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Orchard JW, Rio E, Crossley KM, Orchard JJ, Mountjoy M. Orchard Sports Injury and Illness Classification System (OSIICS) Version 15. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:599-604. [PMID: 38494156 DOI: 10.1016/j.jshs.2024.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/30/2024] [Accepted: 02/15/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Sports medicine (injury and illnesses) requires distinct coding systems because the International Classification of Diseases is insufficient for sports medicine coding. The Orchard Sports Injury and Illness Classification System (OSIICS) is one of two sports medicine coding systems recommended by the International Olympic Committee. Regular updates of coding systems are required. METHODS For Version 15, updates for mental health conditions in athletes, sports cardiology, concussion sub-types, infectious diseases, and skin and eye conditions were considered particularly important. RESULTS Recommended codes were added from a recent International Olympic Committee consensus statement on mental health conditions in athletes. Two landmark sports cardiology papers were used to update a more comprehensive list of sports cardiology codes. Rugby union protocols on head injury assessment were used to create additional concussion codes. CONCLUSION It is planned that OSIICS Version 15 will be translated into multiple new languages in a timely fashion to facilitate international accessibility. The large number of recently published sport-specific and discipline-specific consensus statements on athlete surveillance warrant regular updating of OSIICS.
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia.
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3083, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, VIC 3083, Australia
| | - Jessica J Orchard
- School of Public Health, University of Sydney, Sydney, NSW 2006, Australia
| | - Margo Mountjoy
- Department of Family Medicine, McMaster University, Hamilton L8S 4L8, Canada
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Tamujo AC, Flores HN, Cetolin T, Ribeiro-Alvares JB, Haupenthal A, Baroni BM. Creatine kinase concentration on the second post-match day is not associated with risk of subsequent muscle injury in professional football players: a four-season cohort study. PHYSICIAN SPORTSMED 2024; 52:271-276. [PMID: 37548364 DOI: 10.1080/00913847.2023.2246175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/29/2023] [Accepted: 08/06/2023] [Indexed: 08/08/2023]
Abstract
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.
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Affiliation(s)
- Augusto Camillo Tamujo
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Hebert Nunes Flores
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Tiago Cetolin
- Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - João Breno Ribeiro-Alvares
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Alessandro Haupenthal
- Graduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
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Snow F, O'Connell C, Yang P, Kita M, Pirogova E, Williams RJ, Kapsa RMI, Quigley A. Engineering interfacial tissues: The myotendinous junction. APL Bioeng 2024; 8:021505. [PMID: 38841690 PMCID: PMC11151436 DOI: 10.1063/5.0189221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 05/06/2024] [Indexed: 06/07/2024] Open
Abstract
The myotendinous junction (MTJ) is the interface connecting skeletal muscle and tendon tissues. This specialized region represents the bridge that facilitates the transmission of contractile forces from muscle to tendon, and ultimately the skeletal system for the creation of movement. MTJs are, therefore, subject to high stress concentrations, rendering them susceptible to severe, life-altering injuries. Despite the scarcity of knowledge obtained from MTJ formation during embryogenesis, several attempts have been made to engineer this complex interfacial tissue. These attempts, however, fail to achieve the level of maturity and mechanical complexity required for in vivo transplantation. This review summarizes the strategies taken to engineer the MTJ, with an emphasis on how transitioning from static to mechanically inducive dynamic cultures may assist in achieving myotendinous maturity.
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Lerchbaumer MH, Perschk M, Gwinner C. [Ultrasound in sports traumatology]. SPORTVERLETZUNG SPORTSCHADEN : ORGAN DER GESELLSCHAFT FUR ORTHOPADISCH-TRAUMATOLOGISCHE SPORTMEDIZIN 2024; 38:89-99. [PMID: 38781978 DOI: 10.1055/a-2267-1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Ultrasound (US) has numerous applications in sports traumatology. The technical progress of mobile US devices has led to increasing use of ultrasound as a primary diagnostic tool. New applications such as elastography and 3 D vascularization are used for special indications.The purpose of this review is to present the current status of ultrasound in the diagnosis of sports injuries and sport traumatology including established applications and new technical advances. US is presented both in its comparison to other imaging modalities and as a sole diagnostic tool.US can be used for initial diagnosis to improve the clinical examination and for intensive shortterm follow-up imaging. The main areas of application are currently the diagnosis of acute muscle and tendon injuries as well as overuse injuries. In particular, the exclusion of structural muscle injuries can be adequately ensured with US in the majority of anatomical regions. The recently published guideline on fracture ultrasound has strengthened the clinical evidence in this area, especially in comparison to conventional radiography and in the development of algorithms and standards. The increasing use of mobile ultrasound equipment with adequate image quality makes US a location-independent modality that can also be used at training sites or during road games.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Department of Radiology, Charité Universitätsmedizin Berlin, Berlin, Germany
- 1. FC Union Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
| | | | - Clemens Gwinner
- 1. FC Union Berlin, Charité Universitätsmedizin Berlin, Berlin, Germany
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Berlin, Germany
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5
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Kellis E, Kekelekis A, Drakonaki EE. Thoracolumbar Fascia and Lumbar Muscle Stiffness in Athletes with A History of Hamstring Injury. J Sports Sci Med 2024; 23:436-444. [PMID: 38841644 PMCID: PMC11149066 DOI: 10.52082/jssm.2024.436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 05/09/2024] [Indexed: 06/07/2024]
Abstract
The purpose of this study was to examine the differences in thoracolumbar fascia (TLF) and lumbar muscle modulus in individuals with and without hamstring injury using shear wave elastography (SWE). Thirteen male soccer players without a previous hamstring injury and eleven players with a history of hamstring injury performed passive and active (submaximal) knee flexion efforts from 0°, 45° and 90° angle of knee flexion as well as an active prone trunk extension test. The elastic modulus of the TLF, the erector spinae (ES) and the multifidus (MF) was measured using ultrasound SWE simultaneously with the surface electromyography (EMG) signal of the ES and MF. The TLF SWE modulus was significantly (p < 0.05) higher in the injured group (range: 29.86 ± 8.58 to 66.57 ± 11.71 kPa) than in the uninjured group (range: 17.47 ± 9.37 to 47.03 ± 16.04 kPa). The ES and MF modulus ranged from 14.97 ± 4.10 to 66.57 ± 11.71 kPa in the injured group and it was significantly (p < .05) greater compared to the uninjured group (range: 11.65 ± 5.99 to 40.49 ± 12.35 kPa). TLF modulus was greater than ES and MF modulus (p < 0.05). Active modulus was greater during the prone trunk extension test compared to the knee flexion tests and it was greater in the knee flexion test at 0° than at 90° (p < 0.05). The muscle EMG was greater in the injured compared to the uninjured group in the passive tests only (p < 0.05). SWE modulus of the TLF and ES and MF was greater in soccer players with previous hamstring injury than uninjured players. Further research could establish whether exercises that target the paraspinal muscles and the lumbar fascia can assist in preventing individuals with a history of hamstring injury from sustaining a new injury.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Afxentios Kekelekis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Greece
| | - Eleni E Drakonaki
- Department of Anatomy, Medical School, University of Crete, Heraklion Crete, Greece
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6
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Dünkel J, Scheider TO, Tamborrini G. [Muscle injuries: the importance of high-resolution dynamic sonography in diagnostics, treatment and monitoring]. ORTHOPADIE (HEIDELBERG, GERMANY) 2024; 53:404-414. [PMID: 38739271 PMCID: PMC11142968 DOI: 10.1007/s00132-024-04505-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/15/2024] [Indexed: 05/14/2024]
Abstract
BACKGROUND Muscle injuries are common in football. Imaging diagnostics have a major role in establishing a diagnosis. The main diagnostic procedures are MRI and ultrasound. Both diagnostics have advantages and disadvantages, which should be balanced against each other. NEW ULTRASONIC TECHNIQUES The role of MRI as the gold standard is increasingly being replaced by high-resolution ultrasound techniques, and MRI imaging is not always useful. To detect complications in the early stages it is advised to perform regular ultrasound-imaging check-ups. The healing process can be monitored, and it offers additional options for ultrasound-guided interventions such as hematoma punctures and targeted infiltrations. ADVANTAGES AND DISADVANTAGES However, ultrasound imaging is highly user dependent. Experienced operators can eliminate this disadvantage, which makes ultrasound a superior imaging system in many areas, especially for dynamic examinations. Nevertheless, MRI imaging remains a necessary imaging method in certain areas.
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Affiliation(s)
- Jörg Dünkel
- Sportklinik Bern, Bümplizstrasse 83, 3018, Bern, Schweiz.
| | | | - Giorgio Tamborrini
- UZR - Schweizer Ultraschallzentrum und Institut für Rheumatologie, Basel, Schweiz
- Klinik für Rheumatologie, Universitätsspital Basel, Basel, Schweiz
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Luo W, Zhang H, Wan R, Cai Y, Liu Y, Wu Y, Yang Y, Chen J, Zhang D, Luo Z, Shang X. Biomaterials-Based Technologies in Skeletal Muscle Tissue Engineering. Adv Healthc Mater 2024:e2304196. [PMID: 38712598 DOI: 10.1002/adhm.202304196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 04/26/2024] [Indexed: 05/08/2024]
Abstract
For many clinically prevalent severe injuries, the inherent regenerative capacity of skeletal muscle remains inadequate. Skeletal muscle tissue engineering (SMTE) seeks to meet this clinical demand. With continuous progress in biomedicine and related technologies including micro/nanotechnology and 3D printing, numerous studies have uncovered various intrinsic mechanisms regulating skeletal muscle regeneration and developed tailored biomaterial systems based on these understandings. Here, the skeletal muscle structure and regeneration process are discussed and the diverse biomaterial systems derived from various technologies are explored in detail. Biomaterials serve not merely as local niches for cell growth, but also as scaffolds endowed with structural or physicochemical properties that provide tissue regenerative cues such as topographical, electrical, and mechanical signals. They can also act as delivery systems for stem cells and bioactive molecules that have been shown as key participants in endogenous repair cascades. To achieve bench-to-bedside translation, the typical effect enabled by biomaterial systems and the potential underlying molecular mechanisms are also summarized. Insights into the roles of biomaterials in SMTE from cellular and molecular perspectives are provided. Finally, perspectives on the advancement of SMTE are provided, for which gene therapy, exosomes, and hybrid biomaterials may hold promise to make important contributions.
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Affiliation(s)
- Wei Luo
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Hanli Zhang
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Renwen Wan
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Yuxi Cai
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Yinuo Liu
- The Second Clinical Medical College of Nanchang University, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, 330006, P. R. China
| | - Yang Wu
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Yimeng Yang
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Jiani Chen
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Deju Zhang
- Food and Nutritional Sciences, School of Biological Sciences, The University of Hong Kong, Pokfulam Road, Hong Kong, 999077, Hong Kong
| | - Zhiwen Luo
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
| | - Xiliang Shang
- Department of Sports Medicine Huashan Hospital, Fudan University, Shanghai, 200040, P. R. China
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8
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Flores HN, Tamujo AC, Cetolin T, Ribeiro-Alvares JB, de Noronha M, Baroni BM, Haupenthal A. Muscle Pain Code: a novel tool for screening the risk of time-loss muscle injury in professional male football players. PHYSICIAN SPORTSMED 2024:1-6. [PMID: 38651766 DOI: 10.1080/00913847.2024.2346463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 04/19/2024] [Indexed: 04/25/2024]
Abstract
OBJECTIVE To investigate the association of a novel post-match muscle pain map, named Muscle Pain Code (MPC), with the risk of subsequent time-loss muscle injury in a cohort of professional football (soccer) players. METHODS The MPC classifies pain in four codes: code 0, 'no pain;' code 1, 'generalized muscle pain;' code 2, 'diffused site muscle pain;' and code 3, 'specific site muscle pain.' Over four consecutive seasons, MPC was collected on the second post-match day and players were followed for occurrence of time-loss muscle injury over the next five days. Players exposed to at least 45 minutes in two consecutive matches within seven days were included as cases for analysis. RESULTS Eighty players participated in the study. Of 1,656 cases analyzed, 229 resulted in time-loss muscle injuries. Only 2% of cases with codes 0 and 1 resulted in time-loss muscle injuries. Conversely, 63% and 78% of codes 2 and 3 were followed by time-loss muscle injuries, respectively. Compared with the reference scenario (i.e. code 0 on MPC), the risk of subsequent time-loss muscle injury was significantly higher when players recorded code 2 (odds ratio, 4.29; 95%CI, 3.62 to 4.96) or code 3 (odds ratio, 5.01; 95%CI, 4.05 to 5.98) on MPC, but not when they recorded code 1 (odds ratio = -0.27; 95%CI, 1.05 to 0.56). CONCLUSIONS Players experiencing well-outlined pain area on the second post-match day were more likely to incur a time-loss muscle injury in the subsequent days compared to those experiencing spreading pain or no pain.
