Demitri Constantinou

Sport related stress fracture of the clavicle with non-union: Case report and review.

Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery.

Early Sports Specialization: An International Perspective

The physical activity required for most sports has numerous health benefitsVphysical, mental, and academic (5,22,35). Some young athletes specialize in a single sport, while others play multiple sports throughout adolescence. Primary reasons to specialize early include enjoying that single sport; lifestyle access to a particular sport, such as running (34); hope for financial or other special success; or parental pressure. Regions with few resources expect organized sports may provide a safer environment for physical activity than the outdoor neighborhood (e.g., South Africa and Brazil) or increase government-supplied resources to youth sports organizations based on the number of children enrolled (Australia (1)). Recent concerns by sports medicine experts have sparked debate about the wisdom of early sports specialization (3Y6,21,36), but virtually no solid data have been published to inform caregivers, coaches, and families about possible risks and benefits. Sports specialization below the age of 18 yr has been suggested to increase injury risk, decrease social opportunity, and impair life satisfaction (4,16). Additional review articles (23,24) and consensus statements by major sports medicine organizations (3Y5,8,21,36) suggest that early specialization is a culprit potentially leading to adults with history of excessive injuries and limited social opportunity, even suggesting dire consequences (24). However, research supporting these statements is minimal or absent.

Injuries at Johannesburg high school rugby festivals

Background. Injuries occurring at the popular schoolboy rugby festivals in South Africa have not previously been evaluated. A rugby festival is a unique event with multiple matches occurring over a 5-day period and a potentially increased risk of injury compared with adult games. Objectives. To analyse the prevalence and type of injuries over 2 years of a Johannesburg High School rugby festival, to compare the injuries between the 2 years and to compare the injuries between the 3 days of the festivals. Methods. The study design was a retrospective, descriptive and observational study. The study population were participating rugby players at the two rugby festivals in 2010 and 2011 who came to the medical tent provided. A standardised medical form was used to capture data. Results. A total of 626 players participated with 100 injury data sets analysed over the 2 years. The injury rate per player was 17% in year 1 and 15% in year 2. There was no statistical difference (p=0.65) in the injury numbers between the 2 years. The injury profiles between the respective days and between the 2 years were not statistically different. Most injuries were to the head/face (30%), with the majority being concussion related (6%). Tackles were the most common mechanism of injury. Overall 24% of injuries were deemed severe enough to stop the players from continuing play. Few injuries required referral for investigations or specialist physician care (19% and 2%, respectively) and most were managed with simple first aid at the primary care level. Conclusion. The number, nature and mechanisms of rugby injuries at this rugby festival were similar to numerous local and international studies of schoolboy rugby players. Adequate standardised record keeping is recommended to increase knowledge and monitor trends.

Cardiovascular Disease Risk Profile and Readiness to Change in Blue- and White-collar Workers

This study provides a health and risk profile of blue- (BCWs) and white-collar workers (WCWs). Health screening data (n = 603; age 38.2 ± 9.7 years) included cholesterol and glucose finger-prick test, blood pressure, body mass index, and self-reported stress levels and readiness to change. Blue-collar workers were significantly older and had higher blood pressure readings and were more likely to develop hypertension (odds ratio [OR]: 1.72; 95% confidence interval [CI]: 1.05-2.81; P = .03), but less likely to present with hypercholesterolemia (OR: 0.50; 95% CI: 0.31-0.81; P = .01) and overweight/obesity (OR: 0.65; 95% CI: 0.42-0.99; P = .047). White-collar workers showed significantly higher cholesterol and stress levels. This study highlights the importance of occupation type in workplace health screening and intervention planning.

P-85 The relationships of eccentric and concentric isokinetic strength with sprinting speed in male sub-elite footballers

Introduction Sprinting in football matches contributes directly to securing ball possession and goal scoring (1). Research into physical qualities that underlie sprint performances is crucial. There is a strong relationship between strength and maximal sprinting speed in elite male footballers (2). However, it is uncertain whether these findings apply at sub-elite levels. Moreover, there is limited research investigating the relationships of concentric and more specifically eccentric strength with sprint performances. Therefore the aim was to determine the relationships of concentric and eccentric isokinetic strength with sprinting speed in male sub-elite footballers. Methods Data was collected from preseason testing of 53 male footballers {University (n = 32; age 20.8 ± 2.17 years) and semi-professional (n = 21; age = 23 ±3.22 years)}. The following tests were performed; 1.) Eccentric and concentric strength testing of the knee extensors and flexors at an isokinetic speed of 90 degrees per second and 2.) Linear sprints over 30 metres which included times for 10 metres (acceleration) and the flying 20 metre (maximal speed). Pearson product moment correlations were used to determine the relationships between isokinetic peak torque to body mass values (bilateral average) and sprinting times. Significance was set at P < 0.05. Results A significant correlation was observed between eccentric strength of the knee flexors and the flying 20m sprint (r = −0.34; P = 0.02) (Table 1). Furthermore, concentric strength of the knee extensors and flexors were correlated with both 30m (r = −0.35, P = 0.02; r = −0.42, P = 0.002) and flying 20m sprints (r = −0.50, P = 0.0002; r = −0.52, P = 0.00007), respectively (Table 1). Abstract P-85 Table 1 Correlations between isokinetic strength (normalised to body mass) and sprint times in male sub-elite footballers (n = 53) r - values Concentric knee extensors Concentric knee flexors Eccentric knee extensors Eccentric knee flexors 10m −0.05 −0.18 −0.18 −0.05 30m −0.35* −0.42** −0.03 −0.25 Fly 20m −0.50† −0.52† −0.07 −0.34* * P < 0.05, **P < 0.01, P < 0.001 Conclusion The results confirm the relationships of concentric (knee extensor/flexor) and eccentric (knee flexor) strength with maximal sprinting in male sub-elite footballers. However, the relationships are moderate, suggesting that other factors (neuromuscular and technical), may also play a role in determining sprint performances. The insignificant findings between strength and 10 metre sprints could be attributed to a smaller contribution of the knee extensor/flexor muscles to horizontal propulsion during accelerations. It is suggested that exercises that develop maximal concentric and eccentric strength be added to football-specific speed interventions in sub-elite footballers. Improving maximal strength in both contraction modes of the knee extensors and flexors may improve speed in sprints longer than 10m. References Faude O, Koch T, Meyer T. Straight sprinting is the most frequent action in goal situations in professional soccer. Journal of Sports Sciences. 2012;30(7):625–631 Cotte T, Chatard J-C. Isokinetic strength and sprint times in English Premier League football players. Biology in Sport. 2011;28(2):89–94

