Patellar tendinopathy : on evaluation methods and rehabilitation techniques

Background: Patellar tendinopathy is an increasingly common overuse and degenerative injury for recreational and elite athletes. The management of this injury is often difficult and frustrating and the treatment may take a long time. There is therefore a need for efficient and well-evaluated treatment protocols based on evidence based rehabilitation training. The aim of this thesis was to evaluate and develop new training techniques and treatment protocols for active patients with patellar tendinopathy. Material, Methods and Results: Outcome evaluation instrument such as the VISA- P score for patellar tendinopathy, which are easily administrated, clinically and scientifically standardized and allow systematical follow-up of chronic symptoms are important and useful. The VISA-P questionnaire has been translated and culturally adapted to be the sensitive for changes during treatment. The translated score showed good test-retest reliability when used to evaluate symptoms of patellar tendinopathy and for tests of physical activity. A new eccentric overload device Bromsman in which controlled and safe training can be performed may play an important role for the development of new rehabilitation protocols. The device can handle different heavy loads on a barbell and showed a load- and resistance dependency and no significant difference between testretest. A direct feed-back system of force under each foot is a new feature and can make rehabilitation very specific when suffering from a unilateral injury. The load on the patellar tendon during four different eccentric squat exercises was measured on the decline board and in Bromsman. Eccentric work, mean force and peak patellar force and angle at peak force were greater for squats on a 25 degree decline board compared to horizontal surface, but higher knee load forces for the same measurements were observed in Bromsman. In a prospective randomized study two eccentric training methods; the eccentric overload device Bromsman and the 25 degree decline board; were compared. The clinical evaluation of both training techniques improved the VISA-P outcome score for patients with patellar tendinopathy problem. There was no difference between the groups. The number of patients in this study was limited. Conclusions: The VISA-P questionnaire is useful for research and clinical evaluation of patients with patellar tendinopathy. The new eccentric overload device Bromsman is safe for high performance and rehabilitation training with eccentric overload for multi-joint movement. There are different biomechanical loading pattern on the knee during different squat exercises. It is therefore important to individualize and to be more precise when designing a rehabilitation program. After 12 weeks eccentric overload treatment in the new device or a decline board the majority of patellar tendinopathy patients could be regarded as more or less symptom free

High injury burden in elite adolescent athletes : a 52-week prospective study

Context: Our understanding of the injury burden in elite adolescent athletes in most sports is limited or unknown because of the lack of prospective, long-term injury studies. Objective: To describe injury patterns in terms of type, location, prevalence and incidence, recurrence, and severity grade; time to first injury; and prevalence of illness in elite adolescent athletes and to compare differences in injury data by sex and sport type. Design: Cohort study. Setting: Fifteen national sports high schools in Sweden. Patients or Other Participants: Participants were 284 elite adolescent athletes (boys = 147, girls = 137; median age = 17 years; 25th–75th percentile range = 16–18 years) competing at a high national level for their age in athletics (track and field), cross-country skiing, downhill skiing, freestyle skiing, handball, orienteering, or ski orienteering. Main Outcome Measure(s): All athletes were monitored weekly over 52 weeks, using a validated online questionnaire to identify injury type, location, prevalence or incidence, and severity grade; time to first injury; and prevalence of illness. Results: Among all athletes, 57.4% reported at least 1 new injury, whereas the 1-year injury prevalence was 91.6%. The overall injury incidence was 4.1/1000 hours of exposure to sport, and every week, on average, 3 of 10 (30.8%) elite adolescent athletes reported being injured. Of all injuries from which athletes recovered, 22.2% (n = 35) resulted in absence from normal training for at least 2 months. Female athletes reported higher (P < .05) average weekly injury prevalence and substantial injury prevalence (injuries leading to a moderate or severe reduction in sport performance or participation or time loss) than male athletes. Conclusions: A considerable number of elite adolescent athletes were injured weekly, resulting in serious consequences for sport participation, training, or performance (or a combination of these). Appropriately designed interventions to prevent knee and foot injuries will target both the greatest number of injuries and the injuries with the most serious consequences in elite adolescent athletes

Conceptual and Practical Strategy Work to Promote Ergonomics/Human Factors in Sweden

This paper describes the results of the conceptual and practical strategy work performed by the Swedish Ergonomics and Human Factors Society (EHSS) today. The rationale of EHSS is to strengthen the quality of ergonomics/human factors knowledge and practice in Sweden and form a multidisciplinary platform across disciplines and professions for collaboration and for knowledge sharing. EHSS gathers about 350 members, representing different occupations in industry, academia and the public sector. Together, EHSS members hold knowledge and experience in physical, cognitive and organizational ergonomics and its application in working life and society. The overall aim of this paper is to inspire related societies and stakeholders to initiate discussions about strategies and future projects that allow for collaboration and knowledge sharing. Proposedly follow the EHSS model where we have formed a multidisciplinary platform for collaboration across disciplines and professions. The activities initiated and supported by EHSS are one step towards broadening the knowledge and application of HFE in Sweden, and to comprise new arenas of specialization. By participating in the key areas in society such as teaching, standardization, product development and occupational safety and health, the work of EHSS is one piece of the puzzle to improve human activities in the future. The vision is that together, we can improve safety, efficiency and well-being for all