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Affiliation(s)
- Hebert Nunes Flores
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Augusto Camillo Tamujo
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Tiago Cetolin
- Graduate Program in Neurosciences, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - João Breno Ribeiro-Alvares
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Marcos de Noronha
- Department of Community and Allied Health, La Trobe University, Melbourne, VIC, Autralia
| | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil
| | - Alessandro Haupenthal
- Graduate Program in Rehabilitation Sciences, Federal University of Santa Catarina, Araranguá, SC, Brazil
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9
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Fernandes CA, Norte GE, Schwab SM, Gokeler A, Murray A, Bazett-Jones DM, Sherman DA. Interpersonal Coordination between Female Soccer Players: Leader-Follower Roles within a Collision-Avoidance Task. Int J Sports Phys Ther 2024; 19:548-560. [PMID: 38707861 PMCID: PMC11065781 DOI: 10.26603/001c.116156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/29/2024] [Indexed: 05/07/2024] Open
Abstract
Background/Purpose Return to sport decision-making may be improved by assessing an athlete's ability to coordinate movement with opponents in sport. The purpose was to investigate whether previous injuries associated with female soccer players' interpersonal coordination during a collision avoidance task. The authors hypothesized that external perturbations would disrupt the strength and stability of coordinated movement, and that individuals with a history of injury would be less likely to recover coordinated movement. Study Design Cross-Sectional. Methods Nine female athletes with a history of lower extremity injuries and nine without injuries were paired into dyads. Each dyad completed twenty trials of an externally paced collision-avoidance agility task with an unanticipated perturbation. Participant trajectories were digitized and analyzed using cross-recurrence quantification analysis (CRQA) to determine the strength and stability of interpersonal coordination dynamics. Trials in which participants with injury history assumed leader or follower roles within each dyad were then used to study how dyadic coordination varied across task stages (early, perturbation, and late) using linear mixed effect models. Cohen's d effect sizes were calculated to demonstrate magnitude of differences. In exploratory analysis, psychological readiness (i.e., self-reported knee functioning, fear of injury, and risk-taking propensity) was evaluated for their association with leader-follower status. Results Perturbation disrupted the strength (R2=0.65, p<0.001, early=49.7±1.7, perturbation=41.1±1.7, d=0.39) and stability (R2=0.71, p < 0.001, early=65.0±1.6, perturbation=58.0±1.7, d=0.38) of interpersonal coordination regardless of leader-follower status. Individuals with injury history failed to restore coordination after the perturbation compared to control participants (injury=44.2.0±2.1, control=50.8±2.6, d=0.39). Neither demographic nor psychological measures were associated with leader-follower roles (B=0.039, p=0.224). Conclusion Individuals with a history of lower extremity injury may have a diminished ability to adapt interpersonal coordination to perturbations, possibly contributing to a higher risk of re-injury. Level of Evidence 3.
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Affiliation(s)
| | - Grant E Norte
- Cognition Neuroplasticity and Sarcopenia LaboratoryUniversity of Central Florida
| | - Sarah M Schwab
- 3. Department of Rehabilitation, Exercise, & Nutrition SciencesUniversity of Cincinnati
| | - Alli Gokeler
- 4. Exercise Science and Neuroscience, Department of Exercise & HealthPaderborn University
| | - Amanda Murray
- College of Health and Human ServicesUniversity of Toledo
| | | | - David A Sherman
- Chobanian & Avedisian School of MedicineBoston University
- Live4 Physical Therapy and Wellness
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10
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Lerchbaumer MH, Perschk M, Gwinner C. Ultrasound in sports traumatology. ROFO-FORTSCHR RONTG 2024; 196:440-449. [PMID: 37944936 DOI: 10.1055/a-2185-8264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
Abstract
BACKGROUND Ultrasound (US) has numerous applications in sports traumatology. The technical progress of mobile US devices has led to increasing use of ultrasound as a primary diagnostic tool. New applications such as elastography and 3 D vascularization are used for special indications. METHOD The purpose of this review is to present the current status of ultrasound in the diagnosis of sports injuries and sport traumatology including established applications and new technical advances. US is presented both in its comparison to other imaging modalities and as a sole diagnostic tool. RESULTS AND CONCLUSION US can be used for initial diagnosis to improve the clinical examination and for intensive short-term follow-up imaging. The main areas of application are currently the diagnosis of acute muscle and tendon injuries as well as overuse injuries. In particular, the exclusion of structural muscle injuries can be adequately ensured with US in the majority of anatomical regions. The recently published guideline on fracture ultrasound has strengthened the clinical evidence in this area, especially in comparison to conventional radiography and in the development of algorithms and standards. The increasing use of mobile ultrasound equipment with adequate image quality makes US a location-independent modality that can also be used at training sites or during road games. KEY POINTS · Typically used for quick, focused initial diagnostic assessment and short-term follow-up after injury. · Mobile US devices allow increased use in training centers and training camps. · New US applications (SWE, 3 D) increase standardization in follow-up of tendon injuries. · Targeted use of US for musculoskeletal diagnostic assessment saves money and frees up capacity. CITATION FORMAT · Lerchbaumer MH, Perschk M, Gwinner C. Ultrasound in sports traumatology. Fortschr Röntgenstr 2024; 196: 440 - 449.
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Affiliation(s)
- Markus Herbert Lerchbaumer
- Department of Radiology, Charité Universitätsmedizin Berlin, Germany
- 1. FC Union Berlin, Charité Universitätsmedizin Berlin, Germany
| | | | - Clemens Gwinner
- Center for Musculoskeletal Surgery, Charité Universitätsmedizin Berlin, Germany
- 1. FC Union Berlin, Charité Universitätsmedizin Berlin, Germany
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11
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Watts V GJ, Tai R, Joshi G, Garwood E, Saha D. Reinjury Following Return to Play. Semin Musculoskelet Radiol 2024; 28:154-164. [PMID: 38484768 DOI: 10.1055/s-0043-1778022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Radiologists are frequently called on for guidance regarding return to play (RTP) for athletes and active individuals after sustaining a musculoskeletal injury. Avoidance of reinjury is of particular importance throughout the rehabilitative process and following resumption of competitive activity. Understanding reinjury risk estimation, imaging patterns, and correlation of clinical and surgical findings will help prepare the radiologist to identify reinjuries correctly on diagnostic imaging studies and optimize management for a safe RTP.
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Affiliation(s)
- George J Watts V
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Ryan Tai
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Ganesh Joshi
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Elisabeth Garwood
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
| | - Debajyoti Saha
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, UMass Chan Medical School, Worcester, Massachusetts
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12
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Hoy MK, Stache S, Roedl JB. Hamstring Injuries: A Paradigm for Return to Play. Semin Musculoskelet Radiol 2024; 28:119-129. [PMID: 38484764 DOI: 10.1055/s-0043-1778027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
Muscle injuries are the most common sports-related injuries, with hamstring involvement most common in professional athletes. These injuries can lead to significant time lost from play and have a high risk of reinjury. We review the anatomy, mechanisms of injury, diagnostic imaging modalities, and treatment techniques for hamstring injuries. We also present the latest evidence related to return to play (RTP) after hamstring injuries, including a review of articles targeted to RTP in European soccer (Union of European Football Associations), American football (National Football League), and other professional sports. Review of imaging findings in hamstring injury, grading systems for injuries, considerations for RTP, as well as advances in injury prevention, are discussed.
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Affiliation(s)
- Michael K Hoy
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
| | - Stephen Stache
- Departments of Orthopaedics and Family and Community Medicine, Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Johannes B Roedl
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
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13
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Abstract
Hamstring muscle injuries (HMI) are a common and recurrent issue in the sport of athletics, particularly in sprinting and jumping disciplines. This review summarizes the latest literature on hamstring muscle injuries in athletics from a clinical perspective. The considerable heterogeneity in injury definitions and reporting methodologies among studies still needs to be addressed for greater clarity. Expert teams have recently developed evidence-based muscle injury classification systems whose application could guide clinical decision-making; however, no system has been adopted universally in clinical practice, yet.The most common risk factor for HMI is a previously sustained injury, particularly early after return-to-sport. Other modifiable (e.g. weakness of thigh muscles, high-speed running exposure) and non-modifiable (e.g. older age) risk factors have limited evidence linking them to injury. Reducing injury may be achieved through exercise-based programs, but their specific components and their practical applicability remain unclear.Post-injury management follows similar recommendations to other soft tissue injuries, with a graded progression through stages of rehabilitation to full return to training and then competition, based on symptoms and clinical signs to guide the individual speed of the recovery journey. Evidence favoring surgical repair is conflicting and limited to specific injury sub-types (e.g. proximal avulsions). Further research is needed on specific rehabilitation components and progression criteria, where more individualized approaches could address the high rates of recurrent HMI. Prognostically, a combination of physical examination and magnetic resonance imaging (MRI) seems superior to imaging alone when predicting 'recovery duration,' particularly at the individual level.
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Affiliation(s)
- Spyridon A Iatropoulos
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Patrick C Wheeler
- School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- National Centre of Sport and Exercise Medicine, Loughborough, UK
- Department of Sport & Exercise Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
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Massidda M, Flore L, Cugia P, Piras F, Scorcu M, Kikuchi N, Cięszczyk P, Maciejewska-Skrendo A, Tocco F, Calò CM. Association Between Total Genotype Score and Muscle Injuries in Top-Level Football Players: a Pilot Study. SPORTS MEDICINE - OPEN 2024; 10:22. [PMID: 38448778 PMCID: PMC10917720 DOI: 10.1186/s40798-024-00682-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 01/30/2024] [Indexed: 03/08/2024]
Abstract
BACKGROUND Recently, genetic predisposition to injury has become a popular area of research and the association between a few single nucleotide polymorphisms (SNPs) and the susceptibility to develop musculoskeletal injuries has been shown. This pilot study aimed to investigate the combined effect of common gene polymorphisms previously associated with muscle injuries in Italian soccer players. RESULTS A total of 64 Italian male top football players (age 23.1 ± 5.5 years; stature 180.2 ± 7.4 cm; weight 73.0 ± 7.9 kg) were genotyped for four gene polymorphisms [ACE I/D (rs4341), ACTN3 c.1729C > T (rs1815739), COL5A1 C > T (rs2722) and MCT1 c.1470A > T (rs1049434)]. Muscle injuries were gathered for 10 years (2009-2019). Buccal swabs were used to obtain genomic DNA, and the PCR method was used to genotype the samples. The combined influence of the four polymorphisms studied was calculated using a total genotype score (TGS: from 0 to 100 arbitrary units; a.u.). A genotype score (GS) of 2 was assigned to the "protective" genotype for injuries, a GS of 1 was assigned to the heterozygous genotype while a GS of 0 was assigned to the "worst" genotype. The distribution of genotype frequencies in the ACE I/D (rs4341), ACTN3 c.1729C > T (rs1815739) and MCT1 c.1470A > T (rs1049434) polymorphisms was different between non-injured and injured football players (p = 0.001; p = 0.016 and p = 0.005, respectively). The incidence of muscle injuries was significantly different among the ACE I/D (rs4341), ACTN3 c.1729C > T (rs1815739) and COL5A1 C > T (rs2722) genotype groups, showing a lower incidence of injuries in the "protective" genotype than "worse" genotype (ACE, p < 0.001; ACTN3, p = 0.005) or intermediate genotype (COL5A1, p = 0.029). The mean TGS in non-injured football players (63.7 ± 13.0 a.u.) was different from that of injured football players (42.5 ± 12.5 a.u., p < 0.001). There was a TGS cut-off point (56.2 a.u.) to discriminate non-injured from injured football players. Players with a TGS beyond this cut-off had an odds ratio of 3.5 (95%CI 1.8-6.8; p < 0.001) to suffer an injury when compared with players with lower TGS. CONCLUSIONS These preliminary data suggest that carrying a high number of "protective" gene variants could influence an individual's susceptibility to developing muscle injuries in football. Adapting the training load parameters to the athletes' genetic profile represents today the new frontier of the methodology of training.
