Annette Heijne

Early versus late start of open kinetic chain quadriceps exercises after ACL reconstruction with patellar tendon or hamstring grafts: a prospective randomized outcome study

The purpose of the present investigation was to evaluate physical outcome after anterior cruciate ligament (ACL) reconstruction with early versus late initiation of open kinetic chain (OKC) exercises for the quadriceps in patients operated on either patellar tendon or hamstring grafts. Sixty-eight patients, 36 males and 32 females, with either patellar tendon graft (34 patients) or hamstring graft (34 patients) were enrolled in this study. All patients were randomly allocated to either early (the 4th postoperative week) or late (the 12th postoperative week) start of OKC exercises for the quadriceps, resulting in four subgroups: patellar tendon reconstruction, early start (P4) or late start (P12) of OKC quadriceps exercises, hamstring tendon reconstruction, early start (H4) or late start (H12) of quadriceps OKC exercises. Prior to surgery and 3, 5 and 7 months later, assessments of range of motion (goniometer), anterior knee laxity (KT-1000), postural sway (KAT 2000), thigh muscle torques (Kin–Com dynamometer) and anterior knee pain (anterior knee pain score) were evaluated. No significant group differences were found in terms of range of motion 3, 5 and 7 months postoperatively. The H4 group showed a significantly higher mean difference of laxity over time of 1.0 mm (CI: 0.18–1.86) than the P4 group (P = 0.04). Within the same type of surgery, the H4 against the H12, the mean difference over time was 1.2 mm (0.37–2.1) higher in the H4 group than in the H12 group (P = 0.01). There were no significant group differences in terms of postural sway or anterior knee pain at the different test occasions. Significant differences in trends (changes over time) were found when comparing the four groups, for both quadriceps muscle torques (P < 0.001) and hamstring muscle torques (P < 0.001). All groups, except the P4 group, reached preoperative values of quadriceps muscle torques at the 7 months follow-up. In the H4 and the H12 groups, significantly lower hamstring muscle torques at the 7 months follow-up compared with preoperative values were found. In conclusion, early start of OKC quadriceps exercises after hamstring ACL reconstruction resulted in significantly increased anterior knee laxity in comparison with both late start and with early and late start after bone–patellar tendon–bone ACL reconstruction. Furthermore, the early introduction of OKC exercises for quadriceps did not influence quadriceps muscle torques neither in patients operated on patellar tendon nor hamstring tendon grafts. On the contrary, it appears as if the choice of graft affected the strength of the specific muscle more than the type of exercises performed. Our results could not determine the appropriate time for starting OKC quadriceps exercises for patients who have undergone ACL reconstruction with hamstring tendon graft. Future studies of long-term results of anterior knee laxity and functional outcome are needed.

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.

Predictive factors for 12-month outcome after anterior cruciate ligament reconstruction

There is a lack of knowledge regarding predictive factors for a successful clinical outcome after an anterior cruciate ligament (ACL) reconstruction. The aim was to investigate pre‐operative factors that may predict good outcomes as measured with the subscales Function in sports and recreation and Quality of life in Knee injury Osteoarthrithis Outcome Score (QOL‐KOOS), one‐leg hop test and Tegner Activity Scale 12 months after ACL reconstruction. Sixty‐four patients, operated with either patellar or hamstring tendon graft, were included. Demographics, range of motion, anterior knee laxity, pivot shift, muscle‐torques, anterior knee pain (AKP) and knee function were registered pre‐operatively and used in a multiple regression model. Results show less degree of AKP and low influence on knee function to be the most important predictors for good outcome in Sport/Rec‐KOOS (explained 31% of variances). Less AKP was in addition the most important predictor for QOL‐KOOS (14%). Patellar‐tendon graft, in favor of hamstring tendon graft, explained 8% of the improvement in the Tegner Activity Scale. In conclusion, a low degree of AKP was found to be the most important predictor for good clinical outcome 12 months after ACL reconstruction. Future studies, including psychological parameters, should use analyses that have the potential to control for independency between variables.

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.

