Robert G. Hosey

Hip Strengthening Prior to Functional Exercises Reduces Pain Sooner Than Quadriceps Strengthening in Females With Patellofemoral Pain Syndrome: A Randomized Clinical Trial

STUDY DESIGN Randomized clinical trial. OBJECTIVES To determine if females with patellofemoral pain syndrome (PFPS) who perform hip strengthening prior to functional exercises demonstrate greater improvements than females who perform quadriceps strengthening prior to the same functional exercises. BACKGROUND Although PFPS has previously been attributed to quadriceps dysfunction, more recent research has linked this condition to impairment of the hip musculature. Lower extremity strengthening has been deemed an effective intervention. However, research has often examined weight-bearing exercises, making it unclear if increased strength in the hip, quadriceps, or both is beneficial. METHODS Thirty-three females with PFPS performed either initial hip strengthening (hip group) or initial quadriceps strengthening (quad group) for 4 weeks, prior to 4 weeks of a similar program of functional weight-bearing exercises. Self-reported pain, function, and functional strength were measured. Isometric strength was assessed for hip abductors, external rotators, and knee extensors. A mixed-model analysis of variance was used to determine group differences over time. RESULTS After 4 weeks, there was less mean ± SD pain in the hip group (2.4 ± 2.0) than in the quad group (4.1 ± 2.5) (P = .035). From baseline to 8 weeks, the hip group demonstrated a 21% increase (P<.001) in hip abductor strength, while that remained unchanged in the quad group. All participants demonstrated improved subjective function (P<.006), objective function (P<.001), and hip external rotator strength (P = .004) from baseline to testing at 8 weeks. CONCLUSION Both rehabilitation approaches improved function and reduced pain. For patients with PFPS, initial hip strengthening may allow an earlier dissipation of pain than exercises focused on the quadriceps.

Ultrasound assessment of spleen size in collegiate athletes

Objectives: To determine normal spleen dimensions in a healthy collegiate athletic population. Methods: 631 Division I collegiate athletes from one university participated in the study. During pre-participation examinations, demographic data collected were collected from volunteer athletes including sex, race, measurement of height and weight, and age. Subjects also completed a medical history form to determine any history of mononucleosis infection, platelet disorder, sickle cell disease (or trait), thalassaemia, or recent viral symptoms. Subjects then underwent a limited abdominal ultrasound examination, where splenic length and width were recorded. Results: Mean (SD) splenic length was 10.65 (1.55) cm and width, 5.16 (1.21) cm. Men had larger spleens than women (p<0.001). White subjects had larger spleens than African-American subjects (p<0.001). A previous history of infectious mononucleosis or the presence of recent cold symptoms had no significant affect on spleen size. In more than 7% of athletes, baseline spleen size met current criteria for splenomegaly. Conclusions: There is a wide range of normal spleen size among collegiate athletes. Average spleen size was larger in men and white athletes than in women and black athletes. A single ultrasound examination for determination of splenomegaly is of limited value in this population.

Mononucleosis and athletic participation: an evidence-based subject review.

Infectious mononucleosis (IM) is a common medical condition that afflicts thousands of young athletes each year. Despite the self-limited nature of this disorder, the variability of the clinical presentation and the rare risk of splenic rupture routinely present sports medicine clinicians with difficult return-to-play decisions. Currently there are no evidence-based guidelines regarding the management of the athlete with IM. This review discusses the available research data pertaining to the management of IM in young athletes and develops questions for future clinical research.

Baseball and Softball Sliding Injuries Incidence, and the Effect of Technique in Collegiate Baseball and Softball Players

We prospectively observed seven softball and three baseball Division I collegiate teams to study the incidence of sliding injuries, the types of injuries resulting from the sliding technique, and the amount of time lost from participation. Slides were categorized as either feet- or head-first on the basis of the leading part of the body during the slide. Slides were further stratified depending on whether a diveback technique was performed. We recorded 37 injuries in 3889 slides in 637 games and 7596 athlete game exposures. The overall incidence of sliding injuries was 9.51 per 1000 slides and 4.87 per 1000 game exposures. Softball players had a significantly higher incidence of sliding injuries (12.13 per 1000 slides) than did baseball players (6.01 per 1000 slides). In baseball, the injury rate was higher for feet-first slides (7.31 per 1000 slides) than for head-first slides (3.53 per 1000 slides) or divebacks (5.75 per 1000 divebacks). In softball, injury rates were higher for head-first slides (19.46 per 1000 slides) than for feet-first slides (10.04 per 1000 slides) or divebacks (7.49 per 1000 divebacks). The majority of injuries sustained were minor, with only four (11%) injuries causing the athlete to miss more than 7 days of participation.

Evaluation and management of stress fractures of the pelvis and sacrum.

Most stress fractures of the pelvis and sacrum can be treated nonoperatively with activity modification and thorough assessment of training activities and nutritional factors.

Scaphoid stress fracture: an unusual cause of wrist pain in a competitive diver.

Evaluation and treatment of athletes with chronie wrist pain can be difficult, espeially In those athletes using repetitive wrist-loading activities.

