Nikolaos Malliaropoulos

Posterior Thigh Muscle Injuries in Elite Track and Field Athletes

Introduction: Posterior thigh muscle injuries in athletes are common, and prediction of recovery time would be of value. Hypothesis: Knee active range of motion deficit 48 hours after a unilateral posterior thigh muscle injury correlates with time to full recovery. Study Design: Cohort study (prognosis); Level of evidence, 2. Methods: One hundred sixty-five track and field athletes with acute, first-time, unilateral posterior thigh muscle injuries were prospectively evaluated regarding knee active range of motion deficit. This was compared with the uninjured side 48 hours after injury. A control group was also examined. Ultrasound was used to image the muscle lesion. All athletes were managed nonoperatively with the same rehabilitation protocol. The “full rehabilitation time” (interval from the injury to full athletic activities) was recorded. Results: Range of motion of the affected leg was decreased in the 165 injured athletes compared with the uninjured side and the control group. Sonography identified abnormalities in 55% (90 of 165) of the injured athletes. The biceps femoris was the most commonly affected muscle (68 of 90 [75%]). The musculotendinous junction (proximal or distal) was involved in 93% (85 of 90) of lesions. Eighty-one percent (133 of 165) of athletes had active range of motion deficit of less than 20°, and had returned to full performance at 2 weeks. In 6 of 165 athletes (3.6%), with active range of motion deficit of more than 30°, recovery time exceeded 6 weeks, with a significant correlation between full rehabilitation time and active range of motion deficit (χ2 = 152.560; P = .0001). Conclusion: Knee active range of motion deficit is an objective and accurate measurement, predicting recovery time in elite athletes.

Reinjury After Acute Posterior Thigh Muscle Injuries in Elite Track and Field Athletes

Background: Hamstring muscle strains often recur. The authors studied the effect of the grade of initial injury on the subsequent risk of reinjury. Hypothesis: No difference in reinjury rate between acute low-grade (grades I and II) and high-grade (III and IV) hamstring muscle strains would be seen. Study Design: Cohort study (prognosis); Level of evidence, 1. Methods: Between 1999 and 2007, the authors managed 165 elite track and field athletes with acute, first-time unilateral hamstring muscle strains. Strains were classified into 4 grades (I, II, III, and IV) based on knee active range of motion deficit at 48 hours. The same rehabilitation protocol was prescribed, and the rate of reinjury was recorded during the following 24 months. Results: The average time to return to sport after initial injury was 7.4 days for grade I injuries, 12.9 days for grade II injuries, 29.5 days for grade III injuries, and 55.0 days for grade IV injuries. At follow-up, 23 of the 165 athletes (13.9%) had experienced a second hamstring muscle strain. Of the 75 athletes with a grade I injury, 7 (9.3%) had experienced a recurrence after 24 months. Of the 58 athletes with a grade II injury, 14 (24.1%) experienced a recurrence. Of the 26 athletes with a grade III injury, 2 (7.7%) experienced a recurrence, and of the 6 athletes with a grade IV injury, none had experienced a recurrence after 24 months. Conclusion: Low-grade hamstring muscle lesions appear to lead to a higher risk of reinjury than high-grade hamstring muscle lesions. However, there were disproportionately fewer high-grade injuries than low-grade injuries. Objective clinical findings can accurately determine the risk of reinjury after acute hamstring muscle strains in elite track and field athletes.

Reinjury after Acute Lateral Ankle Sprains in Elite Track and Field Athletes

Background Lateral ankle sprains can lead to persistent disability in athletes. The authors studied the effect of a lateral ankle sprain on reinjury occurrence in the same region. Hypothesis There will be no difference in reinjury rate between low-grade (grades I and II) and high-grade (IIIA and IIIB) acute lateral ankle sprains. Study Design Cohort study (prognosis); Level of evidence, 1. Methods From 1996 to 2004, the authors managed 202 elite Greek track and field athletes for an acute lateral ankle sprain. Sprains were classified into 4 degrees (I, II, IIIA, and IIIB). The same rehabilitation protocol was prescribed for all the athletes. The rate of a lateral ankle reinjury was recorded in the 24 months following injury. Results At a follow-up of 24 months, 36 of 202 athletes (17.8%) experienced a second lateral ankle sprain. Of the 79 athletes with a grade I injury, 11 (14%) experienced a recurrence during the study period. Of the 81 athletes with a grade II injury, 23 (29%) experienced a recurrence during the study period. Of the 36 athletes with a grade IIIA injury, 2 (5.6%) experienced a recurrence during the study period. Of the 6 athletes with a grade IIIB injury, none experienced a recurrence during the study period. Conclusion Athletes with a grade I or II lateral ankle sprain are at higher risk of experiencing a reinjury. Low-grade acute lateral ankle sprains result in a higher risk of reinjury than high-grade acute lateral ankle sprains.

