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Burgos J, Hevia E, Sanpera I, García V, de Santos Moreno MT, Mariscal G, Barrios C. Incidence and risk factors of distal adjacent disc degeneration in adolescent idiopathic scoliosis patients undergoing fusion surgery: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2024; 33:1624-1636. [PMID: 38372794 DOI: 10.1007/s00586-024-08165-1] [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: 11/13/2023] [Revised: 12/31/2023] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
PURPOSE The objective of this meta-analysis was to determine the incidence of disc degeneration in patients with surgically treated adolescent idiopathic scoliosis (AIS) and identify the associated risk factors. METHODS PubMed, EMBASE, Scopus, and Cochrane Collaboration Library databases were searched. The outcomes of interest were the incidence of disc degeneration, SRS-22, and radiological risk factors. The lower instrumented vertebra (LIV) was also evaluated. Fixed effects were used if there was no evidence of heterogeneity. Statistical analysis was performed using Review Manager. RESULTS A meta-analysis was conducted including nine studies with a total of 565 patients. The analysis revealed that the global incidence of intervertebral disc degeneration in patients with surgically treated AIS patients was 24.78% (95% CI 16.59-32.98%) 10 years after surgery, which significantly increased to 32.32% (95% CI 21.16-43.47% at an average of 13.8 years after surgery. Among patients with significant degenerative disc changes, the SRS-22 functional, self-image, and satisfaction domains showed significantly worse results (MD - 0.25, 95% CI - 0.44 to - 0.05; MD - 0.50, 95% CI - 0.75 to - 0.25; and MD - 0.34, 95% CI - 0.66 to - 0.03, respectively). Furthermore, instrumentation at or above the L3 level was associated with a lower incidence of intervertebral disc degeneration compared to instrumentation below the L3 level (OR 0.25, 95% CI 0.10-0.64). It was also found that the preoperative and final follow-up lumbar curve magnitudes (MD 8.11, 95% CI 3.82-12.41) as well as preoperative and final follow-up lumbar lordosis (MD 0.42, 95% CI - 3.81 to 4.65) were associated with adjacent disc degeneration. CONCLUSIONS This meta-analysis demonstrated that the incidence of intervertebral disc degeneration significantly increased with long-term follow-up using fusion techniques, reaching up to 32% when patients were 28 years of age. Incomplete correction of deformity and fusion of levels below L3, were identified as negative prognostic factors. Furthermore, patients with disc degeneration showed worse functional outcomes.
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Affiliation(s)
| | - Eduardo Hevia
- Spine Unit, University of Navarra Clinic, Madrid, Spain
| | | | - Vicente García
- Spine Surgery Section, Araba University Hospital, Vitoria, Spain
| | | | - Gonzalo Mariscal
- Mediterranean Observatory for Clinical and Health Research (OMEDICS), Valencia, Spain.
- Institute for Research On Musculoskeletal Disorders, Valencia Catholic University, Carrer de Quevedo, 2, 46001, València, Valencia, Spain.
| | - Carlos Barrios
- Institute for Research On Musculoskeletal Disorders, Valencia Catholic University, Carrer de Quevedo, 2, 46001, València, Valencia, Spain
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Bonell Monsonís O, Spörri J, Warsen M, Bolling C, Gouttebarge V, Verhagen E. We know a lot about little and little about a lot: A contextualized scoping review on injury prevention in alpine ski racing. Scand J Med Sci Sports 2024; 34:e14533. [PMID: 37955281 DOI: 10.1111/sms.14533] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 09/19/2023] [Accepted: 10/25/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Our goal was to summarize and contextualize the available literature on alpine ski racing injury epidemiology, injury etiology, injury prevention measures, injury prevention context, and implementation issues. MATERIALS AND METHODS We searched four electronic databases using predetermined search terms. We included original studies that assessed injury, injury risk factors, and injury mechanisms, and assessed and reported the effect of an injury prevention measure in alpine ski racing. Two authors independently conducted title-abstract screening, and one performed the full-text review. For data synthesis and categorization, we used the Translating Research into the Injury Prevention Practice framework and a modified and adapted version of the Haddon matrix. RESULTS Of the 157 included studies, most corresponded to injury epidemiology and etiology, whereas few studies encompassed injury prevention measure development, implementation and evaluation. Preventive interventions targeting equipment, rules and regulations, course design and snow preparation were the most prevalent in the literature. Furthermore, various contextual factors in the current literature have been found, including gender, competition level, countries and federations, and time periods within a season. CONCLUSIONS We provided an in-depth and comprehensive overview of the current state-of-the-art in the alpine ski racing context. We know a lot about little and little about a lot across all the areas associated with injury prevention in such context. The limitations in the literature yield a road map for designing future injury prevention studies to address the key gaps identified. A more comprehensive context-driven approach throughout all stages of injury prevention would benefit the ultimate implementation of effective preventive strategies.
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Affiliation(s)
- Oriol Bonell Monsonís
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Marit Warsen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Caroline Bolling
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
| | - Vincent Gouttebarge
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
- Amsterdam UMC Location University of Amsterdam, Orthopedic Surgery and Sports Medicine, Amsterdam, The Netherlands
- Section Sports Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Evert Verhagen
- Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Movement Sciences, Amsterdam UMC, University Medical Centers - Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health and Sports, Amsterdam, The Netherlands
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Wegner M, Backhauß JC, Michalsky Y, Seesko H, Hensler J, Klueter T, Jansen O, Seekamp A, Lippross S. Prevalence of degenerative vertebral disc changes in elite female Crossfit athletes - a cross-sectional study. BMC Musculoskelet Disord 2023; 24:963. [PMID: 38082262 PMCID: PMC10712126 DOI: 10.1186/s12891-023-07071-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Accepted: 11/27/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Crossfit athletes consistently recruit or transfer high levels of repetitive forces through the spine, and MRI has documented a higher rate of intervertebral disc degeneration in athletes compared with matched controls. The aim of this study was to evaluate early degenerative spinal disc changes in elite female CrossFit athletes quantified by 3.0 Tesla magnetic resonance imaging (MRI) matched with female none-athletes. METHODS In a cross-sectional single-center study 19 asymptomatic adult participants, nine German female elite Crossfit athletes and ten female participants underwent spinal MRI (3.0T). Demographic data, spinal clinical examination results and sport-specific performance parameters were collected prior to the MRI. The primary outcome was the prevalence of degenerative spinal disc changes. The secondary outcome was the grade of degeneration using Pfirrmann grading. RESULTS A total of 437 discs underwent spinal MRI (3.0T). The prevalence of early degenerative disc disease was not increased. Pfirrmann degenerative grade did not show significant differences among groups. CONCLUSION Asymptomatic female elite Crossfit athletes do not show an increased prevalence of degenerative disc disease. Compared to a sex-matched control group, high training volume in Crossfit does not correlate to a higher incidence of degenerative disc changes in young females.
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Affiliation(s)
- Mathis Wegner
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany.
| | - Jan-Christoph Backhauß
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Yannik Michalsky
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Henrik Seesko
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Johannes Hensler
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Tim Klueter
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Olav Jansen
- Department of Radiology and Neuroradiology, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Andreas Seekamp
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
| | - Sebastian Lippross
- Department of Orthopedics and Trauma Surgery, University Hospital Schleswig-Holstein, Arnold-Heller-Strasse 3, Kiel, 24105, Germany
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Rosenqvist L, Hebelka H, Baranto A, Brisby H, Lagerstrand K. Detailed MRI evaluation of the spine: a 2-year follow-up study of young individuals reporting different training doses. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:4145-4152. [PMID: 37815636 DOI: 10.1007/s00586-023-07961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/21/2023] [Accepted: 09/16/2023] [Indexed: 10/11/2023]
Abstract
OBJECTIVE To characterize the discs and vertebrae in detail over time in a group of adolescent individuals with varying training doses using magnetic resonance imaging (MRI). METHOD Thirty-five students were recruited from regular high schools (n=13) as well as schools with athlete competitive skiing programmes (n = 22). The thoraco-lumbar spine of all individuals was examined at baseline and at 2-year follow-up using the same 1.5T scanner and imaging protocol. The individuals were grouped based on their reported training dose: low-to-normal training dose (≤5 h/week, n = 11, mean age 16.5 ± 0.5 years) and high training dose (>5 h/week, n = 24, mean age 17.2 ± 0.6 years.) RESULTS: At baseline, the signal intensity in the discs and vertebrae were significantly lower in individuals reporting high compared to low-to-normal training dose. The vertebral signal changed significantly over the 2-year period in both groups. However, only individuals reporting low-to-normal training dose displayed an overall disc signal change. Interestingly, the regional analysis displayed at baseline high annular signals in the more training-active individuals followed by a reduction over the two-year period. CONCLUSION This study suggests that disc degeneration is manifested earlier in individuals reporting a higher training dose. Over a 2-year period, however, the degeneration process did not accelerate further. Also, a significant difference in the vertebral signal, at baseline and follow-up as well as over time, could be seen between groups of individuals reporting high versus low-to-normal training dose.
