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Law L, Heerey JL, Devlin BL, Brukner P, Kemp JL, Attanayake A, Hulett MD, De Livera A, Mosler AB, Morris HG, White NP, Culvenor AG. Effectiveness of an anti-inflammatory diet versus low-fat diet for knee osteoarthritis: the FEAST randomised controlled trial protocol. BMJ Open 2024; 14:e079374. [PMID: 38569708 PMCID: PMC10989185 DOI: 10.1136/bmjopen-2023-079374] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 03/12/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Chronic inflammation plays a key role in knee osteoarthritis pathophysiology and increases risk of comorbidities, yet most interventions do not typically target inflammation. Our study will investigate if an anti-inflammatory dietary programme is superior to a standard care low-fat dietary programme for improving knee pain, function and quality-of-life in people with knee osteoarthritis. METHODS AND ANALYSIS The eFEct of an Anti-inflammatory diet for knee oSTeoarthritis study is a parallel-group, assessor-blinded, superiority randomised controlled trial. Following baseline assessment, 144 participants aged 45-85 years with symptomatic knee osteoarthritis will be randomly allocated to one of two treatment groups (1:1 ratio). Participants randomised to the anti-inflammatory dietary programme will receive six dietary consultations over 12 weeks (two in-person and four phone/videoconference) and additional educational and behaviour change resources. The consultations and resources emphasise nutrient-dense minimally processed anti-inflammatory foods and discourage proinflammatory processed foods. Participants randomised to the standard care low-fat dietary programme will receive three dietary consultations over 12 weeks (two in-person and one phone/videoconference) consisting of healthy eating advice and education based on the Australian Dietary Guidelines, reflecting usual care in Australia. Adherence will be assessed with 3-day food diaries. Outcomes are assessed at 12 weeks and 6 months. The primary outcome will be change from baseline to 12 weeks in the mean score on four Knee injury and Osteoarthritis Outcome Score (KOOS4) subscales: knee pain, symptoms, function in daily activities and knee-related quality of life. Secondary outcomes include change in individual KOOS subscale scores, patient-perceived improvement, health-related quality of life, body mass and composition using dual-energy X-ray absorptiometry, inflammatory (high-sensitivity C reactive protein, interleukins, tumour necrosis factor-α) and metabolic blood biomarkers (glucose, glycated haemoglobin (HbA1c), insulin, liver function, lipids), lower-limb function and physical activity. ETHICS AND DISSEMINATION The study has received ethics approval from La Trobe University Human Ethics Committee. Results will be presented in peer-reviewed journals and at international conferences. TRIAL REGISTRATION NUMBER ACTRN12622000440729.
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Affiliation(s)
- Lynette Law
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joshua L Heerey
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Brooke L Devlin
- School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Queensland, Australia
| | - Peter Brukner
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Joanne L Kemp
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Amanda Attanayake
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Mark D Hulett
- Department of Biochemistry and Chemistry, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria, Australia
| | - Alysha De Livera
- Department of Mathematics and Statistics, La Trobe University, Melbourne, Victoria, Australia
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea B Mosler
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | | | | | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia
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Jooste BR, Kolivas D, Brukner P, Moschonis G. Effectiveness of Technology-Enabled, Low Carbohydrate Dietary Interventions, in the Prevention or Treatment of Type 2 Diabetes Mellitus in Adults: A Systematic Literature Review of Randomised Controlled and Non-Randomised Trials. Nutrients 2023; 15:4362. [PMID: 37892437 PMCID: PMC10609579 DOI: 10.3390/nu15204362] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 10/06/2023] [Accepted: 10/10/2023] [Indexed: 10/29/2023] Open
Abstract
Evidence suggests that low carbohydrate dietary (LCD) approaches can improve glycaemic control and may result in type 2 diabetes mellitus (T2DM) remission. This systematic literature review (SLR) aimed to assess the effectiveness of technology-enabled LCD interventions in the management of people with prediabetes or T2DM. Data sources included Medline, Embase, CINAHL, and Web of Science. Randomised (RCTs) or non-randomised (non-RCTs) controlled trials investigating the effect of technology-enabled LCDs (<130 g/day) or very low carbohydrate diets (VLCDs < 50 g/day) on glycosylated haemoglobin A1c (HbA1c) for at least three months and published in English between 2009 and 2023 were included. Risk of bias assessment, data extraction, and synthesis were conducted using standard tools and procedures. Six studies (two RCTs and four non-RCTs, total sample, n = 1519) were identified and included in the SLR. Two studies examining LCDs reported significant reductions in mean HbA1c (0.4% and -1.2%) and weight loss (-3.8 kg and -7.5 kg) at one year. Three studies examining VLCDs reported significant reductions in mean HbA1c (-0.8% to -1.3%) and weight loss (-12 kg to -14 kg) up to two years. Technology-enabled LCD or VLCD interventions can be a novel approach in helping people with prediabetes or T2DM self-manage their condition and possibly achieve remission. However, further research is required to determine the sustainability, effectiveness, and safety of this approach.
