bluuebunny/crossref_metadata_2025 huggingface dataset:
Exercise, sports and musculoskeletal medicine in UK medical school curricula: a survey
Authors: Oluwajana F , Rufford C , Morrissey D
Published: January 2011

Introduction

Exercise and obesity (EO) and sports and exercise medicine (SEM) are important topics in today's society and musculoskeletal medicine (MSK) is already a well established subject in medical schools. Despite the importance of these subjects, little is known about their occurrence in medical school curricula. the study aimed to investigate the availability of EO, SEM and MSK teaching in UK medical schools, opinions regarding the importance and quality of the teaching and to compare SEM and EO with MSK teaching.

Method

An anonymous online survey was designed, piloted and distributed to the deans of undergraduate medical education at 33 UK medical schools. reminder emails were sent to participants every 4 weeks for 4 months.

Results

The response rate was 76%. all medical schools have a direct focus on MSK in their curriculum. 68% have a direct focus on EO and 40% on SEM. There are more optional study opportunities in msk. 92% of medical schools assess MSK knowledge, while only 60% and 28% do so for EO and SEM respectively. MSK is perceived to be more important and have better quality teaching. The most common barrier to improving education was space in the curriculum.

Conclusions

EO and SEM teaching are uncommon and considered less important in UK medical schools compared to MSK teaching. Increasing the perceived importance of these subjects and providing curricular guidance to medical schools will help improvements to be implemented. The optional curriculum is likely to be the most appropriate initial method of increasing and improving teaching in EO and SEM.
Physical therapy treatment for adhesive capsulitis: clinical evidence and clinical reasoning
Authors: Salam A , Hemmings S , Morrissey D
Published: January 2011

Background

Many barriers exist impeding the translation of treatment evidence into practice for adhesive capsulitis (AC). The need for evidence-based practice is unquestionable, with reasoning skills needed to evaluate and apply the evidence. This study aims to combine published evidence and clinical reasoning to optimally guide clinical practice.

Objectives

The first is to categorise and grade the evidence for each individual physical therapy treatment modality for AC, through a literature review. This informs the second; qualitative exploration of physiotherapists' perceptions of the evidence and its interaction with clinical reasoning.

Methods

A systematic literature search was conducted for reviews and trials describing a physical therapy treatment for AC. Summaries of each individual modality were generated, and graded on the strength of supporting evidence. Semi-structured interviews were also conducted with experienced physiotherapists until data saturation.

Results

The literature search yielded 26 studies, from which 19 physical therapy interventions were identified. Strong evidence exists to support the use of education, steroid injection, mobilisations, stretching, supervised exercise, home exercise, acupuncture, heat therapy, transcutaneous electrical nerve stimulation, non-steroidal anti-inflammatory drugs and interferential electrotherapy. Moderate evidence exists for six modalities, and limited evidence for two. Fourteen themes surrounding the assessment, treatment and evidence behind AC were identified from framework analysis of interview transcripts.

Conclusion

There is relatively little high quality evidence in favour of one modality over another for AC. Until the quality and scope of evidence improves, clinicians will continue to rely heavily on their own expertise for treatment. These results are a meaningful guide to clinical practice, and reveal a number of research questions.
‘In it for the long run’: sources of self-efficacy in adolescent female athletes
Authors: Watson L , Binks E , Kawycz S
Published: January 2011

Introduction

Most research in sport psychology investigating the sources of efficacious beliefs has been conducted within the parameters of Bandura's (1977) self-efficacy theory.1 Within the context of a situation six sources are believed to be cognitively appraised; mastery performances, vicarious experiences, verbal persuasion, imaginal experience, emotional states and physiological states, to develop one's efficacy expectations and goal directed behaviour.2 The aim of the study was to identify the sources of self-efficacy most salient to female adolescent long distant runners, why such sources are selected and whether they were interlinked.

Method

Semi-structured interviews were conducted to allow athletes’ sources and types of efficacy to emerge inductively. Interviews were recorded, transcribed verbatim and analysed using the interpretative phenomenological approach. After obtaining ethical approval, six female adolescent athletes (mean age=15 years, national level) were recruited, using opportunistic sampling, from a single running club.

Results

Nine sources emerged from this investigation with numerous variations within them being exclusive to sport and female adolescent athletes. The nine sources of self-efficacy identified were: performance accomplishments, vicarious experiences, verbal persuasion, physiological experiences, imaginal experiences, emotional states, situational favourableness, self-perception and athlete specific. Specifically, it was found that performance accomplishments provide a catalyst for the additional sources. In particular performance accomplishments inform the athlete efficacious beliefs, however this is only situational specific and is none transferable. Individual differences arose as an imperative factor in how one interprets the efficacious sources.