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Affiliation(s)
- Louise Rosenqvist
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Hanna Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Adad Baranto
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helena Brisby
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kerstin Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
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5
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Azevedo VD, Ferreira Silva RM, de Carvalho Borges SC, Fernades MDSV, Miñana-Signes V, Monfort-Pañego M, Silva Noll PRE, Noll M. Instruments for assessing back pain in athletes: A systematic review. PLoS One 2023; 18:e0293333. [PMID: 37922315 PMCID: PMC10624266 DOI: 10.1371/journal.pone.0293333] [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: 03/24/2023] [Accepted: 10/10/2023] [Indexed: 11/05/2023] Open
Abstract
Back pain in athletes varies with sport, age, and sex, which can impair athletic performance, thereby contributing to retirement. Studies on back pain in this population use questionnaires to assess components, such as pain intensity and location and factors associated with pain, among others. This study aimed to review validated questionnaires that have assessed back pain in athletes. This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) by searching the databases Embase, MEDLINE, SPORTDiscus, CINAHL, and Scopus. The articles were selected regardless of language and date of publication. Titles and abstracts were independently selected by two reviewers; disagreements were resolved by a third reviewer. All the steps were conducted using the software Rayyan. The methodological quality of the questionnaire validation articles was assessed using a critical appraisal tool checklist proposed by Brink and Louw. The search returned 4748 articles, of which 60 were selected for this review, including 5 questionnaire validation studies. These articles were published between 2004 and 2022, which were performed in more than 20 countries, particularly Germany (14) and Sweden (5). Thirteen different instruments were identified, of which 46.1% were developed in Europe. The most commonly used questionnaires were the Oswestry Disability Index and Nordic Standardized Questionnaire. In addition, five questionnaire validation studies were selected for methodological quality assessment, with only two studies demonstrating high methodological quality. The following three instruments were identified for assessing back pain specifically in athletes: Micheli Functional Scale, Persian Functional Rating Index, and Athlete Disability Index. This review confirmed that all three instruments were specifically designed to assess this condition.
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Affiliation(s)
| | | | | | | | | | | | | | - Matias Noll
- Federal University of Goiás, Goiânia, Brazil
- Goiano Federal Institute, Itumbiara, Brazil
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Nakagawa Y, Mukai S, Miyata M, Minami K, Hattori Y, Yamagishi H. Radiological Findings of the Lumbar Spine in High School and Collegiate Sumo Wrestlers. Orthop J Sports Med 2023; 11:23259671231206712. [PMID: 37941889 PMCID: PMC10629334 DOI: 10.1177/23259671231206712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 05/19/2023] [Indexed: 11/10/2023] Open
Abstract
Background Sumo wrestling is a traditional sport in Japan and becoming popular worldwide. Risk factors for lower back injuries in sumo wrestlers are heavier weight and larger body mass index (BMI). The mawashi (loincloth belt) worn by sumo wrestlers has been shown to restrict motion of the lumbar spine. Purpose To study the effects of sumo wrestling on the lumbar spine of high school and freshmen collegiate wrestlers, investigating the relationship between radiological findings, wearing of the mawashi during training, and lower back symptoms. Study Design Case series; Level of evidence, 4. Methods From 2001 to 2017, a total of 197 members of the Japanese Sumo Federation (55 high school and 142 college freshman students) underwent routine radiographic examination of their lumbar spines and answered a questionnaire regarding lumbar symptoms. Wrestlers were classified as symptomatic and asymptomatic based on responses to a custom questionnaire. We used the unpaired t test to evaluate patient demographics and the chi square test to analyze radiographic lumbar spine abnormalities between symptomatic and asymptomatic wrestlers. Results The wrestlers' mean height, weight, BMI, and duration in the sport were 174.0 ± 6.7 cm, 107.1 ± 22.4 kg, 35.2 ± 6.4, and 8.0 ± 3.2 years, respectively. There were 91 participants in the symptomatic group (46.2%) and 106 (53.8%) in the asymptomatic group. Ten wrestlers (5.1%) had osteophyte formations in the lumbar body; 8 of the 11 osteophytes (72.7%) appeared in the upper lumbar spine. Of the total, 48 wrestlers (24.4%) had deformities (Schmorl nodules) in the lumbar body, and 23 of 50 (46.0%) and 10 of 16 (62.5%) deformities were found in the upper lumbar spine of collegiate and high school wrestlers, respectively. Five wrestlers of the total 197 athletes (2.5%) had disc space narrowing in the lumbar body, with 3 of the 5 cases of disc space narrowing (60.0%) found in the upper lumbar spine. Spondylolysis in the lumbar body was found in 25 wrestlers (12.7%); 19 of the 91 symptomatic wrestlers (20.9%) had spondylolysis, compared with 6 of the 106 (5.7%) asymptomatic wrestlers (P = .0028). Conclusion Almost one-third of sumo wrestlers had ≥1 abnormal radiological finding in the lumbar spine. There was a significant relationship between symptomatic wrestlers and spondylolysis.
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Affiliation(s)
- Yasuaki Nakagawa
- Clinical Research Center, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
- Department of Orthopaedic Surgery, Japan Baptist Medical Foundation, Kyoto, Japan
| | - Shogo Mukai
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Masahiko Miyata
- Department of Orthopaedic Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Kazufumi Minami
- Department of Orthopedic Surgery, International University of Health and Welfare, Tokyo, Japan
| | | | - Hiroya Yamagishi
- Department of Chest Surgery, Japanese Red Cross Fukui Hospital Fukui, Japan
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Wan ZY, Zhang J, Shan H, Liu TF, Song F, Samartzis D, Wang HQ. Epidemiology of Lumbar Degenerative Phenotypes of Children and Adolescents: A Large-Scale Imaging Study. Global Spine J 2023; 13:599-608. [PMID: 33843321 DOI: 10.1177/21925682211000707] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE Recently, there has been a rise in children and adolescents developing low back pain and/or sciatica. Degenerative lumbar spine MRI phenotypes can occur in this population but reports have been sporadic and the true incidence of such spine changes remains debatable. As such, the study aimed to address the epidemiology of MRI phenotypes of the lumbar spine in this young population. METHODS 597 children and adolescents with lumbar MRIs were included in the study. T1- and T2-weighted lumbar images from L1/2 to L5/S1 were analyzed in axial and sagittal planes. Global phenotype assessment was performed of each level and based on established nomenclature protocols. RESULTS The cohort consisted of 57.3% (342) boys and 42.7% (255) girls, with a mean age of 10.75 ± 5.25 years (range: 0 to 18 years). The prevalence of imaging findings of lumbar disc degeneration (LDD) and lumbar disc herniation (LDH) were 2.2% (95% CI: 0.93-3.43) and 5.8% (95%CI: 2.58-8.99), respectively. There was significant difference between each disc segment from L1/2 to L5/S1 for both LDD and LDH. Schmorl's nodes were noted in 16 cases (2.7%, youngest case as 15 years), with 11 boys (68.8%) and most frequent segment as L3/4. Modic changes and high-intensity zones were absent in this cohort. CONCLUSIONS LDD can emerge as early as the first decade of life with Schmorl's nodes, without additional specific phenotypes, including Modic changes and high-intensity zones. The study provides valuable information of a unique age group that is often under-represented but equally important as adults.
