Please click on the image to the left to download and view a PDF of the MRC Annual Report for 2006-2007.

In the 2006-2007 calendar year period, MRC researchers attracted nearly $3M in research grants and published 2 books, 6 book chapters and 81 peer-reviewed journal articles.

Please click on the image to the left to download and view a PDF of Striding Forward - a report on the first three years of the Gait CCRE. The Gait CCRE is an NHMRC-funded collaboration between the Murdoch Children's Research Institute, the Royal Children's Hospital, the University of Melbourne, La Trobe University, Monash University and Southern Health.

MRC researchers are strongly represented in the Gait CCRE, with A/Prof Julian Feller leading the gait analysis in osteoarthritis research program.

The purpose of this study by MRC researchers Gerard Zammit, Dr Karl Landorf Dr Shannon Munteanu and A/Prof Hylton Menz was to evaluate differences in dynamic plantar pressure distribution between older people with and without radiographically confirmed osteoarthritis (OA) of the first metatarsophalangeal joint (first MPJ) of the foot. Dynamic plantar pressure recordings using the TekScan MatScan(R) system were obtained during barefoot level walking in 40 older participants; 20 with radiographically confirmed OA of the first MPJ displaying less than 55 degrees of passive dorsiflexion, and 20 with no evidence of OA in the first MPJ displaying greater than 55 degrees of passive dorsiflexion. Group comparisons between the variables maximum force and peak pressure were made for seven different regions underneath the right foot (heel, midfoot, first MPJ, second MPJ, third to fifth MPJs, hallux, and lesser toes). Compared to the control group, participants with OA of the first MPJ exhibited 34% greater maximum force (7.9 +/- 2.5 vs. 5.9 +/- 1.7 kg, p = 0.005) and 23% higher peak pressure (1.6 +/- 0.3 vs. 1.3 +/- 0.3 kg/cm(2), p = 0.001) under the hallux. Similar results were also found under the lesser toes with 43% greater maximum force (5.0 +/- 1.9 vs. 3.5 +/- 1.4 kg; p = 0.006) and 29% higher peak pressure (0.9 +/- 0.2 vs. 0.7 +/- 0.2 kg/cm(2), p = 0.018). No significant differences were found to exist between groups for any other plantar region. These findings indicate that OA of the first MPJ is associated with significant changes in load-bearing function of the foot, which may contribute to the development of secondary pathological changes associated with the condition, such as plantar callus formation and hyperextension of the hallux interphalangeal joint (more from Journal of Orthopaedic Research...)

The Muscle Function and Rehabilitation and Back and Neck Pain research groups in the MRC were recently featured in the Musculoskeletal Physiotherapy Association's magazine In Touch.

• To download a PDF of the article, click here

MRC researcher A/Prof Tim Bach was recently featured on the ABC's science program Catalyst. The olympics special edition of the program featured a story on the use of "blades" prostheses and was filmed in the MRC Movement Laboratory. Also featured was Australian paralympian Don Elgin and MRC staff Jodie McClelland and Jo Wittwer.

• To read a transcript or stream the story, click here
• To download the story as an MP4, click here
• To download the story as a WMV, click here

Jan Lovett has joined the MRC as a casual administration officer. Jan will be located in Room 216 on Fridays and can be contacted on 9479-2202 or by email: j.lovett@latrobe.edu.au.

The aim of this study by MRC researchers Dr Nora Shields, Prof Nicholas Taylor and Prof Karen Dodd was to determine whether progressive resistance training improves muscle strength, muscle endurance, and physical function in adults with Down syndrome. 20 adults with Down syndrome (13 men, 7 women; mean age, 26.8+/-7.8 y) were randomly assigned through a concealed allocation block randomized method to either an intervention group (n=9) or a control group (n=11). The intervention was a supervised, group progressive resistance training program, consisting of 6 exercises using weight machines performed twice a week for 10 weeks. Participants completed 2 to 3 sets of between 10 to 12 repetitions of each exercise until they reached fatigue. The control group continued with their usual activities. The results indicated that the intervention group showed significant improvement in upper-limb muscle endurance compared with the control group, and a trend toward an improvement in upper-limb muscle strength. There were no significant differences between the groups for lower-limb muscle performance or physical function measures. No major adverse events for the intervention were noted. It was concluded that progressive resistance training is a safe and feasible fitness option that can improve upper-limb muscle endurance in adults with Down syndrome (more from Archives of Physical Medicine and Rehabilitation...).

