David F. Gerrard

Longitudinal study of physical activity and inactivity in preschoolers: the FLAME study.

PURPOSE To investigate patterns of activity and inactivity in a birth cohort of children followed from 3 to 5 yr and to investigate whether changes in activity occurred over time. METHODS Two hundred and forty-four children (44% female) were seen annually at 3, 4, and 5 yr. Physical activity and inactivity was measured by questionnaire (parent-proxy) and by Actical accelerometers for five consecutive days (24-h monitoring) each year in children and once in each parent for 7 d (69% with data). RESULTS Retention of participants was high (92%). Viable accelerometry data were obtained for 76-85% of children at each age. Reliability estimates ranged from 0.80 (3 yr) to 0.84 (5 yr). Day of the week, season, sex, hours of childcare, or birth order did not affect daily average accelerometry counts (AAC) at any age. Parental activity correlated weakly with the childs activity at 3 and 4 yr (r values = 0.17-0.28), but only the fathers activity remained a significant predictor of the childs activity after adjustment for confounders. Children spent approximately 90 min.d in screen time (television, videos, DVD, and computers) with an additional 90 min in other sedentary activities (reading, drawing, and music). Physical activity was significantly reduced at 4 and 5 yr compared with 3 yr in both sexes, whether measured as AAC (24-h data, awake time only, weekend days, weekdays), time in moderate or vigorous activity, or from parental reports of activity. CONCLUSION Levels of physical activity declined in boys and girls between the ages 3 and 4-5 yr, whether using objective measures or parental reports of activity.

Effectiveness of external ankle support : Bracing and taping in rugby union

SummaryAnkle inversion sprain is common in rugby. This review outlines research evidence relating to the effects of external ankle support by means of bracing and taping, on the incidence of ankle injuries, how performance is affected by support, how support may act at the joint (with respect to end range of motion, strength, resistive torque, muscle activation patterns and proprioception) to prevent injury, and how exercise changes the effectiveness of support. In addition, the implications of the laws of rugby for the use of external support are discussed. Prospective epidemiological studies have shown a decrease in the incidence of ankle injury with external ankle support use. The effectiveness of external ankle support was dependent upon the material properties and application method of the tape or brace, and on the athlete’s status of ankle stability or previous injury. Experimental studies have indicated that the degree of ankle inversion restriction provided, and the degree of loss of restriction after exercise, were dependent upon the external support tested. External ankle support has been reported to have no effect on performance, or to have an adverse effect on performance in a variety of movement tasks. No prophylactic external ankle support has been shown to improve performance. If an external support is to provide mechanical support to a ligament it should exceed the strength of the ligament, which for the anterior fibular ligament is a force limit of between 6 and 56kg. Tape can provide only limited mechanical support of the ankle joint complex, but it may have pro-prioceptive effects. Taping may work as a psychological reminder, so that the athlete consciously moderates lower limb—loading behaviour. There is equivocal evidence of the effect of brace use on ground reaction force excursions, balance ability and ankle strength. It is concluded that while there have been many investigations of the effects of tape and some forms of brace on ankle range of motion with and without exercise, there is equivocal evidence regarding the mechanism by which an external support acts. It is recommended that future research address the effects of external ankle support during dynamic exercise and that brace manufacturers utilise the information in the development of future brace designs to help reduce the risk of ankle inversion sprain injury. As external support can decrease the incidence of ankle inversion sprain the International Rugby Board should consider the use of ankle braces in rugby, allowing for stiff lateral components of the brace.

Sports injuries and illnesses in the 2009 FINA World Championships (Aquatics)

