Mechanical Low Back Pain in Elite Track and Field Athletes: An observational cohort study

OBJECTIVE: The aim of the study was to gain information about the incidence of mechanical Low Back Pain (MLBP) injuries etiology in elite track and field athletes and to assess the recurrence rate. BACKGROUND: The prevalence and the etiology of Low Back Pain (LBP) in athletic populations at the elite level of competition lack of longitudinal studies focused on certain sport fields. The present study evaluates MLBP incidents in elite track and field athletes visiting National Track and Field Centre in Thessaloniki, Greece and classifies MLBP according to etiology. METHODS: One hundred and thirty Elite Track and Field Athletes with MLBP injuries were included in a 20-year observational cohort study recording the initial MLBP etiology according to a classification system based on mechanical diagnosis. It was examined if age, gender and sport category predispose the incidence of the initial MLBP etiology and if they consist risk factors for MLBP recurrence. RESULTS: Discogenic MLBP in elite track and field athletes was significantly higher at 46.9% (α= 0.05) compared with the other MLBP etiologies under consideration. Secondary findings of the present study regarding the incidence of MLBP etiology categories did not reveal significant associations with gender, age and contest categories (α= 0.05). Additionally, recurrence pathophysiology showed that discogenic MLBP obtained high recurrence rates at 0.48 (14 athletes from 29 athletes recurred) compared with other etiologies, followed by back elements injury recurrence rate at 0.24 (7 athletes out of 29). CONCLUSIONS: The study provided us with evidence of higher incidence of discogenic etiology of MLBP in elite track and field athletes. Further research is suggested in the use of etiology related LBP classification system in order to evaluate causes, prevalence and epidemiology of MLBP in athletic populations of specific sport categories. © 2017 - IOS Press and the authors

Estimating the dynamic ratio of the lateral/medial hamstrings. A case control study

Purpose. Hamstring injuries are among the most common injuries in sports. The current study estimates the hamstrings dynamic ratio (HDR) between the mean muscle activation of lateral (biceps femoris longus) and medial part (semitendinosus) of the hamstring muscles during a maximal voluntary isometric contraction in elite uninjured track and field athletes. Methods. Following isokinetic assessment to estimate the hamstrings to quadriceps dynamic ratio (H:Q), the participants were divided in two groups (Group 1 (N = 10): Athletes with a H:Q ratio range 55-70% and no side to side difference of the ratios more than 6 units; and Group 2 (N = 8) athletes with a H:Q ratio outside of the 55-70% range and/or a side to side difference of the ratios greater than 6 units). All athletes were assessed by electromyography during a maximum voluntary isometric contraction of their hamstrings. Results. There was difference on the range and means between the two groups regarding hamstrings dynamic ratio (78% and 69% respectively), although this difference did not reach statistical significance. Conclusions. A proposed HDR of 78% between lateral to medial hamstrings could be used as a risk factor for hamstring injuries in athletes with hamstring muscle imbalances. Better characterisation of the normal patterns of hamstring muscle activation will allow targeted rehabilitation to address specific neuromuscular coordination patterns. © 2021, CIC Edizioni Internazionali s.r.l.. All rights reserved

Individualised radial extracorporeal shock wave therapy (rESWT) for symptomatic calcific shoulder tendinopathy: A retrospective clinical study

Background: A retrospective single centre cohort analysis was performed to evaluate an individualised radial extracorporeal shock wave therapy (rESWT) protocol for treatment of symptomatic calcific shoulder tendinopathy. Methods: 67 patients (79 Shoulders) were identified with 76 shoulders included for analysis. rESWT treatment protocol was adapted according to individual response to treatment. Variables included number of sessions, shockwave impulses, pressure and frequency. Success rate was estimated as the percentage of patients having ≥60% visual analogue score (VAS) pain decrease at follow-up. Recurrence at 1 year was recorded. Results: Using this individualised symptom guided protocol, patients underwent a mean of 7 ± 1.5 rESWT sessions, with mean pressure of 1.7 ± 0.2 bar, mean frequency of 5 ± 0.3 Hz and 2175 ± 266 impulses. The mean pre-treatment VAS score of 6.7 ± 1.1 was significantly decreased to 3.2 ± 0.8 immediately post-treatment, 2.6 ± 0.9 at 1 month, 1.7 ± 1.0 at 3 months and 0.8 ± 1.0 at 1 year follow up (α = 0.05). One-year success rate was estimated at 92% and 1-year recurrence rate was 7%. Conclusions: We conclude that in this retrospective study an individualised rESWT protocol resulted in a high success rate with low number of recurrences. Randomised controlled trials to support these findings are recommended. © 2017 The Author(s)

Low-level laser therapy in meniscal pathology: a double-blinded placebo-controlled trial.