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Affiliation(s)
- Bernice Rozemai Jooste
- School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - Despina Kolivas
- School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - Peter Brukner
- School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, VIC 3086, Australia
| | - George Moschonis
- School of Allied Health, Human Services & Sport, La Trobe University, Bundoora, VIC 3086, Australia
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Kolivas D, Fraser L, Schweitzer R, Brukner P, Moschonis G. Effectiveness of a Digitally Delivered Continuous Care Intervention (Defeat Diabetes) on Type 2 Diabetes Outcomes: A 12-Month Single-Arm, Pre-Post Intervention Study. Nutrients 2023; 15:2153. [PMID: 37417727 DOI: 10.3390/nu15092153] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 04/12/2023] [Accepted: 04/19/2023] [Indexed: 07/08/2023] Open
Abstract
Low-carbohydrate dietary approaches can lead to improvements in blood glucose levels and weight loss, as well as a reduction and/or cessation in medication use in people with type 2 diabetes (T2D). Recent technological advances have led to the development of health-related applications (apps), including a high proportion dedicated to the management of diabetes. The Defeat Diabetes Program is a smartphone- and web-based app that provides guidance on a low-carbohydrate dietary approach for T2D and was designed to be used in conjunction with standard care in the medical management of T2D. The primary aim of this protocol is to provide the rationale and design of a single-arm 12-month pre-post intervention clinical trial using the Defeat Diabetes Program in an Australian community-based cohort of people with T2D who were referred by their general practitioner (GP). The study seeks to engage the GP community to help demonstrate whether the results of using a low-carbohydrate dietary approach for T2D can be achieved by the Defeat Diabetes Program in their patients. This protocol describes (1) the rationale for the selection of primary and secondary outcome measures, (2) the sampling procedures and methodological steps used to identify eligible participants and collect data, and (3) the approach followed to involve and educate GPs to support the trial.
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Affiliation(s)
- Despina Kolivas
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
| | - Liz Fraser
- Watson General Practice, Watson 2602, Australia
| | - Ronald Schweitzer
- East Bentleigh Medical Group, Bentleigh East 3165, Australia
- Department of General Practice, School of Public Health and Preventive Medicine, Monash University, Clayton 3800, Australia
| | - Peter Brukner
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
| | - George Moschonis
- Department of Sport, Exercise and Nutrition Sciences, School of Allied Health, Human Services & Sport, La Trobe University, Bundoora 3086, Australia
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Cooper I, Brukner P, Devlin BL, Reddy AJ, Fulton M, Kemp JL, Culvenor AG. An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study. BMC Musculoskelet Disord 2022; 23:47. [PMID: 35027029 PMCID: PMC8757404 DOI: 10.1186/s12891-022-05003-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 12/23/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis. METHODS This 9-week single-arm feasibility study recruited participants aged 40-85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval. RESULTS Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m-2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection. CONCLUSION This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis. TRIAL REGISTRATION ACTRN12620000229976 prospectively on 25/2/2020.