Background Analysis of injury and illness prevalence in elite sport provides the basis for the development of prevention programmes. Objectives To analyse the frequency and characteristics of injuries and illnesses occurring during the 13th Federation Internationale de Natation (FINA) World Championships 2009. Design Prospective recording of newly incurred injuries and illnesses. Methods The 13th FINA World Championships hosted 2592 athletes from 172 countries in the disciplines of swimming, diving, synchronised swimming water polo and open water swimming. All team physicians or physiotherapists were asked to complete daily a standardised reporting form for all newly incurred injuries and illnesses for their teams. To cover teams without medical staff, the physicians of the Local Organizing Committee also submitted daily report forms. Results 171 injuries were reported resulting in an incidence of 66.0 per 1000 registered athletes. The most affected body parts were the shoulder (n=25; 14.6%), and head (n=21; 12.3%). Half of the injuries occurred during training. The most common cause of injury was overuse (n=61; 37.5%). 184 illnesses were reported resulting in an incidence of 71.0 per 1000 registered athletes. The respiratory tract was most commonly affected (n=91; 50.3%) and the most frequently classified cause was infection (n=81; 49.2%). The incidence of injuries and illnesses varied substantially among the five disciplines, with the highest incidence of injury in diving and the lowest in swimming. Conclusions As the risk of injury varied with the discipline, preventive measures should be discipline specific and focused on minimising the potential for overuse. As most of the illnesses were caused by infection of the respiratory and gastrointestinal tract, preventive interventions should focus on eliminating common modes of transmission.

DEXA: a practical and accurate tool to demonstrate total and regional bone loss, lean tissue loss and fat mass gain in paraplegia

Persons with spinal cord injury lose lean tissue mass and bone but gain body fat. There is a need to quantify the magnitude of these changes in body composition because there are associated skeletal and cardiovascular health risks. We have compared total body and regional (lower limb) differences in body composition in a group of males with paraplegia and in healthy able-bodied males matched for age, and height using dual energy X-ray absorptiometry. Although patients and controls had similar body mass indices, significant reductions in lean tissue mass (16% less) and bone (12% less) were observed in those with spinal cord injury. Group differences were even more pronounced in the lower limb. DEXA also revealed large increases in fat mass in subjects who did not look obese, total fat mass being 47% higher in the paraplegic group. We suggest that DEXA provides a simple and practical means to quantify both whole body and regional changes in body composition associated with spinal cord injury.

Manual Physical Therapy and Exercise Versus Electrophysical Agents and Exercise in the Management of Plantar Heel Pain: A Multicenter Randomized Clinical Trial

STUDY DESIGN Randomized clinical trial. OBJECTIVE To compare the effectiveness of 2 different conservative management approaches in the treatment of plantar heel pain. BACKGROUND There is insufficient evidence to establish the optimal physical therapy management strategies for patients with heel pain, and little evidence of long-term effects. METHODS Patients with a primary report of plantar heel pain underwent a standard evaluation and completed a number of patient self-report questionnaires, including the Lower Extremity Functional Scale (LEFS), the Foot and Ankle Ability Measure (FAAM), and the Numeric Pain Rating Scale (NPRS). Patients were randomly assigned to be treated with either an electrophysical agents and exercise (EPAX) or a manual physical therapy and exercise (MTEX) approach. Outcomes of interest were captured at baseline and at 4-week and 6-month follow-ups. The primary aim (effects of treatment on pain and disability) was examined with a mixed-model analysis of variance (ANOVA). The hypothesis of interest was the 2-way interaction (group by time). RESULTS Sixty subjects (mean [SD] age, 48.4 [8.7] years) satisfied the eligibility criteria, agreed to participate, and were randomized into the EPAX (n = 30) or MTEX group (n = 30). The overall group-by-time interaction for the ANOVA was statistically significant for the LEFS (P = .002), FAAM (P = .005), and pain (P = .043). Between-group differences favored the MTEX group at both 4-week (difference in LEFS, 13.5; 95% CI: 6.3, 20.8) and 6-month (9.9; 95% CI: 1.2, 18.6) follow-ups. CONCLUSION The results of this study provide evidence that MTEX is a superior management approach over an EPAX approach in the management of individuals with plantar heel pain at both the short- and long-term follow-ups. Future studies should examine the contribution of the different components of the exercise and manual physical therapy programs. LEVEL OF EVIDENCE Therapy, level 1b.

The New Zealand Rugby Injury and Performance Project: II. Previous injury experience of a rugby-playing cohort.