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Affiliation(s)
- Myosotis Massidda
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
- Italian Federation of Sports Medicine, Rome, Italy.
| | - Laura Flore
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
| | - Paolo Cugia
- Italian Federation of Sports Medicine, Rome, Italy
- Cagliari Calcio SpA, Cagliari, Italy
| | - Francesco Piras
- Italian Federation of Sports Medicine, Rome, Italy
- Cagliari Calcio SpA, Cagliari, Italy
| | - Marco Scorcu
- Italian Federation of Sports Medicine, Rome, Italy
- Cagliari Calcio SpA, Cagliari, Italy
| | - Naoki Kikuchi
- Nippon Sport Science University (NSSU), Tokyo, Japan
| | - Pawel Cięszczyk
- Department of Physical Education, University of Physical Education and Sport, Gdańsk, Poland
| | - Agnieszka Maciejewska-Skrendo
- Department of Physical Education, University of Physical Education and Sport, Gdańsk, Poland
- Institute of Physical Culture Sciences, University of Szczecin, 71-065, Szczecin, Poland
| | - Filippo Tocco
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
- Italian Federation of Sports Medicine, Rome, Italy
| | - Carla Maria Calò
- Department of Life and Environmental Sciences, University of Cagliari, Cagliari, Italy
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Herring SA, Kibler WB, Putukian M, Boyajian-O'Neill LA, Chang CJ, Franks RR, Hutchinson M, Indelicato PA, O'Connor FG, Powell A, Roach R, Safran M, Statuta SM, Sutton K. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Med Sci Sports Exerc 2024; 56:385-401. [PMID: 37847756 DOI: 10.1249/mss.0000000000003324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
ABSTRACT Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.
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16
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Herring SA, Kibler WB, Putukian M, Boyajian-O'Neill LA, Chang CJ, Franks RR, Hutchinson M, Indelicato PA, O'Connor FG, Powell A, Roach R, Safran M, Statuta SM, Sutton K. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Curr Sports Med Rep 2024; 23:86-104. [PMID: 38437494 DOI: 10.1249/jsr.0000000000001151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024]
Abstract
ABSTRACT Musculoskeletal injuries occur frequently in sport during practice, training, and competition. Injury assessment and management are common responsibilities for the team physician. Initial Assessment and Management of Musculoskeletal Injury-A Team Physician Consensus Statement is title 23 in a series of annual consensus documents written for the practicing team physician. This statement was developed by the Team Physician Consensus Conference, an annual project-based alliance of six major professional associations. The goal of this document is to help the team physician improve the care and treatment of the athlete by understanding the initial assessment and management of selected musculoskeletal injuries.
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17
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Fu C, Xia Y, Wang B, Zeng Q, Pan S. MRI T2 mapping and shear wave elastography for identifying main pain generator in delayed-onset muscle soreness: muscle or fascia? Insights Imaging 2024; 15:67. [PMID: 38424366 PMCID: PMC10904698 DOI: 10.1186/s13244-024-01619-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/06/2023] [Indexed: 03/02/2024] Open
Abstract
INTRODUCTION The main generator of delayed onset muscle soreness (DOMS) is still unknown. This study aimed to clarify the main generator of DOMS. METHODS Twelve participants performed eccentric exercise (EE) on lower legs. MRI and ultrasound were used to assess changes of calf muscle and deep fascia before and after EE. These results were then compared to the muscle pain level. RESULTS Compared to baseline, muscle pain peaked at 24-48 h after EE (downstairs 22.25 ± 6.196, 57.917 ± 9.298, F = 291.168, p < 0.01; resting 5.833 ± 1.899, 5.083 ± 2.429, F = 51.678, p < 0.01). Shear wave speed (SWE) of the deep fascia and T2 values of the gastrocnemius muscle and deep fascia all increased and peaked at 48 h after EE (1.960 ± 0.130, F = 22.293; 50.237 ± 2.963, F = 73.172; 66.328 ± 2.968, F = 231.719, respectively, p < 0.01). These measurements were positively correlated with DOMS (downstairs: r = 0.46, 0.76, 0.87, respectively, p < 0.001; resting: r = 0.42, 0.70, 0.77, respectively, p < 0.001). There was a significant positive correlation between SWE and T2 values of deep fascia (r = 0.54, p < 0.01). CONCLUSION DOMS is a common result of muscle and fascia injuries. Deep fascia edema and stiffness play a crucial role in DOMS, which can be effectively evaluated MR-T2 and SWE. CRITICAL RELEVANCE STATEMENT Delayed-onset muscle soreness is a common result of muscle and deep fascia injuries, in which the edema and stiffness of the deep fascia play a crucial role. Both MRI and shear wave elastography can be effectively used to evaluate soft tissue injuries. KEY POINTS • The deep fascia is the major pain generator of delayed-onset muscle soreness. • There is a significant correlation between fascia injury and delayed-onset muscle soreness. • MRI and shear wave elastography are preferred methods for assessing fascia injuries.
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Affiliation(s)
- Congcong Fu
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Yu Xia
- Department of Medical Ultrasonic, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Bingshan Wang
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China
| | - Qiang Zeng
- Department of Magnetic Resonance Imaging, Zhongshan Hospital of Xiamen University, Xiamen, Fujian, China.
| | - Shinong Pan
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, Liaoning, China.
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18
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Marko D, Vymyslický P, Miřátský P, Bahenský P, Malý T, Vobr R, Krajcigr M. Effect of Floss Band on Anaerobic Exercise and Muscle Tissue Oxygenation. J Sport Rehabil 2024; 33:99-105. [PMID: 38176399 DOI: 10.1123/jsr.2023-0106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 09/04/2023] [Accepted: 10/22/2023] [Indexed: 01/06/2024]
Abstract
CONTEXT Flossing is still a relatively new technique that has yielded varied results in the research literature; therefore, it requires further investigation. Previous research has shown that thigh tissue flossing might improve performance in countermovement jump, sprint time, maximum voluntary contraction, and rate of force development. DESIGN The present study aims to investigate the effect of the floss band on performance during the Wingate test (30-WAT), muscle oxygen saturation (SpO2), and total hemoglobin in vastus lateralis. METHODS Twenty-two students of physical education and sport (11 men and 11 women) were randomly selected to complete either the Wingate test with the application of a floss band in warm-up or the Wingate test without the use of a floss band, followed by the alternative 24 hours apart. RESULTS Throughout the testing, the floss band did not affect performance values during the Wingate test (relative peak power, relative average power, and fatigue index). However, there was a medium to large effect difference during 1 minute prior to 30-WAT (PRE), during the 30-WAT, and 10-minute recovery (REC) in values of SpO2 and total hemoglobin. Use of floss band displayed a higher SpO2 during PRE, 30-WAT, and REC by ∼13.55%, d < 2; ∼19.06%, d = 0.89; and ∼8.55%, d = 0.59, respectively. CONCLUSION Collectively, these findings indicate that the application of thigh flossing during warm-up has no effect on 30-WAT performance; however, SpO2 was significantly increased in all stages of testing. This could lead to potential improvement in repeated anaerobic exercise due to increased blood flow. Increased muscle oxygen saturation can also lead to improved tissue healing as oxygen supply is essential for tissue repair, wound healing, and pain management.
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Affiliation(s)
- David Marko
- Research Sport Center, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
| | - Patrik Vymyslický
- Department of Physiotherapy, Faculty of Sports, Physical Training and Education, Charles University, Prague, Czech Republic
| | - Petr Miřátský
- Research Sport Center, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Petr Bahenský
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
| | - Tomáš Malý
- Research Sport Center, Faculty of Physical Education and Sport, Charles University, Prague, Czech Republic
| | - Radek Vobr
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
| | - Miroslav Krajcigr
- Department of Sports Studies, Faculty of Education, University of South Bohemia in České Budějovice, Ceske Budejovice, Czech Republic
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19
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Gudelis M, Pruna R, Trujillano J, Lundblad M, Khodaee M. Epidemiology of hamstring injuries in 538 cases from an FC Barcelona multi sports club. PHYSICIAN SPORTSMED 2024; 52:57-64. [PMID: 36695100 DOI: 10.1080/00913847.2023.2170684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/13/2023] [Indexed: 01/26/2023]
Abstract
OBJECTIVES Hamstring injuries are the most common muscle injuries in team sports. The aims of this study were to describe the epidemiology of hamstring muscle injuries in the professional and amateur sport sections of a multi-sport club Football Club Barcelona (FCB) and to determine any potential correlation between return-to-play (RTP) and injury location, severity of connective tissue damage, age, sex, and athlete's level of competition. METHODS This descriptive epidemiological study with data collected from September 2007 to September 2017 stored in the FCB database. The study included non-contact hamstring injuries sustained during training or competition. RESULTS A total of 538 hamstring injuries were reported in the club's database, of which 240 were structurally verified by imaging as hamstring injuries. The overall incidence for the 17 sports studied was 1.29 structurally verified hamstring injuries per 100 athletes per year. The muscle most commonly involved in hamstring injuries was the biceps femoris, and the connective tissue most frequently involved was the myofascial. There was no evidence of a statistically significant association between age and RTP after injury, and no statistically significant difference between sex and RTP. However, the time loss by professionals was shorter than for amateurs, and proximal hamstring injuries took longer RTP than distal ones. CONCLUSION In the 17 sports practiced at multi-sport club, the incidence of hamstring injury was 1.29 per 100 athletes per year. Players from sports in which high-speed sprinting and kicking are necessary, and amateurs, were at higher risk of suffering a hamstring injury. In addition, proximally located hamstring injuries involving tendinous connective tissue showed the longest RTP time. Age did not seem to have any influence on RTP. Documenting location and the exact tissue involved in hamstring injuries may be beneficial for determining the prognosis and RTP.
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Affiliation(s)
- Mindaugas Gudelis
- Medical Department of Football Club Barcelona (FIFA Medical Centre of Excellence), Barcelona, Spain
- Barça Innovation Hub of Football Club Barcelona, Barcelona, Spain
- Clinica Tenis Teknon, Bracelona, Spain
- Reabilitacijos ir sporto medicinos centras, Vilnius, Lithuania
| | - Ricard Pruna
- Medical Department of Football Club Barcelona (FIFA Medical Centre of Excellence), Barcelona, Spain
- Barça Innovation Hub of Football Club Barcelona, Barcelona, Spain
| | | | - Matilde Lundblad
- Institute of Clinical Sciences, Sahlgrenska University Hospital, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Center for Health and Performance, Department of Food and Nutrition and Sports Science, University of Gothenburg, Gothenburg, Sweden
| | - Morteza Khodaee
- Department of Family Medicine Department of Orthopedics, University of Colorado School of Medicine Denver, Denver, CO, USA
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20
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Giarda F, Contro D, Fasano M, Poli M, Giacchino M. An insidious rectus abdominis muscle injury in an elite volleyball player: a case report. J Med Case Rep 2024; 18:54. [PMID: 38254134 PMCID: PMC10804748 DOI: 10.1186/s13256-023-04299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 12/01/2023] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Structural muscle injuries are characterized by acute and localized onset of pain. Abdominal muscle injuries are an insidious pathology in overhead athletes. However, only a few cases are reported in literature related to volleyball players, where clinical presentation may not have reflected the severity of the lesion. CASE PRESENTATION An elite volleyball player, a 21-year-old Caucasian female, reported the onset of mild abdominal muscular pain, confirmed on clinical evaluation findings and self-reported symptoms. Abdominal muscle ultrasound was performed following 2 weeks of continuing symptoms. This evidenced a more serious structural muscle injury of the rectus abdominis (type 3b). Having this correct diagnosis allowed a personalized rehabilitation program to be instituted to enable a safe return to play. CONCLUSION In presence of persistent abdominal muscle pain, even if mild, the possibility of a structural muscle injury must be considered. Clinical evaluation must be complemented by an instrumental evaluation including an ultrasound by an experienced operator for correct diagnosis and the setting of functional recovery related to biological healing.