Increased load on the knee joint by excessive levels of impact forces during initial contact has been suggested to lead to knee osteoarthritis (OA). Asymmetric loading after knee replacement may also relate to the development of OA in the contralateral limb. Therefore, the aim of this study by MRC researchers Dr Pazit Levinger, Dr Kate Webster and A/Prof Julian Feller was to investigate the heel strike transient vertical force and subsequent lower extremity kinematic, kinetic and spatio-temporal parameters during level walking between the operated and the contralateral limbs in patients 12 months following unilateral knee replacement. A six camera motion analysis system with a force plate was used to investigate the differences between limbs in the heel strike transient vertical GRF and its relative timing, and hip, knee and ankle angles and moments at initial contact, as well as spatio-temporal parameters during the stance phase of walking in 19 subjects with unilateral knee replacement. Paired t tests showed a significant difference in the contralateral limb relative to the operated limb in the heel strike transient magnitude (p=0.03), hip moment (p=0.01), knee moment (p=0.02) and ankle moment (p=0.03). No significant differences were found for the joint angles at heel contact or the spatio-temporal parameters (p>0.05). The heel strike transient magnitude was lower for the operated limb with no differences in the spatio-temporal parameters or the joint angles at initial contact between the limbs. Differences in the hip, knee and ankle moments were also found indicating an asymmetric loading of the impact force at initial contact on the lower extremity. The current findings may indicate an asymmetric loading on the knee joint and therefore may be clinically relevant in patients undergoing unilateral knee replacement (more from The Knee...).

A COL5A1 gene variant was shown to be associated with chronic Achilles tendinopathies (TEN) in a South African (SA) population. The aim of this case-control genetic association study by MRC researcher Prof Chris Handley and colleagues was to (i) investigate the BstUI and DpnII restriction fragment length polymorphisms (RFLP) in a second population from Australia and (ii) to identify a predisposing haplotype for TEN in both populations. Eighty-five Australian and 93 SA TEN, as well as, 210 Australian and 132 SA control Caucasian subjects were genotyped for the BstUI (rs12722) and DpnII (rs13946) RFLPs, as well as, markers rs10858286, rs3196378, rs11103544, rs4504708 and rs3128575. Results indicated that the BstUI RFLP (P<0.001), as well as markers rs3196378 (P=0.003) and rs11103544 (P=0.003), were associated with TEN in the Australian cohort. Individuals with a BstUI RFLP CC genotype had a significant decreased risk of developing TEN versus any other genotypes (OR=0.42, 95% CI 0.20-0.86, P=0.017). The TTCT and TTCC haplotypes (rs13946, rs12722, rs3196378 and rs11103544) were inferred to be under- (P=0.038) and over-represented (P<0.001) compared to all other haplotypes, respectively, in the tendinopathy group when the combined Australian and SA cohorts were analysed. It was concluded that the (i) BstUI RFLP is associated with chronic Achilles tendinopathy in a second population and (ii) a region within COL5A1 3'-UTR may predispose individuals to an increased risk of developing TEN (more from the British Journal of Sports Medicine...).

The objective of this study by MRC researchers Dr Mrna Ilic, Dr Belinda Martinac, Dr Tom Samiric and Prof Chris Handley was to investigate the effect of glucosamine on the loss of newly synthesized radiolabeled large and small proteoglycans by bovine tendon, ligament and joint capsule. The kinetics of loss of (35)S-labeled large and small proteoglycans from explant cultures of tendon, ligament and joint capsule treated with 10mM glucosamine was investigated over a 10-day culture period. The kinetics of loss of (35)S-labeled small proteoglycans and the formation of free [(35)S]sulfate were determined for the last 10 days of a 15-day culture period. The proteoglycan core proteins were analyzed by gel electrophoresis followed by fluorography. The results indicated that glucosamine at 10mM stimulated the loss of small proteoglycans from ligament explant cultures. This was due to the increased loss of both macromolecular and free [(35)S]sulfate to the medium indicating that glucosamine affected the release of small proteoglycans as well as their intracellular degradation. The degradation pattern of small proteoglycans in ligament was not affected by glucosamine. In contrast, glucosamine did not have an effect on the loss of large or small proteoglycans from tendon and joint capsule or large proteoglycans from ligament explant cultures. The metabolism of cells in tendon, ligament and joint capsule was not impaired by the presence of 10mM glucosamine. It was concluded that glucosamine stimulated the loss of small proteoglycans from ligament but did not have an effect on small proteoglycan catabolism in joint capsule and tendon or large proteoglycan catabolism in ligament, tendon or synovial capsule (more from Osteoarthritis and Cartilage...).

Heel lifts are a treatment option for low back pain (LBP), whilst high-heeled shoes have been linked to LBP development. This study by MRC PhD student Christian Barton evaluated the effects of in-shoe 20mm high bilateral heel lifts on trunk muscle activity. Activity of the erector spinae (ErSp), internal oblique and external oblique muscles was evaluated using surface electromyography in 15 young (20.7+/-0.9 years) healthy female participants. Measures were taken during overground gait, both immediately and following two days habituation to the heel lifts. Immediately following the addition of the heel lifts, levels of ErSp muscle activity in the 5% epoch following heel strike increased by 19.2% (p<0.05). Following habituation, levels of ErSp muscle activity in the 5% epoch prior to heel strike increased by 24.1% (p<0.05), and a 14ms (p<0.001) earlier onset of ErSp muscle activity prior to heel strike was observed. These results indicate the heel lifts altered muscle activity reactively around heel strike (i.e. greater activity after heel strike) immediately after application and proactively (i.e. earlier onsets and greater activity prior to heel strike) after short term habituation. When put in context of previous research on trunk muscle activity in LBP populations, these changes may be important considerations for the aetiology, treatment and prevention of LBP (more from the Journal of Electromyography and Kinesiology...).

