The purpose of this study was to evaluate the patient-reported and objective functional outcomes of those patients who underwent nonoperative management of a single-tendon retracted proximal hamstring avulsion. A retrospective case series of consecutive patients with an MRI-confirmed diagnosis of single-tendon proximal hamstring avulsion treated nonoperatively with at least one year of follow-up was performed. Patient-reported outcome measures (PROMs) including SF-12v2, Lower Extremity Functional Score (LEFS), Hip Outcome Score-activities of daily living and sport subscale (HOS-ADL, HOS-SS) were prospectively collected. Objective measurements included strength testing of the affected and unaffected limbs with a handheld dynamometer and single-leg hop test. Student's t-tests were used to determine differences between limbs. Eleven of fourteen patients were available for PROMs (79%); five completed functional testing. Subjective scores revealed a mean SF-12v2 mental component score of 56.53±8.2, and a physical component score of 50.1±12.7. LEFS was 84%±19.8, HOS-ADL 87.9%±17.2, and HOS-SS 80.9%±24. The differences between limbs were not statistically significant for strength at 45 or 90 degrees of knee flexion, nor for single-leg hop distance. Patients in a non-professional athlete population who undergo nonoperative management of single-tendon retracted proximal hamstring avulsions can expect good subjective and objective outcomes.
Collegiate athletes face rigorous physical, academic, and emotional demands. While significant attention has been paid to injury prevention among young athletes in the past two decades, orthopedic injury rates remain high among collegiate athletes, and a significant number will undergo surgical management for injuries each year. In this narrative review, we describe techniques for perioperative management of pain and stress after surgery in collegiate athletes. In particular, we outline pharmacologic and non-pharmacologic management of surgical pain, with a goal of minimizing opiate consumption. We emphasize a multi-disciplinary approach to optimizing post-operative recovery in collegiate athletes help minimize reliance on opiate pain medication. Additionally, we recommend that institutional resources should be harnessed to support athletes in their well-being, from a nutritional, psychological and sleep standpoint. Critical to success in perioperative pain management is the communication among the athletic medicine team members and with the athlete and family to address pain and stress management and encourage timely, safe return to play.
The return to sport after knee injury is challenging. This is burdensome for sports with a high incidence of injuries, such as team handball. Various tests guide decision making, but often the athlete's preinjury performance of these measures remains unknown. Moreover, objective return-to-sport criteria of a matching population are missing. The purpose of this study was to evaluate objective measures of knee capability in handball depending on players' age. Two hundred sixty-one handball players performed a functional test battery designed to evaluate knee capability after an anterior cruciate ligament injury: two- and one-legged stability analysis, jumps, speed tests, and agility assessments. For age-specific evaluation, athletes were divided into three age groups (16-19; 20-29;≥30 years). Male players showed differences in two and one-legged jumping height (p<0.02) as well as power per body weight (p<0.01) between age groups. Young female players reached better results in two-and one-legged stability. Besides the quick feet test, results of females did not differ between age groups. Functional knee stability in healthy handball players is partly influenced by age, and females show better results in stability and male athletes in power measurements. This aspect should be considered for return to sports testing and underlines the importance of performance measures in athletic testing.
Recently, there has been intense discussion about sports dentistry and potential interactions between oral health and athletes' performance. This narrative review aims to provide a comprehensive overview of the available literature about oral inflammation in sports. For this purpose, it presents the most common types of oral inflammation (gingivitis, periodontitis, pericoronitis, apical periodontitis), and their prevalence in athletes. Both the impact of oral inflammation on performance and causes for oral inflammation in athletes are discussed by presenting current literature. Finally, international recommendations for dental care in sports are presented. Several studies stated a high prevalence of oral inflammation in athletes, especially of gingivitis (58-97%) and periodontitis (41%). Also, many athletes report oral pain (17-30%) and a negative impact of oral health on training (3-9%). Besides this, a systemic impact of oral inflammation is discussed: In periodontitis patients, blood parameters and physical fitness are changed. In athletes, associations between muscle injuries and poor oral health are reported. There are deficits in oral health behavior. Furthermore, systemic changes due to physical stress could influence oral tissues. Overall, complex bidirectional interactions between competitive sports and oral inflammation are possible. Regular dental examinations and prevention strategies should be implemented in sports.
Jump-based asymmetry is often used as an indicator of sport performance and may be used to discern injury susceptibility. Due to task specificity, however, countermovement jump asymmetry may not be representative of on-court asymmetry. As such, we assessed the association between countermovement jump asymmetry and on-court impact asymmetry metrics (n=3, and n=4, respectively) using linear regressions (α=0.05). Fifteen female basketball athletes completed countermovement jump and on-court sessions across a competitive season. A significant negative association was found between peak landing force asymmetry and both overall and medium acceleration on-court asymmetry (b=-0.1, R 2 =0.08, p<0.001; b=-0.1, R 2 =0.11, p<0.001, respectively), as well as between peak propulsive force asymmetry and on-court medium acceleration asymmetry (b=-0.24, R 2 =0.04, p=0.01). Alternatively, both peak landing and peak propulsive force asymmetry were significantly positively associated with on-court high acceleration asymmetry (b=0.17, R 2 =0.08, p<0.001; b=0.35, R 2 =0.02, p=0.04, respectively). While some overlap may exist, countermovement jump and on-court impact asymmetry appear to be independent. Thus, sport-specific monitoring may be necessary to adequately monitor injury susceptibility using asymmetry.