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Affiliation(s)
- Federico Giarda
- Rehabilitation Medicine and Neurorehabilitation Unit, Neuroscience Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Piazza Dell'Ospedale Maggiore 3, Milan, Italy.
| | - Diego Contro
- Technical Director at Medical Lab, Sport Medicine and Physiotherapy Center, Piazza Luigi Rey, Turin, Italy
| | - Maurizio Fasano
- Sport Medicine and Physiotherapy Center, Medical Lab Asti, 226, Alessandria, Asti, Italy
| | - Mirko Poli
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Niguarda, Piazza Maggiore 3, Milan, Italy
| | - Maurizio Giacchino
- Sport Medicine and Physiotherapy Center, Medical Lab Asti, 226, Alessandria, Asti, Italy
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21
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Stathas I, Kalliakmanis A, Kekelekis A, Danassi Afentaki D, Tsepis E, Fousekis K. Effectiveness of an On-Field Rehabilitation framework for return to sports in injured male professional football players: a single-blinded, prospective, randomised controlled trial. BMJ Open Sport Exerc Med 2024; 10:e001849. [PMID: 38268525 PMCID: PMC10806762 DOI: 10.1136/bmjsem-2023-001849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Objectives In football, on-field rehabilitation (OFR) is critical during injury recovery for a player's safe return to sports (RTS). The study aimed to evaluate the effectiveness of an OFR framework for RTS in injured male professional football players. Trial design A prospective block-randomised controlled-parallel trial was conducted (level of evidence 1b). Methods Male professional football players (mean age, 26.3±3.6 years) from Greece diagnosed with an acute, lower limb musculoskeletal (MSK) injury (confirmed clinically and through imaging) participated in the study. During rehabilitation, the participants' OFR was guided by either the On-Field Rehabilitation (On FI.RE.) accelerated framework (experimental group) or a traditional OFR framework for a late injury recovery phase (comparison group). Between July 2021 and January 2022, 76 players were randomly allocated to the experimental group (n=38) and the comparison group (n=38). Participants were blinded during the study regarding intervention therapeutic protocols. The primary outcome measure was the effect of On FI.RE. framework on the time needed to return to team training (RTT) participation. The correlation between the time needed to return to on-field activity and RTT was calculated. Subsequent injuries were registered for a 12-month follow-up period. Results The intervention protocol, On FI.RE. framework, had a statistically significant effect on the time needed to RTT (F(1) = 49 626, p<0.001) with a large effect size (ES; η2=0.422) and fewer days (mean=23.8±9.1 days) needed than the comparison group (mean=30.3±9.8 days). There was a strong correlation between return to on-field activity and the time needed to RTT (r(76) = 0.901, p<0001) with a large ES (r>0.5). Six subsequent injuries were registered in the traditional OFR framework group, and one subsequent injury in the On FI.RE. framework group after a follow-up period of 12 months. Conclusion The On FI.RE., an accelerated OFR framework during injury recovery, is more effective than a traditional OFR framework, reducing the time a player needs to RTS. It entails a very low risk of reinjury. Trial registration number NCT05163470.
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Affiliation(s)
- Ioannis Stathas
- Physiotherapy Department, School of Health Rehabilitation Sciences, University of Patras, Patra, Greece
- Head of Physiotherapy and rehabilitation department, OFI Crete FC, Herakleion, Crete, Greece
| | | | - Afxentios Kekelekis
- Laboratory of Neuromechanics, School of Physical Education and Sport Science at Serres, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | | | - Elias Tsepis
- Physiotherapy Dept School of Health Rehabilitation Sciences, University of Patras, Patra, Greece
| | - Konstantinos Fousekis
- Physiotherapy Department Therapeutic exercise and Sports Rehabilitation exercise laboratory, University of Patras, Patra, Greece
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Crawford SK, Wille CM, Joachim MR, Lee KS, Heiderscheit BC. Ultrasound shear wave seeds reduced following hamstring strain injury but not after returning to sport. Insights Imaging 2024; 15:7. [PMID: 38191955 PMCID: PMC10774410 DOI: 10.1186/s13244-023-01571-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 11/17/2023] [Indexed: 01/10/2024] Open
Abstract
OBJECTIVES The purpose of the study was to investigate differences in ultrasound shear wave speed (SWS) between uninjured and injured limbs following hamstring strain injury (HSI) at time of injury (TOI), return to sport (RTS), and 12 weeks after RTS (12wks). METHODS This observational, prospective, cross-sectional design included male and female collegiate athletes who sustained an HSI. SWS imaging was performed at TOI, RTS, and 12wks with magnetic resonance imaging. SWS maps were acquired by a musculoskeletal-trained sonographer at the injury location of the injured limb and location-matched on the contralateral limb. The average SWS from three 5 mm diameter Q-boxes on each limb were used for analysis. A linear mixed effects model was performed to determine differences in SWS between limbs across the study time points. RESULTS SWS was lower in the injured limb compared to the contralateral limb at TOI (uninjured - injured limb difference: 0.23 [0.05, 0.41] m/s, p = 0.006). No between-limb differences in SWS were observed at RTS (0.15 [-0.05, 0.36] m/s, p = 0.23) or 12wks (-0.11 [-0.41, 0.18] m/s, p = 0.84). CONCLUSIONS The SWS in the injured limb of collegiate athletes after HSI was lower compared to the uninjured limb at TOI but not at RTS or 12 weeks after RTS. CRITICAL RELEVANCE STATEMENT Hamstring strain injury with structural disruption can be detected by lower injured limb shear wave speed compared to the uninjured limb. Lack of between-limb differences at return to sport may demonstrate changes consistent with healing. Shear wave speed may complement traditional ultrasound or MRI for monitoring muscle injury. KEY POINTS • Ultrasound shear wave speed can non-invasively measure tissue elasticity in muscle injury locations. • Injured limb time of injury shear wave speeds were lower versus uninjured limb but not thereafter. • Null return to sport shear wave speed differences may correspond to structural changes associated with healing. • Shear wave speed may provide quantitative measures for monitoring muscle elasticity during recovery.
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Affiliation(s)
- Scott K Crawford
- Department of Kinesiology, University of Wisconsin-Madison, 1300 University Ave, Madison, WI, 53706, USA.
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA.
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA.
| | - Christa M Wille
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Mikel R Joachim
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
| | - Kenneth S Lee
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Bryan C Heiderscheit
- Department of Orthopedics & Rehabilitation, University of Wisconsin-Madison, 1685 Highland Ave, Madison, WI, 53705, USA
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Badger Athletic Performance Program, University of Wisconsin-Madison, Madison, WI, USA
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23
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Scaturro D, de Sire A, Vitagliani F, Lo Nardo D, Tomasello S, Ammendolia A, Letizia Mauro G. Effectiveness of cryo plus ultrasound therapy versus diathermy in combination with high-intensity laser therapy for pain relief in footballers with muscle injuries: A prospective study. J Back Musculoskelet Rehabil 2024; 37:771-780. [PMID: 38160343 DOI: 10.3233/bmr-230265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Muscle injuries are common traumatic events in the clinical practice of the rehabilitation field. There is still a gap in the scientific literature on the effectiveness of physical agent modalities in the management of muscle injuries in athletes. OBJECTIVE The aim of this study was to assess the effectiveness of cryo plus ultrasound therapy com-pared to diathermy in combination with high-intensity laser therapy (HILT) for pain relief in professional footballers with muscle injuries. METHODS A case-control study was conducted on 31 professional footballers with a muscle injury of the lower limbs. Of these, 17 patients, assigned to a Group A (AG), were treated with HILT and cryoultrasound therapy; the remaining 14 patients, assigned to a Group B (BG), underwent HILT and diathermy. We assessed the extent of the pain, the size of the muscle injury, frequency of recurrence and number of days to recovery, at the time of recruitment, at the end of the rehabilitation and 3 months after the injury. RESULTS Group A athletes had a greater benefit on pain (4.65 ± 0.61 vs 3.24 ± 0.63; p< 0.05) and muscle injury recurrence. The return to play in the athletes of group A took place 4.73 days earlier. CONCLUSION HILT and cryo plus ultrasound therapy, in combination with therapeutic exercise, rep-resent a valid strategy in the treatment of muscle injuries in professional footballers.
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Affiliation(s)
- Dalila Scaturro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
| | - Alessandro de Sire
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Fabio Vitagliani
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Davide Lo Nardo
- Department of Biomedical and Biotechnological Sciences, University of Catania, Catania, Italy
| | - Sofia Tomasello
- Faculty of Medicine and Surgery, University of Palermo, Palermo, Italy
| | - Antonio Ammendolia
- Department of Medical and Surgical Sciences, University of Catanzaro "Magna Graecia", Catanzaro, Italy
- Research Center on Musculoskeletal Health, MusculoSkeletalHealth@UMG, University of Catanzaro "Magna Graecia", Catanzaro, Italy
| | - Giulia Letizia Mauro
- Department of Surgical, Oncological and Stomatological Disciplines, University of Palermo, Palermo, Italy
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Romero-Morales C, López-López D, Almazán-Polo J, Mogedano-Cruz S, Sosa-Reina MD, García-Pérez-de-Sevilla G, Martín-Pérez S, González-de-la-Flor Á. Prevalence, diagnosis and management of musculoskeletal disorders in elite athletes: A mini-review. Dis Mon 2024; 70:101629. [PMID: 37716840 DOI: 10.1016/j.disamonth.2023.101629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2023]
Abstract
Musculoskeletal injuries in elite sports are ones of the most impact issue because their remarkable impact on performance caused by drastic absence of training and competition and a progressive deterioration in physical health, emotional and social athletes' dimensions. Also, the prevalence of epidemiologic research found an incidence of musculoskeletal disorders vary within sports and in elite athletes which is even higher as a consequence of higher demand physical performance. This way, the loss of physical performance due to an sport injury impacts not only the individual economic sphere of the professional but also that ofsports entities, reaching, according to some studies, a loss estimated in the range of 74.7 million pounds. Thus, the purpose of this article is to review and to provide an overview of the most common musculoskeletal injuries in elite sports precipitating factors, clinical presentation, evidence-based diagnostic evaluation, and treatment recommendations with a view to preventing medical conditions or musculoskeletal injuries that may alter performance and general health in the elite athletes.
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Affiliation(s)
- Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Industrial Campus of Ferrol , Universidade da Coruña, 15403 Ferrol, Spain.
| | - Jaime Almazán-Polo
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - Sara Mogedano-Cruz
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | - María Dolores Sosa-Reina
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain
| | | | - Sebastián Martín-Pérez
- Faculty of Health Sciences, Universidad Europea de Canarias, La Orotava, Santa Cruz de Tenerife 38300, Spain
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25
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Jia W, Zhao G. Automated recognition of the major muscle injury in athletes on X-ray CT images1. JOURNAL OF X-RAY SCIENCE AND TECHNOLOGY 2024; 32:107-121. [PMID: 37483059 DOI: 10.3233/xst-230135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/25/2023]
Abstract
BACKGROUND In this research, imaging techniques such as CT and X-ray are used to locate important muscles in the shoulders and legs. Athletes who participate in sports that require running, jumping, or throwing are more likely to get injuries such as sprains, strains, tendinitis, fractures, and dislocations. One proposed automated technique has the overarching goal of enhancing recognition. OBJECTIVE This study aims to determine how to recognize the major muscles in the shoulder and leg utilizing X-ray CT images as its primary diagnostic tool. METHODS Using a shape model, discovering landmarks, and generating a form model are the steps necessary to identify injuries in key shoulder and leg muscles. The method also involves identifying injuries in significant abdominal muscles. The use of adversarial deep learning, and more specifically Deep-Injury Region Identification, can improve the ability to identify damaged muscle in X-ray and CT images. RESULTS Applying the proposed diagnostic model to 150 sets of CT images, the study results show that Jaccard similarity coefficient (JSC) rate for the procedure is 0.724, the repeatability is 0.678, and the accuracy is 94.9% respectively. CONCLUSION The study results demonstrate feasibility of using adversarial deep learning and deep-injury region identification to automatically detect severe muscle injuries in the shoulder and leg, which can enhance the identification and diagnosis of injuries in athletes, especially for those who compete in sports that include running, jumping, and throwing.
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Affiliation(s)
- Wanping Jia
- Center for International Education, Philippine Christian University, Manila, Philippines
| | - Guangyong Zhao
- Department of Sports and Health, Linyi University, Shandong, Linyi, China
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26
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Heiss R, Höger SA, Uder M, Hotfiel T, Hanspach J, Laun FB, Nagel AM, Roemer FW. Early functional and morphological changes of calf muscles in delayed onset muscle soreness (DOMS) assessed with 7T MRI. Ann Anat 2024; 251:152181. [PMID: 37871829 DOI: 10.1016/j.aanat.2023.152181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 09/24/2023] [Accepted: 10/19/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND To assess morphological and functional alterations of the skeletal muscle in exercise-induced delayed onset muscle soreness (DOMS) using 7 Tesla (T) magnetic resonance imaging (MRI). METHODS DOMS was induced in 16 volunteers performing an eccentric exercise protocol of the calf muscles of one randomized leg. 7 T MRI including T1w- (0.18×0.18×1mm3), T2w-images (0.2×0.2×2mm3), T2-maps (0.5×0.5×5mm3), and susceptibility weighted imaging (SWI, 0.7×0.7×0.7 mm3) were acquired at baseline, directly (t1) and 60 hours (t2) after the exercise. T2 signal intensity (SI), T2 values [ms], T1 SI and SWI were assessed in the medial (MG) and lateral gastrocnemius muscle (LG) and in the soleus muscle (SM). In addition, the serum creatine kinase (CK) activity, range of motion (ROM) of the ankle, calf circumference, and muscle soreness were assessed at each time point. RESULTS Directly after exercise (t1), T2 SI (p=0.04) and T2 values (p=0.03) increased significantly in the LG. No changes of SI and T2 values for MG and SM were present at t1. At t2, T2 SI and T2 values of LG (p=0.001, p=0.02) and MG (p=0.04, p=0.03) increased significantly compared to baseline. T1 SI did not change in any muscle at any time point. In SWI, no signs of intramuscular signal drop could be detected. Clinical parameters confirmed the induction of DOMS, with a significant increase of CK (p=0.03), muscle soreness (p<0.001), calf circumference (p=0.001), and respective a decrease of ROM (p=0.04). CONCLUSIONS 7 T MRI has the potential to visualize microstructural muscle damage immediately after an exercise that induces DOMS. No changes in susceptibility which could, for example, reflect micro-hemorrhage, could be detected with SWI immediately after exercise or in DOMS. Ultra-high field MRI may potentially be used in sports medicine to monitor intramuscular structural changes, allowing for modification of training intensity or to implement appropriate therapeutic strategies.
