Tom Pietilä

Heavy-Load Eccentric Calf Muscle Training For the Treatment of Chronic Achilles Tendinosis

We prospectively studied the effect of heavy-load eccentric calf muscle training in 15 recreational athletes (12 men and 3 women; mean age, 44.3 7.0 years) who had the diagnosis of chronic Achilles tendinosis (degenerative changes) with a long duration of symptoms despite conventional nonsurgical treatment. Calf muscle strength and the amount of pain during activity (recorded on a visual analog scale) were measured before onset of training and after 12 weeks of eccentric training. At week 0, all patients had Achilles tendon pain not allowing running activity, and there was significantly lower eccentric and concentric calf muscle strength on the injured compared with the noninjured side. After the 12-week training period, all 15 patients were back at their preinjury levels with full running activity. There was a significant decrease in pain during activity, and the calf muscle strength on the injured side had increased significantly and did not differ significantly from that of the noninjured side. A comparison group of 15 recreational athletes with the same diagnosis and a long duration of symptoms had been treated conventionally, i.e., rest, nonsteroidal antiinflammatory drugs, changes of shoes or orthoses, physical therapy, and in all cases also with ordinary training programs. In no case was the conventional treatment successful, and all patients were ultimately treated surgically. Our treatment model with heavy-load eccentric calf muscle training has a very good short-term effect on athletes in their early forties.

Incidence, nature, and causes of ice hockey injuries A three-year prospective study of a Swedish elite ice hockey team

In this prospective study, we have investigated inci dence of injuries of different severity, types of injury, and mechanisms of injury during ice hockey practice and games. One Swedish elite hockey team was closely observed during three seasons (1982 to 1985). There was a total number of 95 injuries and 29 facial lacera tions. The majority of injuries were minor (73%) and only 8% were classified as major. Seventy-six percent of the injuries occurred during games and 24% during practice. The incidence of injury during practice was 1.4 per 1,000 player-practice hours and 78.4 per 1,000 player-game hours. In comparison with other sports, the incidence of injury during hockey practice is very low, while that during games is high. Eighty percent of the injuries were caused by trauma and 20% by over use. The most common types of injury were contusions, strains, and sprains. Complete tear of the medial col lateral ligament of the knee was the most common severe injury. Most injuries resulted from body contact, predominantly tackling (checking), and from puck or stick contact. A reduction of the number of minor and moderate injuries should be possible by stricter en forcement of the hockey rules, especially against stick violations, and more widespread use of visors.

Anterior cruciate ligament injuries in young females playing soccer at senior levels.

The aim of this investigation was to study the consequences of anterior cruciate ligament injuries in female soccer players. Special interest was focused on young female soccer players (< 16 years) sustaining anterior cruciate ligament injuries when playing at a senior level, which means playing together with players 19 years or older. In Sweden, all players belonging to an organized soccer club are insured by the same insurance company, the Folksam Insurance Company. Data of all soccer‐related knee injuries in females reported to the Folksam Insurance Company between 1994 and 1998 were collected. A questionnaire was sent to 978 females who were registered to have sustained a knee injury before the age of 20 years. The response rate was 79%. Three hundred and ninety‐eight female soccer players who had sustained an anterior cruciate ligament injury before the age of 19 years were analysed. Most of their anterior cruciate ligament injuries had been diagnosed using arthroscopy or magnetic resonance imaging (84%). Thirty‐eight percent of the players had been injured before the age of 16 years. Of these, 39% were injured when playing in senior teams. When playing in senior teams 59% of the players below the age of 16 years and 44% of the players 16 years or older sustained their ACL injuries during contact situations. At the time of this investigation (2–7 years after the anterior cruciate ligament injury), altogether 78% (n = 311) reported that they had stopped playing soccer. The most common reason (80%) was symptoms from their anterior cruciate ligament‐injured knee. It appears that many young female soccer players injure their anterior cruciate ligament when playing at a senior level. Therefore, we suggest that female soccer players under the age of 16 years should be allowed to participate only in practice sessions but not games at a senior level.

