Physician and Sportsmedicine最新文献

Relative Energy Deficiency in Sport (RED-S) defines insufficient calorie intake for the physiological and athletic functions of the athlete, and accordingly deterioration in the musculoskeletal, hormonal, cardiovascular and immune systems. Herein, we present a 42-year-old female long-distance runner with multiple pelvic stress fractures who didn't complete her prescribed treatment program and wanted to keep running despite being aware of the associated pain and risks. The Goldman dilemma refers to the unsettling reality that a significant number of professional athletes may contemplate sacrificing their lives in order to achieve Olympic glory. This disregard for the numerous challenges stemming from an obsession with success is equally applicable to the amateur athlete depicted in this case. Our patient's fractures were examined in relation to RED-S and managed through conservative treatment methods. The RED-S and Goldman dilemma should be kept in mind not only in professional but also in semi-professional, and amateur athletes.

Objectives: This intervention study aimed to evaluate how the use of Foam Roller (FR) as a recovery strategy affects water polo performance after a seven-week (28-session) program.

Design: A randomized controlled trial.

Methods: Thirty water polo players (14 male amateur players and 16 female sub-elite players) were assigned by means of sealed opaque envelopes to the control group (CG) or Foam Roller Group (FRG) and performed the same total number and intensity of training sessions. Test protocols were performed before (pretest), in-test (week 5), and after the intervention period (posttest). These included water polo-specific performance tests such as in-water boost, throwing speed, and 20 m sprint swimming tests. In addition, during the intervention, heart rate (HR), the scale of perceived exertion of the session (sRPE), and total quality recovery scale (TQR) data were recorded.

Results: There were no differences in the baseline values in any of the variables analyzed between CG and FRG. A small decrease in in-water boost was observed in CG (-2%, ES = -0.35 [-0.95: 0.26], p = 0.016, very likely small) and in FRG (-2%, ES = -0.33 [-0.93: 0.27], p = 0.021, likely small). No significant changes were found in either the 20 m swim test or the throwing test in CG and FRG. No clear differences among groups and weeks were found in sRPE, TQR and HR.

Conclusion: The findings indicate that the use of FR as a recovery tool after training and matches is not useful in water polo players.

Objective: The objective of this study was to examine the relationship between creatine kinase (CK) concentration following official matches and the risk of subsequent muscle injury in professional male football (soccer) players.

Methods: Blood samples were collected on the second post-match day for CK analysis over four consecutive seasons in a professional football club. Players were then followed for five days to observe any occurrence of indirect muscle injury (structural or functional in nature). Players exposed to at least 45 minutes in two consecutive matches within seven days were considered valid cases for analysis.

Results: Eighty players participated in the study, generating 1,656 cases eligible for analysis, of which 229 resulted in muscle injuries. The hamstrings were the most frequently injured muscle group (54%), followed by the adductor (21%), triceps surae (19%), quadriceps (5%), and psoas (1%). While CK concentration was higher in muscle injury cases [783 ± 507 U/L (95%CI, 717 to 849; min-max, 105-2,800)] compared with uninjured cases [688 ± 446 U/L (95%CI, 665 to 711; min-max, 100-2,950)], it was not an accurate predictor of subsequent muscle injury risk in professional football players (sensitivity = 56%; specificity = 55%; odds ratio = 1.00; area under curve = 0.557).

Conclusion: CK concentration on the second post-match day cannot be used to effectively screen subsequent muscle injury risk in professional male football players.

Objectives: To evaluate the efficacy of post-operative gabapentin administration as an analgesic agent and its effect on narcotic use after orthopedic surgery in an outpatient sports medicine practice by comparing patients prior to and after initiating the routine use of gabapentin as part of a standardized post-operative pain medication regimen. We hypothesized that adding gabapentin to a multimodal post-operative pain regimen would decrease the number of requested pain medication refills and have no detrimental effect on Visual Analogue Scale and Single Assessment Numerical Evaluation scores at these early post-operative visits.

Methods: All outpatient surgical patients, <90 years of age, undergoing outpatient orthopedic surgery by the study's senior author were included between 08/05/2021 and 02/22/2022. Patients were allowed 1 narcotic refill post-operatively and only in the first 3 weeks. The primary outcome was difference in percentage of patients who requested a narcotic refill within 3 weeks post-op. Two- and 6-week Visual Analogue Scale and Single Assessment Numerical Evaluation scores, and baseline health and demographic data. T-tests were run on continuous variables, Chi-Square or Fisher's Exact Test were run on dichotomous variables, and Mann-Whitney U test was run on all other categorical variables. Statistical significance was set at P < .05 for all tests.

Results: There was a significant difference in narcotic refills at 3 weeks: 23 pre-gabapentin patients and 9 post-gabapentin patients (22.8% vs 9.0%, respectively: P = .006). There were no differences between 2- and 6-week Visual Analogue Scale and 2-week Single Assessment Numerical Evaluation scores. There was a significant difference in 6-week SANE between groups: mean difference = 6.4 (P = .027) though less than the established MCID.