Conclusion

The results extend previous conceptualisations related to personal efficacy beliefs within athletic settings and supported the contention that efficacious beliefs play a significant moderating effect on athlete functioning and athletic performance. Findings highlight the need to further examine the uses of multiple sources of self-efficacy and their weighting in individual's sports, as this may provide valuable insight for coaches and sports psychologists working with particular athlete groups and assist in developing interventions which augment or maintain efficacious beliefs in individual athletes.
Sonographic evaluation of achilles tendon thickness in elite track and field athletes: preliminary study
Authors: Kiritsi Olga , Malliaropoulos Nikos , Tsitas Konstantinos , Noussios George
Published: January 2011

The purpose of the study was to measure Achilles tendon thickness in elite track and field athletes and to investigate any difference between dominant and non-dominant lower limb. Ultrasound examination of Achilles tendons was performed in 20 elite track and field athletes (12 males, 8 females; age range, 18–28 years). A control group of 20 healthy individuals, age and sex matched, was used. The thickness of the Achilles tendons was measured in the transverse plane at the level of the medial malleolus. True tendon thickness was evaluated and it was defined as thickness perpendicular to the greatest width of the tendon. For each participant, the Achilles tendons were measured by two operators. Mean Achilles tendon thickness was 5.37±0.78 mm in elite athletes and 4.66±0.65 mm in the control group. Mean thickness of the Achilles tendon in elite track and field athletes was significantly greater than mean thickness in healthy individuals (p=0.003). A significant result was also depicted between athletes and control groups in dominant lower limbs (athletes, 5.46±0.93 mm; control group, 4.71±0.57 mm, p=0.024) and in non-dominant limbs (athletes, non-dominant limb, 5.28±0.64mm; control, 4.47±0.74 mm; p=0.039). In addition no significant difference was observed in mean thickness of Achilles tendon between dominant and non-dominant limbs (p=0.454) in elite athletes as well as control individuals. Our outcome implies that Achilles tendon thickness is increased in elite track and field athletes.
The evaluation of the treatment of 10 cases of chronic compartmental syndrome of the upper arm
Authors: Gasol X , García M A , Turmo A , Valle X
Published: January 2011

Chronic compartment syndrome (CCS) is a pathological situation in which there is an increase in the interstitial muscular pressure which produces a conflict of microcirculation and enervation. The main characteristic is pain and stiffness during activity with intense neurovascular symptoms.

The initial presentation is clinical with diagnosis confirmed by an intracompartmental pressure measurement (ICP) to confirm the diagnosis. Other non-invasive diagnostic techniques like magnetic resonance imaging and near infrared spectroscopy produce less clear results.

Conventional treatment reduces the symptoms but its application presents difficulties for sportspeople. Fasciotomy is still the treatment of choice followed by postsurgical rehabilitation, although the possibility of relapse cannot be discounted.

Materials and methods

10 sportspersons have been studied with CCS, diagnosed by ICP, and looked at in the medical department of CAR Sant Cugat during the period 2003–2009. Personal characteristics were: age: 31.5 years +12.07; weight: 72.4 kg + 6.55: height 171.4 cm+4.95; IMC 24.67+2.42; one woman and nine men. The Whitesides technique was used for administering the PIC and the Pedowitz criteria for confirming the diagnosis. The treatment was evaluated using a test based on Slimonet al(2002). The patients evaluated the results as bad, medium, good or excellent. The pain was evaluated on a subjective scale of 1–10 together with the presence or absence of weakness, muscular contractions or paresthesia.

Results

10 subjects diagnosed with CCS (8 flexors and 8 extensors). The latent diagnostic period was from 18,6 months±19,8.

Over the total 16, 10 were treated with fasciotomy and 6 with conventional treatment.

Total recovery: using fasciotomy 9 versus conservative 0. Using fasciotomy, the total recuperation period took more than a year in eight cases. Compartments with an unsatisfactory therapeutic result: fasciotomy 1, conservative 6. Two cases diagnosed as CCS without fulfilling the Pedowitz criteria due to an extended recovery time. These two cases were given conservative treatment but were not complete a good recovery.

Conclusion

The latency diagnostic period are long

Fasciotomy comes out as the better treatment but with recovery times longer than a year in all cases except one.

The recovery time of basal pressure during the test seems a variable worth taking into account independently of the Pedowitz criteria, so for that reason we think it deserve an analysis in greater depth.
An exploration of the hydration strategies of the runners of the 2010 london marathon by questionnaire
Authors: Williams Jonathan , Kipps Courtney , Tzorgiou Victoria
Published: January 2011

Background

There have been several recorded fatalities due to Exercise-associated hyponatraemia (EAH) attributed to excess fluid intake by marathon runners. A significant proportion of runners finishing marathons have been found to be hyponatraemic, mainly due to inappropriate fluid intake.

Objective

To explore the hydration strategies of marathon runners, their sources of information and knowledge about fluid intake on marathon day and their understanding of hyponatraemia.

Design

Anonymised questionnaire.

Setting

The London Marathon Registration.

Participants

A random sample of 217 runners registering for the marathon.

Results

93% of the runners had read or been told about drinking fluids on marathon day. The majority of competitors had a plan regarding fluid intake prior to, during and after the marathon. 83.9% said that they knew enough about what and how much to drink on marathon day. However, 34% planned to drink a volume large enough to put themselves at higher risk of EAH. Only 21% knew the volumes of water and sports drink bottles from which they planned to drink during the marathon. 20.7% were planning to take a drink from all 24 water stations. Only 25% planned to drink according to their thirst as recommended by the international EAH conference consensus statement.