Achilles Tendinosis and Calf Muscle Strength The Effect of Short-Term Immobilization after Surgical Treatment

We prospectively studied calf muscle strength in 7 men and 4 women (mean age, 40.9 +/- 10.1 years) who had surgical treatment for chronic Achilles tendinosis. Surgery was followed by immobilization in a weightbearing below-the-knee plaster cast for 2 weeks followed by a stepwise increasing strength training program. Strength measurements (peak torque and total work) were done preoperatively (Week 0) and at 16, 26, and 52 weeks postoperatively. We measured isokinetic concentric plantar flexion strength at 90 and 225 deg/sec and eccentric flexion strength at 90 deg/sec on both the injured and noninjured sides. Preoperatively, concentric and eccentric strength were significantly lower on the injured side at 90 and 225 deg/sec. Postoperatively, concentric peak torque on the injured side decreased significantly between Weeks 0 and 16 and increased significantly between Weeks 26 and 52 at 90 deg/sec but was significantly lower than that on the noninjured side at all periods and at both velocities. The eccentric strength was significantly lower on the injured side at Week 26 but increased significantly until at Week 52 no significant differences between the sides could be demonstrated. It seems, therefore, that the recovery in concentric and eccentric calf muscle strength after surgery for Achilles tendinosis is slow. We saw no obvious advantages in recovery of muscle strength with a short immobilization time (2 weeks) versus a longer (6 weeks) period used in a previous study.

Chronic Achilles Tendinitis and Calf Muscle Strength

We evaluated 10 men and 3 women (mean age, 44 ± 8.5 years) with chronic Achilles tendinitis who under went surgical treatment. Surgery was followed by im mobilization in a weightbearing below-the-knee plaster cast for 6 weeks and a stepwise increasing strength training program. We prospectively studied calf muscle strength on the injured and noninjured sides preoper atively and at 16, 26, and 52 weeks postoperatively. Preoperatively, concentric peak torque in dorsiflexion at 90 deg/sec and plantar flexion at 225 deg/sec was significantly lower on the injured side. Postoperatively, concentric plantar flexion peak torque on the injured side increased significantly between Weeks 16 and 26 at 90 deg/sec but was significantly lower than the noninjured side from Weeks 16 to 52 at 90 and 225 deg/sec. Dorsiflexion peak torque at 90 and 225 deg/ sec increased between Weeks 0 and 26 and was significantly higher on the injured side at Week 26. Eccentric plantar flexion peak torque was significantly lower on the injured side at Week 26 but not at 1 year. This prospective study demonstrates that 6 months of postoperative rehabilitation for chronic Achilles tendi nitis is not enough to recover concentric and eccentric plantar flexion muscle strength compared with the non injured side.

Concentric and eccentric shoulder and elbow muscle strength in female volleyball players and non-active females.

Alfredson H, Pietilä T, Lorentzon R. Concentric and eccentric shoulder and elbow muscle strength in female volleyball players and non‐active females.

Injuries in international ice hockey A prospective, comparative study of injury incidence and injury types in international and Swedish elite ice hockey

In this prospective study, we have investigated inci dence, nature, and mechanisms of injury in the Swedish national hockey team during 40 international games. There were 19 injuries associated with absence from practice or games, and 17 facial lacerations. The inci dence of injuries associated with absence was 79.2 per 1,000 player-game hours, compared to the correspond ing incidence of 78.4 found for Swedish national hockey. The incidence of facial wounds was 70.8 per 1,000 player-game hours, compared to the incidence of 21.8 for Swedish national hockey. The high incidence of facial injuries in international hockey is due to a high rate of stick contact injuries. Stricter enforcement of rules and more widespread use of visors would reduce the number of facial injuries.

Long-term Loading and Regional Bone Mass of the Arm in Female Volleyball Players

Abstract. In the present study, we compared the bone mineral content (BMC) and bone mineral density (BMD) in the arms of 11 female volleyball players (mean age 22.0 ± 2.6 years) training for about 8 hours/week, and 11 nonactive females aged 24.6 ± 3.1 years (mean ± SD) not participating in regular or organized sport activity. Using dual X-ray absorptiometry (DXA), BMC was measured in the proximal and distal humerus, and BMD in the distal radius. Isokinetic concentric peak torque (highest value attained during 5 or 10 repetitions) of the rotator muscles of the shoulder and flexor and extensor muscles of the elbow were measured using an isokinetic dynamometer. The volleyball players had significantly higher BMC (P < 0.05) at the proximal humerus of the dominant arm compared with the nonactive group, but there were no differences between the groups in BMC of the distal humerus and BMD of the distal radius. In the volleyball players, BMC was significantly higher at the proximal humerus, at the distal humerus, and at the distal radius in the dominant compared with the nondominant arm. In the nonactive group, there were no significant differences in BMC and BMD between the dominant and nondominant arm at any site measured. Except for shoulder internal rotation strength and elbow flexion strength at 90°/second that was higher in the dominant arm in the volleyball players, there were no significant differences in muscle strength of the rotator muscles of the shoulder and flexor and extensor muscles of the elbow between the dominant and nondominant arm in the volleyball players and nonactive controls. In the volleyball players, but not in the nonactive controls, there were several significant relationships between shoulder and elbow strength and BMC at the distal humerus of the dominant and especially the nondominant arm. These results show that young female volleyball players have a higher bone mass in the proximal humerus, distal humerus, and distal radius in the dominant compared with the nondominant arm, and a higher bone mass in the proximal humerus compared with nonactive controls. Muscle strength of the rotator muscles of the shoulder is not related to the higher bone mass in the proximal humerus of the dominant arm. Theoretically, the observed differences in bone mass can be related to the type of loading the skeleton undergoes when playing volleyball.