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Affiliation(s)
- Zhong-Yuan Wan
- Department of Orthopedics, The Seventh Medical Center of Chinese PLA General Hospital, Beijing, People's Republic of China
| | - Jun Zhang
- Department of Orthopedics, Baoji Central Hospital, Baoji, Shaanxi Province, People's Republic of China
| | - Hua Shan
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Tang-Fen Liu
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
| | - Fang Song
- Department of Stomatology, PLA Rocket Force Characteristic Medical Center, Beijing, People's Republic of China
| | - Dino Samartzis
- Department of Orthopaedic Surgery, 2468Rush University Medical Center, Chicago, IL, USA
| | - Hai-Qiang Wang
- Institute of Integrative Medicine, 107652Shaanxi University of Chinese Medicine, Xi'an, Shaanxi Province, People's Republic of China
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Identeg F, Lagerstrand K, Hedelin H, Senorski EH, Sansone M, Hebelka H. Low occurrence of MRI spinal changes in elite climbing athletes; a cross-sectional study. BMC Sports Sci Med Rehabil 2023; 15:29. [PMID: 36895033 PMCID: PMC9999554 DOI: 10.1186/s13102-023-00637-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/24/2023] [Indexed: 03/11/2023]
Abstract
OBJECTIVES To examine the occurrence of magnetic resonance imaging (MRI) changes in the thoracolumbar spine among elite climbing athletes. METHODS All climbers of the Swedish national sport climbing team (n = 8), and individuals having trained for selection to the national team (n = 11), were prospectively included. A control group, matched in age and sex, were recruited. All participants underwent a thoracolumbar MRI (1.5 T, T1- and T2-weighted imaging), evaluated according to Pfirrmann classification, modified Endplate defect score, Modic changes, apophyseal injuries and spondylolisthesis. Pfirrmann ≥ 3, Endplate defect score ≥ 2 and Modic ≥ 1 was defined as degenerative findings. RESULTS Fifteen individuals, 8 women, participated in both the climbing group (mean age 23.1, SD 3.2 years) and the control group respectively (mean age 24.3, SD 1.5 years). In the climbing group, 6.1% of the thoracic and 10.6% of the lumbar intervertebral discs showed signs of degeneration according to Pfirrmann. One disc with a grade above 3 was present. Modic changes in the thoracic/lumbar spine were prevalent in 1.7%/1.3% of the vertebrae. Degenerative endplate changes according to the Endplate defect score were found in 8.9% and 6.6% of the thoracic and lumbar spinal segments of the climbing group, respectively. Two apophyseal injuries were found, while no participants displayed signs of spondylolisthesis. There was no difference in point-prevalence of radiographic spinal changes between climbers and controls (0.07 < p < 1.0). CONCLUSION In this small cross-sectional study, only a low proportion of elite climbers displayed changes of the spinal endplates or intervertebral discs, as opposed to other sports with high spinal loads. Most observed abnormalities were low grade degenerative changes and did not differ statistically compared to controls.
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Affiliation(s)
- Fredrik Identeg
- Department of Orthopaedics, Gothenburg, Sweden. .,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Kerstin Lagerstrand
- Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Hedelin
- Department of Orthopaedics, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eric Hamrin Senorski
- Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Sansone
- Department of Orthopaedics, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Hebelka
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Morimoto M, Okada R, Sugiura K, Manabe H, Inokuchi T, Tezuka F, Yamashita K, Takao S, Fujitani J, Sairyo K. Low Back Pain and Lumbar Degeneration in Japanese Professional Baseball Players. Orthop J Sports Med 2022; 10:23259671221125513. [PMID: 36250034 PMCID: PMC9561668 DOI: 10.1177/23259671221125513] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 07/25/2022] [Indexed: 11/06/2022] Open
Abstract
Background: Baseball is one of the most popular sports in Asia. It is known that baseball
can easily lead to back pain. However, there has been no survey of low back
pain (LBP) and lumbar disc degeneration in Japanese professional baseball
players to date. Purpose: To investigate the cause of LBP and lumbar degeneration in professional
Japanese baseball players. Study Design: Cross-sectional study; Level of evidence, 3. Methods: We retrospectively reviewed the medical records of Japanese professional
baseball players with LBP who visited our hospital. Data were collected from
July 2018 to April 2021. We also investigated whether the results differed
between players in their 20s and 30s or between pitchers and fielders. Data
analysis was performed using the chi-square test. Results: We surveyed 32 professional baseball players. The most frequent causes of LBP
among players in their 20s (n = 21) were lumbar disc herniation (LDH; 57%)
and spondylolysis (24%). Of the players with spondylolysis, 50% had
adult-onset spondylolysis. Players in their 30s (n = 11) most commonly had
discogenic pain (55%) as well as LDH and facet joint arthritis (each 18%).
The incidence of lumbar intervertebral disc degeneration was significantly
higher in players in their 30s (91%) than those in their 20s (14%), as was
the incidence of Schmorl nodes and Modic type 1 changes. There was no
significant difference in the cause of LBP or the incidence of lumbar
intervertebral disc degeneration between pitchers and fielders
(P = .59). Conclusion: Among professional baseball players in their 20s, lumbar degeneration was
less common, and they most frequently developed diseases less related to
degeneration, such as LDH. However, among players in their 30s, lumbar
degeneration was more advanced, and degenerative diseases such as discogenic
pain occurred more frequently. Research on training methods could lead to
the prevention of LBP. Our data may be applicable to other professional
athletes and will contribute to diagnosis and treatment.
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Affiliation(s)
- Masatoshi Morimoto
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan.,Masatoshi Morimoto, MD, PhD, Department of Orthopedics,
Tokushima University, 3-18-15 Kuramoto, Tokushima 770-8503, Japan (
)
| | - Ryo Okada
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Kosuke Sugiura
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Hiroaki Manabe
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Takashi Inokuchi
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Fumitake Tezuka
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Kazuta Yamashita
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Syoichiro Takao
- Department of Diagnostic Radiology, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Junzo Fujitani
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
| | - Koichi Sairyo
- Department of Diagnostic Orthopedics, Graduate School, Institute of
Health Science, Tokushima University, Tokushima, Japan
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10
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Witwit WA, Hebelka H, Swärd Aminoff A, Abrahamson J, Todd C, Baranto A. No Significant Change in MRI Abnormalities or Back Pain Prevalence in the Thoraco-Lumbar Spine of Young Elite Skiers Over a 2-Year Follow-Up. Open Access J Sports Med 2022; 13:69-76. [PMID: 36003328 PMCID: PMC9394653 DOI: 10.2147/oajsm.s366548] [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: 03/29/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Background Young athletes are at increasing risk for spinal column injuries due to overloading the spine with excessive sports activities, with potential development of complications later in life. Purpose The purpose of this 2-year follow-up study of young elite skiers and non-athletes was to investigate any potential change in the thoraco-lumbar findings on MRI and to outline any change in back pain prevalence with continuing sporting activity and age. Study Design Longitudinal cross-sectional study. Methods MRI of the thoraco-lumbar spine was performed on 30 skiers (mean age 20 years, female 43%) and 16 non-athletes (mean age 19, female 75%), available for the 2-year follow-up. The intervertebral discs were evaluated for signal, height, bulge/herniation, and additionally according to Pfirrmann classification, and the endplates were graded according to endplate defect score. Any of the following disc findings was defined as disc degenerative change: reduced signal, reduced height, bulge, or herniation. All participants answered a specific back pain questionnaire. Results No significant difference in spinal column abnormalities, nor back pain, was found between baseline and 2-year follow-up in neither skiers nor controls. There was significantly higher prevalence of disc degenerative changes in skiers (73%) than in non-athletes (44%, p=0.05). Skiers (63%) had significantly more Pfirrmann grade ≥3 discs compared to non-athletes (25%) (p=0.03). There was no significant difference in number of endplates with score ≥4 between skiers and non-athletes (50% vs 38%, p=0.40) nor in lifetime prevalence of back pain between skiers (46%) and non-athletes (40%). Conclusion There was no significant change over time of the spinal column MRI abnormalities, nor back pain prevalence, during a 2-year follow-up of skiers and non-athletes. Young skiers had significantly higher prevalence of spine abnormalities compared with non-athletes. There was no significant difference of the back pain lifetime prevalence in skiers compared with non-athletes.
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Affiliation(s)
- Wisam A Witwit
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Neuroradiology, Yale University, New Haven, CT, USA
| | - Hanna Hebelka
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Swärd Aminoff
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Josefin Abrahamson
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Carl Todd
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Adad Baranto
- Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden
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11
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Benedikter C, Abrar DB, Konieczny M, Schleich C, Bittersohl B. Patterns of Intervertebral Disk Alteration in Asymptomatic Elite Rowers: A T2* MRI Mapping Study. Orthop J Sports Med 2022; 10:23259671221088572. [PMID: 35464905 PMCID: PMC9019338 DOI: 10.1177/23259671221088572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 01/10/2022] [Indexed: 11/17/2022] Open
Abstract
Background: Repetitive loading of the back puts elite rowers at risk for acute and chronic back injuries. Hypothesis: That asymptomatic elite rowers would demonstrate characteristic intervertebral disk (IVD) alterations on T2* magnetic resonance imaging (MRI) mapping compared with asymptomatic nonrowers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: This study included 20 asymptomatic elite rowers (mean age, 23.4 ± 3.03 years; 9 women, 11 men) studied at 2 different times, once before (t1) and once after (t2) the competition phase. MRI including T2* mapping was performed on a 3-T scanner. The authors derived normative T2* data from a previous study on 40 asymptomatic volunteers (20 men, 20 women) who were not competitive rowers; based on complete T2* data sets, 37 controls were included. T2* values were compared between groups in 4 lumbar IVDs, and midsagittal T2* values were compared in 5 zones: anterior annulus fibrosus (AF), anterior nucleus pulposus (NP), central NP, posterior NP, and posterior AF. The Pfirrmann grade was used for morphological assessment of disk degeneration. Statistical analysis was conducted using the Mann-Whitney U test, Wilcoxon matched-pairs test, and Spearman rank correlation coefficient. Results: Lower T2* values were noted in the rower group compared with the controls (37.08 ± 33.63 vs 45.59 ± 35.73 ms, respectively; P < .001). The intersegmental comparison revealed lower mean T2* values among rowers (P ≤ .027 for all). The interzonal comparison indicated significantly lower mean T2* values for the rowers in all zones except for the anterior NP (P ≤ .008 for all). Lower mean T2* values were observed for the rowers at t1 versus t2 (39.25 ± 36.19 vs 43.97 ± 38.67 ms, respectively; P = .008). The authors noted a higher level of IVD damage according to Pfirrmann assessment in the rower cohort (P < .001); the Pfirrmann grade distributions of rowers versus controls, respectively, were as follows: 51.3% versus 73.7% (grade 1), 20.5% versus 19.5% (grade 2), 21.8% versus 6.8% (grade 3), 5.1% versus 0% (grade 4), and 1.3% versus 0% (grade 5). The authors also noted a correlation between low T2* and high Pfirrmann grade at t1 (r =–0.48; P < .001) and t2 (r =–0.71; P < .001). Conclusion: The cohort of elite rowers revealed more degenerative IVD changes compared with controls. The T2* values suggest that repetitive loading of the spine has demonstrable short-term and possibly permanent effects on the lumbar IVD.
