The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians

BackgroundDespite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews.ResultsTwenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands.ConclusionsInformation provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes

Increasing frailty is associated with higher prevalence and reduced recognition of delirium in older hospitalised inpatients: results of a multi-centre study

Purpose: Delirium is a neuropsychiatric disorder delineated by an acute change in cognition, attention, and consciousness. It is common, particularly in older adults, but poorly recognised. Frailty is the accumulation of deficits conferring an increased risk of adverse outcomes. We set out to determine how severity of frailty, as measured using the CFS, affected delirium rates, and recognition in hospitalised older people in the United Kingdom. Methods: Adults over 65 years were included in an observational multi-centre audit across UK hospitals, two prospective rounds, and one retrospective note review. Clinical Frailty Scale (CFS), delirium status, and 30-day outcomes were recorded. Results: The overall prevalence of delirium was 16.3% (483). Patients with delirium were more frail than patients without delirium (median CFS 6 vs 4). The risk of delirium was greater with increasing frailty [OR 2.9 (1.8–4.6) in CFS 4 vs 1–3; OR 12.4 (6.2–24.5) in CFS 8 vs 1–3]. Higher CFS was associated with reduced recognition of delirium (OR of 0.7 (0.3–1.9) in CFS 4 compared to 0.2 (0.1–0.7) in CFS 8). These risks were both independent of age and dementia. Conclusion: We have demonstrated an incremental increase in risk of delirium with increasing frailty. This has important clinical implications, suggesting that frailty may provide a more nuanced measure of vulnerability to delirium and poor outcomes. However, the most frail patients are least likely to have their delirium diagnosed and there is a significant lack of research into the underlying pathophysiology of both of these common geriatric syndromes

Role of glycine and GLYT-1 transporter in intestinal cell protection

Glycine has been shown to protect a broad range of tissues and cell types against oxidative stress. In the intestine, these effects have been observed against Ischaemia-Reperfusion injury, hypothermic ischaemia and chemically induced colitis. The process by which glycine exerts its protective effects remain uncertain. In this thesis, the ability of glycine to protect human intestinal cells against tert-butyl hydroperoxide (t-BuOOH) induced cell death, and the requirement for GLYT-1 in the protective mechanism were explored. The human i1eo-caecal adenocarcinoma cell line, HCT-8, was chosen as an in vitro mfldel of human intestinal epithlium. RT-PCR with mRNA from HCT-8 cells and the human enterocytic Caco-2 cells was used to determine exwession of a range of amino acid transporters. Immunohistochemistry techniques using a GLYT-1 specific antibody were employed to determine the localisation of GLYT-1 in this cell line and human large intestine. Uptake of glycine in HCT-8 cell monolayers was measured using radio-labelled uptake experiments. For cytoprotection studies, the MIT assay and the ApoGSH assay were used to determine cell viability and glutathione concentration respectively, following t-BuOOH treatment. Expression of GLYT-1 and other specific amino acid transporters known to be expressed in the small and large intestine was determined, confirming the suitability of this cell line as a model for the study of amino acid absorption. GLYT-1 protein was shown to be localised along the apical and basolateral membranes of both human colon and HCT-8 cells. A proportion of Na+/Cr -,.dependent glycine uptake in HCT-8 cells was inhibited by sarcosine and the GLYT-1 inhibitor .ALX-5407, at both apical and basolateral membranes, and was attributed to GLYT-1. Exogenous glycine supplementation, prior to t·BuOOH treatment, protected HCT-8 cells against cell death and preserved intracellular glutathione concentration. Protection was specific to glycine and dependent on GLYT-1 activity. Glycine cytoprotection requires GLYT-1 activity, supporting a requirement for intracellular glycine accumulation. Maintained intracellular glutathione content is indicated as a mechanism through which the protective effect may in part be mediated.EThOS - Electronic Theses Online ServiceGBUnited Kingdo

The effectiveness of aquatic exercise in improving lower limb strength in musculoskeletal conditions: A systematic review and meta-analysis

