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Fernquest S, Lloyd T, Pereira C, Gimpel M, Birchall R, Broomfield J, Glyn-Jones S, Palmer A. Coronal-plane leg alignment in adolescence and the effects of activity: A full leg length MRI study. J Orthop Res 2022; 41:973-983. [PMID: 36196622 DOI: 10.1002/jor.25442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 07/26/2022] [Accepted: 09/12/2022] [Indexed: 02/04/2023]
Abstract
The aim of this study was to explore the association between developing coronal-plane leg alignment and activity levels during adolescence. We performed a cross-sectional cohort study with individuals from soccer club academies and an age-matched control population. Outcome measures were the hip knee angle (HKA), medial proximal tibial physeal angle (MPTPhyA), lateral distal femoral physeal angle (LDFPhyA) on full leg length magnetic reasonance imagine scans, and the physical activity questionnaire (PAQ) score. The cohort comprised 57 elite male soccer players, 34 male and 34 female controls aged 11-21 years. Mean HKA became more varus with age, with little change after 16 years or skeletal maturity. Skeletally mature elite male soccer players were significantly more varus than male controls with a HKA 2.28° less than male controls (p < 0.001). Skeletally mature male controls had a HKA 1.34° less than female controls (p < 0.001). A negative correlation existed between HKA and PAQ score (coefficient -0.24, p = 0.029). A positive correlation existed between HKA and MPTPhyA (coefficient 0.32, p = 0.008). In conclusion, high activity levels during adolescence are associated with the development of varus leg alignment. Mean HKA becomes more varus with age until skeletal maturity. The development of varus alignment may represent a physiological adaptation to load at the proximal tibial physis. Clinical Significance: A time period may exist for intervention before the development of varus leg alignment in young athletes, such as training load modification or proximal tibial morphology monitoring.
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Affiliation(s)
- Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Thomas Lloyd
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Claudio Pereira
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | - John Broomfield
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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2
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Horenstein RE, Meslier Q, Spada JA, Halverstadt A, Lewis CL, Gimpel M, Birchall R, Wedatilake T, Fernquest S, Palmer A, Glyn-Jones S, Shefelbine SJ. Measuring 3D growth plate shape: Methodology and application to cam morphology. J Orthop Res 2021; 39:2398-2408. [PMID: 33368641 PMCID: PMC8222423 DOI: 10.1002/jor.24972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 02/04/2023]
Abstract
Physeal changes corresponding to cam morphology are currently measured using two-dimensional (2D) methods. These methods are limited by definitions of the femoral neck axis and head center that are dependent on the radiographic plane of view. To address these limitations, we developed three-dimensional (3D) methods for analyzing continuous growth plate shape using magnetic resonance imaging scans. These new methods rely on a single definition of the femoral neck axis and head center that are both nondependent on the radiographic plane of view and allow for analysis of growth plate shape across the growth plate surface (performed using statistical parametric mapping). Using our 3D method, we analyzed the position of the growth plate in the femoral head (relative to a plane tangent to the femoral head) and the curvature of the growth plate (relative to a plane through the center of the growth plate) in 9-16-year-old males at risk for cam morphology and their recreationally active peers (n = 17/cohort). These two measurements provide an avenue to separately analyze the effects of these variables in the overall growth plate shape. We detected differences in growth plate shape with age in recreationally active adolescents but did not detect differences between at risk and recreationally adolescents.