68% of runners had heard of hyponatraemia or low sodium levels, but only 35% had a basic understanding of its cause and effects.

Conclusions

Runners of the 2010 London Marathon lack knowledge about appropriate fluid intake on race day. A significant proportion of participants have drinking strategies that put them at risk of EAH. Runners need to be more effectively educated about safe fluid intake prior to future London Marathons.
Stresses and displacements for normal human knee menisci and for sectioned menisci using finite element method
Authors: Daniela Tarnita , Tarnita D N , Grecu D , Popa D , Rusu F I
Published: January 2011

Introduction

The paper has the following objectives: The obtaining of virtual 3D parameterised models of the menisci; the determination of the stresses, deformations and displacements of menisci for different cases and for different mechanical solicitations, using finite element method.

Methods

To obtain the bones cross sections we used a Aura Philips tomograph.

–

The obtained images were redrawn in AutoCad over the real tomographies and the drawings were imported in SolidWorks (a parametrical Computer Aided Design software), section by section, in parallel planes. The virtual models of the internal menisci and external menisci were obtained.

–

The initial parameters and kinematical and kinetostatical functions of the virtual biomechanical system of the knee joint were established.

–

This system was imported in VisualNastran software.

–

The virtual models of the internal menisci, external menisci were discretised and analysed using the finite element method.

Results

We obtained the finite elements structure of both human knee menisci. Maps for the von Misses stresses, for the displacements, for the deformations and for the deformation energy in normal menisci. In the cases of 1/3 from the volume of the medial menisci is cut and 1/3 from the volume of the lateral menisci is cut, we simulated a virtual meniscetomy. The stresses and the displacements diagrams were also obtained.

Conclusions

For an indemn anatomical knee, the stress in menisci is un-uniform distributed, the zone of menisci body being the most loaded in both cases: extension and flexion.

The deformations in menisci are unequal distributed, the maximum being obtained at the level of the menisci body.

In the knee extension, the deformations are almost twice bigger than the deformations in the case of knee flexion.

The increasing twice of the loading force in the knee joint determines an increasing of stresses with only 20% because of the amortiser role of the menisci.
Crisp-padhiar syndrome
Authors: Crisp TA , King JB , Chan O , Padhiar N
Published: January 2011

Introduction

The common cause of medial midfoot pain following acute trauma usually, either pronatory or inversion sprain is due to tibialis posterior tendon dysfunction, tibialis posterior tendinopathy, Os naviculare syndrome, stress fracture of the navicular and Lisfranc ligament injury. These are disabling conditions which are often treated in isolation.

Crisp-Padhiar syndrome

We present a case history which highlights the complexity of the problem and discuss the findings of subsequent series of 42 patients who presented with post-traumatic medial midfoot pain. In Crisp-Padhiar syndrome patients present with combination of the following: (1) trauma, (2) presence of Os naviculare, (3) tibialis posterior tendinopathy, (4) tibialis posterior dysfunction, (5) acquired flatfoot, (6) Os naviculare synchondrosis and (7) anomalous tibialis posterior tendon attachment of Os naviculare.

The treatment of choice in the initial stage is to stabilise the medial structures in Aircast Posterior Tibial Tendon Dysfunction brace for 6 weeks, followed by intensive physiotherapy and dependent on reduction of symptoms and degree of flat footedness, consider fluoroscopy guided tendon distension injection and introduction of customised carbon fibre foot orthoses. Surgery was performed only in two patients who did not respond to conservative management.
Chronic exertional compartment syndrome of the foot
Authors: Padhiar N , Tardioli A , Allen M , King J B
Published: January 2011

In this paper the authors present a case history along with results of case series and a literature review to demonstrate the complexity of this condition.

The main aim is to increase the awareness among clinicians and the scientist to research in the area of chronic exertional compartment syndrome (CECS).

CECS usually refers to myoneural ischaemia due to a reversible increase in tissue pressure within a myofascial compartment.

CECS of the leg is well documented in the literature since it was first described by Mavor in 1956.

CECS of the foot remains underdiagnosed and has been reported in the literature only on an anecdotal basis. Wood Jones proposed that there were four compartments in the foot but Manoli and Weber suggest that there are nine separate muscle compartments.

Clinical signs and symptoms of CECS of the foot remain diverse and lack the consistency of its counter part in the leg. The range of signs and symptoms include swelling, tension, cramps, tightness, paraesthesia, numbness, cyanosis and soft tissue indurations. As a result number of diagnosis is first considered and includes plantar fasciitis, tibialis posterior tendonitis, tarsal tunnel syndrome and medial Lisfranc injury.

CECS of the foot remains a diagnosis of exclusion.

The most effective treatment is a superficial fasciotomy.
The important role of the arthroscopic hip surgery in the athletes with hip injuries. our experience. a retrospective study
Authors: Tsikouris G , Tsolos I , Gosis Ch , Plessas S , Moschonas S , Tsikouris D
Published: January 2011

Hip arthroscopy has gradually evolved over the past two decades.Recently hip arthroscopy has increase its role in diagnosis and treatment for specific intraarticular and extraarticular hip injuries and especially for soft tissue injuries.