We performed a randomized, double-blinded, placebo-controlled study (ISRCTN24203769) to assess the effectiveness of low-level laser therapy (LLLT) in patients with meniscal pathology, including only symptomatic patients with tiny focus of grade 3 attenuation (seen only on 0.7 thickness sequences) or intrasubstance tears with spot of grade 3 signal intensity approaching the articular surface. None of the patients in the study group underwent arthroscopy or new magnetic resonance imaging investigation. Paired-samples t test was used to detect significant changes in subjective knee pain over the experimental period within groups, and ANOVA was used to detect any significant differences between the two groups. Pain was significantly improved for the LLLT group than for the placebo group (F = 154, p  0.05). Four weeks after LLLT or placebo therapy, the laser group reported an average Lysholm score of 82.5 ± 4.6, and the placebo group scored 79.0 ± 1.9. At 6 months, the laser group had an average Lysholm score of 82.2 ± 5.7, and after 1 year, they scored 81.6 ± 6.6 (F = 14.82923, p = 0.002). Treatment with LLLT was associated with a significant decrease of symptoms compared to the placebo group: it should be considered in patients with meniscal tears who do not wish to undergo surgery

Muscle and intensity based hamstring exercise classification in elite female track and field athletes: implications for exercise selection during rehabilitation

Panagiotis Tsaklis,1,2 Nikos Malliaropoulos,3–5,10 Jurdan Mendiguchia,6 Vasileios Korakakis,7–9 Kyriakos Tsapralis,11 Debasish Pyne,5 Peter Malliaras101Department of Physiotherapy, Laboratory of Biomechanics and Ergonomics, Alexander Technological Educational Institute of Thessaloniki, Thessaloniki, Greece; 2Department of Mechanical Engineering, Bioengineering, Massachusetts Institute of Technology, Cambridge, MA, USA; 3National Track and Field Centre, Sports Injury Clinic, Sports Medicine Clinic of SEGAS, 4Thessaloniki Sports Medicine Clinic, Thessaloniki, Greece; 5Rheumatology Department, Sports Medicine Clinic, Mile End Hospital, London, UK; 6Department of Physical Therapy, Zentrum Rehabilitation and Performance Center, Pamplona, Spain; 7Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; 8Faculty of Physical Education and Sport Science, University of Thessaly, Trikala, 9Hellenic Orthopaedic Manipulative Therapy Diploma, Athens, Greece; 10Centre for Sports and Exercise Medicine, Queen Mary, University of London, London, UK; 11K Tsapralis Isokinetic Medical Group, Bologna, ItalyBackground: Hamstring injuries are common in many sports, including track and field. Strains occur in different parts of the hamstring muscle but very little is known about whether common hamstring loading exercises specifically load different hamstring components. The purpose of this study was to investigate muscle activation of different components of the hamstring muscle during common hamstring loading exercises.Methods: Twenty elite female track and field athletes were recruited into this study, which had a single-sample, repeated-measures design. Each athlete performed ten hamstring loading exercises, and an electromyogram (EMG) was recorded from the biceps femoris and semitendinosus components of the hamstring. Hamstring EMG during maximal voluntary isometric contraction (MVIC) was used to normalize the mean data across ten repetitions of each exercise. An electrogoniometer synchronized to the EMG was used to determine whether peak EMG activity occurred during muscle-tendon unit lengthening, shortening, or no change in length. Mean EMG values were compared between the two recording sites for each exercise using the Student's t-test.Results: The lunge, dead lift, and kettle swings were low intensity (<50% MVIC) and all showed higher EMG activity for semitendinosus than for biceps femoris. Bridge was low but approaching medium intensity, and the TRX, hamstring bridge, and hamstring curl were all medium intensity exercises (≥50% or <80% MVIC). The Nordic, fitball, and slide leg exercises were all high intensity exercises. Only the fitball exercise showed higher EMG activity in the biceps femoris compared with the semitendinosus. Only lunge and kettle swings showed peak EMG in the muscle-tendon unit lengthening phase and both these exercises involved faster speed.Conclusion: Some exercises selectively activated the lateral and medial distal hamstrings. Low, medium, and high intensity exercises were demonstrated. This information enables the clinician, strength and conditioning coach and physiotherapist to better understand intensity- and muscle-specific activation during hamstring muscle rehabilitation. Therefore, these results may help in designing progressive strengthening and rehabilitation and prevention programs.Keywords: hamstring injuries, exercise, rehabilitatio

Radial extracorporeal shockwave therapy for the treatment of finger tenosynovitis (trigger digit)

