Musculoskeletal Injuries & Exercise

Prof Peter McNairProf Peter McNair, PhD, Director of the HRRI

AUT University, Private Bag 92006, Auckland, N.Z.
Office: +64-9-921999 ext 7143
Fax: +64-9-92199620

Overview Current Research Themes | Active Research Projects | Recent Publications | Commissioned Report |
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The Researchers in this area are led by Dr Peter McNair Professor of Physiotherapy and Director of the Institute. The focus of their work is the effects of exercise and fitness on physical task performance related to activities of daily living, work and sports, particularly in patients with musculoskeletal disorders.

Muscle performance is a key element to undertaking work and recreational activities safely and effectively. Specific deficits in muscle performance can be seen after many injuries, and there is a need to address why these patterns emerge, with a view that understanding the mechanisms can lead to more appropriate and cost effective treatments being developed. A number of studies are examining these mechanisms in injured knee and ankle joints.

Decreased fitness (strength, endurance and flexibility) is commonly associated with many injuries. Levels of fitness should be addressed to ensure that when people return to work and sport, they are able to cope with the physical demands placed upon them. Without appropriate rehabilitation, that includes assessment of fitness the likelihood of injury recurring is increased. Studies in this area are exploring the suitability of both general and specific training regimes for various injuries.

In respect to assessing improvements in function after injury, research is examining the development of appropriate outcome measures and physical performance tests that can be undertaken easily in clinical practice. Such assessments will be valuable and relevant to clinicians, particularly those involved in activity based rehabilitation programs. To date, work in this area has focused upon lower limb injuries.

The above mentioned research areas have not been confined to musculoskeletal injuries but have also encompassed the elderly, and those people who have additional problems such as osteoarthritis. Such co-morbidities may increase the risk of injury, for example by falling. Hence focused exercise programs may provide a foil to the additional risks that they pose.

The research mentioned above links well with that of Professor Kathryn McPherson’s team who are examining the psychological and social elements that affect peoples ability to undertake exercise in their rehabilitation. It also links with research being undertaken by Dr Denise Taylor which is examining specific programs for reducing falls in the elderly.

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  • Exercise therapy after injury
  • Identifying patterns of muscle performance deficits after specific injuries
  • Examining physiological mechanisms associated with patterns of lost strength and flexibility
  • Finding appropriate outcome measures for assessing tasks performed in work and sport after injury
  • Measuring fitness in individuals following injury
  • Establishing new exercise regimes for lower limb injuries and chronic conditions.
  • Matching exercise programs to tasks patients undertake in work and sport 

Our Aims

  • To advance knowledge related to the use of exercise in rehabilitation.
  • To identify appropriate outcome measures and tests for clinicians to assess the effectiveness of their rehabilitation programs.
  • To understand the mechanisms associated with strength, endurance and flexibility deficits following injuries.
  • To develop more efficacious rehabilitation programs for people with injuries and arthritic conditions.

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  • Pain, joint instability and degeneration
    • Strength and detraining
    • Qualitative perception related to training
    • Fatigue in quadriceps muscles (prediction)
    • Force appreciation in quadriceps
    • Voluntary activation patterns in quadriceps
    • Effects of pain and inflamation on quadriceps muscle activation
    • Effects of icing and corticosteroid on chronic arthritic knees
    • Changes in muscle extensibility: acute and chronic
    • MRI and loading in osteoarthritic and ACL deficient knee joints
    • Adherence to exercising
  • Diagnostic tests at the shoulder and hip joint
    • Reliability of clinical tests
    • Prediction of diagnosis from clinical tests
  • Outcome measures
    • Continued validation of Lower Limb Task Questionnaire
  • Viscoelasticity
    • Stretching parameters
    • Technical aspects related to stretching (curve fitting parameters)
    • Measuring stiffness when muscle is active.
    • Muscle length changes in stroke at the calf
    • Creep
  • Neuro conditions
    • Muscle and joint patterns during gait in children with cerebral palsy
  • Cardiovascular fitness in clinical populations
    • Exercise testing pre-surgery
  • Musculoskeletal ultrasound
    • Diagnosis of muscle and tendon injuries



Young S, Patel A, Zhu M, van Dijck S, McNair P, Bevan W, Tomlinson M.  Weight bearing in the non operative treatment of acute Achilles tendon ruptures- a randomised controlled trial.  J Bone and Joint Surgery 96(13), 1073-79, 2014

Stewart S, Rome K, Stewart S, Vandal AC, Gow P, McNair P, Dalbeth N.  The effect of good and poor walking shoe characteristics on plantar pressure and gait in people with gout. Clinical Biomechanics, 29:1158-63, 2014

