The Algorithm for overload syndrome prevention: Osgood-Schlatter's syndrome (OSD) as an overload syndrome caused by early inclusion of children in sports and excessive physical activity (sports and recreation)

Introduction: Osgood-Schlatter’s syndrome (Osgood-Schlatter disease [OSD]) is caused by an accumulation of repeated microtraumas and is classified as a type of chronic injury called “overload syndrome“. It is considered that the root causes of OSD are accelerated growth as well as excessive sports and recreational activity. Currently, more than 50% of children of school age are involved in sports activities. In this study, 40 external risk factors were analyzed. Considering that frequent medical examinations, expensive rehabilitation, time-consuming sports activities, and school obligations result in major socio-economic and financial consequences, a need to work on a preventive program was recognized. The aim of this study was to determine external risk factors and to develop an algorithm for the prevention of injuries caused by overload syndrome through a detailed analysis of Osgood-Schlatter’s syndrome concerning aerobic and anaerobic sports (football, basketball, karate, and taekwondo). Methods: The research has been conducted on 200 patients who were previously diagnosed with Osgood-Schlatter’s syndrome. The participants were divided into two groups, each containing 100 patients, first group – aerobic sports (football and basketball) and the second group – anaerobic sports (karate and taekwondo). Personal information, anthropometric measurements, complete medical, and sports history were taken from the patients. A clinical examination was conducted by the researcher himself. This clinical study was prospective, comparative, analytical, and descriptive. The research was conducted in the Public Center for Sports Medicine of Canton Sarajevo. Software used for statistical data analysis was SPSS for Windows (version 20.0, SPSS Inc., Chicago, Illinois, USA) and Microsoft Excel (version 13 of Microsoft Corporation, Redmond, WA, USA). Results: Patients experienced the first symptoms of OSD at 4 years (football) and 6 years (taekwondo). About 60% of patients who trained in anaerobic sports and 38% of patients who trained in aerobic sports trained other sports more often as well. The research showed that a higher percentage of patients who trained anaerobic sports trained multiple sports at the same time (karate 88%, and taekwondo 82%) compared to patients who trained aerobic sports (football 68%, and basketball 76%). Patients who trained in anaerobic sports were also more likely to engage in recreational activities (58.3%) compared to patients who trained in aerobic sports (41.7%). On average, the number of hours per week which patients spent actively training (primary sport, additional sports activity, and recreational sport) was 17.2 h for basketball players, 16.8 h for taekwondo trainees, 16.7 h for caratists, and 15.7 h in case of football players. About 32% of football players, 24% of basketball players, 12% of karate trainees, and 18% of taekwondo trainees did not engage in additional sports or recreational activities. Only 36% of patients who trained in aerobic sports and 37% of patients who trained anaerobic sports respected the planned rest days, and in both groups, some subjects trained for 12 months. Conclusion: The research showed that patients who trained in anaerobic sports more frequently trained more than one sport at the same time and spent more hours doing recreational activities compared to patients who trained in aerobic sports. By analyzing weekly physical activity, it was concluded that the rest is limited. Future research aims to identify risk factors so that children, parents, and trainers can be educated to work on prevention through teamwork

The Osgood-Schlatter's Syndrome (OSD) and Involvement of Children of Young Age in Sports

