Mohamad Shariff A. Hamid

Platelet-Rich Plasma Injections for the Treatment of Hamstring Injuries A Randomized Controlled Trial

Background: A hamstring injury is one of the most common types of injury affecting athletes. Despite this, the optimal management of hamstring muscle injuries is not yet defined. The effect of autologous platelet-rich plasma (PRP) therapy on the recovery of hamstring injuries is unclear. Purpose: To investigate the effect of a single PRP injection in the treatment of grade 2 hamstring muscle injuries. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: Twenty-eight patients diagnosed with an acute hamstring injury were randomly allocated to autologous PRP therapy combined with a rehabilitation program or a rehabilitation program only. The primary outcome of this study was time to return to play. In addition, changes in pain severity and pain interference scores over time were examined. Results: Patients in the PRP group achieved full recovery significantly earlier than controls (P = .02). The mean time to return to play was 42.5 ± 20.6 days in the control group and 26.7 ± 7.0 days in the PRP group. Significantly lower pain severity scores were observed in the PRP group throughout the study. However, no significant difference in the pain interference score was found between the 2 groups. Conclusion: A single autologous PRP injection combined with a rehabilitation program was significantly more effective in treating hamstring injuries than a rehabilitation program alone.

Platelet-Rich Plasma (PRP) for Acute Muscle Injury: A Systematic Review

Introduction Acute muscle injury is one of the commonest injuries that often result in loss of training and competition time. The best management for muscle injury has not been identified. Sports medicine practitioners used several approaches in attempt to accelerate time to recovery from muscle injury. More recently growing interest focussed on autologous blood product injection. Methods A literature search was conducted systematically using OvidMEDLINE, PubMed, EMBASE, SPORTDiscus and CINAHL databases to retrieve articles published until December 2012. Controlled trials and controlled laboratory studies comparing different strategies to promote early recovery of muscle injury were included. The methodological quality of studies was assessed. Results There are limited studies on the effects of PRP therapy for muscle injury. Three in vivo laboratory studies and one pilot human study were reviewed. The laboratory studies reported histological evidence on significant acceleration of muscle healing in animals treated with autologous conditioned serum (ACS), platelet-rich plasma (PRP) and platelet rich fibrin matrix (PRFM). A pilot human study found athletes treated with repeated ACS injection recovers significantly faster than retrospective controls. Conclusion Several in vivo laboratory studies suggest beneficial effects of ACS, PRP and PRFM in accelerating muscle recovery. Evidence to suggest similar effects on humans is however limited, as valuable information from robust human controlled trials is still not available at this moment. Hence, more studies of satisfactory methodological quality with platelet-rich plasma interventions on muscle injury are justified.

Platelet-rich plasma (PRP): an adjuvant to hasten hamstring muscle recovery. A randomized controlled trial protocol (ISCRTN66528592)

BackgroundMuscle injuries are one of the commonest injuries affecting athletes. It often leads to significant pain and disability causing loss of training and competition time. With current treatment, the duration to return-to-play ranges form six weeks to never, depending on injury severity. Recent researches have suggested that autologous platelet-rich plasma (PRP) injection into the injured site may hasten soft tissues healing. To-date, there has been no randomised clinical trials to evaluate the effects of PRP on muscle healing. The aim of this study is to examine the effects of autologous PRP on duration to return-to-play after muscle injury.Methods and designA randomised, single blind controlled trial will be conducted. Twenty-eight patients aged 18 years and above with a recent grade-2 hamstring injury will be invited to take part. Participants will be randomised to receive either autologous PRP injection with rehabilitation programme, or rehabilitation programme only. Participants will be followed up at day three of study and then weekly for 16 weeks. At each follow up visit, participants will be assessed on readiness to return-to-play using a set of criteria. The primary end-point is when participants have fulfilled the return-to-play criteria or end of 16 weeks.The main outcome measure of this study is the duration to return-to-play after injury.ConclusionThis study protocol proposes a rigorous and potential significant evaluation of PRP use for grade-2 hamstring injury. If proven effective such findings could be of great benefit for patients with similar injuries.Trial registrationCurrent Controlled Trials ISCRTN66528592

