bluuebunny/crossref_metadata_2025_split huggingface dataset:
Low back pain in elite track and field athletes
Authors: Malliaropoulos N , Bikos G , Tsitas K , Papadopoulou S 
Published: January 2011

IntroductionLow 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 methodRetrospective 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).ResultsNinety 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.ConclusionWhen 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

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

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

ObjectiveTo 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.MethodA questionnaire was sent to Club Medical Officers of all the 92 English Football league teams.ResultsThe 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.ConclusionsFA 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

ObjectiveTo study the effectiveness of dextrose prolotherapy in the treatment of recalcitrant medial tibial stress syndrome (MTSS).DesignA prospective case-series.SettingA London private hospital.ParticipantsSeven 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.InterventionSubjects 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 period11/2009–7/2010Main outcome measuresSubjects 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.ResultsAll 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.ConclusionsDextrose 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

BackgroundGroin 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.AimsThe 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.MethodologyNine 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.ResultsA 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).ConclusionThis 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 10Stress 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 11IntroductionEndoscopic treatment of intractable chronic exertional compartment syndrome (CECS) of the lower leg in athletes is reported rarely and anecdotically.MethodsWe 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.Results38 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).DiscussionOur 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 12Low 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 15OccurrenceHamstring 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.PreventionIt 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.RehabilitationThere 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.TestingThere 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 19The 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
Comparison of the Rate of Convergence among Picard, Mann, Ishikawa, and Noor Iterations Applied to Quasicontractive Maps
Authors: Rhoades BE , Xue Zhiqun 
Published: January 2011

AbstractWe provide sufficient conditions for Picard iteration to converge faster than Krasnoselskij, Mann, Ishikawa, or Noor iteration for quasicontractive operators. We also compare the rates of convergence between Krasnoselskij and Mann iterations for Zamfirescu operators.