Ultrasonographic Evaluation of Splenic Enlargement in Athletes with Acute Infectious Mononucleosis

Objective: To quantitatively assess the degree and rate of splenic enlargement and the time required for regression of splenic enlargement in collegiate athletes diagnosed with acute infectious mononucleosis (IM). Design: Prospective cohort study. Setting: Academic Medical Center(s) outpatient sports medicine clinic. Study participants: Volunteer Division I University athletes. Interventions: A limited abdominal ultrasound was performed on each participant by a licensed and experienced ultrasonographer. Splenic measurements were taken to assess maximum splenic length. Athletes who were subsequently diagnosed with infectious mononucleosis (clinical illness and a positive monospot) underwent serial splenic ultrasounds and physical exams (weekly) until resolution of clinical symptoms and splenic enlargement (as determined by ultrasound measurements). Main outcome measures: Per cent enlargement of spleen size (length) from baseline. Time (in days) from onset of clinical illness to maximum splenic length. Time (in days) required for resolution of splenic enlargement. Results: 20 subjects were diagnosed with acute IM during a 5 year time period. Maximum splenic length increased a mean of 33.6% (SD 19.9%) from baseline values. Peak splenic enlargement was reached a mean of 12.3 (SD 5.1) days from onset of clinical illness. A linear model demonstrated that spleen size decreases approximately 1% per day after reaching peak splenic enlargement. Conclusions: The majority of athletes with IM experience a moderate degree of splenomegaly. Peak splenic enlargement occurs within 2 weeks from the time of symptom onset in most cases, but may extend to 3.5 weeks. The rate of splenic enlargement appears to be predictable for an individual who develops IM. Ultrasonographic data further show that splenomegaly associated with acute IM infection resolves within 4–6 weeks of symptom onset in the majority of cases.

Trends in Concussion Return-to-Play Timelines Among High School Athletes From 2007 Through 2009

CONTEXT Whereas guidelines about return-to-play (RTP) after concussion have been published, actual prognoses remain elusive. OBJECTIVE To develop probability estimates for time until RTP after sport-related concussion. DESIGN Descriptive epidemiology study. SETTING High school. PATIENTS OR OTHER PARTICIPANTS Injured high school varsity, junior varsity, or freshman athletes who participated in 1 of 13 interscholastic sports at 7 area high schools during the 2007-2009 academic years. INTERVENTION(S) Athletic trainers employed at each school collected concussion data. The athletic trainer or physician on site determined the presence of a concussion. Athlete-exposures for practices and games also were captured. MAIN OUTCOME MEASURE(S) Documented concussions were categorized by time missed from participation using severity outcome intervals (same-day return, 1- to 2-day return, 3- to 6-day return, 7- to 9-day return, 10- to 21-day return, >21-day return, no return [censored data]). We calculated Kaplan-Meier time-to-event probabilities that included censored data to determine the probability of RTP at each of these time intervals. RESULTS A total of 81 new concussions were documented in 478 775 athlete-exposures during the study period. After a new concussion, the probability of RTP (95% confidence interval) was 2.5% (95% confidence interval = 0.3, 6.9) for a 1- to 2-day return, 71.3% (95% confidence interval = 59.0, 82.9) for a 7- to 9-day return, and 88.8% (95% confidence interval = 72.0, 97.2) for a 10- to 21-day return. CONCLUSIONS For high school athletes, RTP within the first 2 days after concussion was unlikely. After 1 week, the probability of return rose substantially (approximately 71%). Prognostic indicators are used to educate patients about the likely course of disease. Whereas individual symptoms and recovery times vary, prognostic time-to-event probabilities allow clinicians to provide coaches, parents, and athletes with a prediction of the likelihood of RTP within certain timeframes after a concussion.

Sudden cardiac death.

Sudden cardiac death is a rare but devastating event. The majority of cases in young athletes are caused by congenital cardiac abnormalities that are routinely clinically silent before causing sudden death. An optimal screening practice to help identify underlying asymptomatic cardiac abnormalities has met with much debate. Beyond the American Heart Associations recommendations for cardiovascular screening guidelines for the preparticipation physical examination [47], there are conflicting views regarding the use of more advanced diagnostic screening tests. Athletes in whom a potentially life-threatening cardiovascular abnormality is found face the probability of being restricted from participating in certain types of athletic activity. Participation guidelines for athletes with cardiovascular disease are detailed in the recommendations of the 26th Bethesda Conference [36]. Future goals should continue to focus on the prevention of SCD. The development of a cost-effective screening process that incorporates the use of echocardiography, although having its own set of inherent limitations, may prove to be the most viable option.

Nitric oxide therapy: Fact or fiction?

Nitric oxide (NO) has been the topic of many studies regarding its therapeutic benefit in patients with cardiac disease. Recent studies are now revealing potential advantages for healthy individuals and endurance athletes. This article discusses current research focused on NO augmentation in relation to muscular strength and endurance. Arginine, an NO precursor, has been more extensively studied as a supplement for performance enhancement. Its role in cardiovascular endurance and strength training is assessed in individuals with various athletic backgrounds. The therapeutic role of NO in the treatment of tendinopathies is also reviewed.