Showing papers in "Clinical Journal of Sport Medicine in 2006"

Consensus Statement on Injury Definitions and Data Collection Procedures in Studies of Football (Soccer) Injuries

Abstract: BACKGROUND: Variations in definitions and methodologies have created differences in the results and conclusions obtained from studies of football (soccer) injuries; this has made interstudy comparisons difficult. PROCEDURE: An Injury Consensus Group was established under the auspices of Federation Internationale de Football Association Medical Assessment and Research Centre. Using a nominal group consensus model approach, a working document that identified the key issues related to definitions, methodology, and implementation was discussed by members of the group during a 2-day meeting. After this meeting, iterative draft statements were prepared and circulated to the members of the group for comment before the final consensus statement was produced. RESULTS: Definitions of injury, recurrent injury, severity, and training and match exposures in football, together with criteria for classifying injuries in terms of location, type, diagnosis, and causation are proposed. Proforma for recording players' baseline information, injuries, and training and match exposures are presented. Recommendations are made on how the incidence of match and training injuries should be reported and a checklist of issues and information that should be included in published reports of studies of football injuries is presented. CONCLUSIONS: The definitions and methodology proposed in the consensus statement will ensure that consistent and comparable results will be obtained from studies of football injuries.

Postural control deficits in participants with functional ankle instability as measured by the balance error scoring system.

Abstract: Objective: To determine if postural control deficits are present in participants with functional ankle instability (FAI) as measured by the Balance Error Scoring System (BESS).Design and Setting: We used a between-groups design to assess postural control. All testing was conducted in a university athletic training facility.Participants: Sixty collegiate Division I athletes were included in this study. Thirty participants had functional ankle instability and thirty participants had no history of ankle injuries.Main Outcome Measurements: Postural control was measured using the BESS. The BESS test battery requires participants to stand unsupported on two different surfaces (firm and foam) in three different stances (double, single, and in tandem). Each condition lasted 20 seconds. The number of errors were calculated for each individual condition and then summed to produce a total BESS score.Results: We found a significant group by condition interaction (F5,290=5.12, P<0.001) and significant main effects for group (F1,58=16.01, P<0.001) and condition (F5,290=228.88, P<0.001). Post hoc analyses revealed that subjects with functional ankle instability scored more errors (poorer balance) on the single stancefirm condition (2.9±2.1 versus 1.6±1.3 errors), tandem stancefoam condition (4.3±2.4 versus 2.7±1.6 errors), single stancefoam condition (7.0±1.6 versus 5.6±1.8 errors), and total BESS score (15.7±6.0 versus 10.7±3.2).Conclusions: Postural control deficits were identified in participants with functional ankle instability using the BESS. These deficits could be a contributing factor to the repeated episodes of instability and giving way that often occurs following an inversion ankle sprain. These results suggest the BESS, traditionally used for monitoring recovery from mild head injury, may also be useful in screening athletes for postural deficits following lower extremity injury.

Survey of sport participation and sport injury in Calgary and area high schools.

Abstract: Objective:To examine (1) sport participation and (2) sport injury in adolescents.Design, Setting, and Participants:This was a retrospective survey design. In total, 2873 adolescents were recruited from a random sample of classes from 24 Calgary and area high schools. Each subject completed an in-cla

Incidence and distribution of pediatric sport-related injuries.

Abstract: OBJECTIVE:: To provide a critical review of the available literature on the descriptive epidemiology of pediatric sport-related injuries. DATA SOURCES:: MEDLINE (1966 to 2006) and SPORTDiscus (1975 to 2006) were searched to identify potentially relevant articles. A combination of medical subject headings and text words was used (epidemiology, children, adolescents, athletic injuries, sports, injury, and injuries). Additional references from the bibliographies of retrieved articles were also reviewed. STUDY SELECTION:: Published research reports on the incidence and distribution of injury in children's and youth sports. Specific emphasis was placed on reviewing original studies, which report incidence rates (rate of injuries per unit athlete time). Forty-nine studies were selected for this review. DATA EXTRACTION:: Data summarized include incidence of injury relative to who is affected by injury (sport, participation level, gender, and player position), where injury occurs (anatomical and environmental location), when injury occurs (injury onset and chronometry), and injury outcome (injury type, time loss, clinical outcome, and economic cost). DATA SYNTHESIS:: There is little epidemiological data on injuries for some pediatric sports. Many of the studies retrieved were characterized by methodological short-comings and study differences that limit interpretation and comparison of findings across studies. Notwithstanding, the studies reviewed are encouraging and injury patterns that should be studied further with more rigorous study designs to confirm original findings and to probe causes of injury and the effectiveness of preventive measures. CONCLUSIONS:: Incidence and severity of injury are high in some child and youth sports. This review will assist in targeting the relevant groups and in designing future research on the epidemiology of pediatric sports injuries. Well-designed descriptive and analytical studies are needed to identify the public health impact of pediatric sport injury. Language: en

Is physical exercise beneficial for persons with Parkinson's disease?

