M. Julia

Declining Incidence of Catastrophic Cervical Spine Injuries in French Rugby 1996–2006

Purpose To investigate the incidence and the risk factors of catastrophic cervical spine injuries in French rugby. Study Design Descriptive epidemiology study. Methods The patients included had cervical spine injuries causing neurological disorder classified from the ASIA scale, grade A to D. A retrospective review of all cases that occurred between the 1996-1997 and the 2005-2006 seasons was made. Circumstances of the injuries and of the clinical outcome were collected by interview. Results There were 37 cases of catastrophic cervical spine injuries in French rugby for the last 10 years. The incidence of the cervical spine injuries decreased during this period. The rates of injury were 2.1 per 100 000 players per year during the 1996-1997 season and 1.4 during the 2005-2006 season (P <. 01). The scrum was a major cause of injury, accounting for 51.3% (19/37). The forwards represented 89.2% (33/37) of the injured players. The hookers were involved in 37.8% (14/37) of the cases. The measures of prevention with the modification of the rules of scrum and the creation of a medical certificate required for players to play in the front row must have been successful. Conclusion The incidence of disabling cervical spine injuries in French rugby has decreased for the last 10 years, which is linked to the decreasing incidence of injuries in the scrum. This epidemiological study shows the effectiveness of the preventive measures on cervical spine injuries in French rugby players. A national register of catastrophic cervical spine injuries extends our epidemiological observations.

Reproducibility of isokinetic peak torque assessments of the hip flexor and extensor muscles.

OBJECTIVES Isokinetic assessment is currently the reference method for measuring dynamic muscle strength. We have sought to evaluate the reproducibility over time of isokinetic testing of the hip flexor (FI) and extensor (Ext) muscles and to establish whether there is a significant difference in peak torque (PT) between the left and right hips. PATIENTS AND METHODS Ten adults were tested once a week for 3 weeks by the same investigator and according to the same protocol, with two velocities (60 degrees /s and 180 degrees /s) for the hip FI and Ext in concentric tests and one velocity (30 degrees /s) for the Ext only in eccentric tests. The reproducibility of the measured PT was analyzed by using the intraclass correlation coefficient (ICC) and a Bland and Altman plot. The difference in PT between the right and left hips was tested using Students T test. RESULTS The ICC for the observed PT values revealed very good reproducibility (with a value of between 0.75 and 0.96) for the hip FI and Ext measurements (regardless of the body side, test velocity or contraction mode). We did not observe any significant PT differences between the right and left hips. CONCLUSION The isokinetic assessment of the concentric and eccentric PT values generated by the hip FI and Ext is highly reproducible. There is no difference between dominant and nondominant body sides, which enables the use of the contralateral limb as a reference.

Upper Limb Isokinetic Strengthening Versus Passive Mobilization in Patients With Chronic Stroke: A Randomized Controlled Trial

OBJECTIVE To assess the benefit of isokinetic strengthening of the upper limb (UL) in patients with chronic stroke as compared to passive mobilization. DESIGN Randomized blinded assessor controlled trial. SETTING Physical Medicine and Rehabilitation departments of 2 university hospitals. PARTICIPANTS Patients (N=20) with incomplete hemiplegia (16 men; mean age, 64y; median time since stroke, 32mo). INTERVENTIONS A 6-week comprehensive rehabilitation program, 3d/wk, 3 sessions/d. In addition, a 45-minute session per day was performed using an isokinetic dynamometer, with either isokinetic strengthening of elbow and wrist flexors/extensors (isokinetic strengthening group) or passive joint mobilization (control group). MAIN OUTCOME MEASURES The primary endpoint was the increase in Upper Limb Fugl-Meyer Assessment (UL-FMA) score at day 45 (t1). Secondary endpoints were increases in UL-FMA scores, Box and Block Test scores, muscle strength, spasticity, and Barthel Index at t1, t2 (3mo), and t3 (6mo). RESULTS Recruitment was stopped early because of excessive fatigue in the isokinetic strengthening group. The increase in UL-FMA score at t1 was 3.5±4.4 in the isokinetic strengthening group versus 6.0±4.5 in the control group (P=.2). Gains in distal UL-FMA scores were larger (3.1±2.8) in the control group versus 0.6±2.5 in the isokinetic strengthening group (P=.05). No significant group difference was observed in secondary endpoints. Mixed models confirmed those results. Regarding the whole sample, gains from baseline were significant for the UL-FMA at t1 (+4.8; P<.001), t2, and t3 and for the Box and Block Test at t1 (+3; P=.013) and t2. CONCLUSIONS In a comprehensive rehabilitation program, isokinetic strengthening did not show superiority to passive mobilization for UL rehabilitation. Findings also suggest a sustained benefit in impairments and function of late UL rehabilitation programs for patients with stroke.

Revue de la littérature sur l’efficacité du plasma riche en plaquettes (PRP) en médecine du sport

Méthodes.– Les joueurs de l’équipe de ligue 2 Châteauroux effectuait une évaluation isocinétique du genou en début de saison sur dynamomètre Cybex Norm en mode concentrique (60◦/s et 240◦/s) et excentrique (30◦/s). En cas d’asymétrie > 20 %, d’anomalie du ratio mixte < 0,6 et/ou agoniste/antagoniste < 0,45, les joueurs bénéficiaient d’un protocole personnalisé de prévention. L’étude portait sur les saisons 2010–11, 2011–12 avec recueil prospectif des blessures. Résultats.– La saison 2010–11, 9 joueurs sur 21 présentaient un test isocinétique anormal et sept joueurs se sont blessés (total de 164 jours d’arrêt de travail [AT]). La saison 2011–12, 7 tests isocinétiques anormaux sur 21, 7 joueurs se sont blessés (total de 92 jours d’AT). La moyenne des jours d’AT était de 225 jours les saisons précédentes l’étude. La fréquence des blessures était plus importante dans le groupe ayant un test isocinétique normal (41 % vs 25 %). Conclusion.– Ces résultats nous incitent à proposer de façon systématique pour tous les joueurs un protocole de prévention des blessures car les joueurs avec test normaux qui n’ont pas eu de prévention ont eu plus de blessures.