Jens Lykkegaard Olesen

To investigate the 12-months prognosis and prognostic factors of 8-19-year-olds with musculoskeletal pain in general practice. A prospective cohort was conducted in a setting of Danish general practice clinics. Participants were children and adolescents aged 8–19 years old consulting the general practitioner with self-reported musculoskeletal pain completed a questionnaire at baseline, 3-, 6-, and 12-month follow-up. No interventions were applied. The primary outcome was activity-limiting pain at 6 months, regardless of pain location. We included one hundred children and adolescents (median age 13 years interquartile range 12–16.5, 55% female) with a follow-up rate of 70% at 6 months and 67% at 12 months. The most common pain site was the knee. After 6 months, 36% reported activity-limiting pain and 42% reported multi-site pain. After 12 months, 26% reported activity-limiting pain. Children and adolescents who felt nervous (odds ratio (OR) 4.2 95% confidence interval (CI) 1.4–12.5) or tired during the day (OR 2.9 95% CI 1.1–7.7), with 1–7 days of pain episodes (OR 7.1 95% CI 1.8–28.9), who used pain medication (OR 5.4 95% CI 1.6–18.4), had difficulties falling asleep (OR 4.8 95% CI 1.7–13.9), carrying a schoolbag (OR 3.8 95% CI 1.1–13.1), or bending down to put on socks due to pain (OR 4.1 95% CI 1.3–13.2) had a higher risk of pain after 6 months. Conclusion: One-third of adolescents consulting their GP for MSK pain continue to experience activity-limiting pain at 6 months. This highlights the need for early identification of risk factors and a biopsychosocial approach to pain management in general practice. This study was performed at the Center for General Practice at Aalborg University, Fyrkildevej 7 1st floor, 9220 Aalborg Ø, Denmark. This work was supported by the Multidisciplinary Committee (MPU) providing a grant used for compensation for the general practice clinic’s time spent on recruitment [grant number ID: MPU 20–2017/date 100117]. ClinicalTrials.gov (Identifier NCT03678922) and link: https://clinicaltrials.gov/study/NCT03678922?term=NCT03678922&rank=1. What is Known: • Musculoskeletal pain, among other pain sites; headache and abdominal pain account for most of the recurrent painful states among children and adolescents; they may have a poorer prognosis and the MSK pain a larger impact than realized. • Many adolescents consult their GP with MSK pain, but there is a lack of data in this setting of early stage management resulting in a limitation in the current body of evidence on the prognosis of adolescent MSK pain complaints is studies based on secondary care population or school-based population. What is New: • A substantial proportion of children and adolescents (36%) continue to experience activity-limiting MSK pain six months after consulting their GP, with 26% still affected after 12 months. • Children and adolescents with persistent MSK pain at six months was characterized by functional difficulties in daily activities, all linked to their pain, - one of the most notable challenges was carrying a schoolbag.

Background/Objectives: The aim of this study was to evaluate the effects of lifelong team handball/football training on regional bone health and body composition in elderly women. Methods: Seventeen elderly women team handball/football players (65.9 ± 5.7 years) and twenty-one untrained age-matched women (controls) (67.7 ± 5.1 years) participated. Whole-body and regional dual-energy X-ray absorptiometry scans of arms, legs, and lower spine (L1–L4) were performed. Results: We observed 8% and 9% higher bone mineral density (BMD) and bone mineral content (BMC), respectively, at the whole-body level and in the legs and 11.5% higher BMC in the legs in team handball/football players compared to untrained age-matched controls (p < 0.05). Higher total and leg lean body mass (p < 0.05), along with lower total body fat percentage (p < 0.05) and higher T- and Z-scores, markers of fragility risk fracture (0.294 ± 1.461 vs. −0.538 ± 1.031; 1.447 ± 1.278 vs. 0.724 ± 0.823, respectively), were also found in team handball/football players compared to controls (p < 0.05). No significant differences in nutritional habits were observed between groups. Conclusions: Our study suggest that the beneficial effects of lifetime handball/football practice on bone preservation in elderly women occur independently from nutritional intake, which emphasize the potential role of team sports in osteoporosis prevention. Future studies should focus on the cofounding factors and causative mechanisms mediated by team sport practice in osteoporosis prevention.