Abstract: Objective:To review existing studies evaluating the effectiveness of physical exercise on mortality, strength, balance, mobility, and activities of daily living (ADL) for sufferers of Parkinson's disease (PD).Data Sources:The following databases were searched (1) Cochrane Database of Systema

The use of dietary supplements and medications by Canadian athletes at the Atlanta and Sydney Olympic Games.

Abstract: Objective:To learn more about the prevalence of dietary supplement and medication use by Canadian athletes in the Olympic Games in Atlanta 1996 and Sydney 2000.Setting and Participants:Data were collected from personal interviews with Canadian athletes who participated at the 1996 Atlanta and 2000 S

The influence of in-season injury prevention training on lower-extremity kinematics during landing in female soccer players.

Abstract: OBJECTIVE: To examine the influence of in-season injury prevention training on hip and knee kinematics during a landing task. DESIGN: Longitudinal pre-post intervention study. SETTING: Testing sessions were conducted in a biomechanics research laboratory. PARTICIPANTS: Eighteen female soccer players between the ages of 14 and 17 participated in this study. All subjects were healthy with no current complaints of lower extremity injury. INTERVENTIONS: Testing sessions were conducted prior to and following a season of soccer practice combined with injury prevention training. MAIN OUTCOME MEASUREMENTS: During each testing session three-dimensional kinematics were collected while each subject performed a drop landing task. Peak hip and knee joint angles were measured during the early deceleration phase of landing and compared between pre- and post-training using paired t-tests. RESULTS: Following a season of soccer practice combined with injury prevention training, females demonstrated significantly less hip internal rotation (7.1 degrees vs. 1.9 degrees ; P=0.01) and significantly greater hip abduction (-4.9 degrees vs. -7.7 degrees ; P=0.02). No differences in knee valgus or knee flexion angles were found post-season. CONCLUSIONS: Female soccer players exhibited significant changes in hip kinematics during a landing task following in-season injury prevention training. Our results support the premise that a season of soccer practice combined with injury prevention training is effective in altering lower extremity motions that may play a role in predisposing females to ACL injury. Language: en

Weight Training in Youth-Growth, Maturation, and Safety: An Evidence-Based Review

Abstract: Objective:To review the effects of resistance training programs on pre- and early-pubertal youth in the context of response, potential influence on growth and maturation, and occurrence of injury.Design:Evidence-based review.Methods:Twenty-two reports dealing with experimental resistance training pr

Musculoskeletal injury in the masters runners.

Abstract: ObjectiveTo determine if injury patterns and risk factors for injury differ between masters and younger runners.DesignRetrospective survey.SettingHood to Coast running relay, Oregon, USA.ParticipantsA total of 2886 runners consented to participate and completed the survey. Ninety-four (2712/2886) pe

Heart rate variability, blood pressure variability, and baroreflex sensitivity in overtrained athletes

Abstract: Objective: To assess the effects of abruptly intensified physical training on cardiovascular control. Design: Retrospective longitudinal study. Setting: Research laboratory. Participants: Ten healthy athletes (5 men and 5 women) from track and field as well as triathlon. Interventions: A 2-week training camp, including daily stepwise increasing cycling tests, running of 40 minutes, and additional cycling of 60 minutes. Main Outcome Measurements: Time and frequency domain parameters of resting heart rate and blood pressure variability (HRV and BPV) and baroreflex sensitivity (BRS), before, during, and after the training camp. Results: We found significantly reduced HRV during the training camp (mean beat-to-beat interval: 1042 [937 to 1194] ms vs. 933 [832 to 1103] ms vs. 1055 [947 to 1183] ms, P , 0.01; root-meansquare of beat-to-beat interval differences: 68 [52 to 95] ms vs. 52 [38 to 71] ms vs. 61 [48 to 78] ms, P , 0.05). Further, BRS was significantly reduced: 25.2 (20.4 to 40.4) ms/mmHg vs. 17.0 (12.9 to 25.7) ms/mmHg vs. 25.7 (18.8 to 29.1) ms/mmHg, P , 0.05. These effects disappeared at a large degree after 3 to 4 days of recovery. Conclusion: Abruptly intensified physical training results in an altered autonomic cardiovascular activity towards parasympathetic inhibition and sympathetic activation that can be monitored by means of HRVand BRS analyses and might provide useful markers to avoid the overtraining syndrome.