Injuries in judo: a systematic literature review including suggestions for prevention

Background There is limited knowledge on epidemiological injury data in judo. Objective To systematically review scientific literature on the frequency and characteristics of injuries in judo. Methods The available literature up to June 2013 was searched for prospective as well as retrospective studies on injuries in judo. Data extraction and presentation focused on the incidence rate, injury risk, types, location and causes of injuries. Results During the Olympic Games in 2008 and 2012, an average injury risk of about 11–12% has been observed. Sprains, strains and contusions, usually of the knee, shoulder and fingers, were the most frequently reported injuries, whereas being thrown was the most common injury mechanism. Severe injuries were quite rare and usually affected the brain and spine, whereas chronic injuries typically affected the finger joints, lower back and ears. The most common types of injuries in young judo athletes were contusions/abrasions, fractures and sprains/strains. Sex-differences data on judo injuries were mostly inconsistent. Some studies suggested a relationship between nutrition, hydration and/or weight cycling and judo injuries. Also, psychological factors may increase the risk of judo injuries. Conclusions The present review provides the latest knowledge on the frequency and characteristics of injuries in judo. Comprehensive knowledge about the risk of injury during sport activity and related risk factors represents an essential basis to develop effective strategies for injury prevention. Thus, the introduction of an ongoing injury surveillance system in judo is of utmost importance.

High-speed running type or stretching-type of hamstring injuries makes a difference to treatment and prognosis

The article focuses on the two distinct types of hamstring muscle strains, highlighting the applicable rehabilitation approaches. It notes that acute hamstring strains are distinguished by the inju ...

Ultrasound as a Primary Evaluation Tool of Bone Stress Injuries in Elite Track and Field Athletes

Background: Little is known about therapeutic ultrasound (TUS) to diagnose bone stress injuries. Hypothesis: Therapeutic ultrasound is an accurate, cost-efficient alternative to other imaging methods for primary assessment of bone stress injuries. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: One hundred thirteen elite track and field athletes (mean age, 20.1 years; range, 17-28 years) underwent TUS and magnetic resonance imaging (MRI) for clinical suspicion of a bone stress injury. A 5-stage MRI grading system was used to classify bone stress injuries. Sensitivity, specificity, accuracy, and positive and negative predictive values of TUS were calculated using MRI as the standard for diagnosis. Results: At MRI, of 113 assessed patients, 3 (2.7%) had grade 0 injuries, 12 (10.6%) had grade 1, 15 (13.3%) had grade 2, 77 (68.2%) had grade 3, and 6 (5.3%) had grade 4. At TUS, no injury was detected in 22 of 113 patients: 2 with grade 0 injury, 8 with grade 1, 8 with grade 2, and 4 with grade 3. Using MRI as the gold standard, TUS showed 81.8% sensitivity, 66.6% specificity, 99.0% positive predictive value, 13.4% negative predictive value, and 81.4% accuracy. Conclusion: Therapeutic ultrasound is a reproducible procedure that is reliable to diagnose bone stress injuries.

Isolated Tears of the Gracilis Muscle

Background: Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. Purpose: To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures. Study Design: Case series; Level of evidence, 4. Methods: This is a retrospective review of 7 elite athletes with posterior thigh pain (3 dancers, 2 soccer players, 1 tae kwon do player, 1 tennis player). In all athletes, the injury occurred during thigh adduction with the hip internally rotated, as clearly evident at ultrasound scans performed 1 to 20 days after the injury. Management included an initial rest period, followed by physiotherapy and gradual return to sports activities. Results: According to the ultrasound scans, the lesions were in the proximal-middle third junction of the thigh, at the muscle-tendon junction. The lesions were classified as grade 2 (partial discontinuity). The muscle injury area was, on average, 17.1 × 23.7 mm (range, 10-31 × 9-46 mm). The average length of the lesions was 40.14 mm (range, 20-52 mm). All athletes recovered and returned to full performance within 6 weeks of the injury (average, 35.6 days). Conclusion: Medial thigh pain after eccentric contraction during hip adduction should raise suspicion of a gracilis muscle tear. Ultrasound is useful, and full recovery occurs within 6 weeks from the injury.

