The continuum of tendon pathology : Current view and clinical implications
- Authors: Cook, Jill , Rio, Ebonie , Purdam, Craig , Girdwood, Michael , Ortega-Cebrian, Silvia , Docking, Sean
- Date: 2017
- Type: Text , Journal article
- Relation: Apunts Medicina de l'Esport Vol. 52, no. 194 (2017), p. 61-69
- Full Text: false
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- Description: Cook and Purdam first proposed the Continuum model in 2009, with the aim of improving the understanding of the complexity of tendon pathologies. The Continuum is based on three states of tendon structure: reactive tendon, tendon disrepair and degenerative tendon. In contrast to other proposals, the Continuum model describes continuous changes in tendon structure. Each state of tendon structure represents a particular clinical presentation and requires a particular type of management. Evidence seen in histopathological studies, imaging and clinical studies all support the Continuum model for the analysis of tendon pathologies. © 2017 Consell Català de l'Esport. Generalitat de Catalunya
Pain mapping of the anterior knee: Injured athletes know best
- Authors: Rio, Ebonie , Girdwood, Michael , Thomas, Jake , Garofalo, Christopher , Fortington, Lauren , Docking, Sean
- Date: 2018
- Type: Text , Journal article
- Relation: Scandinavian Journal of Pain Vol. 18, no. 3 (2018), p. 409-416
- Full Text: false
- Reviewed:
- Description: Research investigating differences in pain location and distribution across conditions is lacking. Mapping a patient's pain may be a useful way of understanding differences in presentations, however the use of pain mapping during a pain provocation task has not been investigated. The aim of this study was to assess the reliability of patient and clinician rated pain maps during a pain provocation task for the anterior knee. Participants were recruited from a larger study of professional Australian rules football players (n=17). Players were invited to participate if they reported a current or past history of patellar tendon pain. No clinical diagnosis was performed for this reliability study. Participants were asked to point on their own knee where they usually experienced pain, which was recorded by a clinician on a piloted photograph of the knee using an iPad. Participants then completed a single leg decline squat (SLDS), after which participants indicated where they experienced pain during the task with their finger, which was recorded by a clinician. Participants then recorded their own self-rated pain map. This process was repeated 10 min later. Pain maps were subjectively classified into categories of pain location and spread by two raters. Pain area was quantified by the number of pixels shaded. Intra- and inter-rater reliability (between participants and clinicians) were analysed for pain area, similarity of location as well as subjective classification. Test-retest reliability was good for participants (intraclass correlation coefficients [ICC]=0.81) but only fair for clinicians (ICC=0.47) for pain area. There was poor agreement between participants and clinicians for pain area (ICC=0.16) and similarity of location (Jaccard index=0.19). Clinicians had good inter- and intra-rater reliability of classification of pain spread (k=0.75 and 0.67). Participant completed pain maps were more reliable than clinician pain maps. Clinicians were reliable at classifying pain based on location and type of spread. Clinicians should ask patients to complete their own pain maps following a pain provocation test, to elicit the most reliable and consistent understanding of their pain perception. © 2018 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston.