Michael Skovdal Rathleff

• Cand.Scient.San, PhD
• Professor (Full) at Aalborg University

The aim of this study was to investigate the effectiveness of shoe inserts and plantar fascia-specific stretching vs shoe inserts and high-load strength training in patients with plantar fasciitis. Forty-eight patients with ultrasonography-verified plantar fasciitis were randomized to shoe inserts and daily plantar-specific stretching (the stretch...

Background: More than 670,000 total knee replacements are performed annually in the United States; however, high-quality evidence to support the effectiveness of the procedure, as compared with nonsurgical interventions, is lacking. Methods: In this randomized, controlled trial, we enrolled 100 patients with moderate-to-severe knee osteoarthriti...

Background Patellofemoral pain (PFP) is common among adolescents and associated with long-lasting pain and disability. Patient education and exercise therapy are commonly used treatments in primary and secondary care but the effect of these treatments in adolescents is unknown. We aimed to determine the effect of exercise therapy as an add-on thera...

Background Despite advances in medicine and technology, pain remains a significant global burden. Improving pain education for undergraduate healthcare students is considered an important step toward enhancing pain management. The Neurophysiology of Pain Questionnaire (NPQ) is commonly used to assess pain knowledge in healthcare students, but its v...

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...

Background and objectives: By definition, patients with transient ischemic attack (TIA) should not have residual symptoms beyond 24 hours. However, preliminary evidence indicates lasting challenges such as fatigue. It is unknown who develops fatigue, and the extent. This knowledge is required to develop evidence-based support for patients. We aime...

BACKGROUND Musculoskeletal (MSK) pain is commonly managed in primary care in Denmark through a wide range of medical and non-medical treatments, including self-management approaches. Due to the substantial direct and indirect societal costs of MSK pain, there is increasing political interest in effective, low-cost interventions such as mobile healt...

Background Chronic musculoskeletal (MSK) pain poses a significant societal burden, yet many evidence‐based interventions fail to reach clinical practice, highlighting an implementation gap. This study aimed to identify barriers and facilitators in implementing MSK pain interventions across healthcare settings. Methods We conducted a scoping review...

Background Physical activity (PA) is a first‐line treatment for knee osteoarthritis and provides benefits for functional improvement and pain relief. However, movement‐evoked pain often hinders PA participation and long‐term adherence. The relationship between PA and pain is not fully understood and may vary across individuals. We examined the temp...

Introduction Greater trochanteric pain syndrome (GTPS) is a common and disabling condition characterised by lateral hip pain. The condition often persists for several months, and there is low evidence for any superior treatment. The aim of this study protocol is to describe a randomised controlled trial (RCT) investigating the effectiveness of a se...

Objectives Poor sleep is common among young adults and is often associated with pain. This study investigates the relationship between pain-related outcomes, sleep quality, and quality of life in young adults with and without knee pain. Methods This study is a secondary analysis of the 5-year follow-up of a prospective cohort study. 523 young adul...

Background Subacromial pain syndrome (SAPS) is the most common shoulder pain condition in primary care). Although exercise is the recommended first-line treatment, the absence of a universally superior option underscores the need for personalized care facilitated by shared decision-making (SDM). Despite the importance of SDM is increasingly recogni...

OBJECTIVE: To amplify the voices of people living with atraumatic shoulder pain, their relatives and healthcare practitioners, and to establish research questions. DESIGN: Priority-setting study following a modified approach originally formulated by the James Lind Alliance (JLA). METHODS: The process consisted of six phases (initiation, consultatio...

Background/Objectives: Pain science education accommodating low health literacy is needed for people with chronic pain. The purpose of this study was to translate PNE4Kids, contextually adapt it into PNE4Adults, and test the feasibility of the newly developed pain science education program (PNE4Adults) for adult patients with chronic musculoskeleta...

Background: Chronic musculoskeletal pain is among the most significant burdens to society. Despite years of research on effective interventions for managing chronic musculoskeletal (MSK) pain, most interventions have not reached clinical practice, underlining the significant implementation gap. Hence, understanding existing barriers and facilitator...

Objective: To describe the development and initial evaluation of a new context-specific patient decision aid for care-seeking patients with subacromial pain syndrome (SAPS) in primary care. Methods: To develop a new contextually relevant decision aid, mixed methods research study with four components was conducted. We adapted a previously tested de...