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Affiliation(s)
- Chiara Benedikter
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Daniel Benjamin Abrar
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Markus Konieczny
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Christoph Schleich
- Department of Diagnostic and Interventional Radiology, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
| | - Bernd Bittersohl
- Department of Orthopedics and Trauma Surgery, University of Düsseldorf, Medical Faculty, Düsseldorf, Germany
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12
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Yu HJ, Wadi L, Say I, Paganini-Hill A, Chow D, Jafari AH, Farhan SD, Del Sol SR, Mobayed O, Alvarez A, Hasso A, Li SS, Do H, Berkeley D, Lee YP, Su LMY, Rosen C, Fisher M. Magnetic Resonance Imaging Findings in High School Football Players: Brain and Cervical Spine. Neurotrauma Rep 2022; 3:129-138. [PMID: 35403100 PMCID: PMC8985528 DOI: 10.1089/neur.2021.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Football exposes its players to traumatic brain, neck, and spinal injury. It is unknown whether the adolescent football player develops imaging abnormalities of the brain and spine that are detectable on magnetic resonance imaging (MRI). The objective of this observational study was to identify potential MRI signatures of early brain and cervical spine (c-spine) injury in high school football players. Eighteen football players (mean age, 17.0 ± 1.5 years; mean career length, 6.3 ± 4.0 years) had a baseline brain MRI, and 7 had a follow-up scan 9–42 months later. C-spine MRIs were performed on 11 of the 18 subjects, and 5 had a follow-up scan. C-spine MRIs from 12 age-matched hospital controls were also retrospectively retrieved. Brain MRIs were reviewed by a neuroradiologist, and no cerebral microbleeds were detected. Three readers (a neuroradiologist, a neurosurgeon, and an orthopedic spine surgeon) studied the cervical intervertebral discs at six different cervical levels and graded degeneration using an established five-grade scoring system. We observed no statistically significant difference in disc degeneration or any trend toward increased disc degeneration in the c-spine of football players as compared with age-matched controls. Further research is needed to validate our findings and better understand the true impact of contact sports on young athletes.
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Affiliation(s)
- Hon J. Yu
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Lara Wadi
- Department of Neurology, University of California Irvine, Irvine, California, USA
| | - Irene Say
- Department of Orthopedic Surgery, University of California Irvine, Irvine, California, USA
| | - Annlia Paganini-Hill
- Department of Neurology, University of California Irvine, Irvine, California, USA
| | - Daniel Chow
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | | | - Saifal-Deen Farhan
- Department of Orthopedic Surgery, University of California Irvine, Irvine, California, USA
| | - Shane Rayos Del Sol
- Department of Neurology, University of California Irvine, Irvine, California, USA
| | - Osama Mobayed
- Department of Neurology, University of California Irvine, Irvine, California, USA
| | - Andrew Alvarez
- Department of Orthopedic Surgery, University of California Irvine, Irvine, California, USA
| | - Anton Hasso
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Scott Shunshan Li
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Hung Do
- Canon Medical Systems USA, Tustin, California, USA
| | | | - Yu-Po Lee
- Department of Orthopedic Surgery, University of California Irvine, Irvine, California, USA
| | - Lydia Min-Ying Su
- Department of Radiological Sciences, University of California Irvine, Irvine, California, USA
| | - Charles Rosen
- Department of Orthopedic Surgery, University of California Irvine, Irvine, California, USA
| | - Mark Fisher
- Department of Neurology, University of California Irvine, Irvine, California, USA
- Department of Pathology & Laboratory Medicine, University of California Irvine, Irvine, California, USA
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13
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Strutzenberger G, Ellenberger L, Bruhin B, Frey WO, Scherr J, Spörri J. Deadbug Bridging Performance in 6- to 15-Year-Old Competitive Alpine Skiers—A Cross-Sectional Study. BIOLOGY 2022; 11:biology11020329. [PMID: 35205195 PMCID: PMC8869284 DOI: 10.3390/biology11020329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 02/15/2022] [Accepted: 02/17/2022] [Indexed: 11/16/2022]
Abstract
Simple Summary In competitive alpine skiing, a stable trunk plays an important role in increasing performance and preventing injuries. The aim of the present study was to investigate the ability to stabilize the trunk during so-called deadbug bridging (DBB) exercises, a stabilizing, dynamic movement task in the supine position with the pelvis lifted and unilateral leg raising, in 6- to 15-year-old skiers. Trunk stabilization performance was better in female skiers of the under 15-year (U15) category than in their male counterparts, whereas there was no sex difference at ages under 10 years (U10). The only potential confounder when testing youth skiers revealed being body height, but only in female U10 skiers. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners. Abstract In competitive alpine skiing, a superior antirotation and rear-chain stabilization capacity is essential to constantly remain in dynamic equilibrium while skiing and to counteract the ski-specific adverse loading patterns of the back. As such, skiers’ trunk stabilization performance during deadbug bridging (DBB) exercises has been shown to be associated with both skiing performance and overuse complaints of the lower back in skiers under 16 years of age (U16). However, to date, little is known about the corresponding stabilization abilities in younger skiers, i.e., 6- to 15-year-old skiers. As part of a biomechanical field experiment during a national off-snow fitness competition, a total of 101 youth competitive alpine skiers were tested with respect to their trunk stabilization performance during DDB exercise. The maximum contralateral displacement of the pelvic drop during leg lift (DBBdisplacement) was quantified using reflective markers and a motion capture system (Vicon, Oxford, UK). Potential age group and sex differences in DBBdisplacement were assessed using analysis of variance (ANOVA) at p < 0.05. Within each subgroup, the associations of DBBdisplacement with age, anthropometrics and maturity offset were analysed using Pearson’s correlation (p < 0.05). Female skiers under 15 years of age (U15) showed better DBB performance than male U15 skiers, while there was no sex difference at the under 10-year (U10) level. In female U10 skiers, DBBdisplacement was moderately associated with body height, while in all other subgroups, no confounding associations with anthropometrics or biological maturation were found. Biomechanically quantifying DBB performance may be considered a feasible and nonconfounded screening test approach in young skiers older than 6 years. Body height may represent a confounding bias in exclusively the U10 female skier cohort and, therefore, should be considered when interpreting the test results. In summary, this study provided sport-specific normative reference data that may be of equal interest to both researchers and sport practitioners.
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Affiliation(s)
- Gerda Strutzenberger
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Lynn Ellenberger
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | | | - Walter O. Frey
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Johannes Scherr
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland; (G.S.); (L.E.); (W.O.F.); (J.S.)
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Motion Analysis Zurich, Department of Orthopedics, Balgrist University Hospital, Children’s Hospital, University of Zurich, 8008 Zurich, Switzerland
- Correspondence: ; Tel.: +41-44-510-70-09
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14
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Flores DV, Murray TÉ, Bohyn C, Mohr B, Cresswell M. Imaging Review of Alpine Ski Injuries. Semin Musculoskelet Radiol 2022; 26:41-53. [PMID: 35139558 DOI: 10.1055/s-0041-1731794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Skiing is a continuously evolving winter sport, responsible for a considerable number of musculoskeletal injuries. Specific injury patterns and mechanisms in the upper and lower extremities, head, and spine are influenced by skier expertise and skill, position during injury, and environmental conditions. Predilection for certain joints and injury patterns have changed over time, largely due to technological advancements in equipment, increased awareness campaigns, and preventive protocols. Knowledge and understanding of these trends and developments can aid the radiologist to reach a timely and accurate diagnosis, thereby guiding clinical management and potentially reducing the overall incidence of debilitation and death.