Preparticipation physical examination using a box drop vertical jump test in young athletes: the effects of puberty and sex

Abstract: ObjectiveNeuromuscular performance increases rapidly in males throughout pubertal development, whereas no similar neuromuscular spurt occurs in females. This fact may underlie neuromuscular imbalances related to increased risk of injury in females. The hypothesis: female athletes would demonstrate m

Practical management: nonsteroidal antiinflammatory drug (NSAID) use in athletic injuries

Abstract: Nonsteroidal antiinflammatory drugs (NSAIDs) are frequently used in the treatment of acute athletic injuries, often for analgesic purposes as the evidence to support enhanced healing is limited. However, the current evidence on NSAID use in athletic injury is slowly growing. On the basis of animal models and limited human studies, some practical management guidelines can be drawn to assist the sports physician. Specifically, NSAIDs are not recommended in the treatment of completed fractures, stress fractures at higher risk of nonunion, or in the setting of chronic muscle injury. The only exception may be very short-term use (eg, a few days) for analgesic purposes only. Judicious use of NSAIDs may be more appropriate in the management of acute ligament sprains, muscle strains, tendinitis, and eccentric muscle injury. However, length of treatment should always be kept as short as possible, with consideration of the specific type of injury, level of dysfunction, and pain.

Intratester and Intertester Reliability of Clinical Measures of Lower Extremity Anatomic Characteristics: Implications for Multicenter Studies

Abstract: Objective: To determine whether multiple examiners could be trained to measure lower extremity anatomic characteristics with acceptable reliability and precision, both within (intratester) and between (intertester) testers. We also determined whether testers trained 18 months apart could perform these measurements with good agreement.Setting: University's Applied Neuromechanics Research Laboratory.Participants: Sixteen, healthy participants (7 men, 9 women).Assessment of Risk Factors: Six investigators measured 12 anatomic characteristics on the right lower extremity in the Fall of 2004. Four testers underwent training immediately preceding the study, and measured subjects on 2 separate days to examine intratester reliability. Two testers trained 18 months before the study (Spring 2002) measured each subject on day 1 to examine the consistency of intertester reliability when testers are trained at different times.Main Outcome Measurements: Knee laxity, genu recurvatum, quadriceps angle, tibial torsion, tibiofemoral angle, hamstring extensibility, pelvic angle, navicular drop, femur length, tibial length, and hip anteversion.Results: With few exceptions, all testers consistently measured each variable between test days (intraclass correlation coefficient>=0.80). Intraclass correlation coefficient values were lower for intertester reliability (0.48 to 0.97), and improved from day 1 to day 2. Intertester reliability was similar when comparing testers trained 18 months before those trained immediately before the study. Absolute measurement error varied considerably across individual testers.Conclusions: Multiple investigators can be trained at different times to measure anatomic characteristics with good to excellent intratester reliability. Intratester reliability did not always ensure acceptable intertester reliability or measurement precision, suggesting more training (or more experience) may be required to achieve acceptable measurement reliability and precision between multiple testers.

Updated fluid recommendation: position statement from the International Marathon Medical Directors Association (IMMDA).