Foot Problems in Older People: Assessment and Management by A/Prof Hylton Menz provides a comprehensive guide to the assessment and management of foot and ankle problems in older people. Areas covered include the epidemiology of foot problems, functional implications, assessment of the older person with foot problems, common foot problems and their management, foot and ankle manifestations of common systemic conditions, wound management, footwear and orthotic considerations, surgical considerations and outcome assessment. Each chapter provides a comprehensive and critical review of the literature as well as providing practical evidence-based guidelines for clinicians. Foot Problems in Older People is now available from Churchill Livingstone / Elsevier.

For more information, click here.

Dr Jon Ford has joined the MRC / School of Physiotherapy as a research fellow. Jon leads a research team of higher degree students investigating the management of low back pain, and was previously employed at the University of Melbourne.

For more information about the back pain research group, click here.

Elin Wee has joined the MRC as a research officer. Elin is a physiotherapist and was previously employed as a research assistant at the University of Melbourne.

Elin will be working on the NHMRC-funded trial into the efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people.

Dr Mohammadreza Fotoohabadi ("Reza") has joined the MRC as a research officer. Reza recently completed his PhD at the University of Melbourne and holds a bachelor degree in physiotherapy and two Masters degrees from Shiraz University and Beheshtee University in Iran.

Reza will be working on the NHMRC-funded trial into the efficacy of a multifaceted podiatry intervention to improve balance and prevent falls in older people.

The 3rd Australian and New Zealand Falls Prevention Conference will be held in Melbourne, Victoria from the 12-14 October 2008 and is an initiative of the Australian and New Zealand Falls Prevention Society (ANZFPS). MRC researchers Prof Keith Hill and A/Prof Hylton Menz are on the conference organising committee. It will follow on the success of the two earlier conferences: 2006 in Brisbane and 2004 in Sydney. The ANZFPS was formed in 2006 to support and promote falls prevention research, policy, practice and education across all settings, working toward the goal of reducing falls and falls injuries among older people in Australia and New Zealand. Activities range from health promotion and health ageing approaches, through to multifactorial multidisciplinary interventions for those with high levels of risk, and from individual focus through to organisation and system-wide approaches.

To download the conference flyer, click here.

This study by Monash University researchers Dr Peter Kent and Prof Jenny Keating, and MRC researcher Prof Nicholas Taylor investigated the assessment of acute (<12 weeks duration) nonspecific low back pain (NSLBP) by primary care clinicians. The aims were to determine the methods used, whether methods differ across professional disciplines, and the extent to which clinicians assess across domains of health. Survey data were gathered from 651 primary care clinicians from six professional disciplines (Physiotherapy, Manipulative Physiotherapy, Chiropractic, Osteopathy, General Medicine, and Musculoskeletal Medicine). The results indicated that the methods used by different professional disciplines to assess NSLBP vary considerably, as 44 out of 48 assessment techniques showed significantly different utilisation rates across professions. Furthermore, assessment across domains of health in this condition was variable, as clinicians commonly assess physical impairments and pain and less commonly assess activity limitation and psychosocial function (100% of clinicians very frequently or often assess physical impairment, 99% assess pain, 21 assess activity limitation, and 7% assess psychosocial function). Adoption of greater standardisation of assessment by clinicians may require demonstration of the capacity of this standardisation to improve patient outcomes (more from Manual Therapy...)

Plantar heel pain is soreness or tenderness of the heel that is restricted to the sole of the foot. It often radiates from the central part of the heel pad or the medial tubercle of the calcaneum, but may extend along the plantar fascia into the medial longitudinal arch of the foot. Severity may range from an irritation at the origin of the plantar fascia, which is noticeable on rising after rest, to an incapacitating pain. This systematic review by MRC researchers Dr Karl Landorf and A/Prof Hylton Menz reached the following conclusions regarding the evidence for heel pain treatments: Casted orthoses (custom-made insoles) may improve function (but not pain) at 3 months in people with plantar heel pain compared with a sham orthosis, but they may be no better than appropriate prefabricated orthoses; supportive taping may improve pain in the short term at 1 week, but we found no evidence on its effectiveness beyond 1 week; we don't know whether heel pads, heel cups , or night splints reduce pain; corticosteroid injections are commonly used to treat plantar heel pain, but we don't know whether they reduce pain compared with placebo or other treatments; we don't know whether local anaesthetic injections, alone or added to corticosteroids , improve pain relief compared with corticosteroids alone; extracorporeal shock wave therapy may reduce pain, but we don't know for sure that it is beneficial; we don't know whether laser treatment, ultrasound, or surgery reduce symptoms compared with sham treatment or no treatment, and; we don't know whether stretching exercises reduce pain compared with no treatment or other treatments (more from BMJ Clinical Evidence...)