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Affiliation(s)
- Dyan V Flores
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Timothy É Murray
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cedric Bohyn
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Radiology, AZ Monica, Antwerpen, Belgium
| | - Bruce Mohr
- Whistler Health Care Center, Whistler, British Columbia, Canada
| | - Mark Cresswell
- Department of Radiology, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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15
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Enoki S, Kuramochi R, Nakajyuku S, Mitsuyama H. The prevalence of spondylolysis and intervertebral disc degeneration in male pole vaulters. J Back Musculoskelet Rehabil 2022; 35:147-151. [PMID: 34092599 DOI: 10.3233/bmr-200296] [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] [Indexed: 02/04/2023]
Abstract
BACKGROUND The lower back is the most common injury location in pole vaulters, but the prevalence of lumbar spondylolysis and intervertebral disc degeneration is not known. OBJECTIVE This study aimed to determine the prevalence of lumbar spondylolysis and intervertebral disc degeneration in pole vaulters. METHODS This cross-sectional study was conducted in the Tokai area of Japan and included 21 pole vaulters (mean ± standard deviation [range]: age, 22.2 ± 3.2 [18-28] years; height, 172.2 ± 4.7 [165.0-182.0] cm; body weight, 67.6 ± 7.3 [54.0- 80.0] kg). The majority of pole vaulters were collegiate athletes. We performed anterior, lateral, and oblique radiography at 45∘ and magnetic resonance imaging in the sagittal and coronal planes of the lumbar spine. The evaluation was performed independently of whether the athletes had lower back pain (LBP). Moreover, we investigated the duration of pole-vaulting experience and history and current presence of LBP using a questionnaire. RESULTS The prevalence of lumbar spondylolysis and intervertebral disc degeneration was 28.6% (6/21) and 38.1% (8/21), respectively. Herniation was found in six discs in four vaulters (19.0%). All athletes had a history of LBP. The prevalence of lumbar spondylolysis was high (28.6%). CONCLUSIONS Sport-specific movements performed by pole vaulters may be a risk factor for lumbar spondylolysis.
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Affiliation(s)
- Shota Enoki
- Graduate School of Health and Sport Sciences, Chukyo University, Aichi, Japan
| | - Rieko Kuramochi
- Graduate School of Health and Sport Sciences, Chukyo University, Aichi, Japan.,School of Health and Sport Sciences, Chukyo University, Aichi, Japan
| | - Shinya Nakajyuku
- Department of Orthopedic Surgery, Yoshida Orthopedic Hospital, Toyota, Aichi, Japan
| | - Hirohito Mitsuyama
- Graduate School of Health and Sport Sciences, Chukyo University, Aichi, Japan.,School of Health and Sport Sciences, Chukyo University, Aichi, Japan.,Department of Orthopedic Surgery, Yoshida Orthopedic Hospital, Toyota, Aichi, Japan
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16
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Effect of Skiing on Physical Performance, Pain, and Quality of Life Based on Gender. J Sport Rehabil 2022; 31:885-893. [DOI: 10.1123/jsr.2021-0334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/06/2022] [Accepted: 03/14/2022] [Indexed: 11/18/2022]
Abstract
Context: Identifying gender-specific differentiation in each sport type is significant. In this way, sport- and gender-specific gains can be predicted. Therefore, this study aimed to examine the effects of skiing on physical performance, pain, quality of life, and gender-based differentiation. Design: Crossover trial. Methods: Sixty-eight volunteers, between 18 and 25 years of age, with no history of severe trauma in the spine and extremities, participated in our study. The skiers group consisted of licensed athletes (17 males and 17 females) who did active skiing for at least the past 2 years, the control group consisted of nonathletic and age-matched participants with no skiing experience (17 males and 17 females). Step test, vertical jump test, Flamingo balance test, hand-grip strength, and back-leg-chest strength measurements were performed to evaluate physical performance. Visual Analog Scale, McGill Pain Questionnaire, and Oswestry Low Back Pain Disability Questionnaire were used to evaluate pain experience. Quality of life was evaluated with Short Form-36 (SF-36). Results: Compared to the sedentary controls, VAS-activity and Oswestry Disability Index scores were lower; and aerobic performance, balance, hand-grip strength, back-leg-chest strength, and quality of life (SF-36-general health, SF-36-vitality, SF-36-mental health, and SF-total score) were higher in skiers. Skiing was found to be effective in eliminating gender-based differentiation of the variables of hand-grip strength, pain, and quality of life; however, back-leg-chest strength and anaerobic performance variables were found to be ineffective in eliminating gender differentiation. Conclusions: Skiing allows that the individual increases physical performance and quality of life. It can also minimize gender-based differentiation of certain variables, such as muscular force, pain, and quality of life.
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17
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Imaging of exercise-induced spinal remodeling in elite rowers. J Sci Med Sport 2021; 25:75-80. [PMID: 34400092 DOI: 10.1016/j.jsams.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/29/2021] [Accepted: 07/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVES As in-vivo knowledge of training-induced remodeling of intervertebral discs (IVD) is scarce, this study assessed how lumbar IVDs change as a function of long-term training in elite athletes and age-matched controls using compositional Magnetic Resonance Imaging (MRI). DESIGN Prospective case-control study. METHODS Prospectively, lumbar spines of 17 elite rowers (ERs) of the German national rowing team (mean age: 23.9 ± 3.3 years) were imaged on a clinical 3.0 T MRI scanner. ERs were imaged twice during the annual training cycle, i.e., at training intensive preseason preparations (t0) and 6 months later during post-competition recovery (t1). Controls (n = 22, mean age: 26.3 ± 1.9 years) were imaged once at corresponding time points (t0: n = 11; t1: n = 11). Segment-wise, the glycosaminoglycan (GAG) content of lumbar IVDs (n = 195) was determined using glycosaminoglycan chemical exchange saturation transfer (gagCEST). Linear mixed models were set up to assess the influence of cohort and other variables on GAG content. RESULTS During preseason, IVD GAG values of ERs were significantly higher than those of controls (ERs(t0): 2.58 ± 0.27% (mean ± standard deviations); controls(t0): 1.43 ± 0.36%; p ≤ 0.001), while during post-competition recovery, such differences were not present anymore (ERs(t1): 2.11 ± 0.18%; controls(t1): 1.89 ± 0.24%; p = 0.362). CONCLUSIONS Professional elite-level rowing is transiently associated with significantly higher gagCEST values, which indicate increased lumbar IVD-GAG content and strong remodeling effects in response to training. Beyond professional rowing, core-strengthening full-body exercise may help to enhance the resilience of the lumbar spine as a potential therapeutic target in treating back pain.
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18
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Gause PR, Godinsky RJ, Burns KS, Dohring EJ. Lumbar Disk Herniations and Radiculopathy in Athletes. Clin Sports Med 2021; 40:501-511. [PMID: 34051943 DOI: 10.1016/j.csm.2021.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lumbar disk herniation is the most common surgical condition of the spine. High-level athletes participate in activities that place extreme loads on the intervertebral disks. These repetitive loads may lead to an elevated risk for degenerative disk disease, which in turn predisposes to disk herniations. Treatment algorithms for athletes with disk herniations are similar to those in the nonathletic population; however, success in the athletic population is often measured in the ability to return to play. Both nonoperative and operative treatment show a high success rate in return to play in athletes treated for disk herniations.
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Affiliation(s)
- Paul R Gause
- Spine Institute of Arizona, 9735 North 90th Place, Scottsdale, AZ 85258, USA.
| | - Ryan J Godinsky
- Spine Institute of Arizona, 9735 North 90th Place, Scottsdale, AZ 85258, USA
| | - Keven S Burns
- Spine Institute of Arizona, 9735 North 90th Place, Scottsdale, AZ 85258, USA
| | - Edward J Dohring
- Spine Institute of Arizona, 9735 North 90th Place, Scottsdale, AZ 85258, USA
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19
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Lagerstrand K, Baranto A, Hebelka H. Different disc characteristics between young elite skiers with diverse training histories revealed with a novel quantitative magnetic resonance imaging method. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:2082-2089. [PMID: 34013394 DOI: 10.1007/s00586-021-06869-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/05/2021] [Accepted: 05/02/2021] [Indexed: 12/17/2022]
Abstract
PURPOSE To evaluate if there are differences in thoraco-lumbar disc characteristics between elite skiers and non-athletic controls as well as between different types of elite skiers, with diverse training histories, using a novel quantitative MRI method. METHODS The thoraco-lumbar spine of 58 elite skiers (age = 18.2 ± 1.1 years, 30 males) and 26 normally active controls (age = 16.4 ± 0.6 years, 9 males) was examined using T2w-MRI. Disc characteristics were compared quantitatively between groups using histogram and regional image analyses to determine delta peak and T2-values in five sub-regions. RESULTS A statistical difference in the delta peak value was found between skiers and controls (p <0.001), reflecting higher degree of disc degeneration. The histogram analysis also revealed that the type of training determines where and to what extent the changes occur. Alpine skiers displayed lumbar changes, while mogul skiers displayed changes also in the thoracic spine. Alpine skiers with diverse training dose differed in delta peak value (p = 0.005), where skiers with highest training dose displayed less changes. Regional T2-value differences were found in skiers with divergent training histories (p <0.05), reflecting differences in disc degeneration patterns, foremost within the dorsal annulus. CONCLUSION Differences in quantitative disc characteristics were found not only between elite skiers and non-athletic controls but also between subgroups of elite skiers with diverse training histories. The differences in the disc measures, reflecting tissue degradation, are likely related to type and intensity of the physical training. Future studies are encouraged to explore the relation between disc functionality, training history and pain to establish adequate prevention and rehabilitation programs.
