Anna Frohm

Eccentric treatment for patellar tendinopathy: a prospective randomised short-term pilot study of two rehabilitation protocols

Objective: To compare the efficacy and safety of two eccentric rehabilitation protocols for patients with symptomatic patellar tendinopathy. A new eccentric overload training device was compared with the present standard eccentric rehabilitation programme on a decline board. Design: Prospective, randomised clinical trial. Setting: Sports rehabilitation clinic, university sports laboratory, supplemented with home exercises. Patients: 20 competitive and recreational athletes, all with clinical diagnosis of patellar tendinopathy, verified by MRI or ultrasound imaging. Interventions: A 12-week rehabilitation period, either with bilateral eccentric overload strength training using the Bromsman device twice a week or with unilateral eccentric body load training using a decline board twice a week, supplemented with daily home exercises. Outcome measures: The primary outcome was pain and function, assessed by the Swedish Victorian Institute of Sport Assessment for Patella (VISA-P) score. Secondary outcome measures were isokinetic muscle torque, dynamic function and muscle flexibility, as well as pain level estimations using visual analogue scale (VAS). Side effects were registered. Results: Both treatment groups improved in the short term according to the VISA-P scores during the 12-week rehabilitation period. However, there were no significant differences between the groups in terms of pain and function. After a 3-month rehabilitation period, most patients could be regarded as improved enough to be able to return to training and sports. No serious side effects were detected in either group. Conclusion: In patients with patellar tendinopathy pain, two-legged eccentric overload training twice per week, using the new device (Bromsman), was as efficient and safe as the present standard daily eccentric one-legged rehabilitation-training regimen using a decline board.

A nine-test screening battery for athletes: a reliability study.

Studies have shown that reduced neuromuscular control or strength increases the risk of acute injuries. It is hypothesized that a non‐functional movement pattern can predispose for injuries. In the present paper a detailed description of a test battery consisting of nine different tests to screen athletic movement pattern is provided. The aim was to evaluate the inter‐ and intra‐rater reliability of the test battery on a group of male elite soccer players. Twenty‐six healthy elite soccer players (17–28 years) were screened. Eighteen participated at a second occasion 7 days later. No significant difference (P=0.31) was found between test occasion 1 (LS means 18.3, 95% confidence interval 14.9–21.7) and test occasion 2 (18.0, 14.4–21.7) in the mean total score of the test battery. No significant difference in the inter‐rater reliability was found between the eight physiotherapists at the two test occasions. The intra‐class correlation coefficient was 0.80 and 0.81, respectively. The test battery showed good inter‐ and intra‐rater reliability. The screening battery is easy to use for familiarized professionals and requires minimal equipment. However, further studies are needed to confirm the validity of the test battery in injury prevention, rehabilitation and performance enhancement.

Psychometric properties of a Swedish translation of the VISA-P outcome score for patellar tendinopathy

BackgroundSelf-administrated patient outcome scores are increasingly recommended for evaluation of primary outcome in clinical studies. The VISA-P score, developed at the Victorian Institute of Sport Assessment in Melbourne, Australia, is a questionnaire developed for patients with patellar tendinopathy and the patients assess severity of symptoms, function and ability to participate in sport. The aim of this study was to translate the questionnaire into Swedish and to study the reliability and validity of the translated questionnaire and resultant scores.MethodsThe questionnaire was translated into Swedish according to internationally recommended guidelines for cross-cultural adaptation of self-report measures. The reliability and validity were tested in three different populations. The populations used were healthy students (n = 17), members of the Swedish male national basketball team (n = 17), considered as a population at risk, and a group of non-surgically treated patients (n = 17) with clinically diagnosed patellar tendinopathy. The questionnaire was completed by 51 subjects altogether.ResultsThe translated VISA-P questionnaire showed very good test-retest reliability (ICC = 0.97).The mean (± SD) of the VISA-P score, at both the first and second test occasions was highest in the healthy student group 83 (± 13) and 81 (± 15), respectively. The score of the basketball players was 79 (± 24) and 80 (± 23), while the patient group scored significantly (p < 0.05) lower, 48 (± 20) and 52 (± 19).ConclusionsThe translated version of the VISA-P questionnaire was linguistically and culturally equivalent to the original version. The translated score showed good reliability.

Too little sleep and an unhealthy diet could increase the risk of sustaining a new injury in adolescent elite athletes

Little is known about health variables and if these variables could increase the risk of injuries among adolescent elite athletes. The primary aim was to present overall data on self‐perceived stress, nutrition intake, self‐esteem, and sleep, as well as gender and age differences, on two occasions among adolescent elite athletes. A secondary aim was to study these health variables as potential risk factors on injury incidence. A questionnaire was e‐mailed to 340 adolescent elite athletes on two occasions during a single school year: autumn semester and spring semester. The results show that during autumn semester, the recommended intake of fruits, vegetables, and fish was not met for 20%, 39%, and 43% of the adolescent elite athletes, respectively. The recommended amount of sleep during weekdays was not obtained by 19%. Multiple logistic regression showed that athletes sleeping more than 8 h of sleep during weekdays reduced the odds of injury with 61% (OR, 0.39; 95% CI, 0.16–0.99) and athletes reaching the recommended nutrition intake reduced the odds with 64% (OR, 0.36; 95% CI, 0.14–0.91). Our findings suggest that nutrition intake and sleep volume are of importance in understanding injury incidence.

