Foot Orthoses Enhance the Effectiveness of Exercise, Shockwave, and Ice Therapy in the Management of Medial Tibial Stress Syndrome.

OBJECTIVE: Our aim was to assess the effects of adding arch-support foot-orthoses (ASFO) to a multimodal therapeutic intervention on the perception of pain and improvement of recovery from medial tibial stress syndrome (MTSS) in recreational runners. DESIGN: A prospective randomized controlled trial. SETTING: Sport training and medical centers. PARTICIPANTS: Fifty female recreational runners with MTSS were randomized into 2 groups. INTERVENTIONS: Runners either received ASFO or sham flat noncontoured orthoses. Both groups received a multimodal therapeutic intervention, including ice massage, ankle muscle exercises, and extracorporeal shockwave therapy. MAIN OUTCOME MEASURES: Pain during bone pressure using a numerical Likert scale (0-10), MTSS severity using an MTSS scale, perceived treatment effect using the global rating of change scale, and quality of life using the short Form-36 questionnaire were determined at week 6, 12, and 18. RESULTS: Pain intensity and MTSS severity were lower, and the perceived treatment effect and physical function were better in the ASFO than in the sham flat noncontoured orthoses group at week 6 and week 12. Cohen's dz effect size for between-group differences showed a medium difference. However, arch-support foot-orthoses did not add to the benefits of multimodal therapeutic intervention on pain, MTSS severity and perceived treatment effect at week 18. CONCLUSIONS: Adding ASFO to a therapeutic intervention leads to an earlier diminishment of pain and MTSS severity, and improved PF and perceived therapeutic effects.

Adding Mindfulness Practice to Exercise Therapy for Female Recreational Runners With Patellofemoral Pain: A Randomized Controlled Trial.

CONTEXT: Considering current models that highlight the role of psychological components in pain management, mindfulness practice may be an effective strategy in the management of pain. OBJECTIVE: To examine the effects of adding an 8-week mindfulness program to exercise therapy on the perceptions of pain severity, knee function, fear of movement, and pain catastrophizing of female recreational runners with patellofemoral pain (PFP). DESIGN: Randomized controlled clinical trial. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: Thirty female runners (age = 28.3 ± 7.08 years) with PFP were randomly assigned to the exercise or mindfulness-exercise group. INTERVENTION(S): The exercise-only group followed a protocol (18 weeks, 3 sessions/wk) that featured training modifications to help control injury-related symptoms. The mindfulness-exercise group received an 8-week mindfulness intervention in addition to the exercise protocol. The mindfulness component started 4 weeks before the exercise component; therefore, the 2 components overlapped during the first 4 weeks of the intervention. MAIN OUTCOME MEASURE(S): Usual pain, pain during stepping, and pain during running were assessed using visual analog scales. Functional limitations of the knee were assessed using the Knee Outcome Survey. Fear of movement, pain catastrophizing, and coping strategies were measured via the Tampa Scale for Kinesiophobia, the Pain Catastrophizing Scale, and the Coping Strategies Questionnaire, respectively. These outcomes were assessed at baseline, at week 9, and after 18 weeks. RESULTS: Pain during running, pain during stepping, and functional limitations of the knee were less for the mindfulness-exercise group than for the exercise-only group (P values < .05). The mindfulness-exercise group reported greater perceived treatment effects than the exercise-only group (P < .05). Pain catastrophizing was less and coping strategies were more favorable for mindfulness-exercise participants than for exercise-only participants (P values < .05). CONCLUSIONS: Mindfulness practice can be an effective adjunct to exercise therapy in the rehabilitation of PFP in recreational female runners.