Stott NS, Reynolds N, McNair P.  Level Versus Inclined Walking: Ambulatory Compensations in Children With Cerebral Palsy Under Outdoor Conditions: Ambulatory Compensations in Children With Cerebral Palsy Under Outdoor Conditions.  Pediatric Physical Therapy. 26(4), 428-35, 2014

Laslett M, Steele M, Hing W, McNair P, Cadogan A.  Shoulder pain patients in primary care - Part 1: Clinical outcomes over 12 months following standardized diagnostic workup, corticosteroid injections, and community-based care.  J Rehabilitation Medicine. 46(9), 898-907, 2014

Laslett M, Steele M, Hing W, McNair P, Cadogan A.  Shoulder pain in primary care - Part 2: Predictors of clinical outcome to 12 months.  J Rehabil Medicine. 47(1), 66-71, 2014

Javaid Z, Unsworth CP, Boocock M, McNair P. (2014). Fast detection & modelling of the real osteoarthritic holes in the human knee with contour interpolated radial basis functions.  IEEE Eng Med Biol Soc. Aug:2348-51, 2014

Rice DA, McNair PJ, Lewis GN, Dalbeth N. (2014).  Quadriceps arthrogenic muscle inhibition: The effects of experimental knee joint effusion on motor cortex excitability. Arthritis Research & Therapy. 16(502): doi:10.1186/s13075-014-0502-4, 2014

Lewis GN, Leys A, Rice DA, McNair PJ. Subconscious manipulation of pain expectation can modulate cortical nociceptive processing.  Pain Practice 15(2):117-23, 2015

Lewis GN, Rice DA, McNair PJ, Kluger M. (2014) Predictors of persistent pain following total knee arthroplasty: A systematic review and meta-analysis. British Journal of Anaesthesia. doi: 10.1093/bja/aeu441. In press.

White SG, McNair P, Laslett M, Hing W.(2014) Do patients undergoing physical testing report pain intensity reliably?  Arthritis Care & Research. In press.


McNair, PJ.  Invited review.  The growing cause of disability following limb injuries.  New Zealand Journal of Physiotherapy 41(1):20-22, 2013

McKay C, Prapavessis H and McNair P. Comparing the Lower Limb Tasks Questionnaire to the WOMAC: Agreement, responsiveness, and convergence with physical performance for knee osteoarthritis patients.  Archives of Physical Medicine and Rehabilitation, 94(3):474-9, 2013

Cadogan A, McNair P, Laslett M and Hing W. Shoulder pain in primary care. Diagnostic accuracy of clinical examination tests for non-traumatic acromioclavicular joint pain. BMC Musculoskeletal Disorders. 1;14:156. 2013.

McNair P, Nordez A, Olds M, Young SW, Cornu C.  Biomechanical properties of the plantar flexor muscle-tendon complex 6 months post-rupture of the achilles tendon.  J Orthopaedic Research. Sep;31(9):1469-74, 2013

Marshall, RN., & McNair, PJ. Biomechanical risk factors and mechanisms of knee injury in golfers. Sports Biomechanics.  12(3), 221-230, 2013.

Rome K, Stewart S, Vandal AC, Gow P, McNair P, Dalbeth N. The effects of commercially available footwear on foot pain and disability in people with gout: a pilot study.  BMC Musculoskeletal Disorders. Sep 24;14:278. 2013

Cadogan, A., McNair, P., Laslett, M., Hing, W., & Taylor, S. (2013). Diagnostic accuracy of clinical examination features for identifying large rotator cuff tears in primary health care. Journal of Manual & Manipulative Therapy, 21(3), 148-159. 2013