Material and methods

February 2004–March 2010, 48 athletes, football players, basketball players, weight lifters, gymnasts, three water polo players. Mean age: 32 years. (19–39 year old)

Instrumentation and equipment

70°, 4.5 mm arthroscope, High flow rate mechanical pump, 15 gauge 6″ cardiac needle, Convex full radius chondroplasty blades, special electrocautery. Distraction apparatus, DVD unit, mechanical water pump unit, mage intensifier

Indications

Undiagnosed hip pain, early osteoarthritic signs, labral pathology, loose bodies, osteochondral defects, sepsis, ligamentum teres, trauma, synovitis, femoral acetabular impingment (FAI), ‘frozen hip’, chondrocalcinosis.

Symptoms

Deep dull ache pain during hip flexion and external or internal rotation, decrease range of motion, decreased hip flexion.

Clinical findings

30/48 Cam sign: positive, 12/48 Pincher sign: positive, impingement syndrome in hip flexion and internal and rotation and occasionally in external rotation, snapping hip, iliopsoas tendinitis.

Surgery

Standard orthopaedic traction table, supine position, hip is extended and abducted 25°

Portals

Anterolateral, posterolateral, modified anterolateral

Intraoperative findings

Detachment of the labrum, 10/48 erosion of the articular cartilage of the acetabulum and drilling of the bare area, 30/48 Cam sign excision, 12/48 pincer sign excision, 8/48 superior medial and superior lateral labrum repair with anchors. (intra-articularly)

Results

The modified Harris Hip Score was used for their classification of their symptoms. Two of the athletes had a residual pain due to an iliopsoas tendinitis. 45/48 had relief from their arm symptoms, 1/48 will need to be reoperated shortly (after he developed FAI), 2/48 are treated for the iliopsoas tendinitis.

Conclusion

The athletes with symptoms of an internal hip pain and FAI signs after a detailed clinical exam of their hip and after failure of their conservative treatment, will certainly get a benefit from an arthroscopic procedure (which is technically demanding).
Low back pain in elite track and field athletes
Authors: Malliaropoulos N , Bikos G , Tsitas K , Papadopoulou S
Published: January 2011

Introduction

Low back pain is an extremely common symptom, not a disease, and has many causes with disc pathology being the underlying reason in most of the cases.The aim of this study was to investigate and compare the causes of low back pain (LBP) in elite track and field athletes of their different events.

Material and method

Retrospective cohort study of S.E.G.A.S. sports clinic LBP reports compiled by certified physicians between 1988 and 2008.The participants were 18–26 year-old male and female elite track and field athletes with low bak pain. The main outcome measure was an analysis of aetiology of LBP at three event category athletes: throwers, jumpers, and sprinters and their lumbar pain problems were categorised at discogenic (disk herniation, derangement, bulging), muscle injuries, back element injuries (spondylolysis, spondylolisthesis, facet joint syndrome), complex injuries (combination of the categories above) and other problems (Scheuerman disease, compresion fractures, etc).

Results

Ninety four athletes with low back pain (44 sprinters, 29 throwers and 44 jumpers) which visited the sport clinic totaly 184 times (a percentage of 3.6% at a total number of 2591 injured athletes) were included in the study. When evaluating all events concurrently discogenic problems were the most common cause of low back pain followed in descending order by muscle and back elements injuries with the same percentage and complex problems with the discogenic causal element prevailed.

Conclusion

When evaluating all these three categories emerges clearly the prevalence of discogenic aetiology lumbar pain in these categories of athletes.
The role of the sports and exercise medicine physician in the national health service
Authors: O'Halloran P , Brown V Tzortziou , Morgan K , Maffulli N , Perry M , Morrissey D
Published: January 2011

Objectives

To investigate the opinions of general practitioners, orthopaedic surgeons, rheumatologists, sport and exercise medicine (SEM) registrars and public health consultants on training, caseload, the most appropriate setting and the position of SEM within the National Health Service (NHS) in the UK.

Method

A cross-sectional questionnaire-based survey investigated the opinions of the above professionals from three primary care trusts and associated hospitals in London and Birmingham.

Results

With a 50% response rate (n = 226), 93% (208/224) of participants felt that there was a role for SEM in the NHS. 56% (124/223) agreed that this role should be in both primary and secondary care. 64% (136/212) of participants felt that their practice would benefit from the input of a SEM physician and 95% (191/202) would consider referring patients to SEM services. 74% (165/222) agreed that SEM should have a public health role, and 63% (140/222) believed that these responsibilities should be evenly balanced with the treatment of sports injuries. Despite the emphasis on public health work from SEM policy makers, none of the SEM registrars selected public health as an important training area. 31% (44/140) of participants felt that a lack of education in the medical profession regarding SEM represented the greatest hindrance to its development in the NHS.

Conclusion

Several areas of agreement were demonstrated across the specialties, many of which matched the views of policy makers. This study involved participants from a range of cognate disciplines and was the first to investigate this issue since SEM was recognised as a specialty in 2005.
Experimental study into forearm compartmental pressures
Authors: Ardolino A , Zeineh N , O'Connor D
Published: January 2011

Introduction

Chronic compartment syndrome is well recognised, although rare in the forearm. In our chronic compartment syndrome clinic, we successfully identified and treated four cases. This prompted a literature review searching for normal ranges of forearm compartmental pressures. Existing normal forearm pressure ranges are based on lower limb measurements. This study aimed to establish normal pre- and postexercise forearm pressures.