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Affiliation(s)
- Rafael Heiss
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany.
| | - Svenja A Höger
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Department of Sports Orthopaedics, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany
| | - Michael Uder
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Thilo Hotfiel
- Department of Orthopedic Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Krankenhausstr. 12, Erlangen 91054, Germany; Center for Muskuloskeletal Surgery Osnabrück (OZMC), Klinikum Osnabrück GmbH, Klinikum Osnabrück, Am Finkenhügel 1, Osnabrück 49076, Germany
| | - Jannis Hanspach
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frederik B Laun
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Armin M Nagel
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany
| | - Frank W Roemer
- Institute of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität (FAU), Erlangen-Nürnberg, Maximiliansplatz 3, Erlangen 91054, Germany; Boston University Chobanian & Avedisian School of Medicine, 820 Harrison Ave, Boston, MA 02118, USA
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27
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Santocildes G, Viscor G, Pagès T, Torrella JR. Simulated altitude is medicine: intermittent exposure to hypobaric hypoxia and cold accelerates injured skeletal muscle recovery. J Physiol 2023. [PMID: 38153352 DOI: 10.1113/jp285398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 12/12/2023] [Indexed: 12/29/2023] Open
Abstract
Muscle injuries are the leading cause of sports casualties. Because of its high plasticity, skeletal muscle can respond to different stimuli to maintain and improve functionality. Intermittent hypobaric hypoxia (IHH) improves muscle oxygen delivery and utilization. Hypobaria coexists with cold in the biosphere, opening the possibility to consider the combined use of both environmental factors to achieve beneficial physiological adjustments. We studied the effects of IHH and cold exposure, separately and simultaneously, on muscle regeneration. Adult male rats were surgically injured in one gastrocnemius and randomly assigned to the following groups: (1) CTRL: passive recovery; (2) COLD: intermittently exposed to cold (4°C); (3) HYPO: submitted to IHH (4500 m); (4) COHY: exposed to intermittent simultaneous cold and hypoxia. Animals were subjected to these interventions for 4 h/day for 9 or 21 days. COLD and COHY rats showed faster muscle regeneration than CTRL, evidenced after 9 days at histological (dMHC-positive and centrally nucleated fibre reduction) and functional levels after 21 days. HYPO rats showed a full recovery from injury (at histological and functional levels) after 9 days, while COLD and COHY needed more time to induce a total functional recovery. IHH can be postulated as an anti-fibrotic treatment since it reduces collagen I deposition. The increase in the pSer473Akt/total Akt ratio observed after 9 days in COLD, HYPO and COHY, together with the increase in the pThr172AMPKα/total AMPKα ratio observed in the gastrocnemius of HYPO, provides clues to the molecular mechanisms involved in the improved muscle regeneration. KEY POINTS: Only intermittent hypobaric exposure accelerated muscle recovery as early as 9 days following injury at histological and functional levels. Injured muscles from animals treated with intermittent (4 h/day) cold, hypobaric hypoxia or a simultaneous combination of both stimuli regenerated histological structure and recovered muscle function 21 days after injury. The combination of cold and hypoxia showed a blunting effect as compared to hypoxia alone in the time course of the muscle recovery. The increased expression of the phosphorylated forms of Akt observed in all experimental groups could participate in the molecular cascade of events leading to a faster regeneration. The elevated levels of phosphorylated AMPKα in the HYPO group could play a key role in the modulation of the inflammatory response during the first steps of the muscle regeneration process.
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Affiliation(s)
- Garoa Santocildes
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Ginés Viscor
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Teresa Pagès
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
| | - Joan Ramon Torrella
- Secció de Fisiologia, Departament de Biologia Cel·lular, Fisiologia i Immunologia, Facultat de Biologia, Universitat de Barcelona, Barcelona, Spain
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28
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Ohashi A, Terai S, Furukawa S, Yamamoto S, Kashimoto R, Satoh A. Tenascin-C-enriched regeneration-specific extracellular matrix guarantees superior muscle regeneration in Ambystoma mexicanum. Dev Biol 2023; 504:98-112. [PMID: 37778717 DOI: 10.1016/j.ydbio.2023.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/11/2023] [Accepted: 09/28/2023] [Indexed: 10/03/2023]
Abstract
Severe muscle injury causes distress and difficulty in humans. Studying the high regenerative ability of the axolotls may provide hints for the development of an effective treatment for severe injuries to muscle tissue. Here, we examined the regenerative process in response to a muscle injury in axolotls. We found that axolotls are capable of complete regeneration in response to a partial muscle resection called volumetric muscle loss (VML), which mammals cannot perfectly regenerate. We investigated the mechanisms underlying this high regenerative capacity in response to VML, focusing on the migration of muscle satellite cells and the extracellular matrix (ECM) formed during VML injury. Axolotls form tenascin-C (TN-C)-enriched ECM after VML injury. This TN-C-enriched ECM promotes the satellite cell migration. We confirmed the importance of TN-C in successful axolotl muscle regeneration by creating TN-C mutant animals. Our results suggest that the maintenance of a TN-C-enriched ECM environment after muscle injury promotes the release of muscle satellite cells and supports eventually high muscle regenerative capacity. In the future, better muscle regeneration may be achieved in mammals through the maintenance of TN-C expression.
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Affiliation(s)
- Ayaka Ohashi
- Graduate School of Environment, Life, Natural Science and Technology, Okayama University, Japan
| | - Suzuno Terai
- Okayama University, Faculty of Science, Department of Biological Sciences, Okayama, Japan
| | - Saya Furukawa
- Graduate School of Environment, Life, Natural Science and Technology, Okayama University, Japan
| | - Sakiya Yamamoto
- Graduate School of Environment, Life, Natural Science and Technology, Okayama University, Japan
| | - Rena Kashimoto
- Graduate School of Environment, Life, Natural Science and Technology, Okayama University, Japan
| | - Akira Satoh
- Graduate School of Environment, Life, Natural Science and Technology, Okayama University, Japan; Research Core for Interdisciplinary Sciences (RCIS), Okayama University, Okayama, Japan.
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29
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Plastow R, Raj RD, Fontalis A, Haddad FS. Quadriceps injuries. Bone Joint J 2023; 105-B:1244-1251. [PMID: 38035603 DOI: 10.1302/0301-620x.105b12.bjj-2023-0399.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
Injuries to the quadriceps muscle group are common in athletes performing high-speed running and kicking sports. The complex anatomy of the rectus femoris puts it at greatest risk of injury. There is variability in prognosis in the literature, with reinjury rates as high as 67% in the severe graded proximal tear. Studies have highlighted that athletes can reinjure after nonoperative management, and some benefit may be derived from surgical repair to restore function and return to sport (RTS). This injury is potentially career-threatening in the elite-level athlete, and we aim to highlight the key recent literature on interventions to restore strength and function to allow early RTS while reducing the risk of injury recurrence. This article reviews the optimal diagnostic strategies and classification of quadriceps injuries. We highlight the unique anatomy of each injury on MRI and the outcomes of both nonoperative and operative treatment, providing an evidence-based management framework for athletes.
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Affiliation(s)
- Ricci Plastow
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
| | - Rhody D Raj
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
| | - Andreas Fontalis
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
| | - Fares S Haddad
- Department of Trauma and Orthopaedics, University College London NHS Hospitals, London, UK
- Princess Grace Hospital, London, UK
- The Bone & Joint Journal , London, UK
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30
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Marth AA, Auer TA, Bertalan G, Gebert P, Kirchenberger T, Geisel D, Hamm B, Keller S. Advanced muscle imaging in adolescent elite rowers utilizing diffusion tensor imaging: Association of imaging findings with stroke typology. PLoS One 2023; 18:e0294693. [PMID: 38019893 PMCID: PMC10686450 DOI: 10.1371/journal.pone.0294693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 11/07/2023] [Indexed: 12/01/2023] Open
Abstract
PURPOSE Muscular overuse injuries are a common health issue in elite athletes. Changes in the muscular microenvironment can be depicted by Diffusion Tensor Imaging (DTI). We hypothesize that the biomechanics of different stroke typologies plays a role in muscle injury and tested our hypothesis by magnetic resonance imaging (MRI) examination of the lumbar spine muscles of adolescent rowers utilizing DTI. METHODS AND MATERIALS Twenty-two male elite rowers (12 sweep, 10 scull rowers) with a mean age of 15.8 ± 1.2 years underwent 3-Tesla MRI of the lumbar spine 6 hours after cessation of training. Apparent diffusion coefficient (ADC) and fractional anisotropy (FA) were calculated for the erector spinae and multifidus muscle. Student's t-test was used to test differences of DTI parameters between sweep and scull rowers and a Pearson correlation was utilized to correlate the parameters to training volume. RESULTS ADC values in the erector spinae and multifidus muscle were significantly higher (p = 0.039) and FA values significantly lower (p < 0.001) in sweep rowers compared to scull rowers. There was no significant association between DTI parameters and training volume (r ≤ -0.459, p ≥ 0.074). CONCLUSIONS Our DTI results show that lumbar spine muscle diffusivity is higher in sweep rowers than in scull rowers. Altered muscle diffusivity is suggestive of microscopic tissue disruption and might be attributable to biomechanical differences between stroke typologies.
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Affiliation(s)
- Adrian Alexander Marth
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Timo Alexander Auer
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Clinician Scientist Program, Berlin Institute of Health at Charité—Universitätsmedizin Berlin, Berlin, Germany
| | - Gergely Bertalan
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Pimrapat Gebert
- Institute for Biometry, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Timo Kirchenberger
- Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Dominik Geisel
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Sarah Keller
- Department of Radiology, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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31
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Heiss R, Tol JL, Pogarell T, Roemer FW, Reurink G, Renoux J, Crema MD, Guermazi A. Imaging of muscle injuries in soccer. Skeletal Radiol 2023:10.1007/s00256-023-04514-1. [PMID: 37991553 DOI: 10.1007/s00256-023-04514-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/24/2023] [Accepted: 11/07/2023] [Indexed: 11/23/2023]
Abstract
Accurate diagnosis of muscle injuries is a challenge in everyday clinical practice and may have profound impact on the recovery and return-to-play decisions of professional athletes particularly in soccer. Imaging techniques such as ultrasound and magnetic resonance imaging (MRI), in addition to the medical history and clinical examination, make a significant contribution to the timely structural assessment of muscle injuries. The severity of a muscle injury determined by imaging findings has a decisive influence on therapy planning and affects prognosis. Imaging is of high importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be needed. This narrative review will discuss ultrasound and MRI for the assessment of sports-related muscle injuries in the context of soccer, including advanced imaging techniques, with the focus on the clinical relevance of imaging findings for the prediction of return to play.
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Affiliation(s)
- Rafael Heiss
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Johannes L Tol
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, The Netherlands
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Tobias Pogarell
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Frank W Roemer
- Department of Radiology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - Guus Reurink
- Musculoskeletal Health and Sports, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Jerome Renoux
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Michel D Crema
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
- Institute of Sports Imaging, Sports Medicine Department, French National Institute of Sports (INSEP), Paris, France
| | - Ali Guermazi
- Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA.
- VA Boston Healthcare System, West Roxbury, MA, USA.
- Department of Radiology, VA Boston Healthcare System, 1400 VFW Parkway, Suite 1B106, West Roxbury, MA, 02132, USA.