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Affiliation(s)
- K Lagerstrand
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Medical Physics and Techniques, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - A Baranto
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopedics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - H Hebelka
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Radiology, Sahlgrenska University Hospital, Gothenburg, Sweden
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20
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The Prevalence of Abnormalities in the Pediatric Spine on MRI: A Systematic Review and Meta-Analysis. Spine (Phila Pa 1976) 2020; 45:E1185-E1196. [PMID: 32355138 DOI: 10.1097/brs.0000000000003527] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVE The aim of this study was to provide an overview of the prevalence of reported musculoskeletal abnormalities on magnetic resonance imaging (MRI) of the pediatric spine. SUMMARY OF BACKGROUND DATA Back pain is a common complaint and significant health issue, already in children. Several studies have investigated musculoskeletal abnormalities of the pediatric spine as possible cause of low back pain (LBP). However, it is not clear which abnormalities are the most prevalent among children. METHODS A systematic literature search on the prevalence of musculoskeletal spinal abnormalities on MRI in children was conducted in the Embase, Medline Ovid, and Cochrane CENTRAL databases. Risk of bias (RoB) was assessed using a checklist based on the Downs and Black checklist. General information on study and patient characteristics and the prevalence of spinal abnormalities were extracted from the studies. Prevalence data were presented in three subgroups: nonathletes without LBP, participants with LBP, and athletes. Prevalence data of the most reported abnormalities were pooled using random-effects proportion meta-analysis. The study protocol was prospectively registered in PROSPERO (CRD42017080543). RESULTS The search resulted in 16,783 articles, of which 31 articles (2373 participants) were included in this systematic review. Two-thirds of the studies had a low RoB. The pooled prevalence in nonathletes without LBP, participants with LBP, and athletes without LBP was respectively 22%, 44%, and 22% for disc degeneration, 1%, 38%, and 13% for herniated discs, 5%, 22%, and 11% for endplate changes, and 0%, 30%, and 6% for pars fractures. CONCLUSION Disc degeneration, herniated discs, endplate changes, and spondylolysis are the most reported spinal abnormalities on MRI in children in literature. Spinal abnormalities seen in adults are already prevalent in children with LBP, with the highest prevalence for disc degeneration and herniated discs. LEVEL OF EVIDENCE 2.
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21
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Fiani B, Jarrah R, Wong A, Alamah A, Runnels J. Repetitive Traumatic Discopathy in the Modern-Era Tennis Player. Cureus 2020; 12:e9783. [PMID: 32953299 PMCID: PMC7491697 DOI: 10.7759/cureus.9783] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Degenerative disc disease is more prevalent among athletes than the general population. Repetitive traumatic discopathy is a pattern of injury that has been described in athletes participating in sports that impart repetitive mechanical forces on the lumbar spine. Hence, tennis players may be particularly susceptible to repetitive traumatic discopathy due to the fast-paced nature of the modern tennis match. Recent biomechanical studies have identified the lumbar spine as the focal point of motion during tennis strokes, and the lumbar spine is notably the most frequent location of injury observed in tennis players. In this comprehensive review, we examine current evidence and discuss the epidemiology, pathophysiology, biomechanics, diagnosis, and treatment of repetitive traumatic discopathy in tennis players. Additionally, we outline considerations for rehabilitation and return to the tennis court after operative management.
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Zemková E, Kováčiková Z, Zapletalová L. Is There a Relationship Between Workload and Occurrence of Back Pain and Back Injuries in Athletes? Front Physiol 2020; 11:894. [PMID: 32792989 PMCID: PMC7394240 DOI: 10.3389/fphys.2020.00894] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Accepted: 07/02/2020] [Indexed: 12/25/2022] Open
Abstract
The back is subjected to a great deal of strain in many sports. Up to 20% of all sports injuries involve an injury to the lower back or neck. Repetitive or high impact loads (e.g., running, gymnastics, skiing) and weight loading (e.g., weightlifting) affect the lower back. Rotation of the torso (e.g., golf, tennis) causes damage to both, the lumbar and thoracic spine. The cervical spine is most commonly injured in contact sports (e.g., boxing, football). One of the factors that increases the odds of injuries in athletes is excessive and rapid increases in training loads. In spite of currently emerging evidence on this issue, little is known about the balance between physiological loading on the spine and athletic performance, versus overloading and back pain and/or injury in athletes. This scoping review aims (i) to map the literature that addresses the association between the training load and the occurrence of back pain and/or injury, especially between the Acute:Chronic Workload Ratio (ACWR) and back problems in athletes of individual and team sports, and (ii) to identify gaps in existing literature and propose future research on this topic. A literature search of six electronic databases (i.e., MEDLINE, PubMed, Web of Science, SCOPUS, SportDiscus, and CINAHL) was conducted. A total of 48 research articles met the inclusion criteria. Findings identified that fatigue of the trunk muscles induced by excessive loading of the spine is one of the sources of back problems in athletes. In particular, high training volume and repetitive motions are responsible for the high prevalence rates. The most influential are biomechanical and physiological variations underlying the spine, though stress-related psychological factors should also be considered. However, limited evidence exists on the relationship between the ACWR and back pain or non-contact back injuries in athletes from individual and team sports. This may be due to insufficiently specified the acute and chronic time window that varies according to sport-specific schedule of competition and training. More research is therefore warranted to elucidate whether ACWR, among other factors, is able to identify workloads that could increase the risk of back problems in athletes.
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Affiliation(s)
- Erika Zemková
- Department of Biological and Medical Sciences, Faculty of Physical Education and Sports, Comenius University in Bratislava, Bratislava, Slovakia.,Sports Technology Institute, Faculty of Electrical Engineering and Information Technology, Slovak University of Technology, Bratislava, Slovakia.,Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
| | - Zuzana Kováčiková
- Department of Natural Sciences in Kinanthropology, Faculty of Physical Culture, Palacký University Olomouc, Olomouc, Czechia
| | - Ludmila Zapletalová
- Institute of Physiotherapy, Balneology and Medical Rehabilitation, University of Ss. Cyril and Methodius in Trnava, Trnava, Slovakia
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Wong JS, Lalam R, Cassar-Pullicino VN, Tyrrell PN, Singh J. Stress Injuries of the Spine in Sports. Semin Musculoskelet Radiol 2020; 24:262-276. [DOI: 10.1055/s-0040-1709484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AbstractSpine sports stress injuries account for a significant amount of time loss at play in athletes, particularly if left unrecognized and allowed to progress. Spondylolysis makes up most of these stress injuries. This article focuses on spondylolysis, bringing together discussion from the literature on its pathomechanics and the different imaging modalities used in its diagnosis. Radiologists should be aware of the limitations and more importantly the roles of different imaging modalities in guiding and dictating the management of spondylolysis. Other stress-related injuries in the spine are also discussed including but not limited to pedicle fracture and apophyseal ring injury.
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Affiliation(s)
- Jenn Shiunn Wong
- Department of Radiology, Derriford Hospital, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Radhesh Lalam
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | - Victor N. Cassar-Pullicino
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
| | | | - Jaspreet Singh
- Department of Radiology, The Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, Oswestry, United Kingdom
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24
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Beck J, Brisby H, Baranto A, Westin O. Low lordosis is a common finding in young lumbar disc herniation patients. J Exp Orthop 2020; 7:38. [PMID: 32476065 PMCID: PMC7261711 DOI: 10.1186/s40634-020-00253-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 05/13/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose The sagittal alignment of the lumbar spine and pelvis can be classified into several subtypes. It has been suggested that the risk of developing certain pathologies, such as a lumbar disc herniation (LDH) is affected by spinal sagittal profiles. The main aim of this study was to investigate the sagittal profile in young patients surgically treated for a lumbar disc herniation and if a discectomy would alter the sagittal parameters. Methods Sixteen active young patients (mean age 18.3 ± 3.2 SD) with a lumbar disc herniation having a discectomy were included. A classification according to Roussouly of the sagittal parameters was made by two senior spinal surgeons, both pre-operatively and post-operatively on radiographs. The distribution of sagittal parameters and spinopelvic profiles were analysed and compared to a previous established healthy normal population. Results This series of active young patients with LDH exhibited a low lumbar lordosis dominance, with Roussouly sagittal profiles type 1 and type 2 accounting for more than 75% of the examined patients. An analysis of the erect radiographs revealed no significant changes in the post-operative sagittal profile. Conclusions This study showed that sagittal spinal alignment according to Roussouly in a young population with LDH is skewed compared with a normal population cohort. Furthermore, the lack of post-operative correction is suggestive of a non-ephemeral response to a LDH. Roussouly type 2 spinal sagittal profile may be a risk factor in young individuals suffering a disc herniation.