Background Spinal pain affects up to 30% of school-age children and can interfere with various aspects of daily life, such as school attendance, physical function, and social life. Current assessment tools often rely on parental reporting which limits our understanding of how each child is affected by their pain. This study aimed to address this ga...

Letter to the Editor-in-Chief in response to JOSPT article “Heel Pain – Plantar Fasciitis: Revision 2023” by Koc et al. J Orthop Sports Phys Ther 2025;55(1):72-73. doi:10.2519/jospt.2025.0202

Background: Long-term persistent musculoskeletal conditions affect many adults in the United Kingdom (UK) and patellofemoral pain (PFP) is one of the most common. PFP negatively affects important facets of health, including quality of life and physical activity level, and carries a very poor prognosis. People with PFP typically wait for up to 18-we...

Background and purpose The heterogeneous outcomes used in lower-limb lengthening surgery (LLLS) complicate evidence synthesis, weakening systematic reviews and clinical recommendations, and reducing research impact. This scoping review maps the outcomes and outcome measurement instruments (OMIs) used in LLLS. Methods This pre-registered review sys...

Background and purpose Emerging evidence indicates lasting impairments in patients with transient ischaemic attack (TIA), which may be unexpected as symptoms per definition recover within 24 h. How these impairments impact return to work or the ability to maintain independence is unknown. The aim of our study was to investigate the need of sick lea...

Background Postoperative rehabilitation exercise is commonly prescribed after total hip arthroplasty (THA), but its efficacy compared to no or minimal rehabilitation exercise has been questioned. Preliminary efficacy would be indicated if a dose-response relationship exists between performed exercise dose and degree of postoperative recovery. The o...

Introduction The heterogeneity of outcomes used in the field of lower limb lengthening surgery (LLLS) affects our ability to synthesize evidence. This hampers robust systematic reviews and treatment recommendations for clinical practice. Ultimately this reduces the impact of research for both patients and healthcare professionals. This scoping revi...

Background Short-term, self-reported changes in symptom severity for musculoskeletal pain disorders may be more strongly associated with long-term prognoses than baseline patient characteristics, because such changes describe a trajectory and not a state. Purpose To investigate whether short-term improvement in self-reported symptom severity is as...

Background: There are a variety of different treatments for patients living with subacromial pain syndrome (SAPS). All treatments have small to moderate effect sizes, and it is challenging when healthcare practitioners and patients need to decide on which treatment options to choose. The aim of this study was to explore and understand the decisiona...

OBJECTIVE: To investigate how a global rating of change (GROC) score corresponds to change in Knee injury and Osteoarthritis Outcome Score (KOOS) subscales in people with patellofemoral pain (PFP). DESIGN: Secondary analysis of data from 3 clinical trials. METHODS: Four hundred ninety adolescents (10-18 years old) and adults (19-40 years old) with...

Osgood Schlatter's disease (OSD) is characterized by pain at the tibial tuberosity provoked during knee‐loading activities, and is common in adolescent athletes. The aim of this study was to characterize clinical, pain and ultrasound imaging characteristics in participants with OSD compared to controls. This cross‐sectional study included adolescen...

OBJECTIVES: To identify baseline characteristics that modified the effect of a 12-week quadriceps-focused vs hip muscle-focused exercise program on symptoms and physical function, through changes at baseline in the Anterior Knee Pain Scale (AKPS) in patients with PFP. DESIGN: A secondary analysis of a 26-week randomized trial involving 200 particip...

Background Fatigue, depression, anxiety and cognitive difficulties are reported by 1/3 of patients following transient ischemic attack (TIA). Aims To explore the timeline and how the diagnosis impacts individuals experiencing lasting challenges after TIA. Furthermore, to identify what they believed facilitated return to everyday life. Design Qual...

OBJECTIVES: To (1) create and evaluate the usefulness of an online evidence-based education resource about running and knee health (eg, knee osteoarthritis) for the public and health care professionals, and (2) assess the online resource’s effects on perceptions about running and knee health. DESIGN: Cross-sectional survey. METHODS: We created an...

Introduction: Low back pain is a global health challenge with negative consequences for both individuals and healthcare systems. The 'Choosing Wisely' initiative aims to improve communication between patients and clinicians to promote informed healthcare decisions while avoiding unnecessary tests and treatments. The objective of this project is to...