The effectiveness of extracorporeal shockwave therapy in common lower limb conditions: a systematic review including quantification of patient-rated pain reduction

Objective To evaluate extracorporeal shockwave therapy (ESWT) in treating Achilles tendinopathy (AT), greater trochanteric pain syndrome (GTPS), medial tibial stress syndrome (MTSS), patellar tendinopathy (PT) and proximal hamstring tendinopathy (PHT). Design Systematic review. Eligibility criteria Randomised and non-randomised studies assessing ESWT in patients with AT, GTPS, MTSS, PT and PHT were included. Risk of bias and quality of studies were evaluated. Results Moderate-level evidence suggests (1) no difference between focused ESWT and placebo ESWT at short and mid-term in PT and (2) radial ESWT is superior to conservative treatment at short, mid and long term in PHT. Low-level evidence suggests that ESWT (1) is comparable to eccentric training, but superior to wait-and-see policy at 4 months in mid-portion AT; (2) is superior to eccentric training at 4 months in insertional AT; (3) less effective than corticosteroid injection at short term, but ESWT produced superior results at mid and long term in GTPS; (4) produced comparable results to control treatment at long term in GTPS; and (5) is superior to control conservative treatment at long term in PT. Regarding the rest of the results, there was only very low or no level of evidence. 13 studies showed high risk of bias largely due to methodology, blinding and reporting. Conclusion Low level of evidence suggests that ESWT may be effective for some lower limb conditions in all phases of the rehabilitation.

THE EFFECT OF PHYSICAL EXERCISE ON MUSCULO-SKELETAL METABOLISM: A SYSTEMATIC REVIEW OF THE ROLE OF RANK/RANKL/OPG PATHWAY

Background The effect of physical exercise on bone metabolism has been thoroughly discussed and a positive correlation between physical exercise and Bone Mineral Density (BMD) has been established. At the one hand many issues have not been entirely clarified: the impact of exercise on biochemical (especially novel like RANK/RANKL/OPG) markers of bone metabolism and mainly the type of exercise (high or low impact exercise, intensity of training). At the other hand, it is interesting to note that the aforementioned pathway is related not only to bone (and musculo-skeletal in general) metabolism, but also to cardiovascular metabolism and it is thought to be one of the possible causative links of the positive correlation between osteoporosis and cardiovascular disease. Methods The literature search was performed via the internet using the Medline, Scopus and Cochrane database. The key words which were searched in the abstracts were the terms “RANK”, “RANKL”, “OPG”, “physical exercise”, “sports”, “osteoporosis markers”, “bone turnover markers”. Results Our systematic review of the literature revealed 7 (seven) papers concerning the relationship of RANK/RANKL/OPG pathway with sports and physical exercise. The general trend observed in most papers was that physical exercise and sports activity have a positive impact in the RANK/RANKL/OPG pathway. It is important to note that extremely intense exercise (marathon running and beyond) might have detrimental effect on the pathway thus influencing negatively bone metabolism. Four (4) papers were focused on fit persons and intense training whether the rest three (3) papers were focused on exercise for obese or postmenopausal individuals. Conclusions The role of RANK/RANKL/OPG pathway in both bone/musculo-skeletal and cardiovascular metabolism has rather recently been studied. The possible positive influence of exercise on this pathway might have valuable positive effect on both metabolical systems. The further clarification of the exact pattern of exercise that might have the most significant impact on the RANK/RANKL/OPG pathway is needed, but our review points out that high impact (but not extremely intense) exercise is more beneficiary.

DYNAMIC FOOT PRESSURE MEASUREMENTS IN ELITE TRACK AND FIELD ATHLETES

Study design Prospective Study. Introduction With the aim to deal with the probability of metatarsal bone stress injuries and stress fractures we detect and categorize functional alterations during forefoot loadings in plantar pressure area in athletes and explore the frequency of functional alterations. Methods 58 elite track & field athletes (experimental group) and age/sex matched healthy volunteers (control group) conducted dynamic plantar foot pressure and leg-length measurements at the National Track and Field Center in Sports Medicine Clinic of S.E.G.A.S., Thessaloniki (Greece). Pressure, area and force during gait were measured. Measurements were performed during free walking at a speed of 5km/h. Measurements were conducted with T & T MEDILOGIC dynamic foot pressure platform with 2048 SSR-sensors. Statistical analysis and a comparison between the two groups for the metatarsal specific areas mean pressures in both foots (R: right foot, L: left foot) were made by using statistical analysis software. Clinical findings were also assessed. Results Anatomical alterations are descriptively presented. In functional alterations, four forefoot metatarsal print indices were categorized as follows: 1. metatarsal arch, 2. metatarsal fall, 3. metatarsal heads and 4. metatarsal varus. Metatarsal fall and metatarsal varus mean loadings were higher in both feet for the non-athletes. Athletes presented higher percentage of metatarsal arch fall. Factor loadings indicate metatarsal arch fall as a separate factor compared with the other variables. Conclusions Present findings suggest that high impact sporting activities like sprinting, jumping, throwing and long distance running lead to variations in forefoot plantar pressure area. In 29 elite track and field athletes, metatarsal arch and metatarsal heads fall exist in a relatively high percentage. Control group did not have the same high percentage of metatarsal arch and metatarsal heads alteration as athletes but they had significantly higher loadings in metatarsal fall alteration.