Although footwear has been linked to falls in older people, it remains unclear as to which shoe features are beneficial or detrimental to balance in older people. This study by A/Prof Hylton Menz and colleagues from the Prince of Wales Medical Research Institute systematically investigated how footwear features affect balance and stepping in older people. 29 community-dwelling older people undertook tests of postural sway, maximal balance range, coordinated stability and choice-stepping reaction time in a standard shoe and seven other shoes that differed from the standard shoe in one feature only, namely: elevated heel (4.5 cm), soft sole, hard sole, flared sole, bevelled heel, high heelcollar and tread sole. The results revealed significantly increased sway in the elevated heel versus the standard shoe condition. A footwear performance index based on the sum of zscores across three tests (sway, coordinated stability and choice-stepping reaction time) normalized to the standard condition indicated that the elevated heel was most detrimental to balance whereas a high heel-collar and a hard sole showed trends towards being beneficial (more from Gerontology...)

Dr Katja Tecklenburg from the University of Innsbruck, Austria has joined the MRC as a visiting orthopaedic fellow. Katja will undertake surgical training with A/Prof Julian Feller and will conduct clinical gait analysis research with the Orthopaedics Research Group. Katja's research project will focus on gait analysis of patients with patellar instability.

The aim of this study by MRC researchers George Murley and Dr James Wickham was to characterize the electromyographic (EMG) profile of tibialis posterior during barefoot walking in order to establish a reference database for neutral foot posture. Fifteen participants had their foot posture screened using the six-item Foot Posture Index. Bipolar intramuscular electrodes were inserted into tibialis posterior and peroneus longus utilizing ultrasound guidance. Surface electrodes were placed over medial gastrocnemius, peroneus brevis and tibialis anterior. EMG and footswitch gait characteristics were recorded whilst participants completed 10 barefoot walking trials. Individual and grand ensemble averages were used to characterize the intensity profiles for each muscle. Results indicated that for most of the participants, tibialis posterior displayed two bursts of EMG activity, with the first burst during the initial contact phase and the second burst during midstance. It was concludedthat the EMG profile of tibialis posterior during the gait cycle appeared to be highly variable among participants. However, the authors believe that EMG findings from the participants with neutral foot posture in this study may be used for comparison to EMG patterns in people with abnormal foot posture and individuals affected by musculoskeletal disease (more from the Journal of Electromyography and Kinesiology...)

The DM Myers Medal for the best Health Sciences Honours thesis in 2007 is to be awarded to physiotherapy student Sarah Warby. Sarah’s research project, entitled ‘The most appropriate electrical stimulation frequency to reduce shoulder subluxation post stroke’ was supervised by MRC members Dr Alex Ward and Stacey Lucas-Toumbourou. Sarah is the second DM Myers Medal winner to be supervised by MRC member Dr Alex Ward. The first was John Ozcan, whose thesis titled ‘A comparison of true and premodulated interferential current’ won the medal in 2002.

MRC researchers Dr Shannon Munteanu, Dr Karl Landorf, A/Prof Hylton Menz and adjunct researcher A/Prof Jill Cook (Deakin University) have been awarded US$30,000 from the Prescription Foot Orthotic Laboratory Association (PFOLA) to study the effectiveness of customised functional foot orthoses in the treatment of Achilles tendinopathy.

Leading balance and falls researcher Prof Keith Hill was recently appointed Professor of Allied Health at Northern Health, and has also joined the MRC's Gait, Balance and Falls and Muscle Function and Rehabilitation research groups.

MRC researchers Dr Pazit Levinger, A/Prof Hylton Menz, Dr Kate Webster, A/Prof Julian Feller and colleagues were recently awarded $10,000 from Arthritis Australia to study foot posture and function in people with knee osteoarthritis. The study will involve conducting three-dimensional motion analysis on people with knee osteoarthritis and a group of age and sex-matched controls using the Vicon motion analysis system. For more information about the MRC gait laboratory, click here...