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Affiliation(s)
- Indiana Cooper
- Melbourne Medical School, University of Melbourne, Parkville, Australia
| | - Peter Brukner
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Brooke L. Devlin
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Anjana J. Reddy
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Melanie Fulton
- Department of Dietetics, Nutrition and Sport, La Trobe University, Melbourne, Australia
| | - Joanne L. Kemp
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria 3086 Australia
| | - Adam G. Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria 3086 Australia
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Jewson JL, Brukner P, Gara TJ, Fortington LV. Safety in the football codes: a historical review of fatalities in Australian print media. Med J Aust 2020; 213:501-503.e1. [PMID: 33200407 DOI: 10.5694/mja2.50856] [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] [Received: 04/07/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Peter Brukner
- LASEM Research Centre, La Trobe University, Melbourne, VIC
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6
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Caneiro JP, Alaiti RK, Fukusawa L, Hespanhol L, Brukner P, O'Sullivan PP. There is more to pain than tissue damage: eight principles to guide care of acute non-traumatic pain in sport. Br J Sports Med 2020; 55:75-77. [PMID: 32907798 DOI: 10.1136/bjsports-2019-101705] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2020] [Indexed: 11/04/2022]
Affiliation(s)
- J P Caneiro
- Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia .,Body Logic Physiotherapy, Perth, Western Australia, Australia
| | - Rafael Krasic Alaiti
- Universidade de São Paulo, Nucleus of Neuroscience and Behavior and Nucleus of Applied Neuroscience, São Paulo, Brazil.,Projeto Superador, Research and Data Science Unit, São Paulo, Brazil
| | - Leandro Fukusawa
- Projeto Superador, Research and Data Science Unit, São Paulo, Brazil.,Faculdade de Ciências Médicas Santa Casa de São Paulo, Masters and Doctoral Programs in Medical Science, São Paulo, Brazil
| | - Luiz Hespanhol
- Universidade Cidade de São Paulo (UNICID), Masters and Doctoral Programs in Physical Therapy, São Paulo, Brazil.,VU University Medical Center Amsterdam (VUmc), Amsterdam Collaboration on Health and Safety in Sports (ACHSS), Amsterdam Movement Sciences, Amsterdam Universities Medical Centers, Amsterdam, Netherlands
| | - Peter Brukner
- La Trobe Sport & Exercise Medicine Research Centre at La Trobe University, Melbourne, Victoria, Australia
| | - Peter Pb O'Sullivan
- Curtin University, School of Physiotherapy and Exercise Science, Perth, Western Australia, Australia.,Body Logic Physiotherapy, Perth, Western Australia, Australia
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Girdwood M, West L, Connell D, Brukner P. Contact-Related Strain of Quadratus Femoris, Obturator Externus, and Inferior Gemellus in an Australian Football Player: A Case Report. J Sport Rehabil 2019; 28:887-890. [PMID: 30747560 DOI: 10.1123/jsr.2018-0279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 12/04/2018] [Accepted: 12/28/2018] [Indexed: 11/18/2022]
Abstract
CONTEXT Muscle injuries of the hip stabilizers are considered rare in sport. OBJECTIVE This report presents a previously unreported case of a contact injury resulting in acute strain of quadratus femoris, obturator externus, and inferior gemellus in an amateur Australian rules football player. DESIGN Level 4-case report. CASE PRESENTATION A player was tackled ipsilateral to the injured leg, while in hip flexion in a lunged position. The case describes the diagnostic process, initial management, and return to play for this athlete. RESULTS Following rehabilitation, the player was able to return to sport at 8 weeks without ongoing issues. CONCLUSIONS A literature search for sports-related contact injuries to either muscle returned only one result. All other documented cases of injury to these muscle groups are confined to noncontact mechanisms or delayed presentations. Despite conventional teaching, the action of the deep external rotators of the hip appears to be positionally dependent. Knowledge of this type of injury and mechanism may be useful for future clinical reasoning and differential diagnosis in patients with this type of presentation.
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8
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Hunter D, Brukner P, Roos E, Risberg M. Non-surgical management of OA. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.059] [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: 10/25/2022]
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9
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Jewson J, Brukner P, Gara T, Fortington L. Football-related injury deaths in Australia: A review of historical media reports. J Sci Med Sport 2019. [DOI: 10.1016/j.jsams.2019.08.101] [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: 11/17/2022]
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10
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Brukner P, Gara TJ, Fortington LV. Traumatic cricket-related fatalities in Australia: a historical review of media reports. Med J Aust 2019; 208:261-264. [PMID: 29614928 DOI: 10.5694/mja17.00908] [Citation(s) in RCA: 13] [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] [Received: 09/18/2017] [Accepted: 12/08/2017] [Indexed: 11/17/2022]
Affiliation(s)
- Peter Brukner
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), La Trobe University, Melbourne, VIC
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11
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Affiliation(s)
- Peter Brukner
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
| | - Jill L Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia
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13
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Prakash A, Entwisle T, Schneider M, Brukner P, Connell D. Connective tissue injury in calf muscle tears and return to play: MRI correlation. Br J Sports Med 2017; 52:929-933. [DOI: 10.1136/bjsports-2017-098362] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2017] [Indexed: 01/12/2023]
Abstract
ObjectiveThe aim of our study was to assess a group of patients with calf muscle tears and evaluate the integrity of the connective tissue boundaries and interfaces. Further, we propose a novel MRI grading system based on integrity of the connective tissue and assess any correlation between the grading score and time to return to play. We have also reviewed the anatomy of the calf muscles.Materials and methodsWe retrospectively evaluated 100 consecutive patients with clinical suspicion and MRI confirmation of calf muscle injury. We evaluated each calf muscle tear with MRI for the particular muscle injured, location of injury within the muscle and integrity of the connective tissue structure at the interface. The muscle tears were graded 0–3 depending on the degree of muscle and connective tissue injury. The time to return to play for each patient and each injury was found from the injury records and respective sports doctors.ResultsIn 100 patients, 114 injuries were detected. Connective tissue involvement was observed in 63 out of 100 patients and failure (grade 3 injury) in 18. Mean time to return to play with grade 0 injuries was 8 days, grade 1 tears was 17 days, grade 2 tears was 25 days and grade 3 tears was 48 days (p<0.001).ConclusionThe integrity of the connective tissue can be used to estimate and guide the time to return to play in calf muscle tears.
