Study Design Controlled laboratory study, preliminary case-control design. Background The mechanisms that contribute to Achilles tendinopathy remain poorly understood. The disparity between pain experience and peripheral pathology demonstrated in patients with Achilles tendinopathy suggests that changes in central nervous system function may be involved. Objectives To investigate whether lower-limb tactile acuity is impaired in people with nonacute Achilles tendinopathy. Methods Thirteen consecutive participants with nonacute midportion Achilles tendinopathy and 13 healthy controls were enrolled. Two-point discrimination thresholds over the affected Achilles tendon, unaffected tendon, and tendon of healthy controls were evaluated. Independent and dependent t tests were used to compare group means. Results Two-point discrimination distance over the affected limb in participants with Achilles tendinopathy was significantly increased when compared to the unaffected limb (mean difference, 11.7 mm; 95% confidence interval [CI]: 1.9, 21.5; P = .02) and to healthy controls (mean difference, 13.1 mm; 95% CI: 1.6, 24.6; P = .03). There was no significant difference between the healthy controls and the unaffected side in people with Achilles tendinopathy (mean difference, 1.4 mm; 95% CI: -7.9, 5.1; P = .66). Conclusion These data provide the first evidence of reduced 2-point discrimination over the affected tendon in patients with Achilles tendinopathy. Further research is needed to determine the cause for the change in tactile acuity. J Orthop Sports Phys Ther 2016;46(12):1061-1064. Epub 30 Oct 2016. doi:10.2519/jospt.2016.6514.

Uncertainty pervades low back pain (LBP). This study aimed to explore individuals' experiences of navigating uncertainty when seeking care for their LBP, with a view to better understanding the contexts in which they experience uncertainty and gaining insight into how uncertainty may be better navigated during clinical encounters. We conducted 15 semistructured interviews with people who have experienced LBP. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Analysis produced 4 themes. To reflect the unsettled nature of participants' discussions of navigating uncertainty, themes are framed as questions: (1) What will happen over time?; (2) Can clinicians help me? Are they willing to?; (3) What are clinicians talking about?; and (4) Am I being taken seriously? Participants also discussed how clinicians could better navigate these uncertainties. Suggestions included making time to (actively) listen to, and acknowledge, patients' concerns; asking open-ended questions; being honest about uncertainty; creating management plans and returning to them; challenging assumptions; remaining curious about patients' context; and providing guidance on how to manage LBP rather than simply giving certainty that symptoms will worsen, lessen, or continue. These findings indicate that many of the uncertainties individuals with LBP experience are intertwined with relational aspects of their interactions with clinicians. Clinicians therefore may need to consider these broader and relational aspects of care when navigating uncertainty with people who experience LBP, bringing attention to the importance of drawing from knowledge produced outside of the usual hierarchy of evidence (eg, systematic reviews and randomised controlled trials).

IntroductionTraumatic orthopaedic injuries contribute substantially to the burden of disability worldwide.The majority oftraumatic orthopaedic injuries are classified as mild-moderate in severity and affect the extremities. A subset of people with these injuries continue to experience pain and/or distress long after the injury has healed, with personal, societal and economic impacts. We are yet to fully understand the mechanisms underlying non-recovery after traumatic orthopaedic injuries in adults. Cognitive models or representations of a health threat, such as an injury, have been associated with pain and distress in people with traumatic orthopaedic injuries. However,there are currently no reviews that comprehensivelyexamine the association between injury beliefs or representations and recovery outcomes. Objectives Wewill conduct a scoping review with the primary aim of mappingtheliterature examining associations betweeninjurybeliefs orrepresentationsand recovery outcomes.This review will use Leventhal, Meyer andNerenz’s'Common Sense Model of Illness Representations' as a guiding conceptual framework. The secondary aims of this review are to characterise injury representations in adults with traumatic orthopaedic injuries;to determine what biological, psychological and social factors are associated with injury representations;and to describe associations between injury representations and recovery-related outcomes, specifically pain, distress and disability. Methods and analysis This protocol has been written in accordance with the Joanna Briggs Methodology for scoping review protocols. The review will include studies examining injury representations or closely related constructs in adults with traumatic orthopaedic injuries,at any point in time since the original injury. Studies on adults with traumatic brain injuries, Whiplash Associated Disorder, Spinal Cord Injuries, burns or injuries fromlowfallsin adults aged over 65 years of age. There will be no limits on geographical location or healthcare setting. The following databases will be used: Medline (EbscoHost), PsycINFO,Embaseand CINAHL. Grey literature searches will also be conducted. Two reviewers will independently screen the articles and extract the data. Results will be presented in tabular form, together with a narrative summary addressing the primary aims of the review.

Objective To determine if impairment in motor imagery processes is present in Achilles tendinopathy (AT), as demonstrated by a reduced ability to quickly and accurately identify the laterality (left-right judgement) of a pictured limb. Additionally, this study aimed to use a novel data pooling approach to combine data collected at 3 different sites via meta-analytical techniques that allow exploration of heterogeneity. Design Multi site case-control study. Methods Three independent studies with similar protocols were conducted by separate research groups. Each study-site evaluated left/right judgement performance for images of feet and hands using Recognise© software and compared performance between people with AT and healthy controls. Results from each study-site were independently collated, then combined in a meta-analysis. Results 126 participants (40 unilateral, 22 bilateral AT cases, 61 controls) were included. There were no differences between AT cases and controls for hand image accuracy and reaction time. Contrary to the hypothesis, there were no differences in performance between those with AT and controls for foot image reaction time, however there were conflicting findings for foot accuracy, based on four separate analyses. There were no differences between the affected and unaffected sides in people with unilateral AT. Conclusions Impairments in motor imagery performance for hands were not found in this study and we found inconsistent results for foot accuracy. This contrasts to studies in persistent pain of limbs, face and knee osteoarthritis, and suggests that differences in pathoaetiology or patient demographics may uniquely influence proprioceptive representation.