Methods

Using a Stryker intracompartmental pressure monitor, 41 participants underwent pressure measurements of the superficial extensor and flexor forearm compartments before and after exercise.

Results

Normal ranges for pre-exercise extensor compartment (2–27 mm Hg, upper CI 18.8 to 25.2 mm Hg), postexercise extensor compartment (2–24 mm Hg, upper CI 16.8 to 22.8 mm Hg), pre-exercise flexor compartment (1–19 mm Hg, upper CI 13.3 to 17.4 mm Hg) and postexercise flexor compartment (0–19 mm Hg, upper CI 16–21.4 mm Hg) pressures were established. No significant pressure difference was found after exercise (extensor pressures; p=0.41, flexor pressures; p=0.21). There was no correlation between whether pressures increased or decreased following exercise. There was significant sex difference (extensor pressures; p=0.04, flexor pressures; p=0.008). Normal ranges for the extensor compartment were; 0–25.2 mm Hg and for the flexor compartment; 0–21.4 mm Hg.

Conclusions

This study showed a significant difference in normal forearm compartment pressures between sexes. A normal reference range of forearm compartment pressures to aid diagnosis of chronic compartment syndrome has been determined. This may also prove useful in aiding diagnosis of acute forearm compartment syndrome.
Electrocardiographic abnormalities and diagnostic criteria in athletic overtraining
Authors: Evangelos Papoutsidakis , Antonio Turmo , Montse Bellver
Published: January 2011

The overtraining syndrome describes the condition of prolonged imbalance between training load and recovery, with increased incidence in high level performance sports. Is very important to manage this syndrome not only for the consequences at the performance of the athlete, but also because of the potential risk of athlete's health. Although the symptoms vary from one person to another, this syndrome enclose decrease in athletic performance, prolonged fatigue, electrocardiographic changes and psychological symptoms.

The aim of the present study was to provide some aspects of cardiovascular consequences and electrocardiographic abnormalities that may be seen and to up to date the diagnostic criteria of detecting this syndrome, by using as method a systematic revision of the literature.

ECG abnormalities at this syndrome include extreme low heart rate, T wave inversions, atrial-ventricle block, ST segment depressions, atrial-ventricle dislocation and many type of arrhythmias. There happens a cardiac autonomic imbalance with extensive autonomic modulation of the athlete, depressed left ventricular function, impairment of the maximal anaerobic capacity with a reduced tolerance of acidosis and decreased of maximum oxygen consumption.

Although of the multitude of publications for overtraining syndrome, actually we have limited available tools for valid diagnosis. Thus, is important the role of prevention by monitoring of the athlete by the sports physician, controlled training, ECG records and sufficient recovery.
Current practices in determining return to play following head injury in professional football
Authors: Price Jo
Published: January 2011

Objective

To investigate the awareness of English football team doctors of the ‘Consensus in Sport’ guidelines for the assessment and management of concussion. And to identify whether teams are following these recommendations and adhering to best practice.

Method

A questionnaire was sent to Club Medical Officers of all the 92 English Football league teams.

Results

The majority (55.6%) of teams in the English FA do not routinely follow the CIS guidelines. One third are still using outdated fixed periods of abstinence following a concussion.

Conclusions

FA players are not being treated at standards recommended by International sporting organisations. The endorsement of the CIS guidelines by the FA would ensure that all medical teams have a sound and safe protocol for managing concussed players and making return to play decisions.
The effectiveness of prolotherapy in the management of recalcitrant medial tibial stress syndrome: a pilot study
Authors: Curtin M , Crisp T , Malliaras P , Padhiar N
Published: January 2011

Objective

To study the effectiveness of dextrose prolotherapy in the treatment of recalcitrant medial tibial stress syndrome (MTSS).

Design

A prospective case-series.

Setting

A London private hospital.

Participants

Seven patients: five male and two female; (mean age=36 years+4 months) referred to a specialist tertiary referral centre having failed existing care pathways for MTSS.

Intervention

Subjects received a subperiosteal injection containing 15% dextrose solution via a BD spinal needle 22GA 3.5 IN (0.7×90 mm) under ultrasound guidance. Typically a 1 ml volume of the dextrose solution was injected per centimetre of symptomatic area of the tibia using a 20 ml syringe, giving set and three-way tap.

Study period

11/2009–7/2010

Main outcome measures

Subjects completed a visual analogue scale (VAS) for average pain (where 10=severe pain and 0=no pain). Scores recorded at baseline, 1, 2 and 4 weeks postinjection and again during telephone follow-up (mean 18 weeks, range 13–36 weeks). Subjects were also reviewed at least once in a follow-up appointment where they also completed a symptom diary. At final telephone follow-up they completed a six-point Likert global improvement scale, and a five-point activity scale.