Abstract: Controversy exists regarding optimal fluid guidelines for athletes engaging in different sports. Most published recommendations emphasize the detrimental consequences of dehydration, while more recent reports warn of the morbid consequences of hyperhydration. Accordingly, individualized recommendations emphasizing a balance between the two extremes have evolved. These revised guidelines, however, continue to promote static recommendations for what in reality are very dynamic athletic situations. Marathon running epitomizes a dynamic situation that requires a constant adjustment to constantly changing homeostatic requirements. Real-time assessments of fluid and sodium homeostasis are physiologically represented by changes in plasma osmolality (POsm). Pituitary arginine vasopressin (AVP) secretion is stimulated when POsm increases by only 1% to 2%, representing the body’s attempt to prevent dehydration by decreasing kidney water excretion. After maximal antidiuresis is achieved, thirst is then stimulated to replace water losses that are in excess of the ability of AVP-stimulated antidiuresis to conserve body water. In general, the osmotic threshold for thirst is 5 to 10mOsm/g H2O higher than that of AVP secretion. Thus, thirst is stimulated with decreases in body water of approximately 1.7% to 3.5%. Concomitant performance decrements and cardiovascular strain are also documented when baseline body fluid losses exceed approximately 2%. The failure of athletes to replace 100% of bodyweight losses from ad libitum fluid intake has been well-described as ‘‘involuntary’’ or ‘‘voluntary’’ dehydration; this phenomenon has resulted in the devaluation of thirst as a ‘‘poor’’ indicator of body fluid needs. The combination of laboratory with recent field data (see Table 1 and subsequent discussion), however, suggests that the body primarily defends POsm, and not blood or extracellular fluid volume during prolonged endurance exercise. Because it is well established that thirst is stimulated in response to changes in tonicity in most land mammals, it seems reasonable to conclude that thirst would be the predominant physiologic and dynamic regulator governing fluid balance during exercise. This article will focus on the physiology of normal fluid balance as the ultimate guide toward the evolution of optimal fluid recommendations. Six physiologic considerations of fluid and sodium balance will be detailed followed by 6 practical recommendations. The neuroendocrine regulation of homeostasis will be emphasized in defense of the behavioral drives for thirst and sodium palatability during dynamic activities such as prolonged endurance exercise. The behavioral drives to maintain fluid and sodium balance are evolutionary stable, essential for the safety and survival of the species, and deeply rooted within the human genetic makeup.

Practical management of iliotibial band friction syndrome in runners

Abstract: This article outlines the practical management of iliotibial band friction syndrome (ITBFS) in running athletes. ITBFS is the most common cause of lateral knee pain in runners and is related to repetitive friction of the iliotibial band sliding over the lateral femoral epicondyle. Runners predisposed to this injury are typically in a phase of over training and often have underlying weakness of the hip abductor muscles. The diagnosis of ITBFS is clinical and is based on a thorough patient history and physical exam. In the acute phase, treatment includes activity modification, ice, nonsteroidal anti-inflammatory medication, and corticosteroid injection in cases of severe pain or swelling. During the subacute phase emphasis is on stretching of the iliotibial band and soft tissue therapy for any myofascial restrictions. The recovery phase focuses on a series of exercises to improve hip abductor strength and integrated movement patterns. The final return to running phase is begun with an every other day program, starting with easy sprints and avoidance of hill training with a gradual increase in frequency and intensity. In rare refractory cases that do not respond to conservative treatment, surgery can be considered.

Sports Injuries in High School Athletes: A Review of Injury-Risk and Injury-Prevention Research

Abstract: OBJECTIVE:: The objective of this review is to identify the available research regarding the risk factors and prevention of injuries in high school athletes (ages 14 to 18 years). DATA SOURCES:: Relevant manuscripts were identified by searching six electronic databases with a combination of key words and medical subject headings (high school, adolescent, athletic injury, sports injury, risk factors, prevention, and prospective). STUDY SELECTION:: Original research that reported prospective data on high school athletes (ages 14 to 18), reported injury and exposure data, and used data collected throughout the entire sport season or school year. DATA EXTRACTION:: Twenty-nine studies that identified injury risk factors or injury prevention strategies were reviewed and summarized. Data extracted from the studies included a) sport(s) or injuries studied, b) year of publication, c) lead author, d) description of the subjects, e) sample-size calculation, f) variables studied (baseline demographic or performance variables), g) whether multivariate analyses were used, h) data reported (injury rates, risk ratios, and 95% CI), and i) results. Studies that introduced an intervention were characterized by the same data as well as the type of intervention employed and randomization procedures used. DATA SYNTHESIS:: The quality of each injury-risk and injury-prevention study was assessed, and the results were summarized. CONCLUSIONS:: The risk factors for injury in several specific sports such as soccer, American football, and basketball have been documented. Other sports are less well represented in the current literature. The risk factors for injuries to the ankle, head, and knee have been identified, to a limited degree. Upper-extremity injury risk factors are less well known. There is a need for high-quality prospective studies to further identify injury risk factors and injury-prevention strategies for high school athletes. Language: en

Effect of coordination training with and without stochastic resonance stimulation on dynamic postural stability of subjects with functional ankle instability and subjects with stable ankles.

Abstract: ObjectiveTo examine the effects of coordination training with and without stochastic resonance (SR) stimulation on dynamic postural stability.DesignExperimental with repeated measures.SettingResearch Laboratory.ParticipantsThirty subjects with functional ankle instability (FAI) and 30 healthy subjec

Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad.