Conclusion: Addition of gabapentin to a post-operative multimodal pain regimen reduced the use of narcotics after orthopedic sports medicine surgeries while also providing equivalent pain control.

Objective: To determine if specific morphological changes in ultrasonographic images of Achilles tendons are associated with the development of pain in distance runners.

Methods: This study is a blinded, retrospective analysis of 276 Achilles tendon ultrasound images, which were used to determine if specific morphologic findings could positively or negatively predict future Achilles tendon pain development in distance runners. Pre-race ultrasound scans were performed on 138 asymptomatic half- and full marathon runners (276 tendons in total) who were followed for 12 months after their races. Specific patterns of morphologic abnormality were identified (location, size, and appearance of ultrasound abnormality within the tendon). Sonographic findings were blindly assessed by a medical student, a resident, and a physician who has significant sonographic imaging experience. These specific abnormalities were then compared to those who later did or did not develop tendon pain.

Results: Three findings were found to have significant odds of association with the development of pain: 1) focal deep midsubstance intratendinous hypoechogenicity, 2) focal superficial midsubstance intratendinous hypoechogenicity, and 3) linear hyperechogenicity extending into middle of tendon from calcaneus.

Conclusion: These results suggest that the aforementioned specific morphologic abnormalities in the Achilles tendon may be associated with the future development of pain symptoms in distance runners in this cohort. Looking for these specific abnormalities may increase the specificity of identifying precursors to Achilles tendon pain development.

Objectives: Corticosteroid injections have been typically used for the management of plantar fasciitis with apparently good clinical outcomes; however, there is no information of the effect of corticosteroids on the thickness of the plantar fascia which is typically altered in this pathology. We aimed determine whether treatment with corticosteroid injections induces plantar fascia thickness changes in plantar fasciitis.

Methods: MEDLINE, Embase, Web of Science, and Scopus databases were searched for randomized controlled trials (RCT) reporting the use of corticosteroid injection to treat plantar fasciitis to July 2022. Studies must have reported plantar fascia thickness measurement. The risk of bias in all studies was assessed with the Cochrane Risk of Bias 2.0 tool. Meta-analysis was conducted using a random-effects model and the generic inverse variance method.

Results: Data from 17 RCT (including 1109 subjects) were collected. The follow-up period ranged from one to six months. Most studies measured the thickness of the plantar fascia at the insertion into the calcaneus using ultrasound. Pooled analysis revealed that corticosteroid injections had no significant effect on plantar fascia thickness (weighted mean differences [WMD], 0.06 mm [95% CI: -0.17, 0.29]; p = 0.61) or pain relief (WMD, 0.12 cm [95% CI: -0.36, 0.61]; p = 0.62) above active controls.

Conclusion: Corticosteroid injections do not perform better than other common interventions in terms of a decrease of plantar fascia thickness and pain relief for plantar fasciitis.

Objectives: The extent to which knee functions improve after anterior cruciate ligament reconstruction (ACLR) varies. This study aimed to determine the factors that affect lower knee function improvement after two years of ACLR.

Methods: The study included 159 patients who underwent ACLR in the Indonesian ACL community between August 2018 and April 2020. The concomitant injury and graft types of ACLR were determined using patients' pre-surgical MRI and medical records. The five subscales of the knee injury and osteoarthritis outcome score (KOOS) were used to evaluate the patient at baseline, first year, and second year following ACLR. A linear mixed-effect model (LMEM) was used to predict the longitudinal improvement models for the five-subscales KOOS score after ACLR.

Results: The LMEM predicted lower KOOS subscales scores improvements by 0.5 for QOL, 0.1 for symptom, ADL, and QOL, and 0.2 for sports/recreation, respectively, for a one score increase of age and time from injury to surgery. Male patients had higher KOOS subscale scores with the improvement of pain, symptom, and ADL by 5.7, 5.9, and 6.3 compared to female patients, respectively, while patients with patellar tendon grafts had lower improvement of KOOS score pain by 6.5 compared to hamstring tendon grafts.

Conclusion: As the age and time from injury to surgery increased, the KOOS subscales scores of QOL and symptoms, ADL, sports/recreation, and QOL decreased. Male patients reported higher KOOS subscales scores for pain, symptoms, and ADL, while patients with patella tendon grafts had a lower improvement in pain score.

Objective: This systematic review and meta-analysis aim to analyze the effects of ingesting non-steroidal anti-inflammatory drugs (NSAIDs) on physical performance, muscle strength, and muscle damage in three different moments: immediately, 24 and 48 h after resistance exercise practice.

Methods: Relevant studies were researched in three databases (PubMed, Web of Science and SPORTDiscus) in April 2023. After excluding duplicates, the decision to include or exclude studies was made by two independent investigators in the following steps: (I) the study title; (II) the study abstract; and (III) the complete study manuscript. The following characteristics were recorded: (I) first author, (II) year of publication, (III) sample size, (IV) method of NSAIDs administration, (V) exercise protocol, and (VI) analyzed variable results. The studies selected were divided into trials that evaluated the effects of NSAIDs ingestion on performance indices of resistance exercise, endurance exercise and resistance training.

