Carlos Rodriguez de la Cruz

PLATELET-RICH PLASMA (PRP) TO TREAT CHRONIC UPPER PATELLAR TENDINOPATHIES

Background Upper patellar tendinopathies remain often chronic and rebel to a thorough conservative treatment. Moreover, the option of a surgical treatment could be disappointing. New treatments are being developed. Injection of PRP is one of these. Platelets contain lot of growth factors which would have the potentiality to enhance the healing process of tendons. Even if in vitro and animal experiments have demonstrated this stimulation of tendon healing process,1 clinical series are subject to controversy.2 Methods Twenty patients with chronic upper patellar tendinopathy were enrolled. Assessments [VAS, clinical examination with an algometer, algofunctional scores (IKDC and VISA-P), functional assessments (isokinetic and Optojump) and imagery (ultrasounds and MRI)] were made before infiltration of PRP, and 6 weeks and 3 months after. The PRP was obtained by an apheresis system (COM.TEC, Fresenius). Six millilitres of PRP were injected without local anaesthetic. One week after infiltration, patients started a 6-week standardised sub-maximal eccentric reeducation. Results We observed a very significant improvement of the algofunctional status as soon as 6 weeks after the infiltration of PRP, and continued to a lesser extent up to 3 months. During functional evaluation, pain decreased as well, but without significant improvement of performances. No significant improvements in the imagery were observed. Interestingly, patients who had a VAS equal or below 1 after 3 months post-infiltration were younger (24.7 vs 32.2 y.o.). Moreover, these younger patients had a significant increase of the IKDC score (p=0.003), a significant improvement of pain during isokinetic evaluations (p<0.05), and during Optojump assessments (p=0.01). Seventy-five percent of subjects were able to return to sport, even if only half of these patients recovered the same level than before the tendinopathy. Discussion/Conclusions This study demonstrates that a local infiltration of PRP associated with a submaximal eccentric protocol is efficient to improve symptoms of chronic upper patellar tendinopathies, non-responsive to classical conservative treatments. However, up to now, there is no consensus on the method to prepare the PRP. Indeed, each technique could provide a very different PRP (variations in the platelet concentrations and of the amount of red and white cells).

Lumbopelvic motor control and low back pain in elite soccer players: a cross-sectional study

ABSTRACT This study aimed to investigate the relationship between the history of low back pain and quality of lumbopelvic motor control in soccer players. Forty-three male elite soccer players (mean age, 18.2 ± 1.4 years) filled in questionnaires related to low back pain and attended a session to assess lumbopelvic motor control by means of five tests (the bent knee fall out test, the knee lift abdominal test, the sitting knee extension test, the waiter’s bow and the transversus abdominis test). A physiotherapist, blinded to the medical history of the participants, scored (0 = failed, 1 = correct) the performance of the players for each of the tests resulting in a lumbopelvic motor control score ranging from 0 to 5. Forty-seven per cent of the soccer players reported a disabling low back pain episode lasting at least two consecutive days in the previous year. These players scored worse lumbopelvic motor control than players without a history of low back pain (lumbopelvic motor control score of 1.8 vs. 3.3, P < 0.01). The between-groups difference was particularly marked for the bent knee fall out test, the knee lift abdominal test and the transversus abdominis test (P < 0.01). In conclusion, most soccer players with a history of low back pain had an altered lumbopelvic motor control. Further research should examine whether lumbopelvic motor control is etiologically involved in low back pain episodes in soccer players.

The cardiovascular impact of intense eccentric isokinetic exercise versus aerobic treadmill running

BACKGROUND: Regular physical activity is an important health factor, but intense physical stress can increase the risk of heart disease. OBJECTIVE:Our aim was to determine the potential cardiac repercussions of, and the oxidative stress resulting from a maximal eccentric isokinetic exercise and a 1-hour treadmill run at 75% ˙

Effects of twelve weeks of aerobic or strength training in addition to standard care in Parkinson’s disease: a controlled study

