Autologous Blood and Platelet-Rich Plasma Injections in the Treatment of Achilles Tendinopathy: A Critically Appraised Topic.

Clinical Scenario: Achilles tendinopathy is a painful condition commonly affecting the general and athletic population. It presents with localized pain, stiffness, and swelling in the midportion of the Achilles tendon. The physical stress placed on the tendon results in microtrauma, which leads to subsequent inflammation and degeneration. While it is not surprising that this condition affects the physically active, nearly one-third of Achilles tendinopathy cases occur in sedentary individuals. Etiology for this condition stems from a change in loading patterns and/or overuse of the tendon, resulting in microscopic tearing and degenerative changes. There are numerous causes contributing to the maladaptive response in these patients, such as mechanical, age-related, genetic, and vascular factors. The treatment for these patients is typically load management and eccentric strengthening of the gastrocnemius-soleus complex. Unfortunately, conservative treatment can lead to surgical intervention in up to 45% of cases. A relatively new phenomenon in the treatment of this condition is the use of autologous blood injections (ABI) and platelet-rich plasma injections (PRPI). This need for a less invasive treatment fostered more investigation into ABI and PRPI to treat these nonresponsive patients. However, the evidence concerning the effectiveness of these treatments in patients with Achilles tendinopathy has not been synthesized. Focused Clinical Question: In patients with Achilles tendinopathy, how do variations of ABI and PRPI compared with a placebo and/or eccentric training affect pain and function?

Immediate Effects of Proprioceptive Neuromuscular Facilitation Stretching Programs Compared With Passive Stretching Programs for Hamstring Flexibility: A Critically Appraised Topic.

Clinical Scenario: Increasing hamstring flexibility through clinical stretching interventions may be an effective means to prevent hamstring injuries. However the most effective method to increase hamstring flexibility has yet to be determined. CLINICAL QUESTION: For a healthy individual, are proprioceptive neuromuscular facilitation (PNF) stretching programs more effective in immediately improving hamstring flexibility when compared with static stretching programs? Summary of Key Findings: A thorough literature search returned 195 possible studies; 5 studies met the inclusion criteria and were included. Current evidence supports the use of PNF stretching or static stretching programs for increasing hamstring flexibility. However, neither program demonstrated superior effectiveness when examining immediate increases in hamstring flexibility. Clinical Bottom Line: There were consistent findings from multiple low-quality studies that indicate there is no difference in the immediate improvements in hamstring flexibility when comparing PNF stretching programs to static stretching programs in physically active adults. Strength of Recommendation: Grade B evidence exists that PNF and static stretching programs equally increase hamstring flexibility immediately following the stretching program.

The interrater and intrarater reliability of the functional movement screen: A systematic review with meta-analysis.

OBJECTIVE: To synthesize the literature and perform a meta-analysis for both the interrater and intrarater reliability of the FMS™. METHODS: Academic Search Complete, CINAHL, Medline and SportsDiscus databases were systematically searched from inception to March 2015. Studies were included if the primary purpose was to determine the interrater or intrarater reliability of the FMS™, assessed and scored all 7-items using the standard scoring criteria, provided a composite score and employed intraclass correlation coefficients (ICCs). Studies were excluded if reliability was not the primary aim, participants were injured at data collection, or a modified FMS™ or scoring system was utilized. RESULTS: Seven papers were included; 6 assessing interrater and 6 assessing intrarater reliability. There was moderate evidence in good interrater reliability with a summary ICC of 0.843 (95% CI = 0.640, 0.936; Q7 = 84.915, p < 0.0001). There was moderate evidence in good intrarater reliability with a summary ICC of 0.869 (95% CI = 0.785, 0.921; Q12 = 60.763, p < 0.0001). CONCLUSION: There was moderate evidence for both forms of reliability. The sensitivity assessments revealed this interpretation is stable and not influenced by any one study. Overall, the FMS™ is a reliable tool for clinical practice.