  • Cadogan, A., Laslett, M., Hing, W., McNair, P., & Taylor, S. M. Clinical examination predictors of positive response to guided diagnostic block into the subacromial bursa. Journal of Rehabilitation Medicine, 44(8), 877-884., 2012. 
  • Ellis, R., Hing, W. A., & McNair, P. J. Comparison of longitudinal sciatic nerve movement with different mobilization exercises: An in-vivo study utilizing ultrasound imaging. Journal of Orthopaedic and Sports Physical Therapy, 42(8), 667-675, 2012.
  • Fouré A, Cornu C, McNair PJ, Nordez A. Gender differences in both active and passive parts of the plantar flexors series elastic component stiffness and geometrical parameters of the muscle-tendon complex. J Orthop Res. 2012; 30:707-12.
  • Laslett, M., McNair, P., Cadogan, A., & Hing, W. (Comparison of a novel direct measure of rapid pain intensity change to traditional serial 100mm VAS measurement of pain intensity. Clinical Journal of Pain, 28(8), 675-682, 2012.
  • Lewis G, Heales L, Rice D, Rome K, McNair P. The reliability of assessing brainstem pathways that modulate pain.  Pain Research and Management 17(2): 98-102, 2012.
  • Lewis G, Rice D, Jourdain K, McNair P. Influence of stimulus location and posture on the reliability and comfort of the nociceptive flexion reflex. Pain Research and Management 17(2): 110-114, 2012.
  • Lewis, G. N., Rice, D. A., & McNair, P. J. Conditioned pain modulation in populations with chronic pain: A systematic review and meta-analysis. Journal of Pain, 13(10), 936-944. 2012.
  • Lewis, G., Vandal, A. C., & McNair, P. A method to monitor upper limb movement direction encoding in the corticomotor pathway. Journal of Motor Behavior, 44(4), 223-232, 2012.
  • McKay C, Prapavessis H and McNair P. Comparing the Lower Limb Tasks Questionnaire to the WOMAC: Agreement, responsiveness, and convergence with physical performance for knee osteoarthritis patients.  Archives of Physical Medicine and Rehabilitation, 2012, In Press, doi:10.1016/j.apmr.2012.09.013
  • McNair, P., & Lewis, G. Invited paper: Levels of evidence in medicine. International Journal of Sports Physiotherapy, 7(5), 474-481, 2012.
    Reid, D, McNair P, Johnson S, Potts G, Witvrouw E, Mathieu N.  Electromyographic analysis of an eccentric calf muscle exercise in presons with and without Achilles tendinopathy.  Physical Therapy in Sports 13(3):150-155, 2012.
  • Rome K, Frecklington M, McNair P, Gow P, Dalbeth N, Footwear characteristics and factors influencing footwear choice in patients with gout.  Arthritis Care and Rheumatism 63(11):1599-604, 2012.
    Rome K, Frecklington M, McNair P, Gow P, Dalbeth N. Foot pain, impairment and disability in patients with acute gout flares; a prospective observational study.  Arthritis Care and Research 64(3):384-8, 2012.
  • Smythe, E., Larmer, P. J., & McNair, P. J. Insights from a physiotherapist's lived experience of osteoarthritis. Physiother Theory Pract, 28(8), 604-616, 2012.
  • Stavric, V. A., & McNair, P. J. Optimizing muscle power after stroke: A cross-sectional study. Journal of NeuroEngineering and Rehabilitation, 9, 67, 2012.


  • Cadogan A, Laslett M, Hing W, Williams M and McNair P Reliability of a new hand-held dynamometer in measuring shoulder range of motion and strength. Manual Therapy 16(1):97-101, 2011
  • Cadogan A, Laslett M, Hing W, Williams M and McNair P. Inter-examiner Reliability of Orthopaedic Special Tests Used in the Clinical Assessment of the Painful Shoulder. Manual Therapy 16(2):131-5. 2011
  • Cadogan, A., Laslett, M., Hing, W. A., McNair, P. J., & Coates, M. H. A prospective study of shoulder pain in primary care: Prevalence of imaged pathology and response to guided diagnostic blocks. BMC Musculoskeletal Disorders, 12(1), 119, 2011.
  • Foure, A, Nordez, A, McNair, P, Cornu, C. Effects of plyometric training on both active and passive parts of the plantarflexors series elastic component stiffness of muscle-tendon complex. European Journal of Applied Physiology 111(3): 539-542, 2011
  • Fouré, A., Nordez, A., McNair, P., & Cornu, C. Effects of plyometric training on both active and passive parts of the plantarflexors series elastic component stiffness of muscle-tendon complex. European Journal of Applied Physiology, 111(3), 539-548, 2011.
  • Larmer P, McNair P, Smyth L, Williams M.   Ankle sprains: patient perceptions of function and performance of physical task.  A mixed methods approach.  Disability and Rehabilitation 33(23-24):2299-304, 2011
  • McNair P, Colvin M, Reid D.  Predicting maximal strength of quadriceps from sub-maximal performance in individuals with knee joint osteoarthritis.  Arthritis Research and Therapy 63(2):216-22, 2011
    Olds, M. and McNair, P.  Active stiffness in the unstable shoulder.  Journal of Athletic Training 46(6):642-7, 2011
  • Reid D, and McNair P. Effects of a six week lower limb stretching programme on range of motion, peak passive torque and stiffness in people with and without osteoarthritis of the knee.  New Zealand Journal of Physiotherapy 39(1):5-12, 2011
  • Rice, DA, McNair, PJ and Lewis GN. Mechanisms of quadriceps muscle weakness in knee joint osteoarthritis: the effects of prolonged vibration on torque and muscle activation in osteoarthritic and healthy control subjects. Arthritis Care and Research 20;13(5):R151. 2011
  • Rome K, Survepalli D, Sanders A, Lobo, M,  McQueen F,  McNair P, and Dalbeth D Functional and biomechanical characteristics of foot disease in chronic gout: a case-control study Clin Biomechanics Jan;26(1):90-4. 2011
  • Rome\ K, Survepalli D, Sanders A, Lobo, M,  McQueen F,  McNair P, and Dalbeth D Test-retest reliability of gait and plantar pressure measurements in patients with chronic gout.  Journal of American Podiatric Medical Association 101(5):424-9, 2011.