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Affiliation(s)
- Joel Beck
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden.
| | - Helena Brisby
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
| | - Olof Westin
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, Gothenburg University, and Sahlgrenska University Hospital, Bruna Straket 11b, S-413 45, Gothenburg, Sweden
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Peterhans L, Fröhlich S, Stern C, Frey WO, Farshad M, Sutter R, Spörri J. High Rates of Overuse-Related Structural Abnormalities in the Lumbar Spine of Youth Competitive Alpine Skiers: A Cross-sectional MRI Study in 108 Athletes. Orthop J Sports Med 2020; 8:2325967120922554. [PMID: 32528992 PMCID: PMC7263161 DOI: 10.1177/2325967120922554] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Alpine ski racing is known as a sport with unfavorable spinal loads and high rates of back overuse injuries at the elite level. However, little is known about overuse-related structural abnormalities occurring in the spine of youth athletes. Purpose: To describe the prevalence of abnormal magnetic resonance imaging (MRI) findings in the lumbar spine of youth competitive alpine skiers within the U16 category (under 16 years) with respect to sex, height growth, multifidus size, increasing age, and clinical relevance. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A total of 108 youth competitive alpine skiers aged 13 to 15 years underwent MRI examination of the lumbar spine and measurement of the multifidus cross-sectional area on a 3-T Magnetom Prisma scanner. Complementary assessments included the determination of anthropometrics and biological maturation. Athletes were classified as symptomatic when, pursuant to the Oslo Sports Trauma Research Center questionnaire on health problems, at least 1 substantial back overuse–related health problem episode had been registered during the 12 months before the MRI examination. Results: Of the analyzed youth skiers, 37.0% presented with ≥1 abnormal MRI finding in the lumbar spine. The most prevalent findings in both sexes were disc degeneration (23.1%), Schmorl nodes (19.4%), end plate changes (10.2%), and pars interarticularis anomalies (10.2%); the pars interarticularis anomalies occurred exclusively in males. A smaller relative lumbar multifidus cross-sectional area was related to more frequent occurrence of disc protrusions (P = .018; R2 = 0.116) and end plate changes (P = .024; R2 = 0.096). Overall, the occurrence of abnormal MRI findings in the lumbar spine increased with age (P = .034; R2 = 0.054). Disc degeneration (particularly disc dehydration and disc protrusion) were significantly more prevalent in symptomatic versus asymptomatic athletes (P < .05 for all). Conclusion: As early as age 15 years or younger, competitive alpine skiers demonstrated distinct overuse-related structural abnormalities in the lumbar spine, with some of them being clinically relevant and restrictive of sports participation. As sex, height growth, multifidus size, and increasing age seem to play an important role for the occurrence of such abnormalities, considering these factors might be essential for prevention.
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Affiliation(s)
- Loris Peterhans
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Fröhlich
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Christoph Stern
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Walter O Frey
- University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Mazda Farshad
- Spine Surgery, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Spine Centre, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reto Sutter
- Department of Radiology, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Jörg Spörri
- Sports Medical Research Group, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.,University Centre for Prevention and Sports Medicine, Department of Orthopedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
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Witwit W, Thoreson O, Swärd Aminoff A, Todd C, Jonasson P, Laxdal G, Hebelka H, Baranto A. Young football players have significantly more spinal changes on MRI compared to non‐athletes. TRANSLATIONAL SPORTS MEDICINE 2020. [DOI: 10.1002/tsm2.144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Wisam Witwit
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Radiology St. Joseph Mercy Oakland Hospital Pontiac Michigan
| | - Olof Thoreson
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Anna Swärd Aminoff
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Carl Todd
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
| | - Pàll Jonasson
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Orkuhúsið Orthopedic Clinic Reykjavik Iceland
| | | | - Hanna Hebelka
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Radiology Sahlgrenska University Hospital Gothenburg Sweden
| | - Adad Baranto
- Institute of Clinical Sciences at Sahlgrenska Academy University of Gothenburg Gothenburg Sweden
- Department of Orthopaedics Sahlgrenska University Hospital Gothenburg Sweden
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27
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Alhammoud M, Racinais S, Rousseaux‐Blanchi M, Bouscaren N. Recording injuries only during winter competitive season underestimates injury incidence in elite alpine skiers. Scand J Med Sci Sports 2020; 30:1177-1187. [PMID: 32141109 DOI: 10.1111/sms.13648] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Revised: 12/31/2019] [Accepted: 02/28/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Marine Alhammoud
- High‐Level Sport Medicine Centre Hospital of Albertville‐Moûtiers Albertville France
- French Ski Federation Annecy France
- Aspetar Orthopaedic and Sports Medicine Hospital Doha Qatar
| | - Sébastien Racinais
- Aspetar Orthopaedic and Sports Medicine Hospital Doha Qatar
- Laboratory Sport, Expertise and Performance French Institute of Sport (INSEP) Paris France
| | - Marie‐Philippe Rousseaux‐Blanchi
- High‐Level Sport Medicine Centre Hospital of Albertville‐Moûtiers Albertville France
- French Ski Federation Annecy France
- International Ski Federation Oberhofen am Thunersee Switzerland
| | - Nicolas Bouscaren
- French Ski Federation Annecy France
- Inserm CIC1410 CHU Réunion Saint Pierre France
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28
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Abdalkader M, Guermazi A, Engebretsen L, Roemer FW, Jarraya M, Hayashi D, Crema MD, Mian AZ. MRI-detected spinal disc degenerative changes in athletes participating in the Rio de Janeiro 2016 Summer Olympics games. BMC Musculoskelet Disord 2020; 21:45. [PMID: 31959161 PMCID: PMC6972034 DOI: 10.1186/s12891-020-3057-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
Objective To describe the frequency and the distribution of degenerative disc disease (DDD) detected in athletes who underwent spine MRI in the 2016 Summer Olympic Games in Rio de Janeiro. Methods Data on spine MRI examinations from the 2016 Summer Olympics were retrospectively analyzed. We assessed the frequency of DDD of the cervical (Cs), thoracic (Ts), and lumbar (Ls) spine using Pfirrmann’s classification. Grade II and III were considered as mild, grade IV as moderate, and grade V as severe disc degeneration. Data were analyzed according to the location of the degenerative disc, type of sport, age-groups, and gender of the athletes. Results One hundred out of 11,274 athletes underwent 108 spine MRI’s (21 C, 6 T, and 81 L) (53% Females (F), 47% Males (M)). The frequency of DDD was 40% (42% F, 58% M) over the entire spine (28% mild, 9% moderate and 3% severe). There were 58% (12%F, 88%M) of the cervical spine discs that showed some degree of degeneration (44% mild, 13.5% moderate and 1% severe). Athletics, Boxing, and Swimming were the sports most affected by DDD in the Cs. There were 12.5% of the thoracic discs that showed some degree of degeneration, all were mild DDD and were exclusively seen in female athletes. There were 39% (53% F, 47% M) of the lumbar discs with DDD (26% mild, 9% moderate, and 4% severe). Conclusion Athletes who underwent spine MRI during the 2016 Summer Olympic Games show a high frequency of DDD of cervical and lumbar spines. Recognition of these conditions is important to develop training techniques that may minimize the development of degenerative pathology of the spine.