This study by a team of researchers including MRC adjunct A/Prof Jill Cook, Prof Chris Handley, Dr Mirna Ilic and Dr Tom Samiric aimed to characterize the extent and distribution of the large aggregating proteoglycan versican in patients with patellar tendinosis. The authors obtained tendon from tendinopathy patients undergoing debridement of the patellar tendon and from controls undergoing intramedullary tibial nailing. Versican content was investigated by Western blotting and immunohistochemistry. Microvessel thickness and density were determined using computer-assisted image analysis. Markers for smooth muscle actin, endothelial cells (CD31) and proliferating cells (Ki67) were examined immunohistochemically. Western blot analysis and immunohistochemical staining revealed elevated versican content in the proximal patellar tendon of tendinosis patients (P=0.042). Versican content was enriched in regions of fibrocartilage metaplasia and fibroblast proliferation, as well as in the perivascular matrix of proliferating microvessels and within the media and intima of arterioles. Microvessel density was higher in tendinosis tissue compared with control tissue. It was concluded that versican deposition is a prominent feature of patellar tendinosis. Because this molecule is not only a component of normal fibrocartilagenous matrices but also implicated in a variety of soft tissue pathologies, future studies should further detail both pathological and adaptive roles of versican in tendons (more from the Scandinavian Journal of Medicine and Science in Sports...)

The aim of the study by Dr Alex Ward and Stacey Lucas-Toumbourou was to determine the optimum burst duration for discrimination between sensory, motor, and pain-tolerance thresholds using 50-Hz bursts of kilohertz-frequency sinusoidal alternating current (AC) applied transcutaneously to human subjects. Twenty-six healthy young adults received transcutaneous bursts of AC electric stimulation at frequencies of 1 and 4kHz. Burst durations ranged from 250micros (for 1 cycle of 4kHz AC, ie, a single biphasic pulse) to 20ms (continuous AC). The authors found that threshold voltages decreased to a minimum with increasing burst duration. The minimum threshold identified the "utilization time" over which summation of subthreshold stimuli occurs. Above the utilization time, thresholds increased. Estimated utilization times differed for sensory (approximately 7ms), motor (>10ms), and pain-tolerance (>or=20ms). As a consequence, relative thresholds varied with burst duration. A maximum separation between sensory, motor, and pain-tolerance thresholds was found to occur with bursts in the range 1 to 4ms. It was concluded that short-duration kilohertz-frequency AC bursts might have a more useful role in rehabilitation than either pulsed current or the long duration bursts that characterize Russian and interferential currents. Further clinical studies are needed (more from Archives of Physical Medicine and Rehabilitation...)

This randomised controlled trial by MRC researcher Prof Nicholas Taylor and colleagues involved 54 people with moderately severe chronic obstructive pulmonary disease not undergoing pulmonary rehabilitation, and assessed the efficacy of six progressive resistance exercises three times per week (once a week hospital-based, twice a week home-based) for 12 weeks. Exercise intensity was three sets of 8 to 12 repetition maximum progressed against elasticised bands of increasing resistance. The control group received no intervention. Primary outcomes were strength (knee extensor, hip abductor, shoulder horizontal flexor, shoulder flexor) measured using hand-held dynamometry, and walking capacity measured by the 6-minute Walk Test performed before and after intervention and again at 12 weeks after the cessation of intervention. The experimental group increased their knee extensor strength by 4.9 kg (95% CI 1.1 to 8.7) more than the control group by Week 12. However, this gain was not maintained at Week 24. In was concluded that a predominantly home-based progressive resistance exercise program led to modest improvements in knee extensor strength in people with chronic obstructive pulmonary disease. However, 44% of the experimental group were unable to complete the exercise program, highlighting the need to understand factors influencing adherence to exercise in this population (more from the Australian Journal of Physiotherapy...)

MRC researcher Dr Pazit Levinger has been awarded one of only five La Trobe Post-doctoral fellowships to commence in 2008. Pazit's project is titled "Gait, balance and falls risk in people with knee osteoarthritis before and after knee replacement".

Pazit's PhD was undertaken at Southern Cross University and focused on the role of lower limb biomechanics in patello-femoral syndrome, and she joined the MRC in 2007 as part of the Gait CCRE project.

The Australasian Podiatry Council and the Society of Chiropodists and Podiatrists, in conjunction with the open access publisher BioMed Central, are pleased to announce the forthcoming launch of a new journal - the Journal of Foot and Ankle Research (JFAR). JFAR will be an international, peer-reviewed journal publishing original articles and review papers in all aspects of the prevention, diagnosis and management of foot and ankle disorders. Areas covered will include diabetology, paediatrics, sports medicine, gerontology and geriatrics, physical therapy, dermatology, wound management, radiology, orthopaedics, biomechanics and bioengineering, epidemiology and prosthetics / orthotics. Papers will be sought from all health professionals who manage lower limb conditions, including podiatrists, nurses, physical therapists and physiotherapists, orthopaedists, manual therapists and general medical practitioners. MRC researchers A/Prof Hylton Menz and Dr Karl Landorf will be Editor and Deputy Editor, respectively. To view the APodC announcement on the new journal, click here.