P-58 Arthritic patients’ views and perceptions on exercise as an adjunct treatment regime for managing their condition

Introduction Arthritic disease has a myriad of treatment modalities. Treatment is dependent on various types of medication stemming from the specific diagnosis. Treatment is often supplemented with dietary, lifestyle changes and exercise. Objective This study aimed to assess the view of arthritic patients towards exercise as an adjunct treatment in managing symptoms, their knowledge of appropriate exercises, whether or not healthcare providers prescribed exercise, different healthcare providers exercise prescription habits, the exercise modes and the outcome of the effects of exercise. Methods A cross-sectional survey study design was used. Patients presenting at two private general practitioners and a biokineticist practices in the southern suburbs of Johannesburg were invited to participate in this questionnaire-based study. Patients that met the inclusion criteria (any arthritic disease with or without a co-morbid disease not contra-indicating exercise) were included in the study. Questions were developed to determine various aspects of the effect of exercise and participants’ attitudes toward exercise as an additional management tool in arthritic patients. These were all self-reported by the participant using the questionnaire. In addition, information on the type of healthcare providers prescribing exercise, exercise modes and outcomes of exercise were also gathered. Outcomes (improvements in participants’ condition, symptoms and activities of daily living with exercise) were used as criteria for improvement. Results A total of 67 participants were surveyed - 25% male and 73% female. Two percent were unspecified. Age distribution: 60% > 50 years old, 36% were 30-50 years old and four percent < 30 years of age. Most suffered from osteoarthritis (N = 29), rheumatoid arthritis (N = 27), gout (N=five) and post traumatic arthritis (N=three). The remaining participants were not specific. Exercise was advised mostly by doctors, followed by physiotherapists then biokineticists. Exercise that was advised by doctors was general (no specifics regarding intensity and time). It mostly included walking (48%).%. Pain was measured using a numeric pain scale and activities of daily living were self-reported by the participants using the questionnaire. Exercise alone diminished pain (p = 0.18) and improved activities of daily living by 11%, while medication alone did relieve pain (p = 0.034) and improved activities of daily living by 21%. The largest improvement and statistically significant finding in perceived pain relief was with both exercise and medication (p = 0.01) with a 32% improvement in activities of daily living. Participants surveyed are of the view that exercise assists them in managing the symptoms of arthritis. Conclusions Exercise is an important adjunctive treatment modality. Doctor’s advice was very non-specific. Participants believe that exercise can benefit them. This study’s findings suggest that healthcare providers need to prescribe exercise more specific to the patient’s condition and physical capabilities. Observations and analysis from the study concludes that medical treatment aided by exercise will improve symptoms in patients with arthritic disease. There is no “one size fits all” exercise prescription. Future research should be directed toward exploring further these findings and the reasons why healthcare practitioners fail to be specific in their exercise advice.

Radiological changes among artistic gymnasts in Gauteng Province

Background. The skeletal immaturity of competitive female gymnasts allows for a unique physiological predisposition to injuries as a result of the spine, limbs, ankles and wrists still growing. Studies have shown that lower back (spinal) injuries account for approximately 12% of injuries in female gymnasts. Objectives. The primary objective of the study was to determine the prevalence of radiological changes in female artistic gymnasts in South Africa. A further objective was to determine whether these radiological changes were associated with symptoms and with the amount of time spent training. Methods . A sample of 40 female artistic gymnasts with a mean of age 15.2 years (range 10 - 31) was included in the study. Thirty-one were active gymnasts and nine were retired at the time of the current study. Measuring instruments included questionnaires and X-rays. Results. X-ray analysis of symptomatic versus asymptomatic gymnasts showed no significant differences. Of the 18 gymnasts training 25 h/week, 15 (68%) had degenerative changes detected by X-ray. Radiological changes were higher than those in other studies. Conclusion. The prevalence of radiological changes was higher than international norms, however there was little difference between symptomatic and asymptomatic gymnasts. Patient self-reports of symptoms had little value in diagnosing change in the lumbar spine. Training duration affected the prevalence of changes in the lumbar spine and could be related to conditioning and experience.