Bone Mass in the Calcaneus after Heavy Loaded Eccentric Calf-Muscle Training in Recreational Athletes with Chronic Achilles Tendinosis

Abstract. In an ongoing prospective study of 14 recreational athletes (12 males and 2 females, mean age 44.2 ± 7.1 years) with unilateral chronic Achilles tendinosis, we investigated the effect of treatment with heavy-loaded eccentric calf-muscle training. Pain during activity (recorded on a VAS scale) and isokinetic concentric and eccentric calf-muscle strength (peak torque at 90°/second and 225°/second) on the injured and noninjured side were evaluated. In this group of patients, we examined areal bone mineral density (BMD) of the calcaneus after 9 months (range 6–14 months) of training. BMD of the injured side (subjected to heavy-loaded eccentric training) was compared with BMD of the noninjured side. Before onset of heavy-loaded eccentric training, all patients had Achilles tendon pain which prohibited running activity, and significantly lower concentric and eccentric plantar flexion peak torque on the injured compared with the noninjured side. The training program consisted of 12 weeks of daily, heavy-loaded, eccentric calf-muscle training; thereafter the training was continued for 2–3 days/week. The clinical results were excellent—all 14 patients were back at their preinjury level with full running activity at the 3 month follow-up. The concentric and eccentric plantar flexion peak torque had increased significantly and did not significantly differ from the noninjured side at the 3 and 9 month follow-up. There were no significant side-to-side differences in BMD of the calcaneus. There was no significant relationship between BMD of the calcaneus and calf-muscle strength. As a comparison group, we used 10 recreational athletes (5 males and 5 females) mean age 40.9 years (range 26–55 years), who were selected for surgical treatment of chronic Achilles tendinosis localized at the 2–6 cm level. Their duration of symptoms and severity of disease were the same as in the experimental group. There were no significant side-to-side differences in BMD of the calcaneus preoperatively, but 12 months postoperatively BMD of the calcaneus was 16.4% lower at the injured side compared with the noninjured side. Heavy-loaded eccentric calf-muscle training resulted in a fast recovery in all patients, equaled the side-to-side differences in muscle strength, and was not associated with side-to-side differences in BMD of the calcaneus. In this group of middle-aged recreational athletes, BMD of the calcaneus was not related to calf-muscle strength.

Body composition and performance : influence of sport and gender among adolescents

Abstract Högström, GM, Pietilä, T, Nordström, P, and Nordström, A. Body composition and performance: influence of sport and gender among adolescents. J Strength Cond Res 26(7): 1799–1804, 2012—Body composition is well known to be associated with endurance performance among adult skiers; however, the association among adolescent crosscountry and alpine skiers is inadequately explored. The study sample comprised 145 male and female adolescent subjects (aged 15–17 years), including 48 crosscountry skiers, 33 alpine skiers, and 68 control subjects. Body composition (%body fat [BF], %lean mass [LM], bone mineral density [grams per centimeter squared]) was measured with a dual-emission x-ray absorptiometer, and pulse and oxygen uptake was measured at 3 break points during incremental performance tests to determine physical fitness levels. Female crosscountry and alpine skiers were found to have significantly higher %LM (mean difference = 7.7%, p < 0.001) and lower %BF (mean difference = 8.1%, p < 0.001) than did female control subjects. Male crosscountry skiers were found to have lower %BF (mean difference = 3.2%, p < 0.05) and higher %LM (mean difference = 3.3%, p < 0.01) than did male alpine skiers and higher %LM (mean difference = 3.7%, p < 0.05) and %BF (mean difference = 3.2%, p < 0.05) than did controls. This study found strong associations between %LM and the onset of blood lactate accumulation and V[Combining Dot Above]O2max weight adjusted thresholds among both genders of the crosscountry skiing cohort (r = 0.47–0.67, p < 0.05) and the female alpine-skiing cohort (r = 0.77–0.79, p < 0.001 for all). This study suggests that body composition is associated with physical performance amongst adolescents.