Results

All subjects reported a marked improvement in their symptoms. There was a significant decrease in mean average pain measured by VAS scores at 4 weeks (p <0.05) and 18 weeks (p<0.05) compared to baseline. The median VAS average pain score improvement per subject was 4/10. The median change in activity value at 18 week postinjection follow-up was a score of 4.0 representing a return to a desired level of sport but not to preinjury level. The median Likert global improvement score at 18 weeks postinjection follow-up was 2.0 which represented ‘much improved’ on a six-point scale. There were no adverse events.

Conclusions

Dextrose prolotherapy injection resulted in tangible symptom improvement in seven patients with painful recalcitrant MTSS. Controlled trials of this intervention are warranted.
Muscle activation patterns in football code athletes with chronic groin pain: a case control study
Authors: Graham Jennifer , Morrissey Dylan , Small Claire , Twycross-Lewis Richard , Woledge Roger
Published: January 2011

Background

Groin pain is a common injury among football code athletes. The repetitive turning, twisting and kicking involved in such sports place supra-physiological stresses through the pelvic region. It has been suggested that rehabilitation of chronic groin pain requires specific sequencing of muscle activation to be effective. This has been identified as being a difference in subjects with groin and sacroiliac joint pain during lower limb movement.

Aims

The aims of this paper were to; (1) identify any differences in muscle activation before and during an active straight leg raise between football code groin sufferers and controls and to (2) highlight any differences in muscle activity between the symptomatic and asymptomatic sides in the groin sufferers before and during an active straight leg raise.

Methodology

Nine subjects with groin pain and nine matched controls (matched according to age, weight and height) were used. Surface electromyogenic (EMG) electrodes were placed on six bilateral muscle groups – rectus femoris, biceps femoris, adductor longus, internal oblique, multifidus and gluteus medius. Movement was qualified with an active motion tracking system, while the subject lay on two force plates and performed an active straight leg raise manoeuvre. EMG, force and pelvic motion was analysed to demonstrate any muscle activation differences between the symptomatic and asymptomatic group.

Results

A significant difference was found between the symptomatic and asymptomatic limbs in both ipsilateral and contralateral adductor longus muscles (p<0.03, p<0.01), both ipsilateral and contralateral gluteus medius muscles (p<0.02, p<0.04) and ipsilateral rectus femoris (p<0.02) at initial onset of movement. During the movement, a significant difference was found between the control and case groups (both symptomatic and asymptomatic side) in the ipsiateral and contralateral internal oblique muscles (p<0.05, p<0.04) and the ipsilateral adductor longus (p<0.01).

Conclusion

This study has shown that there are differences in the muscle groups supporting the pelvis during lower limb movement. Of this study’s findings, the most notable was that the gluteus medius and adductor longus muscles showed decreased activity in the groin sufferers group. The Adductor Longus decrease correlates with current literature, however the decreased activation of gluteus medius suggests that this muscle group should be integrated into the groin rehabilitation.
Can we predict a bone stress injury?
Authors: Agapi Papalada
Published: January 2011

Lecture 10

Stress fractures are often difficult to early differentiate from other soft tissue injuries.

On the other hand to confirm early the diagnosis of a stress fracture an MRI is needed. Since 1972 the literature indicates that the detection of stress fracture by ultrasound was possible before x-ray findings. Stress fracture's detection by ultrasound will be described and analysed.

During the period 1995–2009, we evaluate with a physio ultrasound 115 track and field athletes. First, we marked on patient's skin the area to be examined both on the injured leg and on the healthy one. The patients were asked to report immediately any painful sensation. We used an ultrasound probe of 1 MHz, with a diameter of 3 cm and maximum intensity of 2.00 W/cm2. We scanned the questioned area in order to spot the point of major symptoms for 30 s. In case of negative findings after a total time of 60 s the procedure was completed. If there was a positive finding of intense pain, we reduced the power density and we continued for another 30 s. We continued in the same pattern until the patient reported no discomfort.

The estimated sensitivity and specificity of this procedure was 94, 39% and 62, 5%, respectively.

The mechanical energy when radiated from a source is mainly converted to heat. According to the literature, this ultrasound procedure highly elevates the temperature in periosteum. This increase of temperature is related to high transmission velocity and high absorption factor of the ultrasound.

The interpretation of the patients' sensation is the key to diagnosis. Sensation of heat, either light heat or burning, vibration, or a pinching ache, did not indicate a positive result of the ultrasound test in contrast to intense pain or pressure. It was the latter that led us to imply the existence of stress fracture.

The ultrasound technique for stress fracture detection is a safe, non-invasive, low cost method easily performed and could be a valuable tool for the physician's regarding decision making in terms of an early diagnosis.
Endoscopic release of fascia in CECS
Authors: Lohrer H , Nauck T
Published: January 2011

Lecture 11

Introduction

Endoscopic treatment of intractable chronic exertional compartment syndrome (CECS) of the lower leg in athletes is reported rarely and anecdotically.

Methods

We developed a minimally invasive, endoscopically assisted technique for release of CECS of the lower leg. Follow-up was performed by telephone interview 47 months (range 5 months to 7 years) after surgery.