Introduction: Variable eligibility criteria across studies on plantar heel pain may result in compromising the generalisability of meta‐analyses when heterogeneity is not accounted for. We aimed to explore: (i) heterogeneity of participant eligibility criteria in studies that have investigated plantar heel pain, and (ii) associations between key eligibility criteria and the characteristics of the participants included in the study.Methods: In this systematic review with narrative synthesis, we extracted participant eligibility criteria, and participants' age, body mass index (BMI), symptom duration and pain level from published studies on plantar heel pain. We performed a content analysis of criteria and aligned overarching criteria to the International Classification of Functioning, Disability and Health (ICF). We pooled studies that used the same thresholds for participant eligibility criteria into sub‐groups. We also pooled and reported studies that did not have any eligibility criteria for the quantitative characteristics to use their data for reference values and pooled studies that did not have any eligibility criteria for the characteristics as reference.Results: Two hundred and fourteen articles were included. The most reported participant eligibility criteria (as aligned to the ICF) related to body structures/function and personal factors. Age, BMI, symptom duration and pain level were used with various ranges and/or thresholds across studies (age was reported in 23 different ways across 97 studies; BMI 7/13; symptom duration 14/100; and pain level 8/31). When eligibility criteria included thresholds close to the reference value of a participant characteristic, characteristics were associated with criteria (e.g., younger participants when an upper age threshold was used).Conclusion: Participant eligibility criteria in studies on plantar heel pain vary widely; studies differed substantially in their use of quantitative thresholds. Participant characteristics of samples in studies were associated with the criteria used. This study emphasises a need for adjusting for participant heterogeneity in systematic reviews to improve their validity.

Background: Despite the established relevance of ultrasonography and assessment of pressure pain thresholds in patients with plantar fasciopathy, patient and probe positioning has been mostly ignored and are not necessarily reported in research. The primary aim of this study was to compare plantar fascia thickness in stretched and relaxed positions in patients with plantar fasciopathy. The secondary aim was to compare plantar heel pressure pain thresholds in these positions. Methods: In this cross-sectional study, we measured the plantar fascia thickness with ultrasonography, and localised pressure pain thresholds using pressure algometry of 20 patients with plantar fasciopathy. These were assessed bilaterally, with the plantar fascia in both a stretched and relaxed position. In the stretched position, toes were maximally dorsiflexed, while in the relaxed position participants’ feet were hanging freely over the end of the table. Results: The plantar fascia of the most symptomatic foot was significantly thicker when stretched compared with the relaxed position (sagittal: mean difference 0.2 mm, 95%CI: 0.1–0.4, P = 0.013; frontal: mean difference − 0.27, 95%CI: − 0.49 to − 0.06, P = 0.014). The plantar fascia was significantly thinner in the frontal plane compared with the sagittal plane in both positions (stretched: mean difference − 0.2 mm, 95%CI: − 0.42 to − 0.03, P = 0.025; relaxed: mean difference − 0.3 mm, 95%CI:-0.49 to − 0.08, P = 0.008). There was no difference between pressure pain thresholds in stretched or relaxed positions in either foot (P > 0.4). Conclusions: The plantar fascia was significantly thicker in a stretched compared with a relaxed position and in the sagittal compared with the frontal plane, but differences were smaller than the standard deviation. Pressure pain thresholds were not different between the positions. These results highlight the importance of how ultrasonography is performed and reported in research to allow for replication. Trial registration: The study was pre-registered September 25th, 2017 on ClinicalTrials.gov (NCT03291665).