Introduction: Two findings can be highlighted from recent medical research, first children of a young age are involved in organized sports activities more frequently than ever and second the first symptoms of Osgood-Schlatter disease (OSD) have been reported in children at the age of 5.5 years. The latest research has shown that children from ages 10 to 12 years have already been actively involved in sports activities for 5–7 years. In recent years, the practice of young children training to master sports has become a trend. Said exposes young children who are training intensively to various external risk factors such as social isolation, addiction, frequent injuries, and syndrome of overload. Enablers of this behavior are commonly parents and coaches who notice the child’s abilities stand out from those of other children in the group and find that such talent requires intensive sport-specific training. The purpose of this study was to determine the average age of the patients and the average age when the first symptoms of the disease appeared as well as to provide an analysis of the average duration of children being actively involved in sports activities before the first symptoms of OSD appeared. Methods: The research has been conducted on 200 patients who were previously diagnosed with Osgood-Schlatter’s syndrome. The participants were divided into two groups each containing 100 patients, first group –aerobic sports (football and basketball) and the second group –anaerobic sports (karate and taekwondo). Personal information, anthropometric measurements, complete medical, and sports history were taken from the patients. A clinical examination was conducted by the researcher himself. The study was prospective, clinical, comparative, analytical, and descriptive. The research was conducted in Public Center for Sports Medicine of Canton Sarajevo. Software used for statistical data analysis was SPSS for Windows (version 20.0, SPSS Inc., Chicago, Illinois, USA) and Microsoft Excel (version 13 of Microsoft Corporation, Redmond, WA, USA). Results: The average age when the patients started with intensive training was highest with basketball players (7.8 years) following with karate trainees (6.8 years). Basketball players had statistically the lowest duration of being actively involved in sports activities before the first symptoms of OSD appeared (5.4 years). No statistically significant difference in the average duration of training was discovered between the test groups. The average age when knee pain or swelling under the knee first appeared was at the age of 11.4 years with players of aerobic sports and 11.8 years with players of anaerobic sports. Furthermore, no statistically significant difference was found between test groups and subgroups. Before the first appearance of knee pain, the taekwondo patients had been in training the longest (4.7 years) and basketball players the least amount of time (3.4 years). Conclusion: By conducting retrospective analysis, it has been concluded that children had started training at the age of 3 or 4 years and had encountered the first symptoms of OSD at the ages of 4 years (football) and 6 years (taekwondo). Research showed that the early involvement of children in sports and their early specialization in sports are both external risk factors that have a dominant influence on OSD development

Importance of clinical examination in diagnostics of Osgood-Schlatter Disease in boys playing soccer or basketball

Introduction: Osgood–Schlatter disease is an irritation of the patellar tendon at the tibial tubercle. Sports with jumps, running, and repeated contractions of knee extension apparatus are considered to be importantexternal risk-factors which could cause Osgood–Schlatter disease.Objectives of the study are to draw attention to the importance of clinical examination in diagnostics of Osgood–Schlatter disease in boys playing soccer or basketball.Methods: The research included data obtained from 120 boys, average age of 14 years. Examinees were split into two groups, one with young athletes which regularly have soccer or basketball trainings and thesecond one with boys who do not participating in sports. We performed anthropological measurements and clinical examinations of both knees and hips for both groups. For the statistical analysis we used pointbiserialcorrelation coefficient.Results: Based on clinical examination, Osgood–Schlatter disease was diagnosed in 51 examinees (42.5%). In “athletic group” Osgood–Schlatter disease had 31 boys or 52%, comparing with “non-athletic group” wherewe found 20 adolescents with disease (33%). Number of boys with Osgood–Schlatter disease was higher for 19% in “athletic group” comparing with “non-athletic group”. Comparing incidence rate for boys in both groups with diagnosed II and III level of Osgood–Schlatter disease we found that rate is higher in “athletic group” 2.25 times comparing with “non-athletic group”.Conclusions: Clinical examination is critical method in the process of diagnosing Osgood–Schlatter disease especially for identifying II and III level of this disease

Relationship between reduced exposure to estrogen over a lifetime and bone mineral density in postmenopausal women

Introduction: The influence and interactions of various genetic, hormonal, environmental and nutritional factors and risks for decreased bone mineral density in older age are not yet clear. The aim of this study was to examine relationship between reduced exposure to estrogen over a lifetime (early age at menopause, shorter period between menarche and menopause) and bone mineral density in older women. Methods: A total of 60 women, aged 60-75 years were included and assigned to osteoporosis group (n=30), or control group with normal bone mineral density or osteopenia (n=30). The values ​​of bone mineral density were obtained by dual energy X-ray absorptiometry (DXA) at the lumbar spine (L2-L4) and proximal femur. Results: Women with osteoporosis entered the menopause at a younger age (43.03±3.18 years) compared to women without osteoporosis (51.93± 2.30 years) and the difference was statistically significant, p=0.0001. In addition, women with osteoporosis had shorter timespan between menarche and menopause (28.33±3.31 years), compared to women without osteoporosis (38.43±2.48 years), which was statistically significant, p=0.0001. Conclusion: Reduced exposure to estrogen over a lifetime because of early menopause, and shorter timespan between menarche and menopause may be associated with decreased bone mineral density and osteoporosis in postmenopausal women

Effects of strength, stretching and balance home exercise program on quality of life of people with knee osteoarthritis