Results: The meta-analysis, based only on resistance exercises, revealed that both performance and muscle strength were similar between placebo or NSAID treatment immediately and 24 h after resistance exercise practice. An ergolytic effect was found 48 hours after resistance exercise (mean effect size (ES) = -0.42; 95% CI: -0.71, -0.12; p = 0.132), as well as reduced muscle strength (ES = -0.50; 95% CI: -0.83, -0.16; p = 0.072). Additionally, NSAID use did not prevent muscle waste as seen by the unchanged CK plasma concentration at all timetables.

Conclusion: The data of the present meta-analysis indicate that NSAID use is ineffective in improving resistance performance and muscle strength, as well as exercise recovery. When considering the practical application of using NSAIDs to improve exercise capacity and strength gains, the present data supports that consumption of analgesic drugs as an endurance performance enhancer or as a muscle anabolic must not be recommended.

Objectives: Potential harms of stationary bike injuries in pediatric patients have been highlighted in the literature, but prior work is limited to case series and without population-level analysis. The purpose of this study is to examine the epidemiology of pediatric stationary bike injuries occurring in the US over the last decade using a national database.

Methods: Injuries resulting from stationary bike use in pediatric patients from 2012 to 2021 were identified using coding from the National Electronic Injury Surveillance System (NEISS) database. Patient demographics, injury characteristics, and case narratives were examined. National annual estimates of injury frequency/incidence were calculated using weighting and survey package in R. Univariate analyses were used to compare injuries among groups.

Results: We identified 525 stationary bike injuries representing an estimated total of 15,509 injuries in the population. Pediatric patients sustained an average of 1,551 injuries annually, with an estimated yearly increase of 288 injuries (p < 0.01) after 2019. While males sustained more injuries, there were age-dependent differences in frequency of injuries between sexes (p < 0.01). The upper extremity was the most commonly injured body region overall, but children 5 and under sustained more injuries to the head/neck. The most common overall injury type was lacerations, while fractures predominated in the 6 to 11-year-old age group. Fifty-six percent of injuries were sustained not while riding the bike, most notably among children under 12.

Conclusion: Our findings indicate that the impact of stationary bike injury in the pediatric population is not insignificant, and most injuries are related to improper play rather than traditional exercise use. Gender and age-related patterns differed in regard to the type and mechanism of injury sustained. Children 5 and under sustain a disproportionate amount of injuries to the head, neck, and upper extremity. As stationary bikes grow in popularity, preventative measures should be considered to reduce injuries to young children.

Purpose: An abundance of literature exists linking eating disorders and fracture risk. However, no studies, to our knowledge, have investigated the impact of eating disorders on lower extremity soft tissue injury or surgery risk. The purpose of this study was to determine if anorexia nervosa and bulimia nervosa are associated with prevalence of lower extremity soft tissue injuries and surgeries.

Methods: Patients with anorexia nervosa or bulimia nervosa over 2010-2020 were identified through the International Classification of Diseases (ICD) codes in the PearlDiver Claims Database. Patients were matched by age, gender, comorbidities, record dates, and region to control groups without anorexia or bulimia. Soft tissue injuries were identified through ICD codes, and surgeries were identified through Current Procedural Terminology codes. Differences in relative prevalence were analyzed using chi-square analysis.

Results: Patients with anorexia had a significantly increased prevalence of meniscus tears (RR = 1.57, CI 1.22-2.03, p = 0.001) or deltoid ligament sprains (RR = 1.83, CI 1.10-3.03, p = 0.025), and patients with bulimia had a significantly increased prevalence of meniscus tears (RR = 1.98, CI 1.56-2.51, p < 0.001), medial collateral ligament sprains (RR = 3.07, CI 1.72-5.48, p < 0.001), any cruciate ligament tears (RR = 2.14, CI 1.29-3.53, p = 0.004), unspecified ankle sprains (RR = 1.56, CI 1.22-1.99, p < 0.001), or any ankle ligament sprains (RR = 1.27, CI 1.07-1.52, p = 0.008). Patients with anorexia had a significantly increased prevalence of anterior cruciate ligament reconstructions (RR = 2.83, CI 1.12-7.17, p = 0.037) or any meniscus surgeries (RR = 1.54, CI 1.03-2.29, p = 0.042), and patients with bulimia had a significantly increased prevalence of partial meniscectomies (RR = 1.80, CI 1.26-2.58, p = 0.002) or any meniscus surgeries (RR = 1.83, CI 1.29-2.60, p < 0.001).

Conclusions: Anorexia and bulimia are associated with increased prevalence of soft tissue injuries and surgeries. Orthopedic surgeons should be aware of this risk, and patients presenting to clinics should be informed of the risks associated with these diagnoses and provided with resources promoting recovery to help prevent further injury or surgery.