evidence based injury research, sports medicine

These days all doctors are expected to practise ‘evidence-based medicine’; in other words, to base their patient care plans on the results of good quality studies published in peer-reviewed scientific journals.

But how evidence-based is the management of sports injuries? That’s what a team of researchers from Scotland set out to find out with a retrospective study of 100 randomly selected adults who had been treated at a physiotherapy-led sports injury clinic attached to a UK university.

The researchers identified the two most commonly presenting injuries – patellofemoral pain syndrome (PFPS, sometimes referred to as ‘anterior knee pain’) and Achilles tendinopathy (inflammation or small tears in the connective tissue in or around the tendon) – then looked at what the physiotherapists had taken into account when devising their management plans.They found that:

• Personal experience formed the basis of management plans in 44% of PFPS cases and 59% of Achilles tendinopathy cases;
• Primary research evidence – ie original research – accounted for only 24% of management plans in PFPS and 14% in Achilles tendinopathy;
• The treatments supported by most scientific evidence were not the ones most commonly used at the clinic;
• When the physiotherapists did use evidence-based treatments they were often unaware of the research data.

In a commentary on this study, Professor Michael Cullen, the Chair of the British Association of Sports Exercise Medicine, points to a worrying lack of evidence on sports medicine by comparison with other medical specialities. ‘It is clear’, he says, ‘that there is a lack of evidence to inform our management of even the most common sports injuries, and we continue to rely on personal experience and expert opinion to a worrying degree. Clearly there is a need to integrate a new culture of critical appraisal into our clinical practice.’