The purpose of this study by Dr Kate Webster and A/Prof Julian Feller was to develop a scale to measure the psychological impact of returning to sport after anterior cruciate ligament (ACL) reconstruction surgery. Three types of psychological responses believed to be associated with resumption of sport following athletic injury—emotions, confidence in performance, and risk appraisal—were incorporated into a 12-item ACL-Return to Sport after Injury (ACL-RSI) scale. Two hundred and twenty participants who had undergone ACL reconstruction completed the scale between 8 and 22 months following surgery. The scale was shown to have acceptable reliability (Cronbach's alpha=0.92). Participants who had given up sport scored significantly lower on the scale (reflecting a more negative psychological response) than those who had returned or were planning to return to sport (p<0.001). It was concluded that the decision to return to sport after ACL reconstruction is associated with a significant psychological response. Preliminary reliability and validity was found for the ACL-RSI scale. This scale may help to identify athletes who will find sport resumption difficult (more from the Physical Therapy in Sport..)

It has been suggested that the positive position of the O'Brien test (shoulder flexion, horizontal adduction, and internal rotation) tensions the bicipital labral complex relative to the negative position (shoulder flexion, horizontal adduction, and external rotation). This study by Dr Rod Green and Prof Nicholas Taylor measured active and passive tension in the long head of biceps in the 2 positions of the O'Brien test to validate the proposed anatomic basis of the test. Active tension was measured using surface electromyography of the long head of biceps in 12 healthy young adults. Passive tension was measured using a load cell attached to the intracapsular tendon of the long head of biceps in 5 cadaver specimens. Active and passive tension were higher in the negative position, thus refuting the proposed anatomic basis of the test. Although there may be an alternative basis for the test, the failure to support the proposed anatomic basis may partly explain the variable likelihood ratios obtained in clinical accuracy studies of the O'Brien test. The results of this study reinforce the need for anatomic validation during the development of clinical testing procedures (more from the Journal of Shoulder and Elbow Surgery..)

Aggrecan loss from mouse cartilage is predominantly due to ADAMTS-5 activity, however, the relative contribution of other proteolytic and non-proteolytic processes to this loss is not clear. This study, by MRC researchers Dr Mirna Ilic and Prof Chris Handley is the first to compare aggrecan loss, with aggrecan processing, in mice with single and double deletions of ADAMTS-4 and -5 activity. Cartilage explants harvested from single and double ADAMTS-4 and -5 cat mice were cultured with or without IL-1a or retinoic acid and analysed for i) the kinetics of 35S-labeled aggrecan loss, ii) the pattern of 35S-labeled aggrecan fragments released into the media and retained in the matrix, iii) the pattern of total aggrecan fragments released into the media and retained in the matrix and iv) specific cleavage sites within the interglobular and CS-2 domains. The results show that chondrocytes have additional mechanism for the turnover of aggrecan and that when proteolytic mechanisms are blocked by ablation of aggrecanase activity, non-proteolytic mechanisms compensate to maintain cartilage homeostasis (more from the Journal of Biological Chemistry...)

People with pes cavus frequently suffer foot pain, which can lead to significant disability. Despite anecdotal reports, rigorous scientific investigation of this condition and how best to manage it is lacking. The aim of this systematic review by Burns et al (including MRC researcher Dr Karl Landorf) was to assess the effects of interventions for the prevention and treatment of pes cavus. The Cochrane Neuromuscular Disease Group Trials Register (April 2007), MEDLINE (January 1966 to April 2007), EMBASE (January 1980 to April 2007), CINAHL (January 1982 to April 2007), AMED (January 1985 to April 2007), all EBM Reviews (January 1991 to April 2007), SPORTdiscuss (January 1830 to April 2007) and reference lists of articles were searched. All randomised and quasi-randomised controlled trials of interventions for the treatment of pes cavus were included. Only one trial (custom-made foot orthoses) fully met the inclusion criteria. Two additional cross-over trials (off-the-shelf foot orthoses and footwear) were also included. Both studies assessed secondary biomechanical outcomes less than three-months after randomisation. It was concluded that in one randomised controlled trial, custom-made foot orthoses were significantly more beneficial than sham orthoses for treating chronic musculoskeletal foot pain associated with pes cavus in a variety of clinical populations. There is no evidence for any other type of intervention for the treatment or prevention of foot pain in people with a cavus foot type (more from the Cochrane Database of Systematic Reviews...)

Publications by MRC staff have been identified among the "hottest" (defined as among the top 25 most downloaded papers) by Elsevier's ScienceDirect database:

Factors associated with chronic plantar heel pain: a systematic review (Journal of Science and Medicine in Sport Top 25, Jan-March and April-June 2007)

Kinematic patterns associated with accuracy of the drop punt kick in Australian Football (Journal of Science and Medicine in Sport Top 25, April-June 2007)

Age-related differences in foot structure and function (Gait and Posture Top 25, April-June 2007)

A structural equation model relating impaired sensorimotor function, fear of falling and gait patterns in older people (Gait and Posture Top 25, Jan-March 2007)

The influence of walking speed on plantar pressure measurements using the two-step gait initiation protocol (The Foot Top 25, Jan-March and April-June 2007)

The inferior calcaneal spur-Anatomical and histological considerations (The Foot Top 25, Jan-March 2007)

To view ScienceDirect's Top 25, click here...

