, Menz HB, Crossley KM. Effects of prefabricated foot orthoses on pain and function in individuals with patellofemoral pain syndrome: a cohort study. Phys Ther Sport. 2011 May;12(2):70-5.

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