Robert Matthew Collins

Elite athletes travelling to international destinations >5 time zone differences from their home country have a 2–3-fold increased risk of illness

Background Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes. Objective To determine if international travel increases the incidence of illness in rugby union players participating in a 16-week tournament. Setting 2010 Super 14 Rugby Union tournament. Participants 259 elite rugby players from eight teams were followed daily over the 16-week competition period (22 676 player-days). Assessment Team physicians completed a logbook detailing the daily squad size and illness in any player (system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause) with 100% compliance. Time periods during the tournament were divided as follows: located and playing in the home country before travelling (baseline), located and playing abroad in countries >5 h time zone difference (travel) and located back in the home country following international travel (return). Main outcome measurement Incidence of illness (illness per 1000 player-days) during baseline, travel and return. Results The overall incidence of illness in the cohort was 20.7 (95% CI 18.5 to 23.1). For all teams, the incidence of illness according to location and travelling was significantly higher in the time period following international travel (32.6; 95% CI 19.6 to 53.5) compared with the baseline (15.4; 95% CI 8.7 to 27.0) or after returning to their home country (10.6; 95% CI 6.1 to 18.2). Conclusions There is a higher incidence of illness in athletes following international travel to a foreign country that is >5 h time difference and this returns to baseline on return to the home country.

Association of type XI collagen genes with chronic Achilles tendinopathy in independent populations from South Africa and Australia

Background Type XI collagen, which is expressed in developing tendons and is encoded by the COL11A1, COL11A2 and COL2A1 genes, shares structural and functional homology with type V collagen, which plays an important role in collagen fibril assembly. We investigated the association of these three polymorphisms with Achilles tendinopathy (AT) and whether these polymorphisms interact with COL5A1 to modulate the risk of AT. Methods 184 participants diagnosed with chronic AT (TEN) and 338 appropriately matched asymptomatic controls (CON) were genotyped for the three polymorphisms. Results Although there were no independent associations with AT, the TCT pseudohaplotype constructed from rs3753841 (T/C), rs1676486 (C/T) and rs1799907 (T/A) was significantly over-represented (p=0.006) in the TEN (25.9%) compared with the CON (17.1%) group. The TCT(AGGG) pseudohaplotypes constructed using these type XI collagen polymorphisms and the functional COL5A1 rs71746744 (-/AGGG) polymorphism were also significantly over-represented (p<0.001) in the TEN (25.2%) compared with the CON (9.1%) group. Discussion The genes encoding structural and functionally related type XI (COL11A1 and COL11A2) and type V (COL5A1) collagens interact with one another to collectively modulate the risk for AT. Although there are no immediate clinical applications, the results of this study provide additional evidence that interindividual variations in collagen fibril assembly might be an important molecular mechanism in the aetiology of chronic AT.

Illness during the 2010 Super 14 Rugby Union tournament – a prospective study involving 22 676 player days

Background Illness accounts for a significant proportion of consultations with a team physician travelling with elite athletes. Objective To determine the incidence, type, cause and consequences of illness in Rugby Union players participating in a 16-week tournament. Setting 8 teams participating in the 2010 Super 14 Rugby tournament Participants A cohort of 259 elite rugby players from eight teams was recruited. Assessmen All players were followed daily over the 16-week competition period (22 676 player days). Each day, team physicians completed an illness log with 100% compliance. Information included the daily squad size and illness details including system affected, final diagnosis, type and onset of symptoms, training/match days lost and suspected cause. Main outcome measurement Incidence of illness (illness per 1000 player days). Results The incidence of illness in the cohort was 20.7/1000 player days (95% CI 18.5 to 23.1) with the highest incidence of illness in the respiratory system (6.4: 95% CI 5.5 to 7.3), gastrointestinal system (5.6: 95% CI 4.9 to 6.6) and the skin and subcutaneous tissue (4.6; 95% CI 4.0 to 5.4). Infections accounted for 54.5% of all illness and 26.1% of illness resulted in time loss of ≥1 day. In over 50% of illnesses, symptoms were present for ≥1 day before being reported to the team physician. Conclusion Infective illness involving the respiratory tract and gastrointestinal tract together with dermatological illness was common in elite rugby players participating in this international tournament. A delay in reporting of symptoms >24 h could have important clinical implications in player medical care.

More than 50% of players sustained a time-loss injury (>1 day of lost training or playing time) during the 2012 Super Rugby Union Tournament: a prospective cohort study of 17 340 player-hours

Background Professional Rugby Union is a contact sport with a high risk of injury. Objective To document the incidence and nature of time-loss injuries during the 2012 Super Rugby tournament. Design Prospective cohort study. Setting 2012 Super Rugby tournament (Australia, New Zealand, South Africa). Participants 152 players from 5 South African teams. Methods Team physicians collected daily injury data through a secure, web-based electronic platform. Data included size of the squad, type of day, main player position, training or match injury, hours of play (training and matches), time of the match injury, mechanism of injury, main anatomical location of the injury, specific anatomical structure of the injury, the type of injury, the severity of the injury (days lost). Results The proportion (%) of players sustaining a time-loss injury during the tournament was 55%, and 25% of all players sustained >1 injury. The overall incidence rate (IR/1000 player-hours) of injuries was 9.2. The IR for matches (83.3) was significantly higher than for training (2.1) and the IR was similar for forwards and backs. Muscle/tendon (50%) and joint/ligament (32.7%) injuries accounted for >80% of injuries. Most injuries occurred in the lower (48.1%) and upper limb (25.6%). 42% of all injuries were moderate (27.5%) or severe (14.8%), and tackling (26.3%) and being tackled (23.1%) were the most common mechanisms of injury. The IR of injuries was unrelated to playing at home compared with away (locations ≥6 h time difference). Conclusions 55% of all players were injured during the 4-month Super Rugby tournament (1.67 injuries/match). Most injuries occurred in the lower (knee, thigh) or upper limb (shoulder, clavicle). 42% of injuries were severe enough for players to not play for >1 week.