Abstract: Objectives: To assess bone marrow edema at the pubic symphysis with magnetic resonance imaging (MRI), and its relation to training and osteitis pubis in an elite group of junior soccer players. Setting: Soccer players on scholarship at the Australian Institute of Sport (AIS). Patients: Nineteen players from an elite junior men’s soccer squad. Intervention/Assessment: Serial MRI examinations of the pubic symphysis over a 4-month training and playing period, training session questionnaire, and review of clinical diagnosis, investigations, and records on presentation of athletes with groin pain at the Department of Sports Medicine. Main Outcome Measures: Assessment of bone marrow edema (4-point scale) on MRI scans, review of athlete questionnaires, and review of clinical records. Results: Initial MRI scans showed moderate to severe bone marrow edema at the pubic symphysis in 11 of the 18 asymptomatic players. There was a greatly decreased risk of developing groin pain (osteitis pubis) with more training prior to entry of the AIS soccer program (odds ratio per 4 sessions of training, 0.003). The correlation between initial bone marrow edema grading and pre-AIS training was small. The increase in bone marrow edema grading from baseline over the scans was 0.5 (90% CL, 0.4). Conclusions: Substantial amounts of bone marrow edema at the pubic symphysis can occur in asymptomatic elite junior soccer players, but it is only weakly related to the development of osteitis pubis. Progressing training loads more slowly in athletes presenting with low current training loads may be a useful

Mechanisms of injury for concussions in university football, ice hockey, and soccer: a pilot study.

Abstract: OBJECTIVE: To examine the mechanisms of injury for concussions in university football, ice hockey, and soccer. DESIGN: Prospective analysis. SETTING: McGill University. PATIENTS: All athletes participating in varsity football, ice hockey, and soccer. MAIN OUTCOME MEASURES: Athletes participating in university varsity football, ice hockey, and soccer were followed prospectively to determine the mechanisms of injury for concussions, whether certain mechanisms of injury causing concussions were more common in any of the three sports, whether different areas of the body seem to be more vulnerable to a concussion after contact, and whether these areas might be predisposed to higher grades of concussion after contact. RESULTS: There were 69 concussions in 60 athletes over a 3-year period. Being hit in the head or helmet was the most common mechanism of injury for all 3 sports. The side/temporal area of the head or helmet was the most probable area to be struck, resulting in concussion for both football and soccer. When examining the body part or object delivering the concussive blow, contact with another player's helmet was the most probable mechanism in football. CONCLUSION: The mechanisms of injury for concussions in football are similar to previously published research on professional football players. The mechanisms of injury for concussions in soccer are similar to past research on Australian rules football and rugby. Language: en

Managing Anterior Cruciate Ligament Deficiency in the Skeletally Immature Individual: A Systematic Review of the Literature

Abstract: Objective:To perform a systematic review of the literature to answer whether early ACL reconstruction for a skeletally immature individuals result in improved outcome compared with nonsurgical treatment or delaying the reconstruction until skeletal maturity in the pediatric athlete.Data Sources:Arti

Parental and coach support or pressure on psychosocial outcomes of pediatric athletes in soccer.

Abstract: OBJECTIVE: The purpose of this article was to examine supportive and/or pressuring influences of parents and coaches on young athletes' maladaptive perfectionist tendencies, relationships to friends, and competency perceptions in soccer. Previous research has revealed that parents and coaches may give rise to both enjoyable and stressful sport experiences for the pediatric athlete and that parents and coaches are thus able to influence whether young people decide to quit sport or continue participating. Less is known about the relation of supportive versus pressuring parental and coach behaviors on the quality of athletes' achievement striving, relationships to friends in sport, and their competence perceptions. Such knowledge may help create a better psychological sport experience for pediatric athletes. DATA SOURCES/SYNTHESIS: A questionnaire-based cross-sectional field study was carried out among 677 young Norwegian soccer players (aged 10 to 14 years; 504 boys, 173 girls; mean age: boys = 11.9 years, SD = 2.9; girls = 11.2 years, SD = 2.1) taking part in the Norway Cup international youth soccer tournament in 2001. Multivariate analysis of variance (MANOVA) with follow-up canonical correlation was used to examine multivariate relationships between supportive and pressuring behavior and athletes' psychosocial experiences. RESULTS: Joint pressuring behaviors from parents and coaches related positively to maladaptive achievement striving, as indicated by overconcern for mistakes, doubt about one's soccer actions, and lowered perceptions of soccer competence. Mirroring these findings, predominantly supportive coach-created psychological climates were related to a linear pattern of psychological outcomes comprising high-quality friendships, positive competency perceptions, and the absence of specific worries related to achievement striving. CONCLUSIONS: Supportive, mastery-oriented coach influence seems beneficial for constructive psychosocial outcomes in pediatric athletes, and athletes experiencing a joint social pressure to excel from coaches and parents may benefit less psychosocially through sport. Language: en

Gender and limb differences in dynamic postural stability during landing.

