Background
Stretching exercises have effects on local and widespread pain sensitivity. A dose–response relationship may exist between the analgesic effect and the intensity of stretching, such that a higher intensity of stretching may generate a larger reduction in analgesic response, but this remains to be studied. This study aimed to examine the dose–response relationship between stretching intensity and the analgesic effect.

Methods
A randomized, repeated-measures crossover study was performed to examine the effect of stretching to the first point of pain onset and stretching to the point of a sensation of stretching (discomfort). The primary outcome was regional and distant pressure pain thresholds.

Results
Thirty-one participants (n = 24 female) were available for analysis. We observed a 22.2% increase in regional pressure pain thresholds (93.2 kPa, p = 0.001) and a 15.0% increase in distant pressure pain thresholds (50.9 kPa, p = 0.012) following stretching to the point of stretch. We observed a 20.0% increase in regional pressure pain thresholds (90.3 kPa, p = 0.001) and a 15.1% increase in distant pressure pain thresholds (52.1 kPa, p = 0.004) following stretching to the point of pain.

Conclusions
The results showed that local and widespread pain sensitivity decreased following acute stretching, regardless of stretching intensity. No differences in pain sensitivity were found between stretching to the point of stretch or stretching to the first onset of pain. Thus, the results showed no evidence of a dose–response relationship between stretching intensity and the analgesic effect.

Significance
The study showed a significant acute hypoalgesic effect of stretching exercises regardless of stretching intensity. This may have appropriate clinical implications for patients with musculoskeletal and nociplastic pain.

Objectives
To conduct a systematic review investigating the effects of physiotherapy in emergency departments (EDs) on health care use and patient-reported outcomes for patients referred to EDs due to low back pain (LBP), compared with usual care.

Methods
A search was conducted in PubMed, Cinahl and Embase in April 2023, and rerun in January 2024. Randomised and quasi-randomised trials and observational studies including adult patients referred to an ED due to LBP were eligible. Study quality was assessed using ROBINS-I and PEDro, and the strength of the evidence was assessed using GRADE.

Results
Included studies were three retrospective cohorts, two prospective cohorts and two randomised controlled trials, totalling 4 017 patients. Four of six studies were rated as serious risk of bias, primarily due to limitations in the study design, two studies were rated as moderate risk, and one as low risk. Overall, the studies indicated a positive effect of ED physiotherapy in comparison with usual care in relation to length of stay, imaging and patient satisfaction. For the remaining outcomes on health-care use and patient-reported outcomes, findings were inconclusive. For all outcomes, the certainty of the evidence was considered very low or low.

Conclusions
The present review indicates that there may be beneficial effects of involving PTs in the management of patients with LBP in EDs. However, given the very low certainty of evidence the findings should be interpreted with great caution. Future high level evidence studies in the field should therefore be a priority.

Registration number PROSPERO
CRD42023420107

Aims:
It has been suggested that the COVID-19 restrictions may have negatively impacted physical activity (PA) levels, especially among adolescents, who often use organised sports to support their intrinsic motivation for staying active. This study aimed to investigate whether adolescents were less physically active after the COVID-19 restrictions compared with before and examine whether participation in organised sports has changed since the COVID-19 restrictions.

Methods:
This was a retrospective cohort study of Danish adolescents aged 15 to 19 years. Data was collected using a questionnaire in SurveyXact. The primary variable of interest was moderate or high-intensity PA frequency before and after COVID-19 restrictions (from March 11, 2020, to September 10, 2021). Secondary variables of interest included whether the PA was self-organised (e.g. running, hiking, going to a gym or cycling) or part of an organised sport delivered by a club or other association, before versus after the restrictions.

Results:
A total of 324 participants responded to the questionnaire. The relative risk of not performing PA at least twice per week after COVID-19 restrictions compared with before was significantly larger (1.44; 95%CI: 1.19 to 1.85, p = 0.005). Before the lockdowns, 190 (59%) were engaged in organised sports compared with 152 (47%) after the restrictions (relative risk: 1.51, 95%CI: 1.19 to 1.92, p < 0.001).

Conclusions:
Compared with activity levels before the pandemic, adolescents became significantly less physically active following the COVID-19 restrictions, beyond what is typically observed during adolescence. These results emphasise a need for strategies to increase PA levels among adolescents to minimise the long-term negative effects of physical inactivity during adolescence.