OBJECTIVE: Can physical therapists who are treating patients with Patellofemoral Pain (PFP) predict the outcome of a 12-week exercise intervention based on initial assessment, and what are the physical therapists’ reasons for prediction? DESIGN: Secondary analysis of a randomized trial. METHODS: After the initial assessment, physical therapists wer...

Background: Subacromial pain syndrome (SAPS), the most common cause of shoulder pain, can be treated through different treatments with similar effects. Therefore, in terms of deciding on the right treatment fit, patient preferences need to be understood. We aimed to identify treatment characteristics that delineate interventions (attributes) and c...

Introduction: Digital transformation and integration of eHealth solutions into chronic pain management faces significant challenges that have not yet been met. To realize the potential of eHealth solutions there is a need to understand the challenges, needs and care processes of eHealth into specific contexts and specific purposes. The objective of...

Background Knee pain affects one in three adolescents, which makes it one of the most common pain sites. Guideline recommendations about the clinical selection of patients likely to benefit from interventions are unclear, which leads to treatment heterogeneity and the potential of wasted resources among adolescents with a good prognosis. In contras...

Background Osgood–Schlatter disease (OSD) is the most common knee pain complaint among adolescents playing sports. Despite this, there remains controversy over the pathophysiology and whether specific anatomical characteristics are associated with OSD. Purpose This study aimed to systematically and comprehensively characterize adolescents with OSD...

Background Long-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with t...

Background Osgood-Schlatter is the most frequent growth-related injury affecting about 10% of physically active adolescents. It can cause long-term pain and limitations in sports and physical activity, with potential sequela well into adulthood. The management of Osgood-Schlatter is very heterogeneous. Recent systematic reviews have found low level...

Objectives Management of patients with chronic musculoskeletal pain (CMP) remains a challenge in general practice. The general practitioner (GP) often experiences diagnostic uncertainty despite frequently referring patients with CMP to specialized departments. Therefore, it remains imperative to gain insights on how to optimize and reframe the curr...

Objectives Pain is a growing concern globally, and an individual and societal burden. Pain science education (PSE) is a promising avenue for managing chronic pain, but targeted PSE is needed. The Concept of Pain Inventory for Adults (COPI-Adult) is a newly developed self-reported outcome measure aimed at targeting PSE. It is currently unavailable i...

Introduction Lateral ankle sprain is the most common ankle injury and up to 40% of those who sustain a lateral ankle sprain will develop chronic ankle instability (CAI). The aim of this study was to explore the thoughts and expectations of CAI-patients concerning their condition and expectations of care in an orthopedic setting. Study Design Qual...

Introduction Patient decision aids can support patient-clinician shared decision-making, yet little is known about the underlying change-mechanisms which facilitates patient-clinician collaboration in clinical settings. The MAP-Knee Tool was developed with GPs and adolescents with non-traumatic knee pain. It incorporated different components (diagn...

Introduction Perceived diagnostic uncertainty emerges during consultations because of miscommunication, potentially leaving adolescents confused and unable to understand ‘what’s wrong with me’. Repeated interviews are a valuable method to facilitate a high-quality, in-depth time-exploration of participants’ experiences and knowledge regarding compl...

Question: Which domains are important to develop a preliminary item bank for a new patient-reported outcome measure relating to adolescents with non-traumatic anterior knee pain? Design: Multiple methods: semi-structured interviews, Participants: Twenty-one adolescents with anterior knee pain participated in semi-structured interviews which explore...

OBJECTIVE: It is unclear if clinical trials of treatments for lower-limb tendinopathies include clinically homogeneous participant populations (an assumption for pooling in meta-analyses). We assessed the recruitment setting and participant characteristics used in randomized controlled trials (RCTs) that were investigating any treatment for lower-l...

Background The Foot and Ankle Outcome Score (FAOS) is widely used in clinical practice and research. However, FAOS reference values are missing to aid interpretation. This study aimed to establish national record–based reference values for the FAOS. Methods A national representative sample of 9996 adult Danish citizens was derived from the Danish...

Background There is limited knowledge about when and how adolescents with low back pain (LBP) interact with health care providers. This limits our understanding of how to best help these young patients. This study aimed to understand when and how care-seeking adolescents with LBP interact with health care providers and which health literacy compete...

Background Implementing new knowledge into clinical practice is a challenge, but nonetheless crucial to improve our healthcare system related to the management of musculoskeletal pain. This systematic review aimed to assess the effectiveness of implementation interventions within musculoskeletal healthcare. Methods We searched Medline, Embase, Coch...