Background: Plantar fasciopathy has a lifetime prevalence of 10%. Patients experience sharp pain under the heel, often for several months or years. Multiple treatments are available, but no single treatment appears superior to the others. A corticosteroid injection offers short-term pain relief but is no better than placebo in the longer term (> 8 weeks). Heavy-slow resistance training has shown potentially positive effects on long-term outcomes (> 3 months), and combining exercises with an injection may prove to be superior to exercises alone. However, the effect of heavy-slow resistance training compared with a simpler approach of patient advice (e.g., load management) and insoles is currently unknown. This trial compares the efficacy of patient advice with patient advice plus heavy-slow resistance training and with patient advice plus heavy-slow resistance training plus a corticosteroid injection in improving the Foot Health Status Questionnaire pain score after 12 weeks in patients with plantar fasciopathy. Methods: In this randomised superiority trial, we will recruit 180 patients with ultrasound-confirmed plantar fasciopathy and randomly allocate them to one of three groups: (1) patient advice and an insole (n = 60); (2) patient advice, an insole, and self-dosed heavy-slow resistance training consisting of heel raises (n = 60); or (3) patient advice, an insole, heavy-slow resistance training, and an ultrasound-guided corticosteroid injection (n = 60). All participants will be followed for 1 year, with the 12-week follow-up considered the primary endpoint. The primary outcome is the Foot Health Status questionnaire pain domain score. Secondary outcomes include the remaining three domains of the Foot Health Status Questionnaire, a 7-point Global Rating of Change, the Pain Self-Efficacy Questionnaire, physical activity level, health-related quality of life measured by the EQ-5D-5L, and Patient Acceptable Symptom State, which is the point at which participants feel no further need for treatment. Additionally, a health economic evaluation of the treatments will be carried out. Discussion: This trial will test if adding heavy-slow resistance training to fundamental patient advice and an insole improves outcomes and if a corticosteroid injection adds even further to that effect in patients with plantar fasciopathy. Trial registration: ClinicalTrials.gov, NCT03804008. Prospectively registered on January 15, 2019.

Plantar fasciopathy, characterised by plantar heel pain, affects one in ten in a lifetime. Heavy-slow resistance training (HSR) is an emerging treatment, but it often takes considerable time before the effect starts to manifest. Combining HSR with a corticosteroid injection (known for its short-term pain relief) could potentially improve outcomes in both short and long term. As this combination is yet to be investigated, we aimed to evaluate the feasibility of combining HSR with a corticosteroid injection for individuals with plantar fasciopathy before investigating the efficacy in a clinical trial. We recruited 20 participants with plantar fasciopathy for this prospectively registered feasibility study ( ClinicalTrials.gov : NCT03535896). Participants received an ultrasound-guided injection and performed heel raises on a step every second day for 8 weeks. To assess participant acceptability of the combined interventions and exercise compliance, we used a 7-point Likert scale dichotomised to “unacceptable” (categories 1–2) or “acceptable” (categories 3–7) and training diaries. Greater than or equal to 10/20 had to rate the combination “acceptable”, ≥ 15/20 had to perform ≥ 20 training sessions, and ≥ 15/20 had to start exercising ≤ 7 days after injection to confirm feasibility. Eighteen out of 20 rated the combination acceptable. Five training diaries could not be retrieved. Ten out of 15 participants performed ≥ 20 training sessions, and 15/15 started exercising ≤ 7 days after injection. Based on participant acceptability and time to exercise start, combining HSR with corticosteroid injection is feasible and the efficacy should be investigated in a future trial. Due to loss of 5/20 training diaries, firm conclusions regarding exercise compliance could not be drawn. ClinicalTrials.gov , NCT03535896

Tendinopathies of the lower extremity (e.g. Achilles, patellar, and plantar heel pain) are common in both general and sporting populations. However, the prevalence and incidence in Danish general practice is unknown. The aim was to determine the prevalence and incidence rate of lower-extremity tendinopathies in a Danish general practice. In this registry-based study, we extracted data from the electronic patient files of all patients in a single Danish general practice. The practice included 8836 patients. We searched ICPC-2 codes to identify patients with either of the following lower-extremity tendinopathies: plantar heel pain; Achilles tendinopathy; patellar tendinopathy; greater trochanteric pain syndrome or adductor tendinopathy. We defined an incident and prevalent case as a patient with a consultation because of tendinopathy in 2016 only. A prevalent, but not incident case was a patient with consultations in both 2015 and 2016. Incidence and prevalence were expressed as the number of patients with a tendinopathy per 1000 registered patients. The prevalence and incidence rate were 16.6 and 7.9 per 1000 registered patients, respectively. Plantar heel pain was the most prevalent tendinopathy and accounted for 39% of lower-extremity tendinopathies. Patients with tendinopathies were significantly older than all registered patients (46.0 years (95%CI: 43.3;48.7) versus 38.8 years (95%CI: 38.4;39.3), respectively). Lower-extremity tendinopathies, especially plantar heel pain, had a high prevalence and incidence rate in a Danish general practice. In a typical general practice with 5000 patients, general practitioners should expect to see more than 80 patients with a lower-extremity tendinopathy every year.