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Affiliation(s)
- Rachel E. Horenstein
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - Quentin Meslier
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA
| | - Julia A. Spada
- Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
| | - Anne Halverstadt
- Department of Physical Therapy & Athletic Training, Boston University, Boston,MA 02215, USA
| | - Cara L. Lewis
- Department of Physical Therapy & Athletic Training, Boston University, Boston,MA 02215, USA
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | | | - Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Siôn Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sandra J. Shefelbine
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA 02115, USA,Department of Bioengineering, Northeastern University, Boston, MA 02115, USA
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Buckthorpe M, Wright S, Virgile A, Gimpel M. Infographic. Recommendations for hamstring injury prevention in elite football: translating research into practice. Br J Sports Med 2020; 55:699-700. [PMID: 33077480 DOI: 10.1136/bjsports-2020-103455] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/25/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew Buckthorpe
- Faculty of Sport, Health and Applied Science, St Mary's University, Twickenham, London, UK .,Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.,Isokinetic Medical Group, FIFA Medical Centre of Excellence, London, UK
| | | | - Adam Virgile
- College of Nursing and Health Sciences, University of Vermont, Burlington, Vermont, USA
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
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4
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Kemp JL, Risberg MA, Mosler A, Harris-Hayes M, Serner A, Moksnes H, Bloom N, Crossley KM, Gojanovic B, Hunt MA, Ishøi L, Mathieu N, Mayes S, Scholes MJ, Gimpel M, Friedman D, Ageberg E, Agricola R, Casartelli NC, Diamond LE, Dijkstra HP, Di Stasi S, Drew M, Freke M, Griffin D, Heerey J, Hölmich P, Impellizzeri FM, Jones DM, Kassarjian A, Khan KM, King MG, Lawrenson PR, Leunig M, Lewis CL, Warholm KM, Reiman MP, Semciw A, Thorborg K, van Klij P, Wörner T, Bizzini M. Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018. Br J Sports Med 2019; 54:504-511. [PMID: 31732651 DOI: 10.1136/bjsports-2019-101458] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2019] [Indexed: 11/04/2022]
Abstract
The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.
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Affiliation(s)
- Joanne L Kemp
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - May Arna Risberg
- Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway.,Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Andrea Mosler
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Marcie Harris-Hayes
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Andreas Serner
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Nancy Bloom
- Physical Therapy, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA.,Orthopaedic Surgery, Washington University School of Medicine in Saint Louis, Saint Louis, Missouri, USA
| | - Kay M Crossley
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Boris Gojanovic
- Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland.,SportAdo consultation, University Hospital of Lausanne (CHUV) Multidisciplinary Unit of Adolescent Health, Lausanne, Switzerland
| | - Michael A Hunt
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lasse Ishøi
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Nicolas Mathieu
- Physiotherapy, HES-SO Valais, University of Applied Sciences Western Switzerland, Leukerbad, Valais, Switzerland
| | - Sue Mayes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia.,The Australian Ballet, Southbank, Victoria, Australia
| | - Mark J Scholes
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Mo Gimpel
- Performance Science, Southampton Football Club, Southampton, Hampshire, UK
| | - Daniel Friedman
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Eva Ageberg
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Rintje Agricola
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Nicola C Casartelli
- Human Performance Lab, Schulthess Clinic, Zurich, Switzerland.,Laboratory of Exercise and Health, ETH Zurich, Schwerzenbach, Switzerland
| | - Laura E Diamond
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE, Menzies Health Institute Queensland Griffith University, School of Allied Health Sciences, Gold Coast, Queensland, Australia
| | - H Paul Dijkstra
- Department for Continuing Education, University of Oxford, Oxford, Oxfordshire, UK.,Aspetar Sports Medicine Hospital, Doha, Qatar
| | - Stephanie Di Stasi
- Division of Physical Therapy, The Ohio State Univesity, Columbus, Ohio, USA