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Palermi S, Vittadini F, Vecchiato M, Corsini A, Demeco A, Massa B, Pedret C, Dorigo A, Gallo M, Pasta G, Nanni G, Vascellari A, Marchini A, Lempainen L, Sirico F. Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies. J Funct Morphol Kinesiol 2023; 8:155. [PMID: 37987491 PMCID: PMC10660751 DOI: 10.3390/jfmk8040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | | | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | - Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal, 08950 Barcelona, Spain;
| | - Alberto Dorigo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | - Mauro Gallo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | | | | | | | | | - Lasse Lempainen
- FinnOrthopaedics, Hospital Pihlajalinna, 20520 Turku, Finland;
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
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Partenheimer A, Warnhoff M, Lill H. [Management of muscle trauma in popular sports]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2023; 126:895-903. [PMID: 37870560 DOI: 10.1007/s00113-023-01377-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/15/2023] [Indexed: 10/24/2023]
Abstract
Muscle injuries make up the majority of injuries in popular sports. The causes for the development are multifactorial and can be divided into functional disorders and a lack of knowledge regarding training control. Insufficient warm-up and overtraining both increase the danger of the occurrence of the injury. Knowledge of the different types of muscle injuries and their incorporation into an exact classification enable the establishment of a correct treatment plan and can have a positive influence on the healing process. In addition to acute treatment the knowledge and application of preventive programs are necessary as these can significantly reduce the prevalence of muscle injuries in sports.
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Affiliation(s)
- Axel Partenheimer
- Spine & Sport, Herrenhäuser Kirchweg 38, 30167, Hannover, Deutschland.
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover, Deutschland.
| | | | - Helmut Lill
- Klinik für Orthopädie und Unfallchirurgie, DIAKOVERE Friederikenstift, Hannover, Deutschland
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Schwiete C, Roth C, Skutschik C, Möck S, Rettenmaier L, Happ K, Broich H, Behringer M. Effects of muscle fatigue on exercise-induced hamstring muscle damage: a three-armed randomized controlled trial. Eur J Appl Physiol 2023; 123:2545-2561. [PMID: 37330434 PMCID: PMC10616225 DOI: 10.1007/s00421-023-05234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 05/21/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Hamstring injuries in soccer reportedly increase towards the end of the matches' halves as well as with increased match frequency in combination with short rest periods, possibly due to acute or residual fatigue. Therefore, this study aimed to investigate the effects of acute and residual muscle fatigue on exercise-induced hamstring muscle damage. METHODS A three-armed randomized-controlled trial, including 24 resistance-trained males, was performed allocating subjects to either a training group with acute muscle fatigue + eccentric exercise (AF/ECC); residual muscle fatigue + eccentric exercise (RF/ECC) or a control group with only eccentric exercise (ECC). Muscle stiffness, thickness, contractility, peak torque, range of motion, pain perception, and creatine kinase were assessed as muscle damage markers pre, post, 1 h post, and on the consecutive three days. RESULTS Significant group × time interactions were revealed for muscle thickness (p = 0.02) and muscle contractility parameters radial displacement (Dm) and contraction velocity (Vc) (both p = 0.01), with larger changes in the ECC group (partial η2 = 0.4). Peak torque dropped by an average of 22% in all groups; stiffness only changed in the RF/ECC group (p = 0.04). Muscle work during the damage protocol was lower for AF/ECC than for ECC and RF/ECC (p = 0.005). CONCLUSION Hamstring muscle damage was comparable between the three groups. However, the AF/ECC group resulted in the same amount of muscle damage while accumulating significantly less muscle work during the protocol of the damage exercise. TRIAL REGISTRATION This study was preregistered in the international trial registration platform (WHO; registration number: DRKS00025243).
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Affiliation(s)
- Carsten Schwiete
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany.
| | - Christian Roth
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Christoph Skutschik
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Sebastian Möck
- Department of Exercise Science, Olympic Training and Testing Center of Hessen, Frankfurt am Main, Germany
| | - Lukas Rettenmaier
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Kevin Happ
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Holger Broich
- Department of Science, Performance and Fitness, FC Bayern München AG, Munich, Germany
- Department of Performance, Neuroscience, Therapy, and Health, Medical School Hamburg, Hamburg, Germany
| | - Michael Behringer
- Department of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany
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Farrell SG, Hatem M, Bharam S. Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention. Am J Sports Med 2023; 51:3591-3603. [PMID: 36661128 DOI: 10.1177/03635465221140923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND Controversies remain regarding the diagnosis, imaging, and treatment of acute adductor injuries in athletes. PURPOSE To investigate the diagnostic imaging, treatment, and prevention of acute adductor injuries based on the most recent and relevant scientific evidence. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS The PubMed and Web of Science databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles studying acute adductor injury in athletes. Inclusion criteria were original publication on acute adductor injury in amateur or professional athletes, level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or the methodological index for non-randomized studies criteria. Articles were grouped as imaging, treatment, prevention focused, or mixed. RESULTS A total of 30 studies published between 2001 and 2021 were selected, involving 594 male patients with a mean age 26.2 years (range, 16-68 years). The most frequent sports were soccer (62%), basketball (14%), futsal (6%), American football (3%), and ice hockey and handball (2%). Risk factors for acute adductor injury were previous acute groin injury, adductor weakness compared with the uninjured side, any injury in the previous season, and reduced rotational hip range of motion. The frequency of complete adductor muscle tears on magnetic resonance imaging was 21% to 25%. For complete adductor tears, the average time to return to play was 8.9 weeks in patients treated nonoperatively and 14.2 weeks for patients treated surgically. Greater stump retraction was observed in individuals treated surgically. Partial acute adductor tears were treated nonoperatively with physical therapy in all studies in the present systematic review. The average time to return to play was 1 to 6.9 weeks depending on the injury grade. The efficacy of adductor strengthening on preventing acute adductor tears has controversial results in the literature. CONCLUSION Athletes with partial adductor injuries returned to play 1 to 7 weeks after injury with physical therapy treatment. Nonoperative or surgical treatment is an acceptable option for complete adductor longus tendon tear.
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Affiliation(s)
| | - Munif Hatem
- Department of Orthopedic Surgery, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - Srino Bharam
- Northwell Lenox Hill Hospital, New York, New York, USA
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36
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Edouard P, Reurink G, Mackey AL, Lieber RL, Pizzari T, Järvinen TAH, Gronwald T, Hollander K. Traumatic muscle injury. Nat Rev Dis Primers 2023; 9:56. [PMID: 37857686 DOI: 10.1038/s41572-023-00469-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2023] [Indexed: 10/21/2023]
Abstract
Traumatic muscle injury represents a collection of skeletal muscle pathologies caused by trauma to the muscle tissue and is defined as damage to the muscle tissue that can result in a functional deficit. Traumatic muscle injury can affect people across the lifespan and can result from high stresses and strains to skeletal muscle tissue, often due to muscle activation while the muscle is lengthening, resulting in indirect and non-contact muscle injuries (strains or ruptures), or from external impact, resulting in direct muscle injuries (contusion or laceration). At a microscopic level, muscle fibres can repair focal damage but must be completely regenerated after full myofibre necrosis. The diagnosis of muscle injury is based on patient history and physical examination. Imaging may be indicated to eliminate differential diagnoses. The management of muscle injury has changed within the past 5 years from initial rest, immobilization and (over)protection to early activation and progressive loading using an active approach. One challenge of muscle injury management is that numerous medical treatment options, such as medications and injections, are often used or proposed to try to accelerate muscle recovery despite very limited efficacy evidence. Another challenge is the prevention of muscle injury owing to the multifactorial and complex nature of this injury.
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Affiliation(s)
- Pascal Edouard
- Université Jean Monnet, Lyon 1, Université Savoie Mont-Blanc, Inter-university Laboratory of Human Movement Biology, Saint-Etienne, France.
- Department of Clinical and Exercise Physiology, Sports Medicine Unit, University Hospital of Saint-Etienne, Faculty of Medicine, Saint-Etienne, France.
| | - Gustaaf Reurink
- Department of Orthopedic Surgery and Sports Medicine, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, Netherlands
- Academic Center for Evidence-based Sports Medicine (ACES), Academic Medical Center, Amsterdam, Netherlands
- The Sports Physicians Group, Onze Lieve Vrouwe Gasthuis, Amsterdam, Netherlands
| | - Abigail L Mackey
- Institute of Sports Medicine Copenhagen, Department of Orthopaedic Surgery M, Bispebjerg Hospital, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Richard L Lieber
- Shirley Ryan AbilityLab, Chicago, IL, USA
- Departments of Physical Medicine and Rehabilitation and Biomedical Engineering, Northwestern University, Chicago, IL, USA
- Hines VA Medical Center, Maywood, IL, USA
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Tero A H Järvinen
- Tampere University and Tampere University Hospital, Tampere, Finland
| | - Thomas Gronwald
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Karsten Hollander
- Institute of Interdisciplinary Exercise Science and Sports Medicine, MSH Medical School Hamburg, Hamburg, Germany
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Martín-Noguerol T, Barousse R, Wessell DE, Rossi I, Luna A. Clinical applications of skeletal muscle diffusion tensor imaging. Skeletal Radiol 2023; 52:1639-1649. [PMID: 37083977 DOI: 10.1007/s00256-023-04350-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/16/2023] [Accepted: 04/17/2023] [Indexed: 04/22/2023]
Abstract
Diffusion tensor imaging (DTI) may allow the determination of new threshold values, based on water anisotropy, to differentiate between healthy muscle and various pathological processes. Additionally, it may quantify treatment monitoring or training effects. Most current studies have evaluated the potential of DTI of skeletal muscle to assess sports-related injuries or therapy, and training monitoring. Another critical area of application of this technique is the characterization and monitoring of primary and secondary myopathies. In this manuscript, we review the application of DTI in the evaluation of skeletal muscle in these and other novel clinical scenarios, with emphasis on the use of quantitative imaging-derived biomarkers. Finally, the main limitations of the introduction of DTI in the clinical setting and potential areas of future use are discussed.
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Affiliation(s)
| | | | | | | | - Antonio Luna
- MRI Unit, Radiology Department, HT Médica, Jaén, Spain
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Boyd NL, von Pfeil D, James DR, Kent M, Fearnside S, White JD. Rupture of the gastrocnemius muscle at its distal musculotendinous junction: conservative treatment and outcomes in 11 dogs. N Z Vet J 2023; 71:275-281. [PMID: 37309587 DOI: 10.1080/00480169.2023.2224753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2023] [Accepted: 05/28/2023] [Indexed: 06/14/2023]
Abstract
CASE HISTORY Medical records from three veterinary referral centres and a university veterinary teaching hospital in Australia and the USA were reviewed to identify dogs with a diagnosis of distal gastrocnemius musculotendinous junction rupture (DGMJR) that were treated without surgery between 2007 and 2020. CLINICAL AND IMAGING FINDINGS All dogs (n = 11) presented with unilateral, pelvic limb lameness and bruising, swelling or pain on palpation at the distal musculotendinous junction. The diagnosis was confirmed with ultrasound or MRI in six dogs; radiographs were used to excluded stifle and tarsus pathology in four dogs; and five dogs were diagnosed on physical examination findings. TREATMENT AND OUTCOME All dogs were managed conservatively, either with complete confinement alone (n = 10; median 9 weeks), external coaptation alone (n = 1), or a combination of both (n = 4). Sporting dogs (n = 7) were completely confined (median 22 weeks) for longer periods than companion dogs (n = 3; median 5 weeks).A good to excellent outcome was achieved for all cases in this cohort. The seven sporting dogs achieved an excellent outcome; returning to their previous level of sport, with complete resolution of lameness and recovery of a normal tibiotarsal stance. The four companion dogs achieved a good outcome; returning to their previous level of activity but with persistently increased tibiotarsal standing angle compared to the contralateral limb. CLINICAL RELEVANCE Conservative treatment represents a viable treatment option for dogs with a rupture of the gastrocnemius muscle at its distal musculotendinous junction.
