Chronic anterior knee pain in athletes: Common causes

Anterior knee pain is a very common clinical presentation. In this article, the classification of anterior knee pain syndromes according to the anatomy of the knee extensor mechanism is described. The clinical diagnosis, special investigations, and principles of management of the more common causes of anterior knee pain are discussed.For full text, click here:SA Fam Pract 2005;47(8):20-2

The incidence and nature of injuries in South African rugby players in the rugby Super 12 competition

Background: There are sparse scientific data concerning the aetiology and incidence of injuries in the Super 12 rugby competition. Aim: The aim of the study was to document the incidence, nature and risk factors associated with injuries during a Super 12 rugby competition. Methods: Injuries, defined as injuries preventing playing or training, or requiring medical treatment, were recorded in a cohort of 75 South African Super 12 players over one season. Injury severity was graded according to sessions missed: minor (1 - 3 missed), intermediate (4 - 9) and severe (> 9). Results: During the tournament, a total of 740 player game hours and 4 900 player training hours were recorded. The overall incidence of injuries was 55.4 injuries / 1 000 player game hours, and 4.3 injuries / 1 000 player training hours. The most common injury types were: ligament sprains (25.8%), musculotendinous strains / tears (24.2%). The most common injured sites were: pelvis, hip (19.3%), head and knee (12.9% each). The tackle caused 40.3%, and rucks and mauls 11.3% of injuries. Injuries sustained during training accounted for 34%, and chronic overuse injuries 9.7% of injuries. Conclusions: There is a high injury rate during a Super 12 rugby competition. However, the majority of injuries were minor injuries. The most dangerous phase of play was the tackle. Training in tackling and rucking techniques, and rule enforcement are therefore recommended to reduce risk of injury. Injuries tended to occur late in games and early in the season, suggesting lack of physical conditioning and fatigue as possible causes of injury.South African Medical Journal Vol. 96 (12) 2006: pp. 1260-126

Healthy lifestyle interventions in general practice: Part 1: An introduction to lifestyle and diseases of lifestyle

Poor lifestyle choices including physical inactivity, adverse nutrition and tobacco use are strongly associated with heart disease, diabetes, respiratory disease and cancer. These four diseases are responsible for over 50% of mortality worldwide. Yet lifestyle intervention is underemphasised in the undergraduate training of doctors and other health professionals. This article reviews the lifestyle factors related to chronic non-communicable disease and suggests small but meaningful interventions for general practitioners to incorporate into daily practice. The upcoming series to be published in Family Practice regarding “lifestyle modification in chronic disease states” is introduced. South African Journal of Family Practice Vol. 50 (4) 2008: pp.6-1

Non-steroidal antiinflammatory drugs fail to enhance healing of acute hamstring injuries treated with physiotherapy

The effects of two non-steroidal anti-inflammatory drugs (NSAIDs), meclofenamate and diclofenac, in combination with physiotherapy modalities on the rate of healing of acute hamstring muscle tears were studied in a doubleblind, placebo-controlled trial. Forty-four of the 75 patients with this injury recruited were assessed and randomly allocated to one of three treatment groups: meclofenamate (100 mg 3 times a day), diclofenac (50 mg 3 times a day) and placebo. All patients received the same intensive physiotherapy treatment over the 7-day treatment period. Patient assessments were performed on days 1, 3 and 7 of the 7-day study period and included pain assessment (visual analogue scale), swelling measurement (thigh circumference measurement at the site of the muscle tear) and isokinetic muscle performance testing. Treatment produced a significant improvement in all measurements in all groups, but there was no difference in any measurement between groups. However, when only the more severe injuries were analysed, the reported pain score at day 7 was significantly lower in the placebo group than in either the  eclofenamate group or the diclofenac group (P < 0,05). Hence this study did not find any additive effect on the healing of acute muscle injuries when meclofenamate or diclofenac was added to standard physiotherapeutic modalities. The study therefore does not support the use of NSAIDs in the treatment of acute hamstring muscle injuries.S Afr Med J 1995; 85: 517-52

Healthy Lifestyle Interventions in General Practice. Part 3: Lifestyle and Chronic Respiratory Disease

Chronic respiratory diseases, in particular chronic obstructive pulmonary disease (COPD), can be classified as a part of the chronic diseases of lifestyle. A lifestyle intervention programme is therefore an essential component of the non-pharmacological management of COPD and other chronic respiratory diseases. The main indication for referral to a lifestyle intervention programme is any symptomatic patient with either COPD or any other chronic respiratory disease, and who also has limited functional capacity. Following a comprehensive initial assessment, patients are recommended to attend either a group-based programme (medically supervised or medically directed, depending on the severity of the disease and the presence of any co-morbidities) or a home-based intervention programme. The main elements of the intervention programme are smoking cessation, exercise training (minimum of three times per week), education, psychosocial support and nutritional support. Regular monitoring should be conducted during training sessions, and a follow-up assessment is indicated after 2-3 months to assess progress and to re-set goals. Longer-term (56 months) intervention programmes are associated with better long-term outcomes. South African Family Practice Vol. 50 (6) 2008: pp. 6-

Pre-race screening and stratification predicts adverse events—A 4-year study in 29585 ultra-marathon entrants, SAFER X