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Abstract
Background: Injury to the distal musculotendinous T junction (DMTJ) of the biceps femoris is a distinct clinical entity that behaves differently from other hamstring injuries due to its complex, multicomponent anatomy and dual innervation. Injury in this region demonstrates a particularly high rate of recurrence, even with prolonged rehabilitation times. Purpose: To describe the anatomy of the DMTJ of the biceps femoris and analyze the injury patterns seen on magnetic resonance imaging (MRI) to aid prognosis and rehabilitation and minimize the risk of recurrence. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Acute injury to the DMTJ of the biceps femoris was identified in 106 MRI examinations from 55 patients at a single institution. Each injury was classified as involving the long head, the short head, or both components of the DMTJ, with each component individually graded. Injuries were classified as recurrent if there was a previous MRI demonstrating an acute injury to the DMTJ or if there was scarring present at the site of an acute injury. Results: Of the 106 acute injuries to the DMTJ of the biceps femoris, isolated injury to the long head component was the most common (51%), with both components involved in [round 42.5% to 43%] of cases. Isolated injury to the short head component accounted for 7% of cases. The recurrence rate for reinjury to the DMTJ was 54% in this series. The date of prior injury was known in 45 of 57 recurrent cases, with 34 of these reoccurring within 3 months (76%) and 40 reoccurring within 12 months (89%). The recurrent injury was of a higher grade than the prior injury in 22 of 44 instances (50%), the same grade in 16 instances (36%), and a lower grade in 6 instances (14%). Thus, 86% of recurrent injuries were of the same or higher grade than prior injury. Conclusion: These results suggest that high-risk muscle injuries, such as that to the DMTJ of the biceps femoris, should be evaluated using MRI to determine the structural components involved and to assess the extent and severity of injury.
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Affiliation(s)
- Tom Entwisle
- Imaging at Olympic Park, Melbourne, Victoria, Australia
| | - Yuan Ling
- Imaging at Olympic Park, Melbourne, Victoria, Australia
| | - Alex Splatt
- Imaging at Olympic Park, Melbourne, Victoria, Australia
| | | | - David Connell
- Imaging at Olympic Park, Melbourne, Victoria, Australia.,Monash University, Melbourne, Victoria, Australia
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15
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Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Orchard J, Paajanen H, Philippon M, Reboul G, Robinson P, Schache AG, Schilders E, Serner A, Silvers H, Thorborg K, Tyler T, Verrall G, de Vos RJ, Vuckovic Z, Hölmich P. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2016; 49:768-74. [PMID: 26031643 PMCID: PMC4484366 DOI: 10.1136/bjsports-2015-094869] [Citation(s) in RCA: 276] [Impact Index Per Article: 34.5] [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] [Indexed: 11/17/2022]
Abstract
Background Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area. Aim The ‘Doha agreement meeting on terminology and definitions in groin pain in athletes’ was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions. Methods A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting. Results Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper. Conclusions The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.