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Affiliation(s)
- N L Boyd
- Sports Medicine and Rehabilitation, Small Animal Specialist Hospital, Sydney, Australia
| | - D von Pfeil
- Small Animal Surgery, Bessy's Kleintierklinik, Zurich, Switzerland
- Small Animal Surgery Locum, PLLC, Dallas, TX, USA
| | - D R James
- Small Animal Surgery, Small Animal Specialist Hospital, Sydney, Australia
| | - M Kent
- Neurology Service, Small Animal Medicine & Surgery, Veterinary Teaching Hospital, University of Georgia, Athens, GA, USA
| | - S Fearnside
- Small Animal Surgery, Small Animal Specialist Hospital, Sydney, Australia
| | - J D White
- Small Animal Internal Medicine, Small Animal Specialist Hospital, Sydney, Australia
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Lin KM, Atzmon R, Pierre KJ, Vel MS, Brinson K, Sherman SL. Common Soft Tissue Injuries About the Knee in American Football. HSS J 2023; 19:330-338. [PMID: 37435123 PMCID: PMC10331270 DOI: 10.1177/15563316231165298] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 02/01/2023] [Indexed: 07/13/2023]
Affiliation(s)
- Kenneth M Lin
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Ran Atzmon
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Kinsley J Pierre
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Monica S Vel
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Kenneth Brinson
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
| | - Seth L Sherman
- Division of Sports Medicine, Department of Orthopedic Surgery, Stanford University, Redwood City, CA, USA
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Mazin Y, Lemos C, Paiva C, Amaral Oliveira L, Borges A, Lopes T. The Role of Extracorporeal Shock Wave Therapy in the Treatment of Muscle Injuries: A Systematic Review. Cureus 2023; 15:e44196. [PMID: 37767244 PMCID: PMC10521343 DOI: 10.7759/cureus.44196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Muscle injuries commonly occur in sports and can be classified as indirect and direct, according to the 2013 Munich Consensus Statement (MCS). Since recent evidence suggests that extracorporeal shock wave therapy (ESWT) improves muscular microcirculation and may increase regeneration after acute muscle injury, we performed a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines to access the efficacy and safety of ESWT in the treatment of patients with muscle injuries. PubMed and Cochrane were searched to screen for potentially relevant articles and the literature search was last updated in June 2023. The inclusion criteria were randomized controlled trials, observational studies, or case controls published in English, Portuguese, or Spanish that studied the effect of ESWT on indirect and direct muscle injuries in individuals aged ≥18, with at least one of the following reported outcomes: pain on the visual analog scale (VAS), functionality assessed either with disability scales or subjectively, time for return to play (RTP), re-injury rate, and ultrasonographic evaluation. The exclusion criteria were literature reviews, systematic reviews, studies in animals, studies in other languages, studies that failed to meet the targeted population or intervention and studies that didn't report any of the outcomes of interest. The quality of the studies was analyzed using the Cochrane Assessment Tool, the Newcastle-Ottawa Quality Assessment Scale, and the JBI Critical Appraisal Checklist. Eight studies were included in the systematic review (two randomized controlled trials, one prospective observational study, two retrospective observational studies, and three case reports), with a total of 143 adult participants. ESWT was associated with less pain on VAS, better function, reduction of size of lesion on ultrasound evaluation, faster RTP and/or lower re-injury rate in patients with indirect and direct muscle injuries and muscular hematomas, a frequent secondary complication of muscle injuries. The evidence regarding the use of ESWT for these types of injuries is therefore promising. Nevertheless, higher-quality studies are needed in the future to prove its efficacy, better comprehend its mechanisms of action and define treatment protocols (timing, type and parameters of ESWT).
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Affiliation(s)
- Yuriy Mazin
- Physical Medicine and Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
| | - Carolina Lemos
- Population Studies, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, PRT
| | - Carolina Paiva
- Physical Medicine and Rehabilitation, Centro de Medicina de Reabilitação da Região Centro-Rovisco Pais, Coimbra, PRT
| | - Luís Amaral Oliveira
- Physical Medicine and Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
| | - Andre Borges
- Physical Medicine and Rehabilitation, Centro Hospitalar De Trás-Os-Montes E Alto Douro, Vila Real, PRT
| | - Tiago Lopes
- Physical Medicine and Rehabilitation, Centro de Reabilitação do Norte, Vila Nova de Gaia, PRT
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41
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Meller L, Oca MC, Wilson K, Allen M, Smitaman E, Kalavacherla S, Vitale K. Intramuscular Degloving Injury of the Rectus Femoris From Kickball: A Case Report and Review. Cureus 2023; 15:e42230. [PMID: 37605671 PMCID: PMC10440009 DOI: 10.7759/cureus.42230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023] Open
Abstract
Intramuscular degloving injuries (IDIs) are a rare and unique type of muscle injury where there is a dissociation between the inner and outer components of a particular muscle. This type of injury is seen exclusively within the rectus femoris (RF) muscle due to its unique muscle-within-a-muscle anatomy and represents 9% of RF injuries. Despite the significance of this injury, limited knowledge exists regarding the mechanism, management, and prognosis of IDIs, and IDIs are not currently included among the various muscle injury classifications. We present a 38-year-old active male with a one-week history of acute onset right anterior mid-thigh pain and palpable lump after playing kickball. Right thigh MRI revealed an IDI of the RF muscle, edema within the inner and outer muscular portions of the muscle, and a retraction of the torn inner indirect myotendinous complex of the RF. He was managed with physical therapy while being advised to avoid aggressive quadriceps contractions, high-intensity, or high-impact exercise. This is the first reported case of an IDI that occurred in an older recreational athlete (versus young competitive athletes), and the first case of an IDI in a kicking sport other than soccer (kickball). This case emphasizes the importance of a broader awareness of this injury, and a heightened index of suspicion is advised in assessing potential IDIs to improve patient prognosis and rehabilitation. Given the limited understanding and rarity of this injury, we also provide a comprehensive review describing the IDI to the RF.
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Affiliation(s)
- Leo Meller
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Michael C Oca
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Katherine Wilson
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Matthew Allen
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Edward Smitaman
- Department of Radiology, University of California San Diego School of Medicine, La Jolla, USA
| | - Sandhya Kalavacherla
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
| | - Kenneth Vitale
- Department of Orthopedic Surgery, Division of Sports Medicine, University of California San Diego School of Medicine, La Jolla, USA
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Martínez-Silván D, Wik EH, Arnáiz J, Farooq A, Mónaco M. Association Between Magnetic Resonance Imaging Findings and Time to Return to Sport After Muscle Injuries in High-Level Youth Athletes. Clin J Sport Med 2023; 33:225-232. [PMID: 37042815 DOI: 10.1097/jsm.0000000000001112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/04/2022] [Indexed: 04/13/2023]
Abstract
OBJECTIVE To describe the relationship between magnetic resonance imaging (MRI) findings and time to return to sport (RTS) from muscle injuries in youth athletes. DESIGN Prospective collection of injury surveillance data over 6 seasons (2014-2015 to 2019-2020) and reanalysis of MRIs by a radiologist blinded to RTS time after the data collection period. SETTING National sports academy and sports medicine hospital. PARTICIPANTS Male youth (11-19 years) athletes participating in the football (soccer) or athletics (track and field) programs with a muscle injury. INDEPENDENT VARIABLES Magnetic resonance imaging findings (eg, grade and location) in time-loss muscle injuries. MAIN OUTCOME VARIABLES Injury incidence, distributions, and RTS time. RESULTS In total, 353 time-loss muscle injuries were recorded for 1089 athlete-seasons, of which 85 satisfied our inclusion criteria (MRI within 14 days). Return to sport time was significantly longer for reinjuries compared with index injuries. Associations between MRI findings and RTS time were specific to the muscle group, with significant differences in RTS time observed between categories of structure, location, and grade. The largest number of injuries was to the hamstrings (n = 46), where injuries involving the tendon were more severe than those involving the myotendinous junction and muscle, proximal injuries were more severe than mid-portion and distal, and longer RTS time was observed for higher injury grade ( P < 0.05). CONCLUSIONS Muscle injuries in youth are diverse and cannot be treated as a single injury type. Specific injury durations can be expected depending on injury characteristics such as reinjury, location, structure, and grade.
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Affiliation(s)
- Daniel Martínez-Silván
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Eirik Halvorsen Wik
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- Institute of Sport and Exercise Medicine, Department of Sport Science, Faculty of Medicine and Health Sciences, Stellenbosch University, Rylaan, Tygerberg, South Africa
- Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Rylaan, Tygerberg, South Africa; and
| | - Javier Arnáiz
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
- School of Medicine-Qatar, Weill Cornell University, Doha, Qatar
| | - Abdulaziz Farooq
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
| | - Mauricio Mónaco
- NSMP - Aspire Academy Sports Medicine Center, Aspetar Orthopedic and Sports Medicine Hospital, Doha, Qatar
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43
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Kellis E, Sahinis C, Baltzopoulos V. Is hamstrings-to-quadriceps torque ratio useful for predicting anterior cruciate ligament and hamstring injuries? A systematic and critical review. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:343-358. [PMID: 35065297 DOI: 10.1016/j.jshs.2022.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 11/11/2021] [Accepted: 12/08/2021] [Indexed: 05/17/2023]
Abstract
BACKGROUND For the past 30 years, the hamstring (H)-to-quadriceps (Q) (H:Q) torque ratio has been considered an important index of muscle strength imbalance around the knee joint. The purpose of this systematic review was to examine the value of H:Q torque ratio as an independent risk factor for hamstring and anterior cruciate ligament (ACL) injuries. METHODS Database searches were performed to identify all relevant articles in PubMed, MEDLINE, Cochrane Library, and Scopus. Prospective studies evaluating the conventional (concentric H:Q), functional (eccentric H: concentric Q), and mixed (eccentric H at 30°/s: concentric Q at 240°/s) H:Q ratios as risk factors for occurrence of hamstring muscle strain or ACL injury were considered. Risk of bias was assessed using the Quality In Prognosis Studies tool. RESULTS Eighteen included studies reported 585 hamstrings injuries in 2945 participants, and 5 studies documented 128 ACL injuries in 2772 participants. Best evidence synthesis analysis indicated that there is very limited evidence that H:Q strength ratio is an independent risk factor for hamstring and ACL injury, and this was not different between various ratio types. Methodological limitations and limited evidence for ACL injuries and some ratio types might have influenced these results. CONCLUSION The H:Q ratio has limited value for the prediction of ACL and hamstring injuries. Monitoring strength imbalances along with other modifiable factors during the entire competitive season may provide a better understanding of the association between H:Q ratio and injury.
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Affiliation(s)
- Eleftherios Kellis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres 62100, Greece.
| | - Chrysostomos Sahinis
- Laboratory of Neuromechanics, Department of Physical Education and Sport Sciences at Serres, Aristotle University of Thessaloniki, Serres 62100, Greece
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences (RISES), Faculty of Science, Liverpool John Moores University, Liverpool L3 5UX, UK
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Valente HG, Oliveira RRD, Baroni BM. How are hamstring strain injuries managed in elite men's football clubs? A survey with 62 Brazilian physical therapists. Phys Ther Sport 2023; 61:73-81. [PMID: 36940549 DOI: 10.1016/j.ptsp.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/02/2023] [Accepted: 03/03/2023] [Indexed: 03/06/2023]
Abstract
OBJECTIVE To describe perceptions and practices of physical therapists from elite men's football clubs on the management of athletes with hamstring strain injury (HSI). DESIGN Cross-sectional study. SETTING Online survey. PARTICIPANTS Physical therapists from clubs engaged in the two main divisions of Brazilian men's football. MAIN OUTCOME MEASURES Practices for assessment and rehabilitation of athletes with HSI. RESULTS This survey had 62 physical therapists from 35 of the 40 eligible clubs (87.5% representativeness). Despite heterogeneity on assessment practices, all respondents use imaging exams, adopt injury classification scales, and evaluate aspects related to pain, range of motion, muscle strength, and functional status of athletes with HSI. Rehabilitation programs are usually divided into 3 to 4 phases. All respondents usually apply electrophysical agents and stretching in HSI rehabilitation programs, 98.4% apply strengthening exercises (93.5% include eccentrics), 96.8% manual therapy, 95.2% exercises that mimic the functional demands of football, and 93.5% lumbopelvic stabilization exercises. Muscle strength was the most reported return to play criterion (71% of respondents). CONCLUSION The present study allowed the sports physical therapy community to become aware of the approaches usually adopted for management of athletes with HSI who play in the highest level of Brazilian men's football.
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Affiliation(s)
- Henrique Gonçalves Valente
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil; Department of Science, Health and Performance, Grêmio Foot-Ball Porto Alegrense, Porto Alegre, RS, Brazil
| | | | - Bruno Manfredini Baroni
- Graduate Program in Rehabilitation Sciences, Federal University of Health Sciences of Porto Alegre, Porto Alegre, RS, Brazil.