Resultant muscle torque and electromyographic activity during high intensity elastic resistance and free weight exercises

Abstract The purpose of this study was to quantify and compare Resultant Muscle Torque (RMT) and muscle activation (EMG) pattern, during resistance exercise comprising eight repetitions maximum (8 RM) biceps curl with elastic resistance and free weight exercise. Sixteen male and female recreationally active subjects completed 8 RM biceps curl by each of three modalities of resistance exercise: (i) dumbbell (DB), (ii) elastic tubing with original un-stretched length at the commencement of contraction (E0), and (iii) elastic tubing with 30% decrement of original length (E30) at the commencement of contraction. The magnitude of muscle activation, external force, acceleration as well as range of motion (ROM) were quantified and synchronised by specific software. The data were collected from all eight repetitions but the first (initial), the fifth (middle) and the eighth (last) repetitions were selected for further data analysis. Each selected repetition was partitioned into a concentric and eccentric phase and then each phase was further divided into three equal segments (3 concentric and 3 eccentric = 6 segments per repetition). The EMG and RMT data demonstrated a bell-shaped muscle activation and muscle torque production pattern for the three modes of exercise. The E30 resulted in 15.40% and 14.89% higher total EMG (µV) as well as 36.85% and 17.71% higher RMT (N · m) than E0 and DB, respectively (all P <0.05). These findings support the contention that an elastic resistance device (E30) has the capacity to provide an appropriate high resistance stimulus to meet the training requirement of elite athletes.

Interrater and Intrarater Reliability of the Active Knee Extension (AKE) Test among Healthy Adults

[Purpose] The purpose of this study was to determine the reliability of the active knee extension (AKE) test among healthy adults. [Subjects] Fourteen healthy participants (10 men and 4 women) volunteered and gave informed consent. [Methods] Two raters conducted AKE tests independently with the aid of a simple and inexpensive stabilizing apparatus. Each knee was measured twice, and the AKE test was repeated one week later. [Results] The interrater reliability intraclass correlation coefficients (ICC2,1) were 0.87 for the dominant knee and 0.81 for the nondominant knee. In addition, the intrarater (test-retest) reliability ICC3,1 values range between 0.78–0.97 and 0.75–0.84 for raters 1 and 2 respectively. The percentages of agreement within 10° for AKE measurements were 93% for the dominant knee and 79% for the nondominant knee. [Conclusion] The finding suggests the current AKE test showed excellent interrater and intrarater reliability for assessing hamstring flexibility in healthy adults.

Incidence and Characteristics of Injuries during the 2010 FELDA/FAM National Futsal League in Malaysia

Objective In Malaysia, futsal is a popular sport played by individuals across all ages and genders. Despite its popularity, information on futsal related injury in Malaysia is not available. The purpose of this study is to examine the injury incidence and injury patterns among amateur men and women futsal players in Malaysia. Methods Players reported injury to the tournament medical team during the FELDA/FAM National Futsal League 2010 were interviewed and assessed by a Sports Medicine registrar. Players socio-demographic profiles and information about the injury were documented in the injury report form adapted from medical report form used by FIFA: Medical Assessment and Research Centre (F-Marc). Results A total of 86 injuries were reported from 141 matches, equivalent to an incidence of 91.5 injuries per 1000 player hours (95% CI 72.2 to 110.8), or 61.0 injuries per 1000 player matches (95% CI 48.1 to 73.9). Most were minor injuries resulted from contact with another player. Injuries often involved the lower extremity (44%) followed by the trunk (14%) and the upper limb (13%). Ankle (n = 7; 39%) and knee (n = 6; 33%) sprains were the most prevalent diagnoses of time-loss injuries. A significant association between time-loss and type of injury was found χ 2 (1,N = 86) = 3.99, p = 0.04. In addition, time-loss injury was significantly associated with playing surface χ 2 (1,N = 86) = 10.11, p = 0.018. Conclusion The injury rate during the FELDA/FAM National Amateur Futsal Mens League in Malaysia was lower compared with previous Futsal World Cups competition. Most injuries resulted from contact with another player were minor and did not lead to time-loss from participation. Time-loss injury was significantly associated with type of injury and playing surface.