Background Perceived diagnostic uncertainty can leave adolescents confused about their condition and impede their ability to understand “what's wrong with me”. Our aim is to develop credible explanations about the condition for adolescents suffering from non‐traumatic knee pain. Methods This multiple‐method study integrated findings from two syste...

THE EFFECTS OF TOTAL SLEEP DEPRIVATION ON PAIN THRESHOLDS AND DELAYED-ONSET MUSCLE SORENESS IN PHYSICALLY ACTIVE INDIVIDUALS Purpose: Sleep quality and perceived pain are related phenomena that remain unclear in the literature. Therefore, this study aimed to determine the effects of total sleep deprivation (TSD) on pain thresholds (PT) and delayed-...

Background: Mobile health (mHealth) applications have the potential to support adolescents’ self-management of knee pain. However, ensuring adherence remains a barrier when designing mHealth concepts for adolescents. Objective: This study aimed to explore barriers and facilitators for adhering to mHealth interventions to inform design principles. M...

OBJECTIVE: To identify which psychological and psychosocial constructs to include in a core outcome set to guide future clinical trials in the tendinopathy field. DESIGN: Modified International Delphi study. METHODS: In 3 online Delphi rounds, we presented 35 psychological and psychosocial constructs to an international panel of 38 clinician/resear...

The mainstay in the treatment of Osgood‐Schlatter Disease (OSD) is guidance on activity modification alongside exercises. The purpose of this study was to create an informative leaflet for patients with OSD, based on evidence and stakeholders perspectives. A synthesis of the literature, including national reference work, clinical research, and syst...

Objectives: Studies suggest that a range of pain mechanisms, such as poor quality of sleep, perceived stress, pain catastrophizing or pain sensitivity, are likely to enhance clinical pain. Animal studies suggest that these pain mechanisms can be modulated by increasing physical activity, but human data are needed to support this hypothesis. This e...

Objectives: Chronic musculoskeletal pain (CMP) is a common condition, often consulted in general practice. Our previous study identified research priorities among people with CMP using a broad recruitment strategy. It is unclear whether these research priorities reflect specific settings, including the population in general practice. Potential dis...

Objective To use individual patient data (IPD) to investigate if the effect of pain on sports-related disability is mediated through physical (lower extremity isometric strength) or psychological (depression/anxiety and knee confidence) factors in adolescents with non-traumatic anterior knee pain. Methods This study included four datasets from a p...

Purpose Postoperative rehabilitation exercise is commonly prescribed after total hip arthroplasty (THA), but its efficacy compared to no or minimal rehabilitation exercise has been questioned. Preliminary efficacy would be indicated if a dose-response relationship exists between performed exercise dose and degree of postoperative recovery. The obje...

Objective To compare the effectiveness of patient advice plus heel cup alone (PA) versus PA and lower limb exercise (PAX) versus PAX plus corticosteroid injection (PAXI) to improve self-reported pain in patients with plantar fasciopathy. Methods We recruited 180 adults with plantar fasciopathy confirmed by ultrasonography for this prospectively re...

Background: Knee Injury and Osteoarthritis Outcome Score (KOOS) and the short form KOOS-12 are commonly used in clinical practice and research but there are no national record-based reference values to aid interpretation. The aim of this study was to establish national record-based reference values for the KOOS and its short form KOOS-12. Patient...

Introduction Interpretation of patient-reported outcome scores such as the Hip Disability and Osteoarthritis Outcome Score (HOOS) can be improved with use of reference values. The aim of the study was to establish population-based reference values for the HOOS’ five subscales and its short-form HOOS-12. Materials and methods A representative sampl...

Objectives: Osgood-Schlatter disease is an overuse musculoskeletal pain condition. The pain mechanism is considered nociceptive, but no studies have investigated nociplastic manifestations. This study investigated pain sensitivity and inhibition evaluated through exercise-induced hypoalgesia in adolescents with and without Osgood-Schlatter. Desig...

Objectives: The aim of this study was to investigate how a specifically designed teaching program for adolescents on the subject of pain medication affects their knowledge and attitudes regarding pain medication. Methods This prospective interventional study used both quantitative and qualitative methods. The teaching intervention was codeveloped w...

Background Long-term strength deficits are common after Achilles tendon ruptures. Early use of progressive resistance exercises may help reduce strength deficits, but the feasibility of this approach is unknown. The aim was to investigate the feasibility of early progressive resistance exercises regarding patient acceptability and compliance with t...

