Josep Gutierrez

Muscle Injuries in Sports: A New Evidence-Informed and Expert Consensus-Based Classification with Clinical Application

Muscle injuries are among the most common injuries in sport and continue to be a major concern because of training and competition time loss, challenging decision making regarding treatment and return to sport, and a relatively high recurrence rate. An adequate classification of muscle injury is essential for a full understanding of the injury and to optimize its management and return-to-play process. The ongoing failure to establish a classification system with broad acceptance has resulted from factors such as limited clinical applicability, and the inclusion of subjective findings and ambiguous terminology. The purpose of this article was to describe a classification system for muscle injuries with easy clinical application, adequate grouping of injuries with similar functional impairment, and potential prognostic value. This evidence-informed and expert consensus-based classification system for muscle injuries is based on a four-letter initialism system: MLG-R, respectively referring to the mechanism of injury (M), location of injury (L), grading of severity (G), and number of muscle re-injuries (R). The goal of the classification is to enhance communication between healthcare and sports-related professionals and facilitate rehabilitation and return-to-play decision making.

Prevention of sudden death in adolescent athletes: Incremental diagnostic value and cost-effectiveness of diagnostic tests

Introduction Pre-participation screening in athletes attempts to reduce the incidence of sudden death during sports by identifying susceptible individuals. The objective of this study was to evaluate the diagnostic capacity of the different pre-participation screening points in adolescent athletes and the cost effectiveness of the programme. Methods Athletes were studied between 12–18 years old. Pre-participation screening included the American Heart Association questionnaire, electrocardiogram, echocardiogram, and stress test. The cost of test was established by the Catalan public health system. Results Of 1650 athletes included, 57% were men and mean age was 15.09 ± 1.82 years. Positive findings were identified as follows: in American Heart Association questionnaire 5.09% of subjects, in electrocardiogram 3.78%, in echocardiogram 4.96%, and in exercise test 1.75%. Six athletes (0.36%) were disqualified from participation and 10 (0.60%) were referred for interventional treatment. Diagnostic capacity was assessed by the area under the curve for detection of diseases that motivated disqualification for sport practice (American Heart Association questionnaire, 0.55; electrocardiogram, 0.72; echocardiogram, 0.88; stress test, 0.57). The cost for each athlete disqualified from the sport for a disease causing sudden death was €45,578. Conclusion The electrocardiogram and echocardiogram were the most useful studies to detect athletes susceptible to sudden death, and the stress test best diagnosed arrhythmias with specific treatment. In our country, pre-participatory screening was cost effective to detect athletes who might experience sudden death in sports.

Rectus abdominis muscle injuries in elite handball players: management and rehabilitation

Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.

Characterizing the spectrum of right ventricular remodelling in response to chronic training

The significance and spectrum of reduced right ventricular (RV) deformation, reported in endurance athletes, is unclear. To comprehensively analyze the cardiac performance at rest of athletes, especially focusing on integrating RV size and deformation to unravel the underlying triggers of this ventricular remodelling. Hundred professional male athletes and 50 sedentary healthy males of similar age were prospectively studied. Conventional echocardiographic parameters of all four chambers were obtained, as well as 2D echo-derived strain (2DSE) in the left (LV) and in the RV free wall with separate additional analysis of the RV basal and apical segments. Left and right-sided dimensions were larger in athletes than in controls, but with a disproportionate RA enlargement. RV global strain was lower in sportsmen (−26.8 ± 2.8% vs −28.5 ± 3.4%, p < 0.001) due to a decrease in the basal segment (−22.8 ± 3.5% vs −25.8 ± 4.0%, p < 0.001) resulting in a marked gradient of deformation from the RV inlet towards the apex. By integrating size, deformation and stroke volume, we observed that the LV working conditions were similar in all sportsmen while a wider variability existed in the RV. Cardiac remodelling in athletes is more pronounced in the right heart cavities with specific regional differences within the right ventricle, but with a wide variability among individuals. The large inter-individual differences, as well as its acute and chronic relevance warrant further investigation.

Utility of blood pressure measured during an exercise as a risk factor for new-onset hypertension

Introduction: An exaggerated response of blood pressure (BP) relative to the increase in heart rate during exercise is a marker of risk for developing hypertension in the future. However, the exact methodology used in the exercise test to define an exaggerated response of BP remains controversial. The aim of this study was to compare two methods for defining exaggerated BP during exercise and their potential to predict high BP in the long term follow-up. Method: Data from 160 exercise tests performed 20 years ago was retrospectively analyzed including two subgroups: group A: BP measurement performed during the stages of the exercise (110 tests), group B: measurement of BP performed during the 1st minute of recovery (50 tests). Exaggerated BP was defined according to the percentile 90th of Miyais criteria. Follow-up was obtained by telephone interview in all subjects completing a follow-up 20 years (1992-2012). Hypertension was defined by the diagnosis of their treating physician or by antihypertensive therapy. Results: Mean age was 28±11 years, 72% were male. According to Miyais criteria, 31 (%) patients and 1 (%) in group A and B respectively, presented an exaggerated BP during exercise. After 20 years, 21 (18%) and 8 (16%) had hypertension respectively in each group. ROC curves for prediction of hypertension in the long-term according to the finding of an exaggerated BP during exercise in each group are shown. ![Figure][1] Conclusions: These results indicate that Miyais criteria to define an exaggerated BP during exercise that could predict long term development of hypertension is useful, provided BP measurement is adequately measured at different stages of the exercise test. [1]: pending:yes

Remodelado auricular adverso en atletas de alto rendimiento: Estudio de deformación auricular con speckle tracking 2D

Atletas de alto rendimiento tienen un riesgo aumentado de desarrollar fibrilacion auricular (FA) y flutter. La dilatacion y disfuncion auricular po-drian ser el sustrato subyacente para este incremento en el riesgo. El objetivo fue analizar y relacionar el tamano y deformacion auricular en un grupo seleccionado de at-letas y en pacientes con FA paroxistica.

EVIDENCE OF LEFT ATRIAL DYSFUNCTION IN HIGHLY TRAINED ATHLETES WITH ATRIAL DILATION. A LEFT ATRIAL MYOCARDIAL DEFORMATION STUDY

Highly trained athletes have an increased risk of atrial fibrilation (AF) as compared to the general population of the same age. Left atrial (LA) dilation and dysfunction might be the underlying substrate responsible for the increased risk. The objective was to analyse LA size and function with

Modelo de comportamiento del músculo sometido a progresivas solicitaciones

Resumen Nuestro estudio busca evaluar la respuesta muscular maxima a nivel del tren superior. Para ello hemos disenado un nuevo test con una metodologia simple y que no requiere un material complejo. Consiste en una serie de lanzamientos que varian entre 0,5 kg y 7,26 kg. El estudio incluye a 22 sujetos, 16 hombres y 6 mujeres de una edad media de 16,78 + 1,67 anos. Del analisis grafico de los resultados se deduce un comportamiento muscular que se ajusta a dos rectas de regresion que no se han descrito hasta el momento y que aparecen en casi la totalidad de los sujetos del estudio (92%). El analisis estadistico obtiene dos rectas de regresion con un punto de interseccion (PC) entre ambas. Tambien se obtiene el punto de la maxima distancia teorica lenta (DL) y el punto de la maxima resistencia teorica rapida (FR).Asi mismo, la repeticion del test despues de un intervalo de entrenamiento suficiente presenta diferencias que nos permiten analizar la repercusion y la asimilacion de las cargas fisicas. En conclusion, nuestro test puede utilizarse como un sistema indirecto para evaluar la proporcion de los dos tipos de fibras musculares, lentas y rapidas.