Comparative Effectiveness of Ultrasound-Guided Intratendinous Prolotherapy Injection with Conventional Treatment to Treat Focal Supraspinatus Tendinosis

Objective To evaluate the efficacy of dextrose prolotherapy injection for focal supraspinatus rotator cuff tendinosis via outcomes such as functional score, range of movement, and real-time ultrasound parameters. Materials and Methods 12 adult patients with focal supraspinatus tendinosis recruited after they had less than 30% improvement in functional (DASH) scores after one month of physiotherapy following initial presentation. Seven patients had 0.5–1.0 ml of prolotherapy injection (12.5% dextrose, 0.5% lignocaine) injected into the area of focal tendinosis under ultrasound guidance. Meanwhile, five patients continued standard physiotherapy with no intervention performed. Regional area of echogenicity in decibels, DASH, range of movements of the shoulder, pain, and sleep scores were measured at baseline and at 12 weeks. Results The prolotherapy group showed significant improvement in shoulder abduction (p=0.030) and an improvement in sleep score (p=0.027). The echogenicity of area of tendinosis significantly increases at the end of treatment (p=0.009). However, there was a nonsignificant reduction in pain score in the injection group (43.5%) and in the control group (25%) at 12 weeks (p > 0.005). Conclusion Ultrasound-guided intratendinous prolotherapy injection significantly improves patients range of abduction and improves sleep within 12 weeks of treatment compared to conventional physiotherapy management. Trial Registration This study was registered under Current Controlled Trials (UK) and given International Standard Randomised Controlled Trial Number (ISRCTN) of 43520960.

Diet and Bone Status in Eumenorrheic Female Athletes

Various risk factors for low bone mass density (BMD) have been reported, such as diet restriction, unbalance body composition and menstrual irregularities. This is apparent in female athletes who have a tendency to seek for a low body weight by adopting chronic energy deficits (low calories intake or malnutrition) practices. The aim of this study was to determine the relationship between energy intake, nutrient consumption amount, energy availability, body weight with BMD status. Eighty-five moderately trained female athletes aged 18–29 years took part in this study. Body fat percentage and BMD were measured using the Tanita Weighing Scale and 200-CM Furuno Ultrasound bone densitometer, respectively. Data on physical activity, menstrual cycle status, and eating attitude were obtained using questionnaires. Dietary variables were assessed from a prospective combination of 24-hour diet recall and 3-day food diary of macronutrients and micronutrients. Results showed that more than half (53%) of the female athletes have low BMD, with z-scores ranging between -2.00 and -0.03 (below the normal range). The mean (SD) of energy intake of female athletes was 1291 (304) kcal/day which is below than recommended nutrient intake (RNI). Similarly minerals (Calcium and Phosphorus) intake did not achieve the RNI. Low energy intake was significantly (p≤0.05) correlated with low eating attitude score (EAT-26). Pearson Correlation also showed that low BMD was significantly associated with low body weight. The common factors of low BMD among eumenorrheic athletes are an insufficient intake of energy intake and bone building nutrients (Calcium, Vitamins D, Vitamin C and Zinc). Higher BMD could be achieved through actively encouraging high-risk group of athletes to focus on good dieting practice.

Electromyographic activity using Elastic Resistance and Nautilus Machine exercises

The purpose of this study, therefore, was to quantify and compare Integrated Electromyography (I-EMG) within perfuming 8-RM seated knee extension in contribution of Elastic Resistance and Nautilus Machine exercises. All data were collected within one testing session. Subjects completed 8-RM seated knee extension by three modalities of resistance exercises comprised of Nautilus Machine (NM), elastic tubing with original elongation (E0%) and elastic tubing with 30% decrement of original elongation (E30%). Electromyographic muscle activation and range of motion were collected and synchronized from Vastus Lateralis (VL). Results: manipulating the resting length of elastic resistance resulted in significantly higher I-EMG for E30% in compare with E0% (25% increasing muscle activation); however, no significant difference observed between E30% and NM (P = 0.443). Based on these results, it seems that shortened form of elastic exercise (E30%) and NM exercises offer equivalent muscle activation. Thus, they could be used interchangeably for lower body strength development.