Shouldering the blame for impingement: the rotator cuff continuum

The aim of this article was to summarise recent research on shoulder impingement and rotator cuff pathology. A continuum model of rotator cuff pathology is described, and the challenges of accurate clinical diagnosis, imaging and best management discussed.Keywords: shoulder impingement syndrome, subacromial impingement syndrome, rotator cuff, tendinopathy, rehabilitatio

Delayed onset muscle soreness: No pain, no gain? The truth behind this adage

The purpose of this article is to provide brief insight into delayed onset muscle soreness (DOMS), a phenomenon that is often experienced by recreational and elite athletes. The negative implications of DOMS include pain, decreased motivation to continue training, and decreased performance. While performance issues may be more relevant to the elite athlete, pain and decreased motivation are  particularly relevant to recreational athletes wishing to sustain a regular level of physical activity. The article is aimed at general practitioners (GPs) who may encounter athletes presenting with DOMS, and who will benefit from understanding the proposed mechanisms, signs and symptoms of the condition. Numerous researchers have hypothesised that certain interventions may prevent or minimise the symptoms thereof, and all GPs could benefit from understanding the available options for athletes, and the scientific evidence that supports these options.Keywords: delayed onset muscle soreness, mechanism, symptoms, treatment, athletes, managemen

Evidence-based prescription for cyclo-oxygenase-2 inhibitors in sports injuries

Healthcare professionals are increasingly under pressure to return athletes to play in the shortest possible time. There is limited choice in providing treatment that speeds up tissue repair, while simultaneously maintaining good quality of healing. Inflammation forms a fundamental part in the process of tissue repair. However, excessive inflammation may cause more pain, and limit functional restoration. Although the use of anti-inflammatory treatment in the form of a cyclo-oxygenase-2 inhibitor (coxibs) has been widely recognised as being effective, the potential detrimental effect on tissue repair, as described mainly in animal model studies, needs to be taken into account. The side-effects profile on the gastrointestinal tract favour coxibs over non-traditional NSAIDs. The possible effects on the renal and cardiovascular systems also need to be considered. The prescription of coxibs should be pathology and situation specific. There are no clear guidelines on the correct time of administration and the duration of the course, but it seems that the literature is in agreement that they should be administered for a limited time at the lowest effective dose possible.Keywords: cyclo-oxygenase-2 inhibitors (coxibs), sports injuries, treatmen

Sternal stress fracture in a gymnast: A case report and literature review

No Abstract

Medical encounters (including injury and illness) at mass community-based endurance sports events: an international consensus statement on definitions and methods of data recording and reporting

Mass participation endurance sports events are popular but a large number of participants are older and may be at risk of medical complications during events. Medical encounters (defined fully in the statement) include those traditionally considered 'musculoskeletal' (eg, strains) and those due to 'illness' (eg, cardiac, respiratory, endocrine). The rate of sudden death during mass endurance events (running, cycling and triathlon) is between 0.4 and 3.3 per 100 000 entrants. The rate of other serious medical encounters (eg, exertional heat stroke, hyponatraemia) is rarely reported; in runners it can be up to 100 times higher than that of sudden death, that is, between 16 and 155 per 100 000 race entrants. This consensus statement has two goals. It (1) defines terms for injury and illness-related medical encounters, severity and timing of medical encounters, and diagnostic categories of medical encounters, and (2) describes the methods for recording data at mass participation endurance sports events and reporting results to authorities and for publication. This unifying consensus statement will allow data from various events to be compared and aggregated. This will inform athlete/patient management, and thus make endurance events safer

The effect of different types of sports on resting heart rate variability and autonomic nervous system balance

No Abstract.AJPHERD Vol. 14 (3) 2008: pp. 326-33

Land- and water-based exercises in rheumatoid arthritis patients: a series of case reports

Objective. To compare the effects of a 3-month land- and waterbased exercise programme among rheumatoid arthritis (RA) sufferers. Methods. Patients with RA Functional Class I and II (N=10) were randomly assigned to a land-based exercise group (Group L) (N=4), water-based exercise group (Group W) (N=4) or a control group (Group C) (N=2). Testing parameters included swollen joint count (SJC), tender joint count (TJC), erythrocyte sedimentation rate (ESR), haemoglobin (Hb), 50-ft (15.2-m) walk test, grip strength, isokinetic strength of knee extensors and flexors, knee range of motion (ROM) and aerobic capacity. Results. There were individual improvements in most of the physical status parameters tested for the experimental groups (land-based exercise group and water-based exercise group) while the general trend for the control group was that of deterioration. Appropriate land-based exercises did not appear to aggravate disease activity. However, the water-based exercise programme was superior in controlling the disease activity with regards to the tender and swollen joint counts. Conclusion. Both exercise interventions appeared to be beneficial in the treatment of RA. Further research is required comparing various modes of exercises for the treatment of RA, using larger samples and evaluating the long-term effects

Iliopsoas haematoma in a rugby player

Traumatic iliopsoas haematoma is a serious complication of haemorrhage disorders rarely seen in young healthy athletes. It is mostly described in patients on anticoagulant therapy and commonly associated with various degrees of femoral nerve palsy. A 22-year-old male rugby player presented with severe onset of pain in the lower back, right hip flexor/pelvic area following a tackle during a rugby match. Magnetic resonance imaging identified a distinct, hyperechoic heterogeneous mass within the right iliopsoas muscle, confirming a diagnosis of iliopsoas haematoma. The case resolved completely after conservative medical treatment in addition to a period of rest and intense active physical therapy. This case study reports the rare diagnosis of an uncomplicated iliopsoas haematoma following a sports injury in a young athlete

Cardiovascular and autonomic response induced by a 20-week military training programme in young healthy South African males

Background. Studies investigating the relationship between exercise and haemodynamic regulation conducted in older caucasian and black African populations suggest that lifestyle modification is effective in the management of numerous disease processes. There are few longterm studies in young healthy populations and even less is known about the influence of habitual exercise on autonomic and haemodynamic variables in young black African subjects.Objective. To investigate the benefit of prolonged exercise on cardiovascular and haemodynamic variables in young healthy black African males.Methods. Fifty-five healthy male volunteers between 18 and 22 years of age participated in this prospective 20-week medium- to highintensity exercise intervention study with a self-control design. The Finometer Pro (Finapres Medical Systems, the Netherlands) was used for non-invasive data sampling of a number of cardiovascular and autonomic variables. Results were generated by computer algorithm and were analysed using non-parametric Wilcoxon signed rank tests.Results. Significant (p<0.05) cardiovascular changes included an increase in aerobic capacity, stroke volume, cardiac output and ejection fraction, and a decrease in diastolic blood pressure and heart rate. There was a significant decrease in total peripheral resistance and ascending aorta impedance. Systolic blood pressure, mean arterial pressure and arterial compliance remained unchanged, while the decrease in blood pressure variability was not statistically significant (p>0.05).Conclusion. The measured changes suggest a favourable response to exercise and imply that habitual exercise may be an important lifestyle modification for reducing the risk of cardiovascular disease in young black African males