Results

38 compartments were released in 17 athletes (19 deep posterior, 16 anterior and 3 lateral compartments). All these patients were available for follow-up analyses. No complications were seen following anterior and lateral compartment decompression. Contrasting to this, two patients operated under tourniquet for deep posterior compartment syndrome suffered intraoperative haemorrhage and open revision surgery was required. No complications due to vascular injuries were seen in all further patients when the tourniquet was omitted. Ten patients returned to previous sport activity. At follow-up, results were good or excellent in 10 out of 17 patients. Visual analogue pain scale improved from 7.4 (range 5–9) before surgery to 2.4 (range 1–8) at follow-up (p = 0.0005).

Discussion

Our data indicate that endoscopic release for CECS of the lower leg is feasible und successful. The procedure is at risk for vascular complications during deep posterior compartment fasciotomy. Consequently, it is emphasised to perform the procedure without tourniquet.
How to rehabilitate an athlete with low back pain
Authors: Ligia Rusu
Published: January 2011

Lecture 12

Low back pain is one of the most common cause of loss playing time at athletes. The best rehabilitation in low back pain can be considered the early prevention. In the case of injury is important to know and to understanding the phases of rehabilitation and needed. At the level of low back during its motions is important to know the kinetic and kinematics aspects. The kinematics of spinal flexion and extension are associated with a shifting instantaneous axis of rotation. Spinal kinetics at athletes includes intrinsic and extrinsic forces that can affect the spine. The sources of low back pain include the intervertebral disc, nerve roots, sacroiliac joints, ligamentous, muscular tissue. Assessment begins with history of pain and relation with sport activity, location of the pain in relation with body position, walking, effort, daily moment and also progressivity. In assessment we include clinical examination of the entire kinetic chain of the spine, by assess the posture, mobility and also using some specific tests like: Gielett, Faber, Thomas, Gaenslen completed by imaging evaluation (MRI, plain radiographs, bone scan, CT scan). Most common causes of low back pain to athletes are: fractures, acute disc herniations, muscular contusions and strain or degenerative disc diseases, spondylolysis, spondylolisthesis, facet syndrome, lordotic posture, sacroiliac inflammation.

Rehabilitation depends of how we understanding the involved sports and according to the injury. Are three phases: acute and subacute, rehabilitative phase and sport specific rehabilitation. Medication includes non-steroidal anti-inflammatory drugs (NSAIDs) and also brace, manipulation.

Acute and subacute phase: propose few days of rest, icing, ultrasounds, iontophoresis, laser therapy and brace. In subacute phase is possible aerobic activity in the pool. For entire period we recommend isometric contraction for abdominal and extensors muscle.

Rehabilitative phase: in this phase we prefer core stabilisation and depend of pathology mechanism, we shall promote flexion or extension programme, for obtain neutral zone that involves comfortable spinal motion. We begin the closed chain strengthening and co-activated muscular coordination for improvement muscle balance. In second part of rehabilitation phase, the programme depends of sports activity, because the core have to transfer the forces from lowers limbs to uppers limbs or to generate forces and recoil forces. For this the athletes must to make these motions.

Sport specific rehabilitation is the third phase and prepare the returning to sport activity. So, are specific programmes for dancers, gymnasts, golf and racquet sports, football, throwing, weightlifters. The programmes must to involve decrease of stress forces at the back, to maintain the static of spine and decrease the disc injuries. All of these programmes have to be included in the training programmes for minimising recurrence and improve sport performance.
Types of hamstring injuries in sports
Authors: Askling Carl
Published: January 2011

Lecture 15

Occurrence

Hamstring strain is the most common single injury in elite soccer. To prevent these injuries and to optimise the rehabilitation it is important to analyse in what situations they occur. There are at least two distinctly different types of acute hamstring strains, one occurring during high-speed running and mainly involving the biceps femoris long head, the other during movements leading to extensive lengthening of the hamstrings (such as high kicking, sliding tackle, sagittal split) often involving the free proximal tendon of semimembranosus. These two injury types will be exemplified with injury situations, MRI findings and time back to sport from our ongoing study on acute hamstring strains. When the free proximal tendon is involved, there seems to be an extended period of time before full function without symptoms is reached. Injury type, palpation of maximal pain and MRI findings (tissues involved) can give important information about prognosis.

Prevention

It seems to be very important to specifically restore the eccentric hamstring muscle strength after injury before returning to sport to prevent the common hamstring re-injury. Also in the few prospective studies that exist, eccentric training appears to be an essential ingredient. This has been indicated in two rather recent Scandinavian studies, one prospective randomised study on Swedish elite male football players and the other on Icelandic and Norwegian male elite football players. However, both studies suffer from methodological shortcomings, which limit their impact.

Rehabilitation

There are no studies describing what kind of rehabilitation programme athletes suffering different types of hamstring strains should perform. One study indicated that core stability training is an important part of the rehabilitation programme. In our ongoing study we randomised the injured athletes into two different programmes. Different exercises with the aim of putting high eccentric demand on the hamstrings in situations with different degrees of lengthening of the hamstring muscle-tendon complex.