The Rugby Injury and Performance Project (RIPP) is a prospective cohort study by a multidisciplinary research group. Rugby injuries constitute an important area for research because rugby union is New Zealands national sport and because of the considerable cost of all sports injury acknowledged by the Accident Rehabilitation and Compensation Insurance Corporation (ACC). The initial phase of data collection in the RIPP involved a pre-season questionnaire which, among other things, sought to establish variables relating to the past injury experience of players. The influence of previous injury, the use of safety equipment and the availability and significance of medical advice were among the variables identified by individual questionnaires. This paper analyses the responses to pre-season questions about injury experience in the previous 12 months. In so doing, it identifies baseline data which will be used to address a possible relationship between past injury experience and the prediction of injury during the season.

Effects of indomethacin and celecoxib on renal function in athletes

INTRODUCTION Strenuous exercise induces a marked reduction in renal hemodynamics. Prostaglandins (PG) play an important role in maintaining renal integrity in the face of hemodynamic changes. Inhibition of cyclooxygenase (COX) and thus PG formation can further compromise renal perfusion. The role of selective COX-2 inhibition on renal hemodynamics during exercise has not been investigated. METHODS Twelve healthy males (22-47 yr) took part in a randomized placebo controlled study investigating the effects of nonselective COX inhibition (indomethacin) and COX-2 selective inhibition (celecoxib) on renal hemodynamics during exercise. Renal blood flow (RBF), glomerular filtration rate (GFR), and free water clearance were measured using standard clearance techniques. Each experimental session was performed at least a week apart. The medications were taken for 36 h before study with the last dose at 0700 h on the day of study. Following baseline studies, each participant exercised for 30 min at 80% of their maximal aerobic power. Renal function was monitored for 2 h post-recovery. RESULTS RBF and GFR fell by 40% after exercise with no significant difference between placebo, indomethacin, or celecoxib. Indomethacin (-2.43 +/- 0.95 mL x min(-1), P < 0.007) and celecoxib (-3.88 +/- 0.94 mL x min(-1), P < 0.0001) significantly reduced free water clearance compared with placebo during recovery. CONCLUSION This study has confirmed that selective and nonselective COX inhibition can induce significant inhibition of free water clearance, indicating that these acute changes are regulated predominantly via COX-2. Acute cerebral edema with hyponatremia has been reported after major endurance sporting events. Identifiable risk factors include excessive hydration and use of NSAID. Impaired free water clearance during exercise potentiated by COX inhibition provides a pathophysiological explanation for these observations.

Overuse injury and growing bones: the young athlete at risk.

Increasing numbers of children are becoming involved in competitive sport. International trends in pre-adolescent sports participation are mirrored in New Zealand, where promising young athletes are being exposed to high-intensity training from an earlier age. As a consequence, overuse injuries which were traditionally described in more mature athletes are now becoming recognized in pre-adolescents. The immature musculoskeletal system is less able to cope with repetitive biomechanical stress. Sites of overuse injury reflect the sites of rapid musculoskeletal development. It therefore behoves all medical practitioners, but particularly those in primary care, to be aware of the young athlete at risk. Inherent in the presentation of such musculoskeletal insult there often lurks an over-enthusiastic parent. We are all well reminded of the covert pressures adults may bring to bear upon children. Psychological, as well as physical injury often results.

Indomethacin potentiates exercise-induced reduction in renal hemodynamics in athletes.

Nonsteroidal anti-inflammatory drugs (NSAID) are frequently used in sports medicine but few studies have documented their potential importance in modifying exercise-induced changes in renal function. The effects of indomethacin (50 mg orally every 8 h for 36 h) on renal blood flow (RBF) and glomerular filtration rate (GFR) were investigated in eight fit healthy males (age 21-42) before and after 30-min treadmill exercise at 80% VO2max and during 120-min recovery. Each volunteer served as their own control. There were no differences between control and indomethacin for the resting values of RBF, GFR, or renal vascular resistance (RVR). Using analysis of variance for repeated measures, indomethacin produced a significant reduction in RBF compared with control (P = 0.009) that was associated with a significant elevation in RVR (P = 0.027). Changes in GFR mirrored the changes in RBF but differences failed to reach statistical significance. These results suggest that with sustained exercise indomethacin can compromise renal function and potentiate the risk of developing acute renal failure. Indomethacin and other NSAID are widely used in the sports arena, and athletes should be warned of the potential danger of their use when renal function may be compromised.

Ethical issues concerning New Zealand sports doctors

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question.