Summer 2016 - Championing Sport in Private Practice

Chronic tennis elbow can be challenging to manage. Evidence from high quality clinical trials indicates that, while steroid injections improve the condition in the short term the longer-term outcome is worse than if the patient was to adopt a wait and see policy. Physiotherapy, consisting of exercise and manual therapy has been shown to speed up resolution of the condition compared to wait and see, but without the longer-term deleterious effects of steroid injections. This article presents the proposition that managing chronic tennis elbow might be optimised if the presenting patient features are considered. For example, evidence suggests that patients who have worse pain and disability, concomitant neck and shoulder pain, or evidence of central sensitisation are likely to have a worse prognosis. The proposition is that patients with a poor prognosis be more carefully examined and worked up in terms of management. In contrast, those who have low pain and disability, and low manual task requirements at work and home could achieve a good outcome with adopting a wait and see policy. The majority will benefit with an appropriately metered exercise programme

Poor body mechanics and / or movement patterns are an underlying cause of many sporting injuries. It is important that athletes maintain and improve their physical competency as they develop physically and mentally. This article outlines the importance of physiotherapists in developing exercises and warm-up regimes that act as stepping stones in improving movement and competency while progressing athletes from a clinical to a sporting environment. 

Mechanotransduction is the physiological process where cells sense and respond to mechanical loads. Here we reclaim the term "mechanotherapy" and present the current scientific knowledge underpinning how load may be used therapeutically to stimulate tissue repair and remodelling in tendon, muscle, ligament, cartiage and bone. The information in this article first appeared in the British Journal of Sports Medicine in 2009, but even seven years after its first publication, the message is still valid.

Hip and groin problems are common in professional and amateur sport, and recovery can often be lengthy. This is frequently due to the delay in the making of an accurate diagnosis, and uncertainty surrounding how best to manage these patients. This article aims to simply the diagnostic process, and give guidance on when to refer and how best to steer the rehabilitation of patients with hip and groin conditions

Lower limb tendinopathies are a substantial problem with a higher incidence than osteoathritis. Current tendinopathy literature has often focused on eccentric exercises as a treatment, but new research suggests other forms of loading may be useful. However, the mechanism by which loading is effective has not been elucidated. This article explains the aetiology of tendinopathy and discusses the potential mechanisms of effect. The focus being that neuromuscular adaptation is most important.

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