The Canadian C-Spine Rule

Description: The Canadian C-Spine Rule was designed in 2001 to assist clinicians assess the need for imaging in people who present to the emergency department with a cervical spine injury following blunt trauma. Specifically, this clinical decision rule was developed for use in adults who are alert (score of 15 on the Glasgow Coma Scale), stable and in whom a clinically important cervical spine injury is a concern (eg, unstable fracture, dislocation).1Instructions and scoring: The Canadian C-Spine Rule is based on three high-risk criteria (age ≥ 65 years, dangerous injury mechanism, paresthesia in extremities), five low-risk criteria (simple rear-end motor vehicle collision, sitting position in the emergency department, ambulatory at any time, delayed onset of neck pain; absence of midline cervical-spine tenderness), and the ability of the person to rotate their neck.2Reliability, validity and sensitivity to change: The Canadian C-Spine Rule has good-to-excellent inter-rater reliability when applied by physicians (kappa = 0.63), nurses (kappa = 0.80) and paramedics (kappa = 0.93).2, 3 The sensitivity of the Canadian C-Spine Rule has been reported to range from 90 to 100%, whereas specificity has ranged from 1 to 77%.4 The large range in specificity reflects the heterogeneity between studies in the number of people who unnecessarily receive imaging (ie, people who do not have a serious cervical spine injury but are still referred for imaging). However, the rule itself errs on the side of caution, as clinicians will not miss a clinically important cervical spine injury. In the only direct comparison, the Canadian C-Spine Rule was found to have better diagnostic accuracy than the National Emergency X-Radiography Utilization Study (NEXUS) criteria,5 which form another widely used clinical decision rule.

Selected static foot assessments do not predict medial longitudinal arch motion during running

Background: Static assessments of the foot are commonly advocated within the running community to classify the foot with a view to recommending the appropriate type of running shoe. The aim of this work was to determine whether selected static foot assessment could predict medial longitudinal arch (MLA) motion during running. Methods: Fifteen physically active males (27 ± 5 years, 1.77 ± 0.04m, 80 ± 10kg) participated in the study. Foot Posture Index (FPI-6), MLA angle and rearfoot angle were measured in a relaxed standing position. MLA motion was calculated using the position of retro-reflective markers tracked by a VICON motion analysis system, while participants ran barefoot on a treadmill at a self-selected pace (2.8 ± 0.5m.s-1). Bivariate linear regression was used to determine whether the static measures predicted MLA deformation and MLA angles at initial contact, midsupport and toe off. Results: All three foot classification measures were significant predictors of MLA angle at initial contact, midsupport and toe off (p < .05) explaining 41-90% of the variance. None of the static foot classification measures were significant predictors of MLA deformation during the stance phase of running. Conclusion: Selected static foot measures did not predict dynamic MLA deformation during running. Given that MLA deformation has theoretically been linked to running injuries, the clinical relevance of predicting MLA angle at discrete time points during the stance phase of running is questioned. These findings also question the validity of the selected static foot classification measures when looking to characterise the foot during running. This indicates that alternative means of assessing the foot to inform footwear selection are required

What are the Main Risk Factors for Running-Related Injuries?

Abstract Background Despite several studies that have been conducted on running injuries, the risk factors for runningrelated injuries are still not clear in the literature. Objective The aim of this study was to systematically review prospective cohort studies that investigated the risk factors for running injuries in general. Online (1998 to Dec 2012) databases, using subject headings, synonyms, relevant terms and variant spellings for each database. Study Selection Only prospective cohort studies investigating the risk factors for running-related musculoskeletal injuries were included in this review. Two independent reviewers screened each article and, if they did not reach a consensus, a third reviewer decided whether or not the article should be included. Study Appraisal and Synthesis Methods Year of publication, type of runners, sample size, definition of runningrelated musculoskeletal injury, baseline characteristics, reported risk factors and the statistical measurement of risk or protection association were extracted from the articles. A scale adapted by the authors evaluated the risk of bias of the articles. Results A total of 11 articles were considered eligible in this systematic review. A total of 4,671 pooled participants were analysed and 60 different predictive factors were investigated. The main risk factor reported was previous injury (last 12 months), reported in 5 of the 8 studies that investigated previous injuries as a risk factor. Only one article met the criteria for random selection of the sample and only six articles included a follow-up of 6 months or more. There was no association between gender and running injuries in most of the studies. Limitations It is possible that eligible articles for this review were published in journals that were not indexed in any of the searched databases. We found a great heterogeneity of statistical methods between studies, which prevented us from performing a meta-analysis. Conclusions The main risk factor identified in this review was previous injury in the last 12 months, although many risk factors had been investigated in the literature. 123 Sports Med DOI 10.1007/s40279-014-0194-6 Relatively few prospective studies were identified in this review, reducing the overall ability to detect risk factors. This highlights the need for more, well designed prospective studies in order to fully appreciate the risk factors associated with running