BACKGROUND Physical exercise in addition to standard care (SC) in patients with Parkinsons disease (PD) is now a common practice in many care units. However, exercises can cover a wide range of interventions, and the specific effects of different interventions still deserve to be further investigated. AIM The aim of this study was to compare the effects of 12 weeks of two different types of physical exercises with SC in patients suffering from PD. DESIGN Pseudo-randomized controlled trial. SETTING University laboratory for outcomes, University Hospital Centre for interventions. POPULATION Fifty-two outpatients suffering from mild to moderate PD at baseline. METHODS Participants were allocated to three groups: the strength training (ST) group performed individualized upper and lower limbs strength training, the aerobic training (AE) group performed tailored gradual aerobic cycling, and the third group received SC. The effects of the interventions on body function were assessed by measuring isokinetic concentric peak torque for knee extension and flexion, peak oxygen consumption (VO2peak) and peak work load (PWL) during an incremental maximal cycling test. Changes in mobility were evaluated from spatial-temporal gait features measured by mean of an accelerometer system and the Six-Minute Walk Distance (6MWD) Test. We used questionnaires to estimate health-related quality of life and habitual physical activity. RESULTS No significant changes in any outcome measures occurred in the SC group. More than 80% of the participants adequately completed the AE and the ST interventions. The ST group significantly improved all peak torque measures (P≤0.01), except knee extension in the least affected side (P=0.13). This group also improved the PWL (P=0.009) and 6mwd (P=0.03). The AE group improved the VO2peak (P=0.02) and PWL (P<0.001). CONCLUSIONS Physical fitness in patients with PD rapidly improved in compliance with training specificities, but better fitness hardly translated into better mobility and health-related quality of life. CLINICAL REHABILITATION IMPACT Physiotherapists can efficiently propose physical conditioning to patients with mild to moderate PD, but these interventions are insufficient to improve gait and participation. Notwithstanding, ST is an efficient intervention for improving walking capacity.

Elevation of cardiac and oxidative stress biomarkers after a running activity in sedentary subjects

Background: A fatty acid (FA) is a carboxilic acid with a long aliphatic chain, which is either saturated or unsaturated. Recently, the role of FA and particularly omega 3 and 6 has emerged as cardiovascular risk factor in the literature. The aim of our study was to establish reference value for these FA and to compare these results with data obtained in acute myocardial infarction (AMI) patients.1 Department of Clinical Chemistry of the University of Liege, Liege, Belgium 2 Department of Cardiology, CHU Sart-Tilman, Liege, Belgium 3 Department of Motricity Sciences of the University of Liege and CHU Sart-Tilman, Liege, Belgium Introduction: Novel high-sensitive cardiac troponin T (hsTnT) and I (TnI II) assays have the potential to detect myocardial injury with a higher sensitivity. The aim of the study was to assess the level of hsTnT and TnI II in patients with atrial fibrillation (AF) as compared to control and following direct current cardioversion. Levels of NT-proBNP, myeloperoxydase (MPO) and hs-CRP were concomitantly measured.

Effect of different warming-up protocols on time to exhaustion at maximal aerobic speed

Middle distance races are characterised by a start at high intensity without progression. Some studies focused on the warming-up (WU) effects on physiological parameters during race from 95% to 120% of the work rate at VO2max. The aim was to determine the efficiency of different WU protocols on time to exhaustion at maximal aerobic speed (M.A.S.). We recruited 11 middle distance runners (mean age 30±4 years, height 177± 7 cm, VO2max 59.7±6.4 mlO2.min-1.kg-1, M.A.S. 17.7±1.16 km/h). Subjects performed a triangular aerobic test to determine M.A.S. and three randomised rectangular tests at M.A.S. after three different WU protocols at 7 days of interval. The three WU protocols consist in no warming-up; 20 min WU at 55% of VO2max (low WU); 15 min WU AT 55% and 5 min at ((speed at LT 1 + speed at O.B.L.A.) / 2) (intense WU). After the WU, subjects observed 5 min rest before the rectangular test. Blood lactate concentration was measured four times (before WU, after WU, before and after rectangular test); whereas heart rate, VO2and ventilation were monitored continually. The mean heart rate during the rectangular test was higher (p<0.05) from the 1st–7th min after low and intense WU than without WU. The VO2max kinetic was the same in the three tests. Average blood lactate concentration was similar at the end of the race in the three protocols (6.9±0.8 mmol.l-1 without WU, 6.8±0.8 mmol.l-1low WU and 6.6±0.7 mmol.l-1 intense WU). Time to exhaustion at M.A.S. was higher (p<0.05) after intense WU. Results suggest that the intense WU has a positive effect on time to exhaustion at M.A.S. and therefore on aerobic performance. This is probably the result of a faster cardiovascular adaptation.