Swedish translation and validation of a web‐based questionnaire for registration of overuse problems

The main aim of this study was to translate the Oslo Sport Trauma Research Center (OSTRC) Overuse Injury Questionnaire into Swedish. The validity and applicability of the questionnaire for studying overuse injuries among Swedish handball, volleyball, tennis, and orienteering top athletes were also examined. The back‐translation method was used for translation. An expert committee further developed it for use in a study of injuries in handball, orienteering, tennis, and volleyball. A 10‐week pretest was then conducted on 43 athletes, average age 21 (18–31) from these sports, during which time the athletes completed the modified OSTRC questionnaire on a weekly basis. In the 10th week, four additional questions were added in order to examine the questionnaires content validity. No major disagreement was found in the translation. The athletes perceived the web‐based questionnaire to be smooth and easy to complete, accurately capturing overuse injuries. However, suggestions were made to add questions relating to the hip for orienteerers and to the hand/fingers for handball players. The average prevalence of overuse injuries for all athletes, in any anatomical area was 22% (95% confidence interval 20–25). Construct validity appeared to be high, and we therefore suggest that the questionnaire may be used when studying overuse injuries in different sports.

Injuries and Associated Risk Factors Among Adolescent Elite Orienteerers: A 26-Week Prospective Registration Study

CONTEXT In orienteering, the number of injury-registration studies is limited. Most researchers have used a cross-sectional design during specific events and, therefore, have mainly identified acute injuries. OBJECTIVE To determine the prevalence of injuries by registering acute and overuse injuries in adolescent elite orienteerers over 26 weeks and to study the variation of injury prevalence over the season and the potential risk factors. DESIGN Cohort study. SETTING Two high schools in Sweden with national orienteering teams. PATIENTS OR OTHER PARTICIPANTS All athletes (33 adolescent girls, 31 adolescent boys; age = 17 ± 1 years) from 2 high schools with orienteering teams. MAIN OUTCOME MEASURE(S) We used a weekly Web-based questionnaire to identify the incidence and prevalence of injuries and training variables. Risk factors for injury were calculated using multiple linear regression techniques. RESULTS The average weekly prevalence of overuse and acute injuries was 35.7% (95% confidence interval = 34.8%, 36.6%) and 1.7% (95% confidence interval = 1.3%, 2.1%), respectively; overuse injuries (78.0%, n = 85) accounted for the majority. The incidence of acute and overuse injuries was highest for the foot/lower leg (48.6%, n = 53), and 71.6% (n = 78) of all injuries affected the foot/lower leg and knee area. Time to the first reported injury was associated with training volume (β = 0.184, P = .001), competition time (β = -0.701, P = .009), running on asphalt roads (β = -0.348, P = .008), and running on forest surfaces and trails (β = -0.331, P = .007), with a model fit of r( 2) = 0.50 (intercept = 2.196, P < .001). During the study, we observed a weekly increase (0.3%) in the prevalence of overuse injuries in the foot/lower leg (r( 2) = 0.33, P = .001); the highest prevalence (26.9%) was at the beginning of the competitive season. CONCLUSIONS Overuse injuries, predominately in the foot/lower leg area, were more common than acute injuries in adolescent elite orienteerers. These injuries had the highest prevalence at the beginning of the competitive season; therefore, this period can be seen as a possible risk factor for sustaining overuse injuries in the foot/lower leg.

Multiple factors explain injury risk in adolescent elite athletes: Applying a biopsychosocial perspective

Many risk factors for injury are presented in the literature, few of those are however consistent and the majority is associated with adult and not adolescent elite athletes. The aim was to identify risk factors for injury in adolescent elite athletes, by applying a biopsychosocial approach. A total of 496 adolescent elite athletes (age range 15‐19), participating in 16 different sports, were monitored repeatedly over 52 weeks using a valid questionnaire about injuries, training exposure, sleep, stress, nutrition, and competence‐based self‐esteem. Univariate and multiple Cox regression analyses were used to calculate hazard ratios (HR) for risk factors for first reported injury. The main finding was that an increase in training load, training intensity, and at the same time decreasing the sleep volume resulted in a higher risk for injury compared to no change in these variables (HR 2.25, 95% CI, 1.46‐3.45, P<.01), which was the strongest risk factor identified. In addition, an increase by one score of competence‐based self‐esteem increased the hazard for injury with 1.02 (HR 95% CI, 1.00‐1.04, P=.01). Based on the multiple Cox regression analysis, an athlete having the identified risk factors (Risk Index, competence‐based self‐esteem), with an average competence‐based self‐esteem score, had more than a threefold increased risk for injury (HR 3.35), compared to an athlete with a low competence‐based self‐esteem and no change in sleep or training volume. Our findings confirm injury occurrence as a result of multiple risk factors interacting in complex ways.