Abstract: Objective: To determine if gender and limb dominance affect dynamic postural stability and vertical ground reaction force data during jump landings. Secondary objective was to assess the reliability of the dynamic postural stability index (DPSI). Design: A mixed model (2 gender 2 limb) repeated measures design was used to determine the effects of gender and limb dominance on dynamic postural stability. Subjects were required to perform a two-legged jump to a height equivalent of 50% of their maximum vertical leap, land on a single-leg and balance for three seconds. Setting: Sports Medicine Research Laboratory. Participants: Forty healthy subjects (20 men, 20 women) participated in this investigation. Main Outcome Measures: The DPSI and its directional components quantified dynamic postural stability during a single-leg jump landing. Normalized vertical ground reaction force data quantified energy absorption. Results: DPSI values revealed that females had significantly different dynamic postural stability as compared to males in the vertical plane [T (78) = 4.2, P<0.01], and in the composite score (dynamic postural stability index) [T (78) = 6.3, P<0.01]. In addition, females had significantly higher peak vertical ground reaction forces [T (78) = 13, P = 0.01] than males. The DPSI also showed excellent reliability (ICC = 0.96), with a 95% confidence interval ranging from 0.94 to 0.97. Conclusions: The results indicate that females have higher dynamic postural stability scores in the vertical direction as well as the composite score. This suggests that females used different dynamic postural stability strategies than males. There were no side-to-side dynamic postural stability differences between healthy contralateral limbs.

Follow-up evaluation 2 years after ACL reconstruction with bone-patellar tendon-bone graft shows that excessive tibial rotation persists.

Abstract: Results: For both activities, no significant differences were found between the control healthy knee and the intact knee of the patient group before and 2 years after the ACL reconstruction. Significant differences were found between the control healthy knee and the affected knee of the patients group for both activities, both before and 2 years after the ACL reconstruction. Conclusion: The increased tibial rotation found in the ACLdeficient knees was not restored with reconstruction using a BPTB graft, even 2 years postoperatively. The authors propose that this excessive tibial rotation over time may lead to further deterioration of the knee resulting from abnormal loading at areas of the cartilage that are not commonly loaded in a healthy knee.

A new view on adduction-related groin pain.

Abstract: Objective: To evaluate the hypothesis that groin pain at isometric hip adduction may not be caused by adductor tendinitis. Design: Symptoms and signs in a cross-sectional analysis. Setting: Multicenter primary care institutes. Subjects: Athletes with pain in the groin(s), provoked by playing sports, with a duration of complaints for at least 1 month and pain provocation on isometric adduction of the hips. Interventions: Data on medical history and symptoms were collected. Pain provocation tests and strength measurements were performed. A pelvic belt was used to investigate its influence on pain provocation and strength. Main Outcome Measurements: Site of the pain, duration of the complaints, severity of the pain, hip adduction force, pain at isometric hip adduction, restriction to perform active straight leg raising, influence of a pelvic belt on pain and strength of isometric hip adduction and straight leg raising. Results: Groin pain was bilateral in 41%; pain was also located at the posterior aspect of the pelvis in 32%; Active Straight Leg Raise (ASLR) test was positive in 39%. When tested with a pelvic belt, the weakness of ASLR improved in all with a positive ASLR, hip adduction force increased significantly in 39% and pain at forceful isometric hip adduction decreased in 68%. Conclusions: Groin pain at isometric hip adduction may not be caused by adductor tendinitis in a large proportion of athletes with adduction-related groin pain. The results suggest that adduction-related groin pain with a positive belt test may be treated by stabilization of the pelvis.

Injury prevention in child and adolescent sport: whose responsibility is it?