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Affiliation(s)
- Mohamad Abdalkader
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA
| | - Lars Engebretsen
- Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.,Oslo Sports Trauma Research Center, Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopedic Surgery, Oslo University Hospital, University of Oslo, Oslo, Norway
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Mohamed Jarraya
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, Brigham and Woman Hospital, Boston, MA, USA
| | - Daichi Hayashi
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.,Department of Radiology, Stony Brook Medicine, Stony Brook, NY, USA
| | - Michel D Crema
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA.,Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, 820 Harrison Avenue, FGH Building 3rd Floor, Boston, MA, 02118, USA
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Bigdon SF, Gewiess J, Hoppe S, Exadaktylos AK, Benneker LM, Fairhurst PG, Albers CE. Spinal injury in alpine winter sports: a review. Scand J Trauma Resusc Emerg Med 2019; 27:69. [PMID: 31324221 PMCID: PMC6642543 DOI: 10.1186/s13049-019-0645-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 07/05/2019] [Indexed: 03/08/2023] Open
Abstract
Introduction Alpine winter sports have become increasingly popular over recent decades, with a similar increase in accident incidence. This review provides an overview of the most recent literature concerning spinal injury epidemiology, mechanisms, patterns and prevention strategies in the context of alpine winter sports. Material and methods The PubMed, Cochrane Library, and EMBASE databases were searched using the keywords spine injury, alpine injury, spine fracture, skiing injuries, snowboard injuries. 64 published studies in English and German met a priori inclusion criteria and were reviewed in detail by the authors. Results There are various mechanisms of injury in alpine winter sports (high speed falls in skiing, jumping failure in snowboarding) whilst regionality and injury severity are broadly similar. The thoracolumbar spine is the most common region for spinal injury. Spinal cord injury is relatively rare, usually accompanying distraction and rotation type fractures and is most commonly localised to the cervical spine. Disc injuries seem to occur more commonly in alpine winter sport athletes than in the general population. Discussion Despite awareness of increasing rates and risks of spinal injuries in alpine winter sports, there has been little success in injury prevention.
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Affiliation(s)
- Sebastian Frederick Bigdon
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010, Bern, Switzerland.
| | - Jan Gewiess
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Sven Hoppe
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Aristomenis K Exadaktylos
- Department of Emergency Medicine, Inselspital University of Bern, Freiburgstrasse 16C, 3010, Bern, Switzerland
| | - Lorin M Benneker
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Paul Gilbert Fairhurst
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
| | - Christoph E Albers
- Department of Traumatology and Orthopaedic Surgery, Inselspital University of Bern, Freiburgstrasse, 3010, Bern, Switzerland
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Novel Application of the Pfirrmann Disc Degeneration Grading System to 9.4T MRI: Higher Reliability Compared to 3T MRI. Spine (Phila Pa 1976) 2019; 44:E766-E773. [PMID: 31205169 DOI: 10.1097/brs.0000000000002967] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Reliability study. OBJECTIVE To evaluate the applicability and reliability of 9.4T magnetic resonance imaging (MRI) in the assessment of degenerative disc disease compared with 3T MRI. SUMMARY OF BACKGROUND DATA MRI is a reliable indicator of biochemical changes in the intervertebral disc (IVD) including hydration status, proteoglycan content, and disc degeneration compared with anatomical and histological studies. High-field 9.4T MRI has been shown to provide superior resolution and anatomical detail. However, it has not been tested against current standard MRI techniques. METHODS Disc degeneration was initiated in 36 skeletally mature ewes 6 months prior to necropsy via validated surgical IVD injury models using either scalpel injury or drill-bit injury techniques at lumbar spine levels L2/3 and L3/4 with L1/2, L4/5, and L5/6 serving as control discs. All ex vivo IVDs were examined with 9.4T MRI and 3T MRI. All scans were analyzed using the Pfirrmann grading system by four independent observers. Intra- and interobserver reliability was assessed using kappa statistics and Spearman correlation. RESULTS Inter- and intraobserver agreement for 9.4T MRI was excellent, both at κ 0.91 (P < 0.001). Comparatively, 3T interobserver reliability demonstrated substantial agreement at κ 0.61 (P < 0.001). Complete agreement was obtained in 92.7% to 100% of discs at 9.4T compared with 69.7% to 83.1% at 3T. A difference of one grade or more occurred in 6.7% at 9.4T and 39.3% at 3T. 9.4T MRI scored 97.3% of discs as grade 1 to 2 compared with 71.3% at 3T. 3T MRI tended to over-score the extent of disc degeneration with 28.6% of discs scored as grade 3 or higher compared with 2.7% at 9.4T MRI. CONCLUSION 9.4T MRI study of IVD degeneration using the Pfirrmann grading system demonstrated excellent inter- and intraobserver reliability. Comparatively, 3T MRI demonstrated a tendency to over score the extent of disc degeneration. This improved reliability of 9.4T MRI holds great potential for its clinical applications. LEVEL OF EVIDENCE 3.
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31
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Spörri J, Kröll J, Supej M, Müller E. Reducing the back overuse-related risks in alpine ski racing: let's put research into sports practice. Br J Sports Med 2018; 53:2-3. [PMID: 30323057 PMCID: PMC6317437 DOI: 10.1136/bjsports-2018-100040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2018] [Indexed: 01/30/2023]
Affiliation(s)
- Jörg Spörri
- Department of Orthopaedics, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Josef Kröll
- Department of Sport Science and Kinesiology, University of Salzburg, Hallein-Rif, Austria
| | - Matej Supej
- Faculty of Sport, University of Ljubljana, Ljubljana, Slovenia
| | - Erich Müller
- Department of Sport Science and Kinesiology, University of Salzburg, Hallein-Rif, Austria
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Swärd Aminoff A, Agnvall C, Todd C, Jónasson P, Sansone M, Thoreson O, Swärd L, Karlsson J, Baranto A. The effect of pelvic tilt and cam on hip range of motion in young elite skiers and nonathletes. Open Access J Sports Med 2018; 9:147-156. [PMID: 30123011 PMCID: PMC6084081 DOI: 10.2147/oajsm.s162675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Current knowledge of the effect of changes in posture and the way cam morphology of the hip joint may affect hip range of motion (ROM) is limited. Purpose To determine the effect of changes in pelvic tilt (PT) on hip ROM and with/without the presence of cam. Study design This was a cross-sectional study. Materials and methods The hip ROM of 87 subjects (n=61 young elite skiers, n=26 nonathletes) was examined using a goniometer, in three different seated postures (flexed, neutral, and extended). The hips of the subjects were further subgrouped into cam and no-cam morphology, based on the magnetic resonance imaging findings in the hips. Results There was a significant correlation between the hip ROM and the seated posture in both extended and flexed postures compared with the neutral posture. There was a significant decrease in internal hip rotation when the subjects sat with an extended posture with maximum anterior PT (p<0.0001). There was a significant increase in internal hip rotation when the subjects sat with a flexed posture with maximum posterior PT (p<0.001). External rotation was significantly decreased in an extended posture with maximum anterior PT (p<0.0001), but there was no difference in flexed posture with maximum posterior PT. The hips with cam morphology had reduced internal hip rotation in all three positions, but they responded to the changes in position in a similar manner to hips without cam morphology. Conclusion Dynamic changes in PT significantly influence hip ROM in young people, independent of cam or no-cam morphology.
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Affiliation(s)
- Anna Swärd Aminoff
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Cecilia Agnvall
- Sports Medicine Åre, Åre, Sweden.,Åre Ski Academy, Åre, Sweden
| | - Carl Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
| | | | - Mikael Sansone
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Leif Swärd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg, and Sahlgrenska University Hospital, Gothenburg, Sweden,
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Todd C, Aminoff AS, Agnvall C, Thoreson O, Swärd L, Karlsson J, Baranto A. No difference in prevalence of spine and hip pain in young Elite skiers. Knee Surg Sports Traumatol Arthrosc 2018; 26:1959-1965. [PMID: 29204863 PMCID: PMC6061433 DOI: 10.1007/s00167-017-4733-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 09/25/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the prevalence between back and hip pain in young Elite skiers. METHODS Sample group (n = 102), consisted of young Elite skiers (n = 75) and age-matched non-athletes (n = 27), all completed a three-part back and hip pain questionnaire, Oswestry Disability Index and EuroQoL to evaluate general health, activity level, back and hip pain prevalence. RESULTS No significant differences were shown for lifetime prevalence of back pain in the skiers (50%) compared with controls (44%) (n.s.). Duration of back pain for the skiers showed (30%) > 1 year, whilst (46%) > 5 years. A significant difference was shown with increased Visual Analogue Scale back pain levels for skiers 5.3 (SD 3.1) compared with controls 2.4 (SD 1.9, p = 0.025). No significant differences were shown for lifetime prevalence of hip pain in skiers (21%) compared with controls (8%) (n.s.). CONCLUSION Young Elite skiers are shown not to have increased lifetime prevalence for back and hip pain compared with a non-athletic control group. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Carl Todd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden.
- The Carl Todd Clinic, 5 Pickwick Park, Park Lane, Corsham, SN13 0HN, UK.
| | - Anna Swärd Aminoff
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Cecilia Agnvall
- Sportsmedicine Åre and Åre Ski High School, Göthenburg, Sweden
| | - Olof Thoreson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Leif Swärd
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Jon Karlsson
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
| | - Adad Baranto
- Department of Orthopaedics, Institute of Clinical Sciences at Sahlgrenska Academy, University of Gothenburg and Sahlgrenska University Hospital, Göthenburg, Sweden
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