MRC staff have been awarded nearly $1M in research funding in the latest NHMRC Project Grant announcements. Prof Nick Taylor, Prof Karen Dodd and colleagues were awarded $256,050 for the project "Targeted strength training to improve functional walking capacity of adolescents and young adults with cerebral palsy", while A/Prof Hylton Menz and Prof Nick Taylor were part of a team headed by Prof Meg Morris (University of Melbourne) awarded $723,00 for the project "Home based rehabilitation to reduce falls and disability in Parkinson disease".

• see press release from the NHMRC

There is a common misperception that a statistically significant result in clinical research equates to a meaningful or worthwhile outcome for patients. However, not all statistically significant findings are considered important by patients. The aim of this project by MRC researcher Dr Karl Landorf and colleagues was to calculate the minimal important difference for commonly used outcome measures in research related to the feet. Data from 175 participants from two trials that evaluated conservative interventions for plantar fasciitis were used to determine minimal important differences for the following outcome measures: the Foot Health Status Questionnaire, the original Foot Function Index and a Visual Analogue Scale used to measure pain. For the Foot Health Status Questionnaire the following minimal important differences were found: 14 for pain, 7 for function and 9 for general foot health. Similar results were found for the Foot Function Index: 12 for pain, 7 for disability and 7 for Total Foot Function Index. The minimal important difference for the Visual Analogue Scale was 9 mm. These findings can now be used to help interpret results from clinical trials that have used these outcome measures to evaluate the effectiveness of interventions, particularly for the treatment of plantar fasciitis (more from The Foot...)

Measurement of ankle joint dorsiflexion is routinely undertaken by clinicians who manage lower limb musculoskeletal pathology. This study by MRC researchers Dr Shannon Munteanu, Dr Karl Landorf, Dr Adam Bird and George Murley aimed to determine the reliability of a technique to measure ankle joint dorsiflexion in a weightbearing position with the knee extended. Four raters with varying clinical experience measured ankle joint dorsiflexion in a weightbearing position with the knee extended on 30 asymptomatic participants. Measurements occurred on two occasions, 1 week apart using (i) a digital inclinometer and (ii) a clear acrylic plate apparatus. Intra-rater reliability of the experienced raters was high for both the digital inclinometer and the clear acrylic plate apparatus. Intra-rater reliability of the inexperienced rater was good to high for both the digital inclinometer and the clear acrylic plate apparatus. Inter-rater reliability was high for both the digital inclinometer and the clear acrylic plate apparatus. It was concluded that measurements of ankle dorsiflexion in a weightbearing position with the knee extended can be performed reliably by experienced and inexperienced raters (more from the Journal of Science and Medicine in Sport...)

MRC researcher Aaron McDonald has received the prestigious Sol Posen Research Award at the 17th Annual Scientific Meeting of the Australian and New Zealand Bone and Mineral Society held in Queenstown, New Zealand in September 2007. The highly competitive award, which carries a $1000 prize, is based on the best paper published in the past 18 months by an early research scientist who is a member of the society. The paper entitled Galanin treatment offsets the inhibition of bone formation and downregulates the increase in mouse calvarial expression of TNFalpha and GalR2 mRNA induced by chronic daily injections of an injurious vehicle was published in the journal Bone in March of this year.

• see related news item on the role of galanin in bone repair

This review by A/Prof Julian Feller presents objective data, as far as possible, about the current understanding of the biomechanics of the patellofemoral joint as it pertains to the management of patellofemoral problems. When faced with a patellofemoral malfunction, it is important to check all the soft-tissue and articular geometry factors relating to the patella locally and not to neglect the overall lower limb alignment and function. It is important to remember that small alterations in alignment can result in significant alterations in patellofemoral joint stresses and that changes in the mechanics of the patellofemoral joint can also result in changes in the tibiofemoral compartments. Surgical intervention for patellofemoral problems needs to be planned carefully and take into account an individual's anatomy (more from Arthroscopy...)

2006 MRC / School of Physiotherapy Honours student Edwina Lorbach (pictured) recently received several awards for her Honours project, which was supervised by Dr Kate Webster, Jo Wittwer and MRC director A/Prof Hylton Menz. Edwina was awarded the following prizes:

• Margaret and Alan Hamer Research Prize
• Eliza McAuley Memorial Prize
• Josephine Jennings and Edith Pratt memorial Prize
• Physiotherapy Research Foundation Research Prize

Edwina's research, which focused on physiological falls risk assessment in older people with Alzheimer's disease, has recently been accepted for publication in the journal Dementia and Geriatric Cognitive Disorders (click here...)

This conference was held at the University of Salford from 3rd-5th September. MRC PhD student Jodie McClelland (pictured) delivered two presentations on her gait analysis research:

• Missing ASIS markers: possible alternatives
• Performance variability in patients who have undergone total knee replacement

MRC director A/Prof Hylton Menz was keynote speaker at the footwear satellite conference: Footwear - technology or psychology? For more info on the conference, click here...