  • Lewis, G. and McNair P.  Heteronymous Ia afferent connections in the upper limb following stroke.  Muscle and Nerve, 41(1):71-7, 2010.
  • Nordez A, Fouré A, Dombrowski E, Mariot J-P, Cornu C, McNair PJ Improvements to Hoang et al.'s method for measuring passive length-tension properties of human gastrocnemius muscle in vivo.  Journal of Biomechanics, 43(2):379-82, 2010
  • Nordez A, McNair PJ, Casari P, and Cornu C*.  Static and cyclic stretching: their different effects on the passive torque-angle curve.  Journal of Science and Medicine in Sport, 13(1):156-160, 2010.
  • Polson, K, Reid, D, McNair, P, Larmer, P.  Responsiveness, Minimal Importance Difference And Minimal Detectable Change Scores Of The Shortened Disability Arm Shoulder Hand (Quickdash) Questionnaire.  Manual Therapy,15:404-7, 2010
  • Reid, D. and McNair, P.  Effects of an acute hamstring stretch in people with and without osteoarthritis of the knee.  Physiotherapy, 96(1):14-21, 2010.
  • Rice D. and McNair P. Quadriceps arthrogenic muscle inhibition: Neural mechanisms and treatment perspectives. Seminars in Arthritis and Rheumatism, 40(3):250-66 2010
  • Van Ginckel A, Baelde N, Almqvist F, Roosen P, McNair P, Witvrouw E. Functional adaptation of knee cartilage in asymptomatic female novice runners compared to sedentary controls.  A longitudinal analysis using delayed Gadolinium enhanced magnetic resonance imaging of cartilage (dGEMRIC).  Osteoarthritis and Cartilage 18(12):1564-9 2010


  • Boocock M, McNair P, Cicuttini F, Stuart A, and Sinclair T.  The short-term effects of running on the deformation of knee articular cartilage and its relationship to biomechanical loads at the knee.  Osteoarthritis and Cartilage, 17(7):869-76, 2009. 
  • Boocock, M.G., McNair, P. J., Larmer P.J. Collier, J., Simmond, M., and Armstrong B. A framework for the classification and definition of upper extremity musculoskeletal conditions.  Seminars in Arthritis and Rheumatism 38(4):296-311, 2009.
  • Lewis, G. and McNair P.  Muscle inhibition following tendon stimulation is reduced in chronic stroke.  Clinical Neurophysiology, 120(9):1732-40, 2009.
  • McNair, P., Simmonds, M., Boocock, M. and Larmer, P.  Exercise therapy in the management of hip osteoarthritis: a systematic review.  In press: Arthritis Research and Therapy:, 2009. 
  • Nordez A, McNair PJ, Casari P, and Cornu C. Characterization and modelling of the musculoarticular complex mechanical behavior in passive conditions: Effects of cyclic and static stretching. IRBM, 30(1), 20-29, 2009.
  • Nordez, A., McNair, P, Casari, P., and Cornu, C.  Effects of cyclic stretching on passive mechanical properties of the knee joint: influence of stretching velocity.  Clinical Biomechanics 24(1):77-81, 2009.
  • Nordez, A., McNair, P, Casari, P., and Cornu, C. The effect of angular velocity and cycle on the dissipative properties of the knee during passive cyclic stretching: a matter of viscosity or solid friction. Clinical Biomechanics, 24(1):77-81, 2009.
  • Rice, D. A., McNair, P. J. and Dalbeth, N. The effects of cryotherapy on quadriceps arthrogenic muscle inhibition using an experimental model of joint swelling. Arthritis and Rheumatism, 61(1):78-83, 2009.


