Bülent Ülkar

Proprioception and ankle injuries in soccer.

Because soccer attracts many participants and leads to a substantial number of injuries, especially of the lower extremities, it is important to study possibilities for injury prevention and proper rehabilitation to return safely to activities. Ankle sprains can be prevented by external ankle supports and proprioceptive-coordination training, especially in athletes with previous ankle sprains. Proprioception is a broad concept that includes balance and postural control with visual and vestibular contributions, joint kinesthesia, position sense, and muscle reaction time. Proprioceptive feedback is crucial in the conscious and unconscious awareness of a joint or limb in motion. Enhancement of functional joint stability by proprioceptive (or neuromuscular) training is important both in prevention and rehabilitation of athletic injuries.

Effect of positioning and bracing on passive position sense of shoulder joint

Objective: To examine the effects of positioning and sleeve type bracing on passive position sense of shoulder joints of healthy untrained subjects. Method: A cross over study was carried out on 26 subjects (13 male, 13 female) with a proprioception measurement device. The selected method of testing was passive reproduction of a target angle. Both shoulder joints of all the subjects were evaluated with and without a compressive neoprene sleeve type of brace at two different start positions (45° internal rotation, 75° external rotation) with an angular rotational movement at a constant speed of 0.5°/s. The angular displacements from the target angles at the end of the reproduction tests were recorded as position sense deficit scores. Results: The overall mean (SD) deficit score (0.99 (0.06)) was significantly (p<0.001) lower with the brace than without, and the overall mean deficit score was significantly (p<0.001) higher at the 45° internal rotation start position than at the 75° external rotation start position. However, there was no significant (p>0.05) interaction between brace application and start position. Conclusion: Terminal limits of range of motion facilitate the position sense of shoulder joints. Compressive brace application improves the passive positioning sense possibly by stimulating cutaneous mechanoreceptors.

Comprehensive isokinetic knee measurements and quadriceps tendon evaluations in footballers for assessing functional performance

Objectives: To ascertain whether detailed isokinetic knee muscle testing reflects the results of other functional measurements in footballers and to look for any correlations between quadriceps tendon thickness and knee strength. Methods: Ultrasonographic evaluation of the quadriceps tendon (Hitachi EUB-405), isokinetic knee testing (Biodex System 3), and sprint measurements using telemetric photoelectric cells (Chronometre Prosport ESC TX02) were carried out on 29 elite footballers. Jumping capacity was evaluated using Bosco’s jumping mat (Ergojump). Anaerobic fitness was assessed by auricular capillary blood lactate measurements (YSI Model 1500 Sport Lactate Analyzer). Results: Quadriceps tendon thickness correlated positively with jumping and sprint measurements and negatively with extensor and flexor strength. However, these correlations did not reach statistical significance. There were significant correlations between knee extensor strength at 60 °/s and jumping or sprint measurements and between the extension acceleration values of both knees during isokinetic tests at 240 °/s and the sprint measurements. No significant correlation was found between the fatigue ratio values of both knees at 240 °/s and the calculated fatigue ratios from the sprint measurements. Conclusions: Apart from a few variables which correlated with the performance tests, the isokinetic studies did not fully predict the various functional measurements. Neither was there any relation between the quadriceps tendon measurements and the knee strength values nor with the functional performance.

Can heart rate values obtained from laboratory and field lactate tests be used interchangeably to prescribe exercise intensity for soccer players

This study was undertaken to investigate the relationship between blood lactate concentration ([La]) and heart rate (HR) values obtained during treadmill and field tests at fixed velocities with respect to interchangeability of results to be used in exercise prescription. A total of 22 male soccer players participated in the study. Each player performed exercise tests on a motorized treadmill and in the field with 3-min runs and 30 s allowed for blood sampling. During both tests, velocities at the first, second, and third stages were 8, 10, and 12 km·hr−1, respectively. Velocity was then increased by 1 km·hr−1 every 3 min until exhaustion. During the field test, players ran on artificial turf on a 120-m hexagonal track marked with cones placed 20 m apart. Running velocity was controlled by means of audio signals. Blood samples were analyzed immediately with an automated lactate analyzer. HR was monitored continuously at 5-s intervals. Data were analyzed with Student’s pairedt tests to look for differences between treadmill and field data. Coefficients of variation and Bland-Altman plots assessed agreement of HR and blood [La] values between the 2 tests. Although running velocities corresponding to a fixed blood [La] of 4 mmol L−1 showed significant differences between treadmill and field tests (15.9±0.9 vs 14.1 ±0.7 km·h−1, respectively) (P < .01), no significant difference between HR values was noted (190±7 vs 187±7, field vs laboratory, respectively). Overall, the mean intermeasurement coefficient of variation was 4.8% (±0.9%) for HR. Although the lowest coefficient of variation (2.4%) was found, fairly wide differences between individual field and laboratory HR values at velocities corresponding to fixed blood [La] of 4 mmol·L−1 cast doubt on the interchangeability of tests.