Objective: To investigate the effectiveness of aquatic exercise in improving lower limb strength in people with musculoskeletal conditions. Data Sources: A systematic search used 5 databases, including MEDLINE, CINAHL, Embase, SPORTDiscus, and The Cochrane Library. Study Selection: Randomized controlled trials evaluating aquatic exercise with a resistance trainingcomponent for adults with musculoskeletal conditions compared with no intervention or land-based exercise were identified. Fifteen studies from the initial yield of 1214 met these criteria. Data Extraction: Data related to participant demographics, study design, and methods, interventions, and outcomes, including numerical means and SDs, were extracted independently by 2 reviewers. Data Synthesis: Nine of the 15 studies were of high quality, scoring at least 6 on the PhysiotherapyEvidence Database Scale. Limited consideration of the prescription of resistance in the aquatic exercise and application of resistance training principles existed. Low- or very low–quality evidence indicates there was no difference in average effect between aquatic exercise and no exercise in improving hip abductor strength (standardized mean difference [SMD], .28; 95% confidence interval [CI], −.04 to .59), knee extensor strength (SMD, .18; 95% CI, −.03 to .40), knee flexor strength (SMD, .13; 95% CI, −.20 to .45), or lower limb endurance (SMD, .35; 95% CI, −.06 to .77). Low-quality evidence indicates no difference in average effect between aquatic and land exercise for knee extensor (SMD, −.24; 95% CI, −.49 to .02) or flexor strength (SMD, −.15; 95% CI, −.53 to .22). Conclusions: It is likely that the inadequate application of resistance in water is a significant contributor to the limited effectiveness of aquatic exercise interventions in improving hip and knee muscle strength in people with musculoskeletal conditions. Future research is needed to quantify resistance with aquatic exercises and to determine if using opportunities for greater resistance in aquatic rehabilitation and appropriate resistance training principles can be more effective in improving muscle strength

Force during functional exercises on land and in water in older adults with and without knee osteoarthritis: Implications for rehabilitation

Background Closed kinetic chain and plyometric exercises are commonly used in aquatic rehabilitation because they are believed to reduce joint loading whilst replicating functional tasks. However, the forces and relationship to land-based functional movement is unknown. This study aims to compare vertical ground reaction force during squats, calf raises and jumping in older adults with and without knee osteoarthritis on land and in water. Methods Forty one participants (Healthy n = 21; Knee osteoarthritis n = 20; Age 68.5 (4.4) years) completed squats and calf raises at slow, medium and maximal speeds and jumping at maximal speed on land and in waist and chest depth water. Vertical ground reaction force and pain rating was measured in each environment. Results Force in all exercises was significantly greater on land than in chest depth water (p < 0.005). Peak force was significantly greater at maximal speed compared to slow speed (p < 0.001). The pattern of force in squats at slow speed in water was different to on land, with force highest at the start and end of the exercise and decreasing in the central phase. Pain ratings were significantly lower (p < 0.001) in water compared to on land in squats. Conclusions Closed kinetic chain exercises offer inherently different loading in an aquatic environment. Body weight squats and calf raises in water could be defined as either neuromotor or low load, high velocity training. Maximal speed exercise in water produces higher relative load compared to slow speed and minimal pain providing an opportunity for clinicians to use greater speed to address power deficits

Low-cost electromyography – validation against a commercial system using both manual and automated activation timing thresholds

Widespread use of electromyography (EMG) as an assessment and biofeedback method may be limited by costly commercial systems. Low-cost devices are available; however their validity is unknown. This study determined the concurrent validity of a low-cost EMG on a microchip compared with a commercially available system during isometric and dynamic muscle contractions. Inter-tester, intra-session reliability of manual data extraction during data processing compared to a simple, automatic thresholding method using the Teager-Kaiser energy operator (TKEO) was also evaluated. 10 healthy women (age 28.1 ± 6.8 yrs, height 162.1 ± 6.8 cm, mass 60.3 ± 10.2 kg) were assessed simultaneously with a commercially available EMG system (Telemyo DTS) and a custom low-cost EMG system (Myoware Muscle Sensor) during voluntary isometric contractions, knee extension, squatting, stepping and jumping. Two surface electrode sets (connected to the low-cost and the commercial system) were placed end to end along the same Vastus Lateralis muscle fibre line. Peak and mean contraction intensity, and contraction duration were analysed. Overall the relative agreement between systems was excellent for peak muscle activation (ICC 0.77–0.96) and modest to excellent for mean muscle activation (ICC 0.68–0.95) and contraction duration (ICC 0.65–0.99). Inter-tester, intra-session reliability was excellent for peak contraction intensity (ICC > 0.99) and modest to excellent for mean contraction intensity, with the TKEO method primarily recording stronger agreement than the manual method. Poor to excellent inter-tester reliability occurred for contraction duration. Our findings indicate that a low-cost EMG system is comparable to a commercial system for assessing muscle activation, and that using the TKEO improved the reliability of timing related variables