Introduction: The aim of this study was to assess effects of strength, stretching and balance home exercise program (moderate intensity, performed once a day, five times a week) on quality of life of people with knee osteoarthritis. Methods: Participants with knee osteoarthritis performed physical therapy for a period of two weeks at the Department for Physical Medicine and Rehabilitation. The study group (n=30) continued to perform exercise program at home while the control group (n=30) did not continue the exercise program. The participants in the study group performed strength, stretching and balance exercises of moderate intensity, once a day, five times a week, for a total of eight weeks. The Short Form-36 Health Questionnaire (SF-36) was used to examine the effects of exercise program. Results: There was no the difference between the average value of quality of life in all examined areas (physical functioning, role limitations due to physical problems, role limitations due to emotional problems, vitality/energy, mental health, social functioning, physical pain, perception of general health) at the beginning of the study between the study group and control group (p>0.05 in all eight areas). The difference between the average value of quality of life at the beginning and end of the study was statistically significantly higher in the study group compared to the control group (physical functioning p=0.0001; role limitations due to physical problems p=0.0001; role limitations due to emotional problems p=0.0001; vitality/energy p=0.0001; mental health p=0.0001; social functioning p=0.0001; bodily pain p=0.0001; perception of general health p=0.0001). Conclusion: Home exercise program consisting of strength, stretching and balance exercises, of moderate intensity, performed once a day, five times a week is effective in improving quality of life of people with knee osteoarthritis

Daily activities of working individuals with hearing and speech disabilities

Introduction Disability is one of the factors that can lead to social exclusion and poverty of individuals with hearing and speech impairment. This is due to the fact that individuals with disabilities are often underestimated, in terms of their work and social skills. The employment of people with disabilities represents a powerful mechanism for achieving full participation of the marginalized groups in all spheres of society. Methods The study included a total of 40 people with hearing and speech disabilities, out of which 16 individuals were employed at DES d.o.o. Sarajevo and 24 at SINKRO d.o.o. Sarajevo. A combination of three questionnaires was used for assessing daily activities and their impact on the quality of life (QoL) of the individuals with hearing and speech disabilities. Results In the total sample, there were 35% males and 65% females. Complete deafness was observed in the majority of participants (90%), while the rest had either moderate (7.5%) or mild (2.5%) hearing impairment. A higher number of participants used sign language as the means of communication, compared to manual alphabet. About 17.5% of the participants used a cochlear implant or a hearing aid. Most of the individuals lived with a spouse (70%), 20% lived with their parents, 7.5% lived independently, and 2.5% lived with a guardian. The majority of the participants who were married had a child (57.5%). The average Ferrans and Powers' Quality of Life Index (QLI) was 19.33, and the average value for total daily activities was 11.700 MET. The average value for the level of physical activity in males was M = 13716.5 and in females M = 10613.56 (p > 0.05). Conclusions Overall, we showed that daily activities have a positive effect on the QoL of working individuals with hearing and speech disabilities, i.e., the individuals who had a higher level of physical activity also had a higher QoL

School bags and associated back pain

Introduction: The most common health problem associated with the negative effect of heavy school bags is back pain, and non-specific back pain is frequently observed in childhood. The prevalence of back pain in schoolchildren varies from 12% to 92%, depending on the age and affected region of the back. To prevent the occurrence of back pain in schoolchildren, the weight of school bag should not exceed 10% of the child’s body mass. Methods: This was a descriptive, cross-sectional study conducted in April 2017. We included 79 students of the fifth and sixth grade from the elementary school in Sarajevo. Information on the weight and type of school bag, method of carrying a school bag, and feelings of pain and tiredness due to school bag were obtained by questionnaire. Results: In the total sample, the majority of the students (64.6%) reported occasional back pain while carrying the bag, 20.3% of students reported no back pain, and 11.4% of students experienced frequent back pain. The mean school bag weight in the fifth grade was 4.01 ± 0.57 kg, and it was significantly higher (4.61 ± 0.86 kg) in the sixth grade. About 48.5% of the students in the fifth and 50% in the sixth grade carried school bags weighing more than 10% of the body mass. A higher mean weight of school bag was significantly more frequent in students who reported always feeling tired (11.03 ± 2.74%) compared to those who did not feel tired while carrying the school bag (8.41 ± 2%). Conclusions: Overall, more frequent occurrence of back pain and tiredness in schoolchildren was associated with heavier school bags (>10% of the body mass), and the occurrence of back pain due to school bag was related to gender (i.e., back pain was more common in girls compared to boys)

The efficiency of the conventional physical treatment of the shoulder pain compared to conventional treatment plus the Mulligan's joint mobilization technique and acupuncture