This study by A/Prof Hylton Menz and colleagues evaluated the hypothesis that an individual's self-selected walking pattern optimizes the stability of accelerations of the head and pelvis. Acceleration patterns of the head and pelvis were recorded in ten healthy young adults as they walked on a level surface in three separate experiments: (1) walking at 18 five different speeds, ranging from very slow to very fast; (2) walking in time to a metronome set at five different cadences, ranging from 33 to 167% of subjects’ usual cadence; and (3) walking at five different step lengths varying from very short to very long while keeping in time with a metronome set at cadences 67, 100 and 125% of usual cadence. The results indicated that acceleration patterns in the V and AP planes were most stable when subjects walked at their usual cadence and step length. In the ML plane, stability was suboptimal, but still adequate, with the usual cadence and step length. The findings suggest that healthy young people walk in a manner that maximizes V and AP rhythm while maintaining adequate, though suboptimal, ML stability (more from Experimental Brain Research...)

Dr Bjorn Barenius from the Karolinska Institute, Stockholm, Sweden has joined the MRC as an Orthopaedic Research Fellow for 6 months. Bjorn will undertake surgical training with A/Prof Julian Feller and will conduct clinical gait analysis projects with the Orthopaedics Research Group. Bjorn's main surgical and research interests relate to anterior cruciate ligament reconstruction.

The International Foot and Ankle Biomechanics community (i-FAB) is an international collaborative activity which was launched on July 2nd 2007 at the foot and ankle session of the International Society of Biomechanics meeting in Taipei, Taiwan. i-FAB hopes to attract members from every community related to foot and ankle biomechanics, from academics, physicians, surgeons, and health professionals, to members of the footwear, insole, surgery and related industries. i-FAB has an open philosophy and connecting people across traditional disciplinary boundaries is one of its key objectives. For more info, click here...

A new organisation - the Australian and New Zealand Falls Prevention Society - has been formed to promote the multidisciplinary study and implementation of falls prevention in older people. MRC director A/Prof Hylton Menz is one of the founding members. The society has already run two successful conferences, and the next conference will be held in Melbourne in October 2008.

The website of the ANZFPS can be viewed here: www.anzfallsprevention.org

Gait analysis has been used to objectively measure patients' function following total knee replacement (TKR). Whilst the findings of this research may have important implications for the understanding of the outcomes of TKR, the methodology of existing research appears to be diverse and many of the results inconsistent. The objective of this systematic review by MRC researchers Jodie McClelland, Dr Kate Webster and A/Prof Julian Feller was to synthesise reported findings and to summarise the methods used by researchers in this field. Eleven articles published in the medical literature that used gait analysis to compare patients following TKR with controls were identified for inclusion in this review. Consistently large effect sizes showed that patients following TKR walk with less total knee motion during gait and with less knee flexion during swing than controls (more details from The Knee...)

Two recent research papers on heel pain by MRC researchers have officially been recognised as "highly accessed" in the journal BMC Musculoskeletal Disorders. As of July 20, the paper "Effectiveness of low-Dye taping for the short-term treatment of plantar heel pain: a randomised trial", first published on the 9th August, 2006, has been accessed 4,388 times, while the paper "Obesity and pronated foot type may increase the risk of chronic plantar heel pain: a matched case-control study", first published on the 17th of May, 2007, has been accessed 1,214 times.

• more info on heel pain research can be found here...

This study by MRC researchers Dr Nora Shields, Prof Nicholas Taylor and Prof Karen Dodd examined whether the self-concept of children with cerebral palsy (CP) differed from that of children without impairment. Forty-seven children (24 males, 23 females; mean age 11y 8mo [SD 2y 6mo]) with spastic diplegia or hemiplegia were matched with children without impairment. The 36-item Self-Perception Profile for Children was used to assess six domains of self-concept. No difference was found between the groups for Global Self-worth, Physical Appearance, or Behavioural Conduct. Children with CP scored lower on Scholastic Competence, Social Acceptance and Athletic Competence than children without impairment. Both males and females with CP had lower scores for Athletic Competence than their peers without impairment. These results suggest that children with CP do not have a lower Global Self-worth, even though they may feel less competent in certain aspects of their self-concept. Clinicians need to account for this when deciding on management strategies and may need to educate parents, carers, and health professionals that a lower self-concept may not necessarily be associated with a diagnosis of CP (more details from Development and Medicine and Child Neurology...)

MRC researchers Aaron McDonald, Dr John Schuijers and Dr Brian Grills recently showed that galanin, a natural neuropeptide, is increased in bone tissue after injury, possibly to suppress the formation of inflammatory cytokines that impede the formation of bone. The implications of this finding are that this protein may have a positive role to play in fracture repair and in diseases such as osteoporosis, where such inflammatory cytokines are increased (more details from Bone...)