Abstract: OBJECTIVE:: Sport and recreational injuries are a leading cause of morbidity in youth. There is a significant body of literature on risk factors for sport-related injuries and a growing body of research supporting the effectiveness of sport-specific prevention strategies in youth. Given the predictability and preventability of injuries in youth sport, the purpose of this article is to develop a model that considers societal responsibility for injury prevention in youth sport, and to discuss the evidence that supports this model. DATA SOURCES/SYNTHESIS:: Previously published papers have provided a basis for expert opinion to discuss an approach to examining the shared societal responsibility for implementing countermeasures to reduce the risk of injury to youth during sports. RESULTS:: Based on a historical perspective, broad conceptual framework, and specific evidence for prevention strategies in youth sport, the authors have developed and supported a theoretical model that defines a responsibility hierarchy in preventing injuries in youth sport. An argument has been made for a hierarchy of responsibility, with the lowest level of responsibility assigned to the child, and the highest level to those organizations or groups with the potential to effect the most change. The justification for this approach has been discussed in the context of the desirability of passive prevention strategies, the limited evidence for the effectiveness of strategies relying solely on behavior change in children and parents, and the level of perceptual and cognitive development in children that inadequately prepares them to take primary responsibility for their own safety in sport. CONCLUSIONS:: The development of effective programs to reduce the burden of sport injury among youth necessitates a scientific approach, the identification of key risk factors for injury, a thorough examination of how factors interact to affect risk, and the identification of potential barriers to the effectiveness of injury-prevention programs. Language: en

Chondral metaplasia in calcific insertional tendinopathy of the Achilles tendon.

Abstract: Objective To ascertain whether tendon samples harvested from patients with calcific insertional Achilles tendinopathy showed features of failed healing response, and whether abnormal quantities of type II collagen had been produced in that area by these tenocytes. Design Comparative laboratory study. Design University teaching hospitals. Patients Tendon samples were harvested from eight otherwise healthy male individuals (average age 47.5±8.4 years, range 38 to 60) who were operated for calcific insertional Achilles tendinopathy and from nine male patients who died of cardiovascular events (mean age 63.1±10.9 years) while in hospital. Interventions Open surgery for calcific insertional Achilles tendinopathy. Main Outcome Measure Semi-quantitative histochemical, immunohistochemical, and immunocytochemical methods to ascertain whether tendinopathic tendons were morphologically different from control tendons, and whether abnormal types of collagen were produced. Results Tenocytes from tendons from patients with calcific insertional Achilles tendinopathy exhibit chondral metaplasia, and produce abnormally high quantities of collagen type II and III. Conclusions The altered production of collagen may be one reason for the histopathological alterations described in the present study. Areas of calcific insertional Achilles tendinopathy have been subjected to abnormal loads. These tendons may be less resistant to tensile forces. Further studies should investigate why some tendons undergo these changes.

Incidence and player risk factors for injury in youth football.

Abstract: OBJECTIVE: To estimate the incidence of injuries in youth football and to assess the relationship between player-related risk factors (age, body size, biological maturity status) and the occurrence of injury in youth football. DESIGN: Prospective over two seasons. SETTING: Two communities in central Michigan. PARTICIPANTS: Subjects were 678 youth, 9-14 years of age, who were members of 33 youth football teams in two central Michigan communities in the 2000 and 2001 seasons. METHODS: Certified athletic trainers (ATCs) were on site to record the number of players at all practices and home games (exposures) and injuries as they occurred. A reportable injury (RI) was defined by the criteria used in the National Athletic Trainers' Association (NATA) survey of several high school sports. Estimated injury rates (95% confidence intervals) per athlete exposures (AE) and per number of athletes were calculated for practices and games by grade. Player risk factors included age, height, weight, BMI and estimated maturity status. MAIN OUTCOME MEASURE: Estimated injury rates and relative risks of injury during practices and games by grade; logistic regression to evaluate relationships between player-related risk factors and risk of injury. RESULTS: A total of 259 RIs, 178 in practice and 81 in games, were recorded during the two seasons. Practice injury rates increased with grade level, while game injury rates were similar among fourth through fifth grade and sixth grade players and about twice as high among seventh and eighth grade players. The majority of RIs during the two seasons was minor (64%); the remainder was moderate (18%) and major (13%). Injured fourth through fifth grade players were significantly lighter in weight and had a lower BMI; otherwise, injured and non-injured players within each grade did not differ in age, body size and estimated biological maturity status. Logistic regressions within grade revealed no significant associations between injury and age, height, BMI, and maturity status. CONCLUSION: Game injury rates are higher than practice injury rates, and the incidence of injury tends to increase with grade level. Age, height, BMI and maturity status were not related to the risk of injury in youth football players. Language: en

Joint laxity and isokinetic thigh muscle strength characteristics after anterior cruciate ligament reconstruction: bone patellar tendon bone versus quadrupled hamstring autografts.