| | - Michael Drew
- University of Canberra Research into Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
| | - Matthew Freke
- School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Damian Griffin
- Warwick Orthopaedics, University of Warwick, Coventry, Warwick, UK
| | - Joshua Heerey
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Per Hölmich
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Franco M Impellizzeri
- Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Denise M Jones
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Ara Kassarjian
- Musculoskeletal Radiology, Corades, LLC, Brookline, Massachusetts, USA.,Musculoskeletal Radiology, Elite Sports Imaging, SL, Madrid, Spain
| | - Karim M Khan
- Family Practice & Kinesiology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Matthew G King
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Peter R Lawrenson
- School of Health & Rehabilitation Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Michael Leunig
- Department of Orthopaedics, Schulthess Klinik, Zurich, Switzerland
| | - Cara L Lewis
- Physical Therapy & Athletic Training, Boston University, Boston, Massachusetts, USA
| | | | - Michael P Reiman
- Orthopedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Adam Semciw
- La Trobe Sports Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Kristian Thorborg
- Sports Orthopaedic Research Center-Copenhagen (SORC-C), Department of Orthopedic Surgery, Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - Pim van Klij
- Department of Orthopaedic Surgery, University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Tobias Wörner
- Department of Health Sciences, Lunds University, Lund, Sweden
| | - Mario Bizzini
- Schulthess Clinic Human Performance Lab, Zurich, Switzerland
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5
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Bowen L, Gross AS, Gimpel M, Bruce-Low S, Li FX. Spikes in acute:chronic workload ratio (ACWR) associated with a 5-7 times greater injury rate in English Premier League football players: a comprehensive 3-year study. Br J Sports Med 2019; 54:731-738. [PMID: 30792258 PMCID: PMC7285788 DOI: 10.1136/bjsports-2018-099422] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 11/12/2022]
Abstract
Objectives We examined the relation between global positioning system (GPS)-derived workloads and injury in English Premier League football players (n=33) over three seasons. Methods Workload and injury data were collected over three consecutive seasons. Cumulative (1-weekly, 2-weekly, 3-weekly and 4-weekly) loads in addition to acute:chronic workload ratios (ACWR) (acute workload (1-week workload)) divided by chronic workload (previous 4-week average acute workload) were classified into discrete ranges by z-scores. Relative risk (RR) for each range was then calculated between injured and non-injured players using specific GPS variables: total distance, low-intensity distance, high-speed running distance, sprint distance, accelerations and decelerations. Results The greatest non-contact injury risk was when the chronic exposure to decelerations was low (<1731) and the ACWR was >2.0 (RR=6.7). Non-contact injury risk was also 5–6 times higher for accelerations and low-intensity distance when the chronic workloads were categorised as low and the ACWR was >2.0 (RR=5.4–6.6), compared with ACWRs below this. When all chronic workloads were included, an ACWR >2.0 was associated with a significant but lesser injury risk for the same metrics, plus total distance (RR=3.7–3.9). Conclusions We recommend that practitioners involved in planning training for performance and injury prevention monitor the ACWR, increase chronic exposure to load and avoid spikes that approach or exceed 2.0.
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Affiliation(s)
- Laura Bowen
- Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Southampton Football Club, Sports Medicine and Science, Southampton, UK
| | | | - Mo Gimpel
- Performance Support, Southampton Football Club, Southampton, UK
| | | | - Francois-Xavier Li
- Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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6
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Buckthorpe M, Wright S, Bruce-Low S, Nanni G, Sturdy T, Gross AS, Bowen L, Styles B, Della Villa S, Davison M, Gimpel M. Recommendations for hamstring injury prevention in elite football: translating research into practice. Br J Sports Med 2018; 53:449-456. [PMID: 30413424 PMCID: PMC6579500 DOI: 10.1136/bjsports-2018-099616] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2018] [Indexed: 12/14/2022]
Affiliation(s)
- Matthew Buckthorpe
- Southampton Football Club, Southampton, UK.,Isokinetic Medical Group, Education and Research Department, FIFA Medical Centre of Excellence, Bologna, Italy.,Isokinetic Medical Group, FIFA Medical Centre of Excellence, London, UK