  •  Armstrong, B. McNair, P. and Taylor, D.  Head and neck position sense.  Sports Medicine:  38(2)101-117, 2008.
  • Boocock, M., McNair, P., Larmer, P., Armstrong, B., Collier, J., Simmonds, M., and Garrett, N. Interventions for the prevention and management of neck/upper extremity musculoskeletal conditions: a systematic review.  Occupational and Environmental Medicine, 64(5):291-303, 2007.
  • Cronin J, Hansen K, Kawamori N, McNair P. Effects of weighted vests and sled towing on sprint kinematics. Sports Biomechanics 7(2): 160-72, 2008.
  • Ellis, R., Hing, W., Dilley, A., and McNair, P.J. Reliability of measuring sciatic and tibial nerve movement with diagnostic ultrasound during a neural mobilisation technique.  Ultrasound in Medicine and Biology, 34(8):1209-16. 2008.
  • Mahieu NN., McNair P., Cools A., D'Haen. C., Vandermeulen K., and Witvrouw E. Effect of eccentric training on the plantar flexor muscle-tendon tissue properties.  Medicine and Science in Sports and Exercise. 40(1):117-23, 2008.
  • Mahieu, N., Blanckaert, I., Smits, N., McNair, P. and Witvrouw, E.  Effect of Static and Ballistic Stretching on the Muscle-Tendon Tissue Properties.  Medicine and Science in Sports and Exercise, 39(3):494-501, 2007.
  • Mawston, G., McNair, P. and Boocock, M.  The effects of prior exposure, warning and initial standing posture on muscular and kinematic responses to sudden loading of a hand-held box.  Clinical Biomechanics, 22(3):275-81, 2007.
  • Mawston, G., McNair, P., and Boocock, M.  The effects of prior warning and lifting-induced fatigue on trunk muscle and postural responses to sudden loading during manual handling.  Ergonomics: 50(12):2157-70, 2008.
  • McNair, P.J., Portero, P., Chiquet, C., Mawston, G. and Lavaste, F.  Acute neck pain: cervical spine range of motion and position sense prior to and after joint mobilisation.  Manual Therapy, 12(4): 390-4, 2007.
  • McNair, P.J., Prapavessis, H., Collier, J. Bassett, S., Bryant, A. and P.J. Larmer.  The lower limb tasks questionnaire: an assessment of validity, reliability, responsiveness and important clinical differences.  Archives of Physical Medicine and Rehabilitation, 88:993-1001, 2007.
  • Mitchell, B., Bressel, E. McNair, P. and Bressel, M. Effect of pelvis, hip and knee position on ankle joint range of motion.  Physical Therapy in Sports 9(4): 202-208, 2008.
  • Nordez, A., Cornu, C. and McNair, P.  Acute changes in musculo-articular dissipation coefficient induced by cyclic and static stretching:  implication in acute muscle adaptations to stretching. International Journal of Sports Medicine, 29(5):414-8, 2008.
  • Nordez, A., Cornu, C. and McNair, P. Acute effects of static stretching on passive stiffness calculated using different mathematical models. Clinical Biomechanics, 21(7): 755-760, 2006.
  • Pengel L, Maher CG, Refshauge KM, Nicholas M, Herbert RD and McNair P. Physiotherapist-Directed Exercise, Advice, or Both for Subacute Low Back Pain.  Annals of Internal Medicine, 146(11): 787-796, 2007.
  • Signal, N. Taylor, D. and McNair, P.J. Central and peripheral contributions to neuromuscular fatigue in people with stroke.  Physical Therapy Reviews 13(4): 249-257, 2008.
  • Sprigings, E., McNair, P., Mawston, G., Sumner, D., and Boocock, M.  Predicting optimal blade size for competition in flat water kayaking.  Journal of Sports Engineering, 9:147-153, 2006.
  • Tucker, N., Reid, D., and McNair, P.J.  Reliability and measurement error of active knee extension range of motion in a modified slump test position: A pilot study.  Journal of Manual and Manipulative Therapy, 15(4): E85-E91, 2007.
  • Witvrouw, E., Mathieu, N., Roosen, P. and McNair, P.  The role of stretching in tendon injuries.  British Journal of Sports Medicine, 41(4): 224-6, 2007.

Research Team Members 

Peter McNair (Professor)

Grant Mawston  (Senior Lecturer)

Gwyn Lewis (Senior Lecturer)

David Rice (Senior Research Officer)

Steve White  (Senior Lecturer)Back to top

Last updated: 10-Jun-2016 12.10pm

The information on this page was correct at time of publication. For a comprehensive overview of AUT qualifications, please refer to the Academic Calendar.