Meralgia paresthetica: A long-standing performance-limiting cause of anterior thigh pain in a soccer player

Meralgia paresthetica is an entrapment neuropathy of the lateral femoral cutaneous nerve. Patients with this disorder are affected by thigh pain, paresthesia, and sensory loss in the distribution of the nerve. More than 80 possible causes have been reported. In most cases, the cause is considered to be idiopathic entrapment of the lateral femoral cutaneous nerve. In other cases, however, traumatic irritation to the nerve adjacent to the anterior superior iliac spine and inguinal ligament is thought to be responsible. Described causes of meralgia paresthetica have ranged from chronic disturbance of the nerve due to a tense inguinal ligament in the case of a leg-length discrepancy; tight trousers; wallet carried in front pants pockets; obesity or pregnancy; or a mass compressing the nerve. Nerve entrapment syndromes, although not uncommon, are seldom diagnosed as being sports-related. Epidemiologic studies in sports medicine have mainly focused on musculoskeletal injuries. In the case presented here, a professional soccer player with symptoms of meralgia paresthetica underwent surgery and was found to have a fibrous band traversing the lateral femoral cutaneous nerve along its course on the sartorius muscle. The band crossed over the nerve at a point 3 cm away from the inguinal ligament where the nerve pierced it while leaving the pelvis.

Glucosamine Supplementation after Anterior Cruciate Ligament Reconstruction in Athletes: A Randomized Placebo-controlled Trial

Although glucosamine is commonly consumed by athletes, its effectiveness in sports injuries is still under debate. We aimed to investigate the effects of glucosamine to the rehabilitation outcomes of anterior cruciate ligament (ACL) reconstructed athletes. Glucosamine-sulfate (1000 mg daily, for 8 weeks) was administered to half of the cohort of 30 male athletes, the other half used a placebo. Both groups received the same rehabilitation protocol. Knee pain and functions were evaluated by a visual analogue scale (VAS), International Knee Documentation Committee (IKDC) and Lysholm scores before and after oral administration. Additionally, an isokinetic test was performed after the administration period. The scores revealed significant improvements in both groups after 8 weeks, but no significant difference was detected between groups in any of the parameters. Glucosamine supplementation did not improve the rehabilitation outcomes of athletes after ACL reconstruction. This is the first study investigating this topic. Further studies will help to obtain clear evidence about glucosamine efficacy on ACL injured or ACL reconstructed athletes.

Comparative body fat assessment in elite footballers

Much attention is directed to measuring body composition, particularly fat mass, the aim being to estimate the untoward health consequences of excessive amounts of fat or to assess physical fitness. There are two main types of method of measurement: reference and prediction techniques. The former consist of measuring body density or total body water and dual energy x ray absorptiometry, and the latter include measurement of skinfold thickness and bioelectrical impedance analysis.1 The Tanita body fat analyser is a commercially available foot to foot bioelectrical impedance analysis system.2 It is a novel method because it measures the weight and percentage of body fat simultaneously while the subject stands …

P-96 Return to preinjury level of activity after ACL reconstruction

Anterior cruciate ligament (ACL) rupture is one of the most common sports-related injuries to the knee.The ability to return to participation at the preinjury level is a key milestone in successful outcome after ACL reconstruction. Many athletes with apparently good knee function do not return to their preinjury level of sport. The aim of this study was to investigate the rate of return to preinjury level of activity and causes of failure in Anterior Cruciate Ligament (ACL) reconstructed patients rehabilitated in our clinic. 41 patients (mean age 30 ± 8,7); 19 recreative, 22 competitive athletes participated in the study. A self-report questionnaire was used to collect data at 1-3 years after ACL reconstruction, regarding the level of athletic activity, reason of failure to return to sport and subjective knee function by Lysholm Knee Scoring Scale (LKSS). 17 (41,4%) of the patients were able to return to preinjury level of athletic activity. 11 of them were competitive (50% of competitive athletes), 6 were recreative athletes (31,5% of recreative athletes). Among 24 athletes who failed to return to preinjury level of athletic activity reported the cause of failure as; 10 (41,7%) feeling of weakness and insufficiency, 9 (37,5%) fear of reinjury and 5 (20,8%) self-decision. Mean LKSS score of patients returned to preinjury level of activity were 97,2, whereas the score for noncompliers were 90,3. An important objective of anterior cruciate ligament (ACL) reconstruction is to enable patients to return to their preinjury sport or recreational activity. Objective physical recovery and returning to the preinjury sport and recreational activity may not necessarily coincide after ACL reconstruction, which raises the question of what other factors could impact on returning. Clinical decision making for return to sports after ACL reconstruction is a challenging process. Return to sport rates to pre-injury level of activity after ACL reconstructions are poor. There was no significant correlation between LKSS scores and return to preinjury level of activity in this study. There is growing evidence to suggest that psychological factors matter and this may have important implications for clinical practice. Majority of the patients participated in this study also remarked fear of reinjury and feeling of weakness and insufficiency to return athletic activities. Postoperative rehabilitation programmes could be warranted to improve the rate of return to sport and recreational activities. The reasons of failure to return to athletic activity are mostly found to be subjective and psychological. Additional research is needed to identify objective criteria and a setting of functional testing to detect the appropriate phase to return to sport besides a well-structured functional rehabilitation program to improve clinical decision making for return to sports after ACL reconstruction.