Abstract: Objectives:To analyze ligamentous stability and isokinetic strength of knee extensor and flexor muscles after anterior cruciate ligament reconstruction using 2 different autografts with identical fixation.Design:This study implements a comparative case series design.Setting:Schulthess Clinic, Switze

Nonsteroidal antiinflammatory drugs in tendinopathy: friend or foe

Abstract: Tendinopathy, a broad term used to describe disorders in and around tendons, 1,2 is associated with repetitive tensile forces exerted on tendons. Rapid increases in the duration and intensity of these forces may cause tendon injuries, possibly the starting point in the pathogenesis of chronic tendinopathy. The exact incidence of chronic tendinopathy is unknown given the vast population of professional and recreational athletes suffering from this condition at different anatomic sites. Studies on incidence of tendinopathies are usually site or sport specific, and only provide an approximation of the magnitude of the problem faced by musculoskeletal and sports medicine clinicians in treating this disorder. In addition, a large number of sedentary subjects develop tendinopathy with no apparent history of increased physical activity. Disorganized, haphazard healing, with frayed, separated, and otherwise disrupted collagen fibrils, are features of tendinopathy. These lesions are characterized by the absence of inflammatory cells and a poor healing response. Age-related tendon changes, and not just mechanical overload, may thus play a role in the pathogenesis of tendinopathy, although the exact etiologic, pathophysiologic, and healing mechanisms are still unknown. Gene expression studies have shown an absence of any inflammatory process in chronic Achilles tendinopathy. Microdialysis experiments have shown no evidence of intratendinous chemical inflammation, with prostaglandin E2 (PGE2) levels being normal in chronic tendinopathies. Microdialysis has also shown higher levels of glutamate, an excitatory neurotransmitter and a potent modulator of pain in the central nervous system, in tendinopathic tendons compared with normal tendons. The same technique reveals that the local concentration of lactate in the tendinopathic Achilles tendon is almost twice that of the normal Achilles tendon. It is possible that there is an ischemic component in the pathogenesis of tendinopathy. Ischemia may precede the start of tendinopathy, but examination of tendinopathic lesions reveals neovascularization and increased blood flow in the affected area of the tendon. Neovascularization may be a response to a primary injury or may be the result of a metabolic disorder. It is possible that anaerobic conditions exist in areas of tendinopathy that have a poor blood supply, and are the primary cause of neovascularization. Neovessels and their accompanying nerves, may be responsible for the pain in the tendinopathic tendon, which would account for the success of local injection of sclerosants such as Polidocanol in the management tendinopathy. Chronic tendinopathy may well be the final manifestation of a long-standing metabolic process in which inflammation, although an initiator, does not participate in the final histopathologic and biochemical features of chronic tendinopathy. It is important in understanding this hypothesis to recall the mechanism of tendon healing. A tendon heals by undergoing inflammatory (1–7 days of injury), proliferative (7–21 days), and remodeling (3 weeks–1 year) phases. Despite collagen maturation and remodeling, tendons are biochemically and metabolically less active than bone and muscle. Type III collagen synthesized by fibroblasts in the proliferative phase is gradually replaced by type I collagen from days 12 to 14, with a progressive increase in tensile strength.

Surgery for chronic Achilles tendinopathy yields worse results in nonathletic patients.

Abstract: Objective To report the outcome of surgery for chronic recalcitrant Achilles tendinopathy in nonathletic and athletic subjects. Design Case-control study. Setting University teaching hospitals. Patients We matched each of the 61 nonathletic patients with a diagnosis of tendinopathy of the Achilles tendon with an athletic patient with tendinopathy of the main body of the Achilles tendon of the same sex and age (±2 years). A match was possible for 56 patients (23 males and 33 females). Forty-eight nonathletic subjects and 45 athletic subjects agreed to participate. Interventions Open surgery for Achilles tendinopathy. Main Outcome Measure Outcome of surgery, return to sport, complication rate. Results Nonathletic patients were shorter and heavier than athletic patients. They had greater body mass index, calf circumference, side-to-side calf circumference differences, and subcutaneous body fat than athletic patients. Of the 48 nonathletic patients, 9 underwent further surgery during the study period, and only 25 reported an excellent or good result. Of the 45 athletic subjects, 4 underwent further surgery during the study period, and 36 reported an excellent or good result. The remaining patients could not return to their normal levels of activity. In all of them, pain significantly interfered with daily activities. Conclusions Nonathletic subjects experience more prolonged recovery, more complications, and a greater risk of further surgery than athletic subjects with recalcitrant Achilles tendinopathy.