Background: Improving jump-landing technique during rehabilitation is important and may be achieved through different feedback techniques, i.e., internal focus of attention (IF) or external focus of attention using a target (EF). However, there is a lack of evidence on the most effective feedback technique after anterior cruciate ligament reconstr...

Objective To assess effectiveness equivalence between two commonly prescribed 12-week exercise programmes targeting either the quadriceps or the hip muscles in patients with patellofemoral pain (PFP). Methods This randomised controlled equivalence trial included patients with a clinical diagnosis of PFP. Participants were randomly assigned to eith...

Background: Long-standing knee pain is one of the most common reasons for adolescents (aged 10-19 years) to consult general practice. Generally, 1 in 2 adolescents will continue to experience pain after 2 years, but exercises and self-management education can improve the prognosis. However, adherence to exercises and self-management education inter...

Aim: Using the Theoretical Domains Framework (TDF) and COM-B model, this study aimed to determine the facilitators to a support tool for adolescent non-traumatic knee pain in general practice. Background: Many children and adolescents with non-traumatic knee pain consult their general practice. Currently, there are no tools to support general pr...

Objectives: To describe the Quality of Life (QoL) among adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD) and investigate characteristics associated with QoL. Study design: Cross-sectional. Participants: 316 adolescents with PFP or OSD. Main outcome measures: QoL subscale of The Knee injury and Osteoarthritis Outc...

Objective The primary aim was to investigate the effectiveness of adding more resistance exercise to usual care on pain mechanisms (including temporal summation, conditioned pain modulation (CPM) and local pain sensitivity) and pain catastrophising in people with subacromial impingement at 16 weeks follow-up. Second, to investigate the modifying ef...

Background Osgood Schlatter disease (OSD) is a commonly seen musculoskeletal pain condition in active adolescents. OSD is an overuse injury, where the underlying mechanism is considered to be nociceptive, but other mechanisms have not yet been considered. Therefore, this study investigates pain sensitivity and inhibition through the paradigm of exe...

Introduction Patellofemoral pain (PFP) is one of the most common knee conditions across the lifespan. An essential question from patients is “what is the expected course/outcome”? Currently, there are no comprehensive syntheses of current evidence to inform clinical practice on prognosis for those living with PFP. This systematic review aims to inv...

Introduction Exercise therapy comprising exercises for the hip and the knee is recommended for improving pain and function in patients with patellofemoral pain (PFP). However, there is uncertainty about which type of exercises that are most effective. We aimed to assess effectiveness equivalence between two commonly prescribed exercise programs tar...

Introduction Short-term self-reported changes may be more strongly associated with long-term prognosis as they describe a disease trajectory and not a state. This study aimed to investigate the association between Global Rating of Change (GROC) after 4 weeks and the outcome after 12 months among adolescents with non-traumatic knee pain (Patellofemo...

Introduction Heel fat pad syndrome (HFPS) is the second leading cause of plantar heel pain. Clinical practice guidelines recommend conservative treatments for HFPS (activity modification, arch taping, and viscoelastic heel-cups). Alarmingly, the evidence for managing HFPS is scant and no well-executed randomised trials exist to support specific tre...

Introduction Knee pain affects one in three adolescents. No studies have prospectively evaluated the long-term impact of knee pain in later life. The Adolescent Pain in Aalborg (APA 2011) cohort included a population-based sample of 504 adolescents aged 15–19 years with knee pain. This study aims to describe the preliminary findings from selected o...

Introduction Two clinical trials tested a new management strategy for adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD). The strategy consisted of activity modification (a 4-week break from sport followed by progressive return to sport), education, and exercises. This strategy appeared to improve self-reported symptoms a...

Introduction We aimed to describe Quality of life (QoL) among adolescents with Patellofemoral Pain (PFP) and Osgood-Schlatter Disease (OSD) according to the QoL subscale of The Knee injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol 5-dimensions (EQ-5D) and to investigate the characteristics associated with QoL. Methods This individual...

Background: One in three people worldwide will experience chronic musculoskeletal pain (CMP). Due to the long-standing nature of CMP, it is inevitable that people with CMP will have to engage in some form of self-management. As highlighted by multiple clinical practice guidelines, it becomes pivotal that healthcare professionals provide effective s...