NINE TEST SCREENING BATTERY – INTRA-RATER RELIABILITY AND SCREENING ON ICELANDIC MALE HANDBALL PLAYERS

Background Injuries are common in handball, but little is known about their risk factors. One potential screening test to identify player at risk is the Nine Test Screening Battery (NTSB). Objective To test the intra-rater reliability of the NTSB and compare the results from NTSB between subgroups in the cohort. Design Test-retest design used for the intra-rater reliability test of NTSB. Experimental design used for testing senior and national team players. Setting Icelandic male handball players. Participants A total of 50 junior players from 5 clubs participated in the intra-rater reliability test. Also, 115 seniorplayers from 13 of 16 teams in the two highest divisions in Iceland and 26 Icelandic national team players (8 playing abroad), participated. Main outcome of measurement Intra-rater reliability of NTSB. Difference in NTSB scores between subgroups. Results There was a strong intra-rater correlation between the test-retest sessions, ICC: 0.95 T1: 21.6±3.5 (95% CI: 20.7–22.6), T2: 22.0±3.4 (95% CI: 21.0–22.9). The retest had significantly higher total score than the first test (P=.041), indicating some learning effect. No difference was found in total score of NTSB between teams, level of play or different age and height groups. However, goalkeepers had higher total score than other players (P=.001). Observing NTSB separately, junior players had significantly less core stability than senior and national team players (tests 5-7, P≤.006) and more mobility in trunk and shoulders (tests 8-9, P<.001). National team players were stronger in abdominal muscles (test 5, P=.003) and more flexible in active hip flexion (test 4, P=.03) than senior players in division 1 and 2. Conclusions NTSB seems to be reliable in test-retest, but some learning effect was noticed. Junior players showed less core stability and more trunk and shoulder mobility than senior players.

Can movement tests predict injury in elite orienteerers? An 1-year prospective cohort study

ABSTRACT The purpose of this study was to determine the predictive value of the movement test, the nine test screening battery (9TSB) and an orienteering-modified version of the 9TSB (M9TSB), for lower extremity injury in adolescent elite orienteerers. Design Prospective cohort study. Participants Forty adolescent (15–19 years), male and female orienteerers from two Swedish orienteering high schools performed the 9TSB, M9TSB, and recorded injuries based on a web-based questionnaire for 52 weeks. Results The results showed no difference in composite scores between injured and non-injured orienteerers for either 9TSB (p = 0.75) or M9TSB (p = 0.83). The optimal cut-off score was calculated at 25 for the 9TSB, with sensitivity and specificity of 74% and 41% respectively, and 17 for the M9TSB, with sensitivity and specificity of 47% and 61%, respectively. There was no association between 9TSB or M9TSB and injury (OR1.38, 95% CI: 0.39–4.92). Including athletes with a history of injury did not result in improved prediction of injury for the 9TSB or M9TSB (OR 2.84, 95% CI: 0.50–16.10). Conclusion Low sensitivity and specificity were obtained for both the M9TSB and the 9TSB. Thus, it is not recommended that physiotherapists use the nine test screening battery to predict lower extremity injury in orienteerers.

High Injury Burden in Elite Adolescent Athletes: A 52-Week Prospective Study

CONTEXT   Our understanding of the injury burden in elite adolescent athletes in most sports is limited or unknown because of the lack of prospective, long-term injury studies. OBJECTIVE   To describe injury patterns in terms of type, location, prevalence and incidence, recurrence, and severity grade; time to first injury; and prevalence of illness in elite adolescent athletes and to compare differences in injury data by sex and sport type. DESIGN   Cohort study. SETTING   Fifteen national sports high schools in Sweden. PATIENTS OR OTHER PARTICIPANTS   Participants were 284 elite adolescent athletes (boys = 147, girls = 137; median age = 17 years; 25th-75th percentile range = 16-18 years) competing at a high national level for their age in athletics (track and field), cross-country skiing, downhill skiing, freestyle skiing, handball, orienteering, or ski orienteering. MAIN OUTCOME MEASURE(S)   All athletes were monitored weekly over 52 weeks, using a validated online questionnaire to identify injury type, location, prevalence or incidence, and severity grade; time to first injury; and prevalence of illness. RESULTS   Among all athletes, 57.4% reported at least 1 new injury, whereas the 1-year injury prevalence was 91.6%. The overall injury incidence was 4.1/1000 hours of exposure to sport, and every week, on average, 3 of 10 (30.8%) elite adolescent athletes reported being injured. Of all injuries from which athletes recovered, 22.2% (n = 35) resulted in absence from normal training for at least 2 months. Female athletes reported higher ( P < .05) average weekly injury prevalence and substantial injury prevalence (injuries leading to a moderate or severe reduction in sport performance or participation or time loss) than male athletes. CONCLUSIONS   A considerable number of elite adolescent athletes were injured weekly, resulting in serious consequences for sport participation, training, or performance (or a combination of these). Appropriately designed interventions to prevent knee and foot injuries will target both the greatest number of injuries and the injuries with the most serious consequences in elite adolescent athletes.