Nikos Malliaropoulos,1–5 Rosanna Jury,1,2,5 Debasish Pyne,3–5 Nat Padhiar,3,5 Jennifer Turner,6 Vasileios Korakakis,3,7 Maria Meke,1 Heinz Lohrer3,8 1Sports and Exercise Medicine, Thessaloniki Musculoskeletal Clinic, 2Thessaloniki National Track and Field Centre, Sports Medicine Clinic of S.E.G.A.S., Thessaloniki, Greece; 3European Sports Care, 4Department of Rheumatology, Sports Clinic, Barts Health NHS Trust, 5Centre for Sports & Exercise Medicine, Queen Mary University of London, London, UK; 6Healthcare Group Guernsey, Guernsey; 7Aspetar, Orthopaedic and Sports Medicine Hospital, Doha, Qatar; 8European SportsCare Network (ESN), Zentrum für Sportorthopädie, Wiesbaden-Nordenstadt, Germany Introduction: Stenosing tenosynovitis that is characterized by the inability to flex the digit smoothly, usually leads to prolonged rehabilitation or surgery.Study design: This case series is a retrospective cohort study.Purpose: The aim of this case series was to evaluate the effectiveness of radial extracorporeal shockwave therapy (rESWT) for the treatment of stenosing tenosynovitis of the digital flexor tendon (trigger digit).Methods: A retrospective analysis of 44 patients (49 fingers) treated with an individually adapted rESWT protocol was conducted. Trigger digit pain and function were evaluated at baseline and 1-, 3-, and 12-months posttreatment. Recurrence and pretreatment symptom duration were analyzed.Results: Significant reductions in pain scores and functional improvement were found between baseline and all follow-up assessments (P<0.001). Pretreatment symptom duration was significantly correlated with the number of rESWT sessions required (r=0.776, P<0.001) and 1-year posttreatment pain score (r=0.335, P=0.019).Conclusion: This study provides initial evidence that rESWT is an effective treatment for trigger digit, but randomised controlled trials are required to provide further evidence of this effect. Keywords: trigger finger, trigger thumb, tendon, shockwave therapy, non-surgical therapy, conservative treatment, physiotherap

Development and validation of a questionnaire (FASH-Functional Assessment Scale for Acute Hamstring Injuries): to measure the severity and impact of symptoms on function and sports ability in patients with acute hamstring injuries

Objective To develop a condition-specific patient-reported outcome measure, the Functional Assessment Scale for Acute Hamstring Injuries (FASH), de novo in three languages, following distinct and rigorous methodology for content generation, analysis and validation and to assess its psychometric properties. Background To our knowledge, there is no patient-reported functional scale specific for acute hamstring injuries. Methods The development of the scale followed specific guidelines, as well as de novo construction in three languages (Greek, English and German). Item generation was accomplished by selecting three different sources of items: literature review, focus group and key informant interviews. Content analysis was conducted by an expert committee. The 21 items selected as appropriate were tested through a structured content analytic method and item-content validity coefficient, and 10 were retained for the FASH. The validation and assessment of its psychometric properties followed theConsensus-based Standards for the selection of health status Measurement Instruments (COSMIN) recommendations to ensure quality, in a convenience sample of 140 participants. Results The face validity was adequate and tested by expert committees, authors and participants. Content validity was characterised as well addressed and conducted independently by experts and through specific content validation procedures. The dimensionality analysis indicated a one-factor solution explaining the 95.8% of total variance. Known group validity was demonstrated by significant differences between patients and controls (p< 0.001). The FASH exhibited very good test-retest reliability (intraclass correlation coefficient= 0.9, p< 0.001), internal consistency (alpha= 0.98) and responsiveness (3.81 and 5.23 using baseline and pooled SD, respectively; standardised response mean (SRD)= 4.68). Conclusion This study provides initial evidence for psychometric properties of the first scale assessing hamstring injuries

Hamstring and other thigh injuries in children and young athletes

Background In adults, hamstring injuries may lead to long periods of rehabilitation and carry a definite risk of recurrence. However, no studies detail how these injuries affect young athletes. Objective To describe and analyze injuries in the hamstring area in young athletes. To identify risk factors for injuries to the hamstring area in this age group, which will make it possible to design and optimize prevention plans. Methods The study population consisted of 1157 young athletes with an average age of 13.56 years, all members of the Barcelona Football Club. Injuries to the hamstring area over three consecutive seasons (from July 2007 to June 2010) were analyzed. Results The 50 injuries in the hamstring muscle complex included 14 injuries to the biceps femoris, 17 to the semitendinosus-semimembranosus complex, 10 cases of delayed onset muscle soreness (DOMS), and nine avulsion of the ischial tuberosity. Hamstring injuries were first identified in young athletes starting from age nine, with an age-related increased rate up to the age of 15, and a lower incidence at age 14, 16, and 18. The average time lost following an hamstring injury was 21 days and 43.4 days following avulsion from the ischium. The highest incidence of injuries occurred in football players. Conclusions Hamstring injuries in this group of young athletes are less prevalent than in adults