Responsiveness of the One-leg Hop Test and the Square Hop Test to Fatiguing Intermittent Aerobic Work and Subsequent Recovery

Abstract Ros, AGM, Holm, SE, Fridén, C, and Heijne, A.I.-L.M. Responsiveness of the one-leg hop test and the square hop test to fatiguing intermittent aerobic work and subsequent recovery. J Strength Cond Res 27(4): 988–994, 2013—The purpose of the present study was to evaluate the responsiveness of the 1-leg hop test and the square hop (SH) test to fatiguing intermittent aerobic work and during recovery. A further aim was to study sex differences in trends. Members of 4 sub-elite-level soccer teams were invited to participate. Ten men (mean ± SD) aged 20.7 ± 3.4 years and 10 women aged 21.8 ± 4.8 years accepted to participate in the test. The Yo-Yo intermittent Endurance test Level 2, was used as a standardized sport-specific fatiguing protocol. The 1-leg hop test and the SH test were performed before, immediately after, 15, and 30 minutes after the fatiguing exercise. To quantify the level and progression of fatigue and recovery, blood lactate and heart rate were measured, and general fatigue was estimated on Borgs rating of perceived exertion scale. No significant difference in performance in either of the hop tests was found immediately after intermittent aerobic fatiguing work. Performance in the 1-leg hop test significantly decreased (p = 0.002), whereas that in the SH test increased (p = 0.001) between baseline and 15–30 minutes after fatiguing work. No significant difference in trends between sexes was found. The performance in the 1-leg hop test significantly decreased during 30 minutes of recovery compared with that in the nonfatigued conditions and might therefore be used on the field as a complement to other physical parameters to detect remaining fatigue. Note that the 1-leg hop test did not immediately respond to intermittent aerobic work. It is not recommended to use the SH test for measuring fatigue and subsequent recovery because the performance constantly increased despite the present objective and subjective fatigue.

Oral contraceptives do not affect muscle strength and hop performance in active women.

Objective:The primary aim of this study was to compare muscle strength in the upper and lower limb, as well as hop performance during oral contraceptive (OC) use with non-OC use in the same woman. A secondary aim was to compare muscle strength and hop performance within 3 specific phases of an OC cycle, as well as during a menstrual cycle of the corresponding cycle days (non-OC cycle). Design:Crossover. Setting:Research laboratory. Participants:Seventeen moderate to highly recreationally active women participated in the study. Intervention:Observational study with no intervention. Main Outcome Measures:Maximal isokinetic muscle strength of knee extensors, isometric handgrip strength, and 1-leg hop test for distance were measured during 1 OC cycle and 1 non-OC cycle at 3 specific phases, respectively, using a crossover design. Results:No significant differences were found in terms of muscle strength and hop performance between the OC cycle and the non-OC cycle. Furthermore, no significant difference in muscle strength and hop performance could be demonstrated within the OC cycle or within the phases of the menstrual cycle except from maximal isokinetic muscle strength in the knee extensors detected between the early follicular phase and the luteal phase. Conclusions:We found no support for any significant influence of OC use on muscle strength and hop performance in healthy moderately active women.

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.

Assessment by portfolio in a physiotherapy programme

The aim of the paper is to describe the introduction of a portfolio method of teaching and learning, and to describe students’ perceptions of the method as well as a peer-review system in a course, in the physiotherapy programme, at the Karolinska Institutet. A further aim was to describe the level of grades over time. A modified form of a showcase portfolio method together with a three-graded assessment criteria was introduced into the course. Students, over five semesters, were included in the project (n = 287) of which 91% answered questions and statements regarding their perception of the assessment method and the peer-review system. All portfolios were graded in a scale of three: fail, pass and pass with distinction. The majority of students were satisfied and reported positive learning effects with the assessment method and review system. However, the students asked for more guidance in how to give feedback. During these five semesters, the percentage of students that passed with distinction increased and the percentage of students that failed decreased. Three years after implementing the portfolio, our impression is that the method encourages students to take a more active part in learning and leads to a deeper approach to knowledge.