| | | | | | - Gianni Nanni
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy
| | | | | | | | | | - Stefano Della Villa
- Isokinetic Medical Group, Education and Research Department, FIFA Medical Centre of Excellence, Bologna, Italy
| | - Michael Davison
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, London, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
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7
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Light N, Gimpel M, Sparks S, Bowen L, Bruce-Low S, Hughes-Jones Z. Associations between adductor strength; flexibility and self-reported symptoms in elite professional footballers: a case series. SCI MED FOOTBALL 2018. [DOI: 10.1080/24733938.2018.1501159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Neil Light
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | | | | | - Zoe Hughes-Jones
- Department of Sport and Exercise Sciences, University of Chichester, Chichester, UK
- Southampton Football Club, Southampton, UK
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8
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Buckthorpe M, Gimpel M, Wright S, Sturdy T, Stride M. Hamstring muscle injuries in elite football: translating research into practice. Br J Sports Med 2017; 52:628-629. [PMID: 29051167 DOI: 10.1136/bjsports-2017-097573] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 11/04/2022]
Affiliation(s)
- Matthew Buckthorpe
- Education and Research Department, Isokinetic Medical Group, FIFA Medical Centre of Excellence, Bologna, Italy.,Isokinetic Medical Group, FIFA Medical Centre of Excellence, London, UK.,Southampton Football Club, Southampton, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | | | - Matthew Stride
- Isokinetic Medical Group, FIFA Medical Centre of Excellence, London, UK
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9
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Palmer A, Fernquest S, Gimpel M, Birchall R, Judge A, Broomfield J, Newton J, Wotherspoon M, Carr A, Glyn-Jones S. Physical activity during adolescence and the development of cam morphology: a cross-sectional cohort study of 210 individuals. Br J Sports Med 2017; 52:601-610. [PMID: 28798039 PMCID: PMC5909766 DOI: 10.1136/bjsports-2017-097626] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 11/16/2022]
Abstract
Introduction Cam morphology is a strong risk factor for the development of hip pain and osteoarthritis. It is increasingly thought to develop in association with intense physical activity during youth; however, the aetiology remains uncertain. The study aim was to characterise the effect of physical activity on morphological hip development during adolescence. Methods Cross-sectional study of individuals aged 9–18 years recruited from Southampton Football Club Academy (103 male) with an age-matched control population (52 males and 55 females). Assessments included questionnaires and 3 Tesla MRI of both hips. Alpha angle, epiphyseal extension and epiphyseal tilt were measured on radial images. Results Alpha angle and epiphyseal extension increased most rapidly between ages 12 and 14 years. Soft-tissue hypertrophy at the femoral head-neck junction preceded osseous cam morphology and was first evident at age 10 years. The greatest increase and highest absolute values of alpha angle and epiphyseal extension were colocalised at 1 o’clock. Maximum alpha angles were 6.7 degrees greater in males than females (p=0.005). Compared with individuals who play no regular sport, alpha angles were 4.0 degrees higher in individuals who play sport for a school or club (p=0.041) and 7.7 degrees higher in individuals competing at a national or international level (p=0.035). There was no association with leg dominance. Conclusions Sporting activity during adolescence is strongly associated with the development of cam morphology secondary to epiphyseal hypertrophy and extension with a dose-response relationship. Males participating in competitive sport are at particularly elevated risk of developing cam morphology and secondary hip pathology.
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Affiliation(s)
- Antony Palmer
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Scott Fernquest
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | | | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - John Broomfield
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Julia Newton
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | | | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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10
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Griffin DR, Dickenson EJ, O'Donnell J, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 2017; 50:1169-76. [PMID: 27629403 DOI: 10.1136/bjsports-2016-096743] [Citation(s) in RCA: 568] [Impact Index Per Article: 81.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2016] [Indexed: 12/29/2022]