Introduction: Shoulder pain is the most common form of extra-articular rheumatism. We aimed to determine the efficiency of the conventional physical treatment of the shoulder pain compared to the conventional treatment plus the Mulligan's joint mobilization technique and acupuncture. Methods: We included a total of 277 patients with the shoulder pain caused by adhesive capsulitis (frozen shoulder), calcific tendinitis, rotator cuff syndrome, or the tendinitis of the biceps muscle. We used clinical and radiological diagnostic criteria to make the diagnosis. Patients were assigned into group treated with conventional physiotherapy treatment during the ten days (CP)(n=148), and the group treated with conventional physiotherapy treatment plus the Mulligan joint mobilization and acupuncture (CP+MA)(n=128). Treatment efficiency was evaluated by assessing the status of the patients before and after the treatment with the Work Abilities and Activities of Daily Living (WAADL) scale as well as the Treatment Success scale. Results: Mean treatment duration was 13.36±5.83 and 10.86±4.55 days in CP and CP+MA group, respectively (p<0.05). Mean WAADL scores after the treatment were 3.98±1.04 and 4.61±1.10 in CP and CP+MA group, respectively (p<0.05). Mean Treatment success score was 3.16±0.74 and 4.35±0.78 in CP and CP+MA group, respectively (p< 0.05). Conclusions: Conventional physical therapy plus the Mulligan's joint mobilization technique and acupuncture resulted in shorter treatment duration and higher WAADL and Treatment success scores in patients with shoulder pain

Influence of coffee consumption on bone mineral density in postmenopausal women with estrogen deficiency in menstrual history

Introduction: Complex etiology of osteoporosis include genetic, hormonal, environmental and nutritional factors. The aim of this study was to examine influence of coffee consumption on bone mineral density in postmenopausal women with estrogen deficiency in menstrual history.Methods: This prospective study included 100 postmenopausal women, aged 50-65 years living in Sarajevo area, with estrogen deficiency in their menstrual history. The controlled clinical trials were conducted. Two groups were formed (based on bone mineral density values). The examination group included 50 women who had osteoporosis, while the control group included 50 women without osteoporosis (osteopenia, normal bone mineral density). The lumbar spine and proximal femur bone mineral density was measured by Dual–Energy X–ray Absorptiometry using Hologic QDR-4000 scanner. Coffee drinking habits were assessed for each subject.Results: The average daily intake of coffee in women with estrogen deficiency in menstrual history was at 267.6 ml in the examination group and in the control group 111.6 ml. The difference in the average daily intake of coffee between the two groups was statistically significant (p &lt; 0.001). There was registered significant correlation between intake of coffee and bone mineral density in examination (p &lt; 0.01) and in control group (p &lt; 0.05).Conclusion: This study indicates that coffee consumption is a risk factor for osteoporosis in postmenopausal women, aged 50-65 years living in Sarajevo area, with estrogen deficiency in their menstrual history. It was shown that the effects of coffee on bone mineral density are dose-dependent

Influence of coffee consumption on bone mineral density in postmenopausal women with estrogen deficiency in menstrual history

Introduction: Complex etiology of osteoporosis include genetic, hormonal, environmental and nutritional factors. The aim of this study was to examine influence of coffee consumption on bone mineral density in postmenopausal women with estrogen deficiency in menstrual history. Methods: This prospective study included 100 postmenopausal women, aged 50-65 years living in Sarajevo area, with estrogen deficiency in their menstrual history. The controlled clinical trials were conducted. Two groups were formed (based on bone mineral density values). The examination group included 50 women who had osteoporosis, while the control group included 50 women without osteoporosis (osteopenia, normal bone mineral density). The lumbar spine and proximal femur bone mineral density was measured by Dual–Energy X–ray Absorptiometry using Hologic QDR-4000 scanner. Coffee drinking habits were assessed for each subject. Results: The average daily intake of coffee in women with estrogen deficiency in menstrual history was at 267.6 ml in the examination group and in the control group 111.6 ml. The difference in the average daily intake of coffee between the two groups was statistically significant (p < 0.001). There was registered significant correlation between intake of coffee and bone mineral density in examination (p < 0.01) and in control group (p < 0.05). Conclusion: This study indicates that coffee consumption is a risk factor for osteoporosis in postmenopausal women, aged 50-65 years living in Sarajevo area, with estrogen deficiency in their menstrual history. It was shown that the effects of coffee on bone mineral density are dose-dependent