The sports concussion note: should SCAT become SCOAT?

Sports concussion research and clinical guidelines have evolved rapidly. The most recent concussion consensus statement and guidelines (Zurich, 2008) provided clinicians with the Sports Concussion Assessment Tool version 2 (SCAT2) as a clinical template for the assessment of acute concussion. For the subsequent serial examinations required for the complete assessment of the concussed athlete, SCAT2 may be inadequate. This paper describes the experience and suggestions of South African sports physicians in evolving a more comprehensive clinical evaluation tool and record of patient care, the Sports Concussion Office Assessment Tool.

Common work-related musculoskeletal strains and injuries

Abstract Muscles, tendons, joints and nerves are susceptible to injury when stressed or traumatised repetitively, or over an extended period of time. Regardless of the nature of the work, a large proportion of the working populations time is spent engaged in repetitive movements and maintaining postures for extended periods of time. The reported incidence of work-related back and neck pain, and carpal tunnel syndrome, is between 15–60%,1–3 indicating that a high proportion of the working population is at risk of developing one or more work-related musculoskeletal disorders. The parts of the body that are most commonly affected are the lower back, neck and shoulder girdle, and upper limbs. Based on current literature, we shall discuss conditions affecting these areas in order to gain a better understanding of the conditions, as well as their prevention.

Zurich 2012: our cohort of ‘concussionologists‘ – conveying consensus

Dr Mike Evans’ YouTube video ‘Concussions 101’1 plays on many desktops partly as a superb audiovisual aid to patients but mostly as a humbling reminder to us as to how efficiently Evans has conveyed to 50 363 people (so far!) the mantra of concussion care. Similarly, every time we watch a South African rugby match, we are astounded by the efficiency of the Wayne Viljoen managed BokSmart2 initiative that has put a field side concussion card in the pocket of 45 432 coaches and referees at all levels of South African rugby countrywide. For those of us who deal frequently with concussed patients, the series of international conferences,3–5 and the consensus documents and team physician guidelines6 ,7 that have emerged since Vienna 2001, have reassuringly guided us from the somewhat dogmatic neurological grading systems of the past to an evolving framework of consensus protocols that facilitate a more personalised approach to the concussed player based on both subjective feedback and objective clinical and cognitive evaluations. We have become comfortable with the on-field screening questions, field side SCAT2, serial office assessments, balance testing and return-to-play protocols. The Fourth International Conference on Concussion in Sport in Zurich from 1 to 2 November 2012 represents the latest gathering of sports neurologys most distinguished minds to further enhance our ability to more objectively and effectively manage this enigmatic neuropathological process. The concussion-in-sport leadership group continues to engage increasingly widely and harness the resources of key international sports bodies. Challenges posed have been taken up internationally and effectively addressed at …

Preseason Functional Movement Screen component tests predict severe contact injuries in professional rugby union players.

Abstract Tee, JC, Klingbiel, JFG, Collins, R, Lambert, MI, and Coopoo, Y. Preseason Functional Movement Screen component tests predict severe contact injuries in professional rugby union players. J Strength Cond Res 30(11): 3194–3203, 2016—Rugby union is a collision sport with a relatively high risk of injury. The ability of the Functional Movement Screen (FMS) or its component tests to predict the occurrence of severe (≥28 days) injuries in professional players was assessed. Ninety FMS test observations from 62 players across 4 different time periods were compared with severe injuries sustained during 6 months after FMS testing. Mean composite FMS scores were significantly lower in players who sustained severe injury (injured 13.2 ± 1.5 vs. noninjured 14.5 ± 1.4, Effect Size = 0.83, large) because of differences in in-line lunge (ILL) and active straight leg raise scores (ASLR). Receiver-operated characteristic curves and 2 × 2 contingency tables were used to determine that ASLR (cut-off 2/3) was the injury predictor with the greatest sensitivity (0.96, 95% confidence interval [CI] = 0.79–1.0). Adding the ILL in combination with ASLR (ILL + ASLR) improved the specificity of the injury prediction model (ASLR specificity = 0.29, 95% CI = 0.18–0.43 vs. ASLR + ILL specificity = 0.53, 95% CI = 0.39–0.66, p ⩽ 0.05). Further analysis was performed to determine whether FMS tests could predict contact and noncontact injuries. The FMS composite score and various combinations of component tests (deep squat [DS] + ILL, ILL + ASLR, and DS + ILL + ASLR) were all significant predictors of contact injury. The FMS composite score also predicted noncontact injury, but no component test or combination thereof produced a similar result. These findings indicate that low scores on various FMS component tests are risk factors for injury in professional rugby players.

Thoracic outlet syndrome in a patient with absent scalenus anterior muscle.

This case report describes the rare anomaly of an absent right anterior scalene muscle presenting with the symptoms and signs of the thoracic outlet syndrome. The thoracic outlet syndrome in our patient can be attributed to the absence of the right anterior scalene muscle, which resulted in the brachial plexus being in proximity to the subclavian vein and artery in a narrowed and abnormal interscalene space. In addition, the absence of the anterior scalene muscle resulted in the neurovascular structures being compressed onto the first rib in the costoclavicular space. The most likely cause of the presentation is, however, the possibility of the presence of aberrant muscle slips, which would cause compression of the structures in the anterior (venous) and posterior (neurological) sections of the thoracic outlet.

Concussion in sport: what is known and what is new?

The aim of this article was to summarise the latest definition of concussion, signs of concussion, as well as important facts on recovery and graduated return to play, for different age groups. New technologies available to the sports physician are listed.