Abstract
The 2016 Warwick Agreement on femoroacetabular impingement (FAI) syndrome was convened to build an international, multidisciplinary consensus on the diagnosis and management of patients with FAI syndrome. 22 panel members and 1 patient from 9 countries and 5 different specialties participated in a 1-day consensus meeting on 29 June 2016. Prior to the meeting, 6 questions were agreed on, and recent relevant systematic reviews and seminal literature were circulated. Panel members gave presentations on the topics of the agreed questions at Sports Hip 2016, an open meeting held in the UK on 27-29 June. Presentations were followed by open discussion. At the 1-day consensus meeting, panel members developed statements in response to each question through open discussion; members then scored their level of agreement with each response on a scale of 0-10. Substantial agreement (range 9.5-10) was reached for each of the 6 consensus questions, and the associated terminology was agreed on. The term 'femoroacetabular impingement syndrome' was introduced to reflect the central role of patients' symptoms in the disorder. To reach a diagnosis, patients should have appropriate symptoms, positive clinical signs and imaging findings. Suitable treatments are conservative care, rehabilitation, and arthroscopic or open surgery. Current understanding of prognosis and topics for future research were discussed. The 2016 Warwick Agreement on FAI syndrome is an international multidisciplinary agreement on the diagnosis, treatment principles and key terminology relating to FAI syndrome.Author note The Warwick Agreement on femoroacetabular impingement syndrome has been endorsed by the following 25 clinical societies: American Medical Society for Sports Medicine (AMSSM), Association of Chartered Physiotherapists in Sports and Exercise Medicine (ACPSEM), Australasian College of Sports and Exercise Physicians (ACSEP), Austian Sports Physiotherapists, British Association of Sports and Exercise Medicine (BASEM), British Association of Sport Rehabilitators and Trainers (BASRaT), Canadian Academy of Sport and Exercise Medicine (CASEM), Danish Society of Sports Physical Therapy (DSSF), European College of Sports and Exercise Physicians (ECOSEP), European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA), Finnish Sports Physiotherapist Association (SUFT), German-Austrian-Swiss Society for Orthopaedic Traumatologic Sports Medicine (GOTS), International Federation of Sports Physical Therapy (IFSPT), International Society for Hip Arthroscopy (ISHA), Groupo di Interesse Specialistico dell'A.I.F.I., Norwegian Association of Sports Medicine and Physical Activity (NIMF), Norwegian Sports Physiotherapy Association (FFI), Society of Sports Therapists (SST), South African Sports Medicine Association (SASMA), Sports Medicine Australia (SMA), Sports Doctors Australia (SDrA), Sports Physiotherapy New Zealand (SPNZ), Swedish Society of Exercise and Sports Medicine (SFAIM), Swiss Society of Sports Medicine (SGMS/SGSM), Swiss Sports Physiotherapy Association (SSPA).
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Affiliation(s)
- D R Griffin
- Warwick Medical School, University of Warwick, Coventry, UK University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - E J Dickenson
- Warwick Medical School, University of Warwick, Coventry, UK University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - J O'Donnell
- Hip Arthroscopy Australia, Melbourne, Victoria, Australia St Vincents Private Hospital, East Melbourne, Victoria, Australia
| | - R Agricola
- Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - T Awan
- Medsport, Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan, USA
| | - M Beck
- Department of Clinic of Orthopaedic and Trauma Surgery, Luzerner Kantonspital, Luzern, Switzerland
| | - J C Clohisy
- Department of Orthopaedic Surgery, Washington University School of Medicine St. Louis, St. Louis, Missouri, USA
| | - H P Dijkstra
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - E Falvey
- Sports Surgery Clinic, Dublin, Ireland Department of Medicine, University College Cork, Cork, Ireland
| | | | - R S Hinman
- Department of Physiotherapy, The University of Melbourne, Melbourne, Victoria, Australia
| | - P Hölmich
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Orthopaedic Surgery, Sports Orthopaedic Research Center (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | - A Kassarjian
- Corades, LLC, Brookline, Massachusetts, USA Medical Service, Madrid Open Tennis, Madrid, Spain
| | - H D Martin
- Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, Texas, USA
| | - R Martin