Testing

There is no consensus about a single test, clinical examination or imaging investigation that would provide strict criteria for safe return to sport following hamstring muscle strain. We are currently evaluating a new active hamstring flexibility test that appears to add discriminative power and provide useful additional information to the common clinical examination before going back to full training/match. Preliminary data will be presented and discussed.
Exercise is medicine: but what is the dose?
Authors: Khan K
Published: January 2011

Lecture 19

The term ‘polypill’ was coined in a BMJ publication; researchers wondered whether a cocktail of five pills taken on a population basis could reduce cardiovascular disease by 80% (Wald 2003). Some would argue that there exists a polypill already – but the multi-system benefits of physical activity have been under-recognised. In this short presentation, I address the question ‘What is the optimum dose of physical activity for health?’

Recommended reading below.1 2
A LOW POWER DIGITALLY ERROR CORRECTED 2.5 BIT PER STAGE PIPELINED A/D CONVERTER USING CURRENT-MODE SIGNALS
Authors: WAWRYN KRZYSZTOF , SUSZYNSKI ROBERT , STRZESZEWSKI BOGDAN
Published: January 2011

This paper, presents a novel low power current mode 9 bit pipelined a/d converter. The a/d converter structure is composed of three 2.5 bit stages and one 3 bit stage operating in current mode and a final comparator which converts the analog current signal into a digital voltage signal. All the building blocks of the converter were designed in CMOS AMS 0.35 μm technology, simulated, and then a prototype converter was manufactured and measured to verify the proposed concept. The performances of the converter are compared to performances of known voltage-mode switched-capacitance and current-mode switched-current converter structures. Low power consumption and small chip area are the advantages of the proposed converter.
CMOS LOW-POWER ANALOGUE BASEBAND CIRCUITS FOR A NON-COHERENT LOW DATA RATE IR-UWB RECEIVER
Authors: CHEN ZHIMING , ZHENG YUANJIN , YUAN XIAOJUN
Published: January 2011

A low-power analogue baseband circuit for a low data-rate impulse radio ultra-wideband (IR-UWB) receiver is designed and implemented in a 0.18 μm CMOS technology, including a variable-gain amplifier (VGA), a received signal strength indicator (RSSI), and a limiting amplifier (LA). The VGA has gain range from -9 to 63 dB and bandwidth from 31 to 187 MHz. An input P1dB of -15.4 dBm is achieved at 0 dB gain. The RSSI has a dynamic range of approximately 70 dB. The RSSI linearity error is within ±1.2 dB for an input power from -77.5 dBm to -36.2 dBm. By adjusting the VGA gain and the LA threshold, the LA is able to detect an input pulse as low as 0.6 mV at a data rate of 15 mega-pulse per second (MP/s). The analogue baseband circuit draws current of 6.03 mA from a single voltage supply of 1.8 V. The test chip occupies an area of 970 μm × 750 μm, including two output buffers.
CIRCUIT-BASED APPROACHES TO SIMPL SYSTEMS
Authors: CHEN QINGQING , CSABA GYÖRGY , LUGLI PAOLO , SCHLICHTMANN ULF , STUTZMANN MARTIN , RÜHRMAIR ULRICH
Published: January 2011

This paper presents circuit-based approaches to SIMPL Systems (SIMulation Possible, but Laborious Systems), which could be regarded as a "public-key" version of Physical Unclonable Functions. The use of these systems can help us to avoid some of the potential vulnerabilities of conventional cryptography, such as its dependency on secret binary keys. Two specially designed circuits for SIMPL systems are discussed: "skew" memories and massively parallel analog processor arrays known as Cellular Nonlinear Networks. We argue that these circuits are able to serve as SIMPL systems in practice, and discuss their security against numerical and physical attacks.
NOISE-AWARE DATA PRESERVING SEQUENTIAL MTCMOS CIRCUITS WITH DYNAMIC FORWARD BODY BIAS
Authors: JIAO HAILONG , KURSUN VOLKAN
Published: January 2011

Multi-threshold voltage CMOS (MTCMOS) is the most widely used circuit technique for suppressing the subthreshold leakage currents in idle circuits. When a conventional sequential MTCMOS circuit transitions from the sleep mode to the active mode, significant bouncing noise is produced on the power and ground distribution networks. The reliability of the surrounding active circuitry is seriously degraded. A dynamic forward body bias technique is proposed in this paper to alleviate the ground bouncing noise in sequential MTCMOS circuits without sacrificing the data retention capability. With the new dynamic forward body bias technique, the peak ground bouncing noise is reduced by up to 91.70% as compared to the previously published sequential MTCMOS circuits in a UMC 80 nm CMOS technology. The design tradeoffs among important design metrics such as ground bouncing noise, leakage power consumption, active power consumption, data stability, and area are evaluated.
FOLD–HOPF BIFURCATION ANALYSIS FOR A COUPLED FITZHUGH–NAGUMO NEURAL SYSTEM WITH TIME DELAY
Authors: ZHEN BIN , XU JIAN
Published: January 2011

A FitzHugh–Nagumo (FHN) model with delayed coupling is considered. For a critical case when the corresponding characteristic equation has a single zero root and a pair of purely imaginary roots, a complete bifurcation analysis is presented by employing the center manifold reduction and the normal form method. The Fold–Hopf bifurcation diagrams are provided to illustrate the correctness of our theoretical analysis. Whether almost periodic motion and bursting behavior occur in the FHN neural system with delayed coupling depends on the time delay in the signal transmission between the neurons.