The kinetic sequencing involved in the overhead throw anticipates an orchestration of body movement in which the more proximal segments of the body initiate movement prior to the more distal segment. This investigation explored neuromuscular and kinematic characteristics associated with one aspect of this kinetic sequencing, pelvic-to-thoracic rotation. Neuromuscular activation was recorded using surface electromyography and kinematic data was acquired using 3D videography. Specific objectives included 1) to describe the maximum angulation between the pelvic and thoracic body segments (X max angle ), 2) to test the hypothesis that glove-side external oblique peak neuromuscular activation (GEOPA) occurs before X max angle , 3) to test the hypothesis that throwing-side external oblique peak neuromuscular activation (TEOPA) occurs following X max angle . Results show the mean X max angle to be 45.96 degrees (±10.83). The time of mean GEOPA (2.3653 sec±0.9094) occurred following the time of mean X max angle (2.2793 sec,±0.9026, p<0.01), thus refuting the first hypothesis. The time of mean TEOPA (2.3658 sec,±0.8978) occurred following the time of mean X max angle (2.2793 sec,±0.9026, p<0.01), thus confirming the second hypothesis. Results suggest that youth baseball participants may not adequately utilize the core of the body to fully benefit from the optimal kinetic sequencing postulated within the literature.
The effect of long gaming sessions on energy intake, caffeine intake, blood pressure, heart rate, heart rate variability, and biochemical cardiac injury markers is unknown. The objective of this exploratory study was to investigate the changes in healthy male adults during two consecutive 18-hour sedentary video gaming sessions. Nine participants were enrolled in the study. Energy intake was noted in food diaries. Heart rate variability was monitored continuously; blood pressure and cardiac injury markers were measured every three to six hours. During the 42-hour study, the participants had an energy and caffeine intake of 8004.9 kcal and 1354.4 mg, respectively. The participants had a significant decrease in energy intake in the second session (p=0.01). A strong, negative correlation was found between body mass index and total energy intake (R=-0.84, p=0.005) and waist circumference and total energy intake (R=-0.70, p=0.036) in the first session. No nightly dip in blood pressure or heart rate was observed. Based on this study, long-term adverse effects of gaming cannot be ruled out. The non-dip of HR and BP suggests that long gaming sessions could be detrimental to cardiovascular health long term.
Concerning balance training, the most effective design of several load dimensions (e. g., training frequency, volume) is unclear. Thus, we determined the effects of different balance training volumes on dynamic balance in healthy children. Three groups of 20 children (age: 11.0±0.7 years; 47% females) were randomly assigned to a balance training group using a low or a high training volume or an active control group that performed regular physical education lessons. All groups trained for 8 weeks (2 sessions/week), whereby balance training volume amounted to 4 min/session and 18-24 min/session for the low- and high-volume group, respectively. Pre- and post-training, balance performance was assessed using the Lower Quarter Y-Balance Test and the Timed-Up-and-Go Test. Fifty-five children completed the study and significant Test x Group interactions were detected for both outcome measures in favor of the two balance training groups. Additionally, improvements in the high-volume group were significantly larger for some measures (Y-balance test anterior reach distance: p <.001, d =.94; Timed-Up-and-Go time: p =.003, d =.81) compared to the low-volume group. The results indicate that balance training is effective to improve balance performance in healthy children and it seems that a 36-48 min/week compared to an 8 min/week training volume provides additional effects.
The resumption of blood flow is an important factor in the remodeling process of the graft. The purpose of this study is to evaluate hemodynamic changes after medial patellofemoral ligament (MPFL) reconstruction using magnetic resonance angiography (MRA) as the evaluation of graft remodeling. Eleven knees that underwent anatomical MPFL reconstruction with the semitendinosus tendon were studied. We evaluated the blood flow around the bone tunnel wall in the arterial phase using MRA approximate 3 months and 1 year after surgery. Clinical and radiological evaluations were also analyzed. MRA showed an inflow vessel into the bone tunnel wall from the medial superior genicular artery on the femoral side, and from the articular branch of the descending genicular artery and the medial superior genicular artery on the patellar side. This contrast effect was decreased at 12 months after surgery in all cases. The clinical scores improved from baseline one year postoperatively. We revealed the blood flow to the bone tunnel wall after anatomical MPFL reconstruction is detected by MRA. The blood flow started within 2 or 3 months postoperatively and was sustained for 12 months. This study supported remodeling of the graft continues 3 months after surgery when the conformity of the patellofemoral joint stabilizes.
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