- Rangos School of Health Sciences, Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA UPMC Center for Sports Medicine, Pittsburgh, Pennsylvania, USA
| | - R C Mather
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - M J Philippon
- Steadman Philippon Research Institute, Vail, Colorado, USA
| | - M P Reiman
- Department of Orthopaedic Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - A Takla
- Hip Arthroscopy Australia, Melbourne, Victoria, Australia Australian Sports Physiotherapy Department of Physiotherapy, The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia Bond University
| | - K Thorborg
- Department of Orthopaedic Surgery, Sports Orthopaedic Research Center (SORC-C), Copenhagen University Hospital, Amager-Hvidovre, Denmark
| | | | - A Weir
- Aspetar, Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Amsterdam Centre for Evidence-based Sports Medicine, Academic Medical Centre, Amsterdam, The Netherlands
| | - K L Bennell
- Department of Physiotherapy, The University of Melbourne, Centre for Health, Exercise and Sports Medicine, Melbourne, Victoria, Australia
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Bowen L, Gross AS, Gimpel M, Li FX. Accumulated workloads and the acute:chronic workload ratio relate to injury risk in elite youth football players. Br J Sports Med 2016; 51:452-459. [PMID: 27450360 PMCID: PMC5460663 DOI: 10.1136/bjsports-2015-095820] [Citation(s) in RCA: 180] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2016] [Indexed: 11/08/2022]
Abstract
Aim The purpose of this study was to investigate the relationship between physical workload and injury risk in elite youth football players. Methods The workload data and injury incidence of 32 players were monitored throughout 2 seasons. Multiple regression was used to compare cumulative (1, 2, 3 and 4-weekly) loads and acute:chronic (A:C) workload ratios (acute workload divided by chronic workload) between injured and non-injured players for specific GPS and accelerometer-derived variables:total distance (TD), high-speed distance (HSD), accelerations (ACC) and total load. Workloads were classified into discrete ranges by z-scores and the relative risk was determined. Results A very high number of ACC (≥9254) over 3 weeks was associated with the highest significant overall (relative risk (RR)=3.84) and non-contact injury risk (RR=5.11). Non-contact injury risk was significantly increased when a high acute HSD was combined with low chronic HSD (RR=2.55), but not with high chronic HSD (RR=0.47). Contact injury risk was greatest when A:C TD and ACC ratios were very high (1.76 and 1.77, respectively) (RR=4.98). Conclusions In general, higher accumulated and acute workloads were associated with a greater injury risk. However, progressive increases in chronic workload may develop the players' physical tolerance to higher acute loads and resilience to injury risk.
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Affiliation(s)
- Laura Bowen
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.,Southampton Football Club, Southampton, UK
| | | | - Mo Gimpel
- Southampton Football Club, Southampton, UK
| | - François-Xavier Li
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
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12
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Harris C, Remedios D, Aptowitzer T, Keat A, Hamilton L, Guile G, Belkhiri A, Newman D, Toms A, Macgregor A, Gaffney K, Morton L, Jones GT, MacDonald AG, Downham C, Macfarlane GJ, Tillett W, Jadon D, Wallis D, Costa L, Waldron N, Griffith N, Cavill C, Korendowych E, de Vries C, McHugh N, Iaremenko O, Fedkov D, Emery P, Baeten D, Sieper J, Braun J, van der Heijde D, McInnes I, Van Laar J, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Paramarta I, Bertolino A, Wright AM, Hueber W, Sofat N, Smee C, Hermansson M, Wajed J, Sanyal K, Kiely P, Howard M, Howe FA, Barrick TR, Abraham AM, Pearce MS, Mann KD, Francis RM, Birrell F, Carr A, Macleod I, Ng WF, Kavanaugh A, van der Heijde D, Chattopadhyay C, Gladman D, Mease P, McInnes I, Krueger G, Xu W, Goldstein N, Beutler A, Van Laar J, Baraliakos X, Braun J, Laurent DD, Baeten D, van der Heijde D, Sieper J, Emery P, McInnes I, Landewe R, Wordsworth BP, Wollenhaupt J, Kellner H, Wright AM, Gsteiger S, Hueber W, Conaghan PG, Peterfy CG, DiCarlo J, Olech E, Alberts AR, Alper JA, Devenport J, Anisfeld AM, Troum OM, Cooper P, Gimpel M, Deakin G, Jameson K, Godtschailk M, Gadola S, Stokes M, Cooper C, Gordon C, Kalunian K, Petri M, Strand V, Kilgallen B, Barry A, Wallace D, Flurey CA, Morris M, Pollock J, Hughes R, Richards P, Hewlett S. Oral abstracts 1: Spondyloarthropathies * O1. Detecting axial spondyloarthritis amongst primary care back pain referrals. Rheumatology (Oxford) 2012. [DOI: 10.1093/rheumatology/kes118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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