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45
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Haddad FS, Paton BM, Plastow R, Wilson MG. Basics must improve to reduce the burden of hamstring muscle injuries. Br J Sports Med 2023; 57:252-253. [PMID: 36759139 DOI: 10.1136/bjsports-2021-105387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Fares S Haddad
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport Exercise and Health (ISEH), Division Surgery and Interventional Science, University College London, London, UK
| | - Bruce M Paton
- Institute of Sport Exercise and Health (ISEH), Division Surgery and Interventional Science, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK
| | - Ricci Plastow
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Orthopaedics, Princess Grace Hospital, London, UK
| | - Mathew G Wilson
- Institute of Sport Exercise and Health (ISEH), Division Surgery and Interventional Science, University College London, London, UK.,Princess Grace Hospital, London, UK
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46
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Paton BM, Court N, Giakoumis M, Head P, Kayani B, Kelly S, Kerkhoffs GMMJ, Moore J, Moriarty P, Murphy S, Plastow R, Pollock N, Read P, Stirling B, Tulloch L, van Dyk N, Wilson MG, Wood D, Haddad F. London International Consensus and Delphi study on hamstring injuries part 1: classification. Br J Sports Med 2023; 57:254-265. [PMID: 36650035 DOI: 10.1136/bjsports-2021-105371] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 01/19/2023]
Abstract
Muscle injury classification systems for hamstring injuries have evolved to use anatomy and imaging information to aid management and prognosis. However, classification systems lack reliability and validity data and are not specific to individual hamstring muscles, potentially missing parameters vital for sport-specific and activity-specific decision making. A narrative evidence review was conducted followed by a modified Delphi study to build an international consensus on best-practice decision-making for the classification of hamstring injuries. This comprised a digital information gathering survey to a cohort of 46 international hamstring experts (sports medicine physicians, physiotherapists, surgeons, trainers and sports scientists) who were also invited to a face-to-face consensus group meeting in London . Fifteen of these expert clinicians attended to synthesise and refine statements around the management of hamstring injury. A second digital survey was sent to a wider group of 112 international experts. Acceptance was set at 70% agreement. Rounds 1 and 2 survey response rates were 35/46 (76%) and 99/112 (88.4%) of experts responding. Most commonly, experts used the British Athletics Muscle Injury Classification (BAMIC) (58%), Munich (12%) and Barcelona (6%) classification systems for hamstring injury. Issues identified to advance imaging classifications systems include: detailing individual hamstring muscles, establishing optimal use of imaging in diagnosis and classification, and testing the validity and reliability of classification systems. The most used hamstring injury classification system is the BAMIC. This consensus panel recommends hamstring injury classification systems evolve to integrate imaging and clinical parameters around: individual muscles, injury mechanism, sporting demand, functional criteria and patient-reported outcome measures. More research is needed on surgical referral and effectiveness criteria, and validity and reliability of classification systems to guide management.
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Affiliation(s)
- Bruce M Paton
- Institute of Sport Exercise and Health, University College London, London, UK .,Physiotherapy Department, University College London Hospitals NHS Foundation Trust, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Babar Kayani
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Gino M M J Kerkhoffs
- Orthopaedic Surgery and Sports Medicine, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - James Moore
- Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | | | - Ricci Plastow
- Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK
| | - Noel Pollock
- Institute of Sport Exercise and Health, University College London, London, UK.,British Athletics, London, UK
| | - Paul Read
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,School of Sport and Exercise, University of Goucester, Gloucester, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew G Wilson
- Division of Surgery and Intervention Science, University College London, London, UK.,Princess Grace Hospital, London, UK
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Fares Haddad
- Institute of Sport Exercise and Health, University College London, London, UK.,Division of Surgery and Intervention Science, University College London, London, UK.,Trauma and Orthopaedics, University College London Hospitals NHS Foundation Trust, London, UK.,Princess Grace Hospital, London, UK
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47
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Plastow R, Kerkhoffs GMMJ, Wood D, Paton BM, Kayani B, Pollock N, Court N, Giakoumis M, Head P, Kelly S, Moore J, Moriarty P, Murphy S, Read P, Stirling B, Tulloch L, van Dyk N, Wilson M, Haddad F. London International Consensus and Delphi study on hamstring injuries part 2: operative management. Br J Sports Med 2023; 57:266-277. [PMID: 36650033 DOI: 10.1136/bjsports-2021-105383] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2022] [Indexed: 01/19/2023]
Abstract
The key indications for surgical repair of hamstring injuries (HSIs) remain unclear in the literature due to a lack of high-level evidence and expert knowledge. The 2020 London International Hamstring Consensus meeting aimed to highlight clear surgical indications and to create a foundation for future research. A literature review was conducted followed by a modified Delphi process, with an international expert panel. Purposive sampling was used with two rounds of online questionnaires and an intermediate round involving a consensus meeting. The initial information gathering (round 1) questionnaire was sent to 46 international experts, which comprised open-ended questions covering decision-making domains in HSI. Thematic analysis of responses outlined key domains, which were evaluated by a smaller international subgroup (n=15) comprising clinical academic sports medicine physicians, physiotherapists and orthopaedic surgeons in a consensus meeting. After group discussion of each domain, a series of consensus statements were prepared, debated and refined. A round 2 questionnaire was sent to 112 international hamstring experts to vote on these statements and determine level of agreement. The consensus threshold was set a priori at 70% agreement. Rounds 1 and 2 survey respondents were 35/46 (76%) and 99/112 (88.4%), respectively. The consensus group agreed that the indications for operative intervention included: gapping at the zone of tendinous injury (87.2% agreement) and loss of tension (70.7%); symptomatic displaced bony avulsions (72.8%); and proximal free tendon injuries with functional compromise refractory to non-operative treatment (72.2%). Other important considerations for operative intervention included: the demands of the athlete/patient and the expected functional outcome (87.1%) based on the anatomy of the injury; the risk of functional loss/performance deficit with non-operative management (72.2%); and the capacity to restore anatomy and function (87.1%). Further research is needed to determine whether surgery can reduce the risk of reinjury as consensus was not reached within the whole group (48.2%) but was agreed by surgeons (70%) in the cohort. The consensus group did not support the use of corticosteroids or endoscopic surgery without further evidence. These guidelines will help standardise treatment of HSIs, specifically the indications and decision-making for surgical intervention.
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Affiliation(s)
- Ricci Plastow
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK
| | - Gino M M J Kerkhoffs
- Department of Orthopedic Surgery and Sports Medicin, Amsterdam Movement Sciences, Amsterdam University Medical Centers, Amsterdam, The Netherlands.,Amsterdam Collaboration for Health and Safety in Sports (ACHSS), Amsterdam IOC Research Center, Amsterdam, The Netherlands
| | - David Wood
- Trauma & Orthopaedic Surgery, North Sydney Orthopaedic and Sports Medicine Centre, Sydney, New South Wales, Australia
| | - Bruce M Paton
- Division of Medicine, Institute of Sport Exercise Health, University College London, London, UK.,Physiotherapy, University College London Hospitals NHS Foundation Trust, London, UK
| | - Babar Kayani
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Noel Pollock
- British Athletics Medical Team, London, UK.,Sports Medicine, Institute of Sport Exercise and Health, London, UK
| | | | | | - Paul Head
- School of Sport, Health and Applied Science, St. Mary's University, London, UK
| | - Sam Kelly
- Salford City Football Club, Salford, UK.,Blackburn Rovers FC, Blackburn, Lancashire, UK
| | - James Moore
- Sports & Exercise Medicine, Centre for Human Health and Performance, London, UK
| | - Peter Moriarty
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Simon Murphy
- Sports Medicine, Arsenal Football Club, London, UK
| | - Paul Read
- Institute of Sport Exercise & Health, London, UK.,Princess Grace Hospital, London, London, UK
| | | | | | - Nicol van Dyk
- High Performance Unit, Irish Rugby Football Union, Dublin, Ireland.,Section Sports Medicine, University of Pretoria, Pretoria, South Africa
| | - Mathew Wilson
- Princess Grace Hospital, London, London, UK.,Targeted Intervention, University College London, London, UK
| | - Fares Haddad
- Trauma & Orthopaedic Surgery, University College London Hospitals NHS Foundation Trust, London, UK.,Institute of Sport Exercise & Health, London, UK
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48
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Heiss R, Janka R, Uder M, Hotfiel T, Gast L, Nagel AM, Roemer FW. [Imaging of muscle injuries in sports medicine]. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:249-258. [PMID: 36797330 DOI: 10.1007/s00117-023-01118-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/09/2023] [Indexed: 02/18/2023]
Abstract
BACKGROUND Early diagnosis of muscle injuries is indispensable in order to initiate appropriate treatment and to facilitate optimal healing. PURPOSE The aim of this review is to provide an update on imaging of muscle injuries in sports medicine with a focus on ultrasound and magnetic resonance imaging (MRI) and to present experimental approaches in addition to routine diagnostic procedures. MATERIALS AND METHODS A PubMed literature search for the years 2012-2022 using the following keywords was performed: muscle, muscle injury, muscle imaging, muscle injury classification, delayed onset muscle soreness, ultrasound, MRI, sodium MRI, potassium MRI, ultra-high-field MRI, injuries of athletes. RESULTS Imaging is crucial to confirm and assess the extent of sports-related muscle injuries and may help establishing treatment decisions, which directly affect the prognosis. This is of importance when the diagnosis or grade of injury is unclear, when recovery is taking longer than expected, and when interventional or surgical management may be necessary. In addition to established methods such as B‑mode ultrasound and 1H‑MRI, individual studies show promising approaches to further improve the imaging of muscle injuries in the future. Prior to the integration of contrast-enhanced ultrasound and X‑nuclei into clinical routine, additional studies are needed to validate these techniques further. CONCLUSION B‑mode ultrasound represents an easily available, cost-effective modality for the initial diagnosis of muscle injuries. MRI is still considered the reference standard and enables an accurate morphological assessment of the extent of the injury. There are still no imaging approaches available for the objective determination of the optimal point of return to play.
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Affiliation(s)
- Rafael Heiss
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.
| | - Rolf Janka
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Michael Uder
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Thilo Hotfiel
- Unfallchirurgische und Orthopädische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland.,Osnabrücker Zentrum für Muskuloskelettale Chirurgie (OZMC), Klinikum Osnabrück, Osnabrück, Deutschland
| | - Lena Gast
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland
| | - Armin M Nagel
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Abteilung Medizinische Physik in der Radiologie, Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutschland
| | - Frank W Roemer
- Radiologisches Institut, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Maximiliansplatz 3, 91054, Erlangen, Deutschland.,Quantitative Imaging Center (QIC), Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
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49
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Purcell C, Duignan C, Fullen BM, Ryan S, Ward T, Caulfield B. Comprehensive assessment and classification of upper and lower limb pain in athletes: a scoping review. Br J Sports Med 2023; 57:535-542. [PMID: 36759138 DOI: 10.1136/bjsports-2022-106380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 02/11/2023]
Abstract
BACKGROUND Upper and lower limb (peripheral) pain is prevalent in athletes. Contemporary research prioritises multidimensional pain assessment and classification. This study aims to review comprehensive athlete pain assessment practices against the reference standard (International Olympic Committee, IOC Athlete Pain framework), identifying trends and highlighting gaps. METHODS AND ANALYSIS Six databases were searched using a comprehensive search strategy. This review followed the Joanna Briggs Institute standardised methodology for scoping reviews and is reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. Title and abstract, full-text screening and data charting were completed by two independent reviewers. INCLUSION CRITERIA Original research, systematic reviews and clinical practice guidelines reporting assessment or classification of pain in athletes of any age with chronic or acute peripheral pain in English on human participants from database inception. RESULTS 470 studies with 175 different pain assessment tools were mapped against the IOC Athlete Pain Framework. Papers included tools from neurophysiological (470/100%), biomechanical (425/90%), affective (103/22%), cognitive (59/13%) and socioenvironmental (182/39%) domains. Pain classification was included in 108 studies (23%). 4 studies (0.85%) defined pain. Athletes with physical disability were included in 13 (3%) studies and no studies included athletes with intellectual disabilities. Socioeconomic factors were addressed in 29 (6%) studies. DISCUSSION Neurophysiological and biomechanical domains are frequently addressed. Affective, socioenvironmental and cognitive tools are under-represented. Potential tools for use by researchers and clinicians are highlighted. Defining and classifying pain and determining predominant pain mechanisms is needed in both research and clinical practice. More work on underrepresented populations is needed. CONCLUSION This review informs researchers and clinicians working with athletes in pain how pain assessment and classification is currently conducted and highlights future priorities.
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Affiliation(s)
- Ciarán Purcell
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland .,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Ciara Duignan
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Brona M Fullen
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland
| | - Shiofra Ryan
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
| | - Tomas Ward
- Insight Centre for Data Analytics, School of Computing, Dublin City University, Dublin, Ireland
| | - Brian Caulfield
- School of Public Health, Physiotherapy & Sport Science, University College Dublin, Dublin, Ireland.,Insight SFI Research Centre for Data Analytics, University College Dublin, Dublin, Ireland
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50
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Orthobiologic Interventions for Muscle Injuries. Phys Med Rehabil Clin N Am 2023; 34:181-198. [DOI: 10.1016/j.pmr.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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