Pre-race screening and risk stratification in recreational endurance runners may predict adverse events (AEs) during a race. Aim: To determine if pre-race screening and risk stratification predict AEs during a race. Methods: A total of 29 585 participants (Male 71.1%, average age = 42.1 years; Female 28.9%, average age = 40.2 years) at the Two Oceans ultra-marathon races (56 km) completed a pre-race medical screening questionnaire and were risk stratified into four pre-specified groups [very high risk (VHR; existing cardiovascular disease–CVD:3.2%), high risk (HR; risk factors for CVD:10.5%), intermediate risk (IR; existing other chronic disease, medication use or injury:53.3%), and low risk (LR:33.0%)]. Race starters, finishers, and medical encounters (ME) were recorded. Did-not-start (DNS) rate (per 1000 entrants that did-not-start), did-not-finish (DNF) rate (per 1000 starters that did-not-finish), AE rate [per 1000 starters that either DNF or had an ME], and ME rate (per 1000 starters with an ME) were compared across risk categories. Results: Adverse events were significantly higher (per 1000 starters; 95%CI) in the VHR (68.9; 52.4-89.9:P =.0407) compared with the LR (51.3; 46.5-56.7)

The COL5A1 gene and musculoskeletal soft-tissue injuries

Background. It has been shown that there is an association between various genetic variants and Achilles tendon injuries as well as anterior cruciate ligament (ACL) ruptures. Among other variants the BstUI restriction fragment length polymorphism (RFLP) within the COL5A1 gene has been shown to be over-represented in asymptomatic participants when compared with those with chronic Achilles tendinopathy, and in asymptomatic female participants when compared with those with ACL ruptures. The male asymptomatic control participants in the ACL study, which were 10 years younger than previously investigated cohorts, had a distinctly different genotype frequency. Aim. The aim of this study was therefore to determine whether the distribution of the COL5A1 BstUI RFLP in the combined asymptomatic participants without any known history of tendon injuries is age dependent, particularly among males. Results. When the 265 male asymptomatic participants from all studies were pooled and divided into age-group tertiles, there was a significant linear increase in the CC genotype frequency (p=0.032) among the male age groups, with the youngest group having the lowest frequency (CC genotype frequency, 13%) and the oldest group having the highest (CC genotype frequency, 27%) frequency. There was however a similar CC genotype content in all three female (N=231) age groups (CC genotype frequency, 24 - 27%; p=0.795). Conclusion. The practical implication is that the selection of asymptomatic groups is of critical importance when future studies of this nature are designed. Future research investigating this genetic variant as a risk factor for soft-tissue injuries should consider these findings when selecting asymptomatic participants

Muscle cramping during exercise : causes, solutions and questions remaining

Muscle cramp is a temporary but intense and painful involuntary contraction of skeletal muscle that can occur in many different situations. The causes of, and cures for, the cramps that occur during or soon after exercise remain uncertain, although there is evidence that some cases may be associated with disturbances of water and salt balance, while others appear to involve sustained abnormal spinal reflex activity secondary to fatigue of the affected muscles. Evidence in favour of a role for dyshydration comes largely from medical records obtained in large industrial settings, although it is supported by one large-scale intervention trial and by field trials involving small numbers of athletes. Cramp is notoriously unpredictable, making laboratory studies difficult, but experimental models involving electrical stimulation or intense voluntary contractions of small muscles held in a shortened position can induce cramp in many, although not all, individuals. These studies show that dehydration has no effect on the stimulation frequency required to initiate cramping and confirm a role for spinal pathways, but their relevance to the spontaneous cramps that occur during exercise is questionable. There is a long history of folk remedies for treatment or prevention of cramps; some may reduce the likelihood of some forms of cramping and reduce its intensity and duration, but none are consistently effective. It seems likely that there are different types of cramp that are initiated by different mechanisms; if this is the case, the search for a single strategy for prevention or treatment is unlikely to succeed.Publisher PDFPeer reviewe

Bovine colostrum supplementation and upper respiratory symptoms during exercise training: a systematic review and meta-analysis of randomised controlled trials

Abstract Background Bovine colostrum is proposed as a nutritional countermeasure to the risk of upper respiratory symptoms (URS) during exercise training. The aim of this systematic review and meta-analysis was to estimate the size of the effect of bovine colostrum supplementation on URS. Methods Databases (CDSR, CENTRAL, Cinahl, ClinicalTrials.gov, Current Controlled Trials, DARE, EMBASE, Medline, PROSPERO and Web of Science) of published, unpublished and ongoing studies were searched for randomised controlled trials of healthy adults (≥18 years), evaluating the effect of oral bovine colostrum supplementation compared to a concurrent control group on URS. Results Five trials (152 participants) met the inclusion criteria, all of which involved individuals involved in regular exercise training. Over an 8–12 week follow-up period, bovine colostrum supplementation when compared to placebo significantly reduced the incidence rate of URS days (rate ratio 0.56, 95 % confidence intervals 0.43 to 0.72, P value < 0.001) and URS episodes (0.62, 0.40 to 0.99, P value = 0.04) by 44 and 38 % respectively. There were limited data and considerable variation in results of included studies for duration of URS episodes hence a meta-analysis of this outcome was deemed inappropriate. The risk of bias assessment in this review was hindered by poor reporting practices of included studies. Due to incomplete reporting of study methods, four of the five studies were judged to have a moderate or high risk of overall bias. Our findings must be interpreted in relation to quantity and quality of the available evidence. Conclusions The present systematic review and meta-analysis provides evidence that bovine colostrum supplementation may be effective in preventing the incidence of URS days and episodes in adults engaged in exercise training. The fact that the majority of included studies did not report significant effects on URS outcomes mitigates concerns about publication bias. The point estimates of the random-effects meta-analyses are greater than the smallest clinically important difference, but the low precision of the individual study estimates means the evidence presented in this review needs to be followed up with an appropriately designed and adequately powered, randomised control trial