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Affiliation(s)
- Adam Weir
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | | | - Eamonn Delahunt
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland Institute for Sport and Health, University College Dublin, Dublin, Ireland
| | - Jan Ekstrand
- Football Research Group, Department of Medicine and Health, University of Linköping, Linkoping, Sweden
| | - Damian Griffin
- Warwick Medical School, University Hospitals of Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Karim M Khan
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - Greg Lovell
- Australian Institute of Sport, Bruce, Australian Capital Territory, Australia
| | | | | | - John Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Hannu Paajanen
- Kuopio University Hospital and University of Eastern Finland, Kuopio, Finland
| | - Marc Philippon
- The Steadman Clinic, Steadman Philippon Research Institute, Vail, Colorado, USA McMaster University, Hamilton, Ontario, Canada University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Gilles Reboul
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Hernia Center, Clinique du Sport, Merignac, France
| | - Philip Robinson
- Leeds Musculoskeletal Biomedical Research Unit, Leeds Teaching Hospitals, University of Leeds, Leeds, UK
| | - Anthony G Schache
- Department of Mechanical Engineering, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ernest Schilders
- Fortius Clinic, Leeds Beckett University, The Wellington Hospital, London, UK
| | - Andreas Serner
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Holly Silvers
- Santa Monica Sports Medicine Foundation & Institute for Sports Science, University of Delaware, Delaware, USA
| | - Kristian Thorborg
- Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen, Denmark
| | - Timothy Tyler
- The Nicholas Institute of Sports Medicine & Athletic Trauma @ Lenox Hill Hospital, New York, New York, USA
| | - Geoffrey Verrall
- SPORTSMED.SA Sports Medicine Clinic, Adelaide, South Australia, Australia
| | - Robert-Jan de Vos
- Department of orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Zarko Vuckovic
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Per Hölmich
- Aspetar Orthopaedic and Sports Medicine Hospital, Doha, Qatar Sports Orthopedic Research Center - Copenhagen (SORC-C), Department of Orthopedic Surgery, Amager-Hvidovre Hospital, Copenhagen, Denmark
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16
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Kountouris A, Orchard JW, Puranik R, Semsarian C, Orchard JJ, Samra D, Duflou J, Groenestein P, Young M, Brukner P. Prevention of Sudden Cardiac Death in Cricketers. ACTA ACUST UNITED AC 2016. [DOI: 10.5005/jp-journals-10028-1193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
ABSTRACT
Aims
Sudden death in cricketers is rare, with the most common causes being cardiac, neurological (head/neck trauma, mainly from ball impact) and environmental (e.g., lightning strike and heat stroke, the former which usually involves cardiac arrest). The aim of this study was to review possible prevention of sudden cardiac death and make recommendations.
Materials and methods
A literature review of possible causes of sudden cardiac death (SCD) among cricketers was performed, along with evaluation of evidence for existing preventative measures. The method for evaluation was expert panel (cardiology and sports medicine) consensus recommendations based on the published evidence base.
Results
Potential cardiac causes of sudden death while playing cricket can be divided into the following categories: (1) atraumatic-origin preexisting arrhythmias, cardiomyopathies and valve disorders (2) traumatic-origin arrhythmia (commotio cordis) (3) acquired coronary or valvular disease (4) viral myocarditis (5) Lightning strike. Preventive measures can be divided into pre-season (e.g., cardiovascular screening), prematch (e.g., assessment of viral illness), protective equipment (e.g., chest guards) and post-event (presence of first aid response including defibrillators). Our panel agreed that there was strong evidence that (1) trained and planned emergency response particularly with a defibrillator is effective at preventing SCD and (2) ceasing play in the presence of lightning strikes prevents lightning-related death (3) players with symptoms, risk factors or history suggestive of possible cardiac disease should undertake specific individual workup. There are other potential methods to prevent SCD, with expert level recommendations made in the absence of strong evidence.
Discussion and conclusion
The most controversial aspect of prevention of SCD is electrocardiogram (ECG) screening of asymptomatic players and this paper outlines the arguments both in favor and against without fully resolving the debate. The possible increase in early diagnosis of potentially life-threatening cases needs to be balanced against the risk of false positive results which may lead to discussion of exclusion from cricket. Cardiac workup is clearly of net benefit to symptomatic individuals (e.g. history of syncope, chest pain) or any player at higher than usual baseline risk (e.g., positive family history). Basic life support including access to defibrillators should be available with trained personnel wherever they can be afforded, which has strong evidence in favor of improving survival at the time of cardiac arrest.
How to cite this article
Orchard JW, Puranik R, Semsarian C, Orchard JJ, Samra D, Duflou J, Groenestein P, Young M, Brukner P, Kountouris A. Prevention of Sudden Cardiac Death in Cricketers. J Postgrad Med Edu Res 2016;50(2):49-58.
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Brukner P, Connell D. 'Serious thigh muscle strains': beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains. Br J Sports Med 2015; 50:205-8. [PMID: 26519522 PMCID: PMC4752668 DOI: 10.1136/bjsports-2015-095136] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [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: 10/12/2015] [Indexed: 11/03/2022]
Abstract
Why do some hamstring and quadriceps strains take much longer to repair than others? Which injuries are more prone to recurrence? Intramuscular tendon injuries have received little attention as an element in 'muscle strain'. In thigh muscles, such as rectus femoris and biceps femoris, the attached tendon extends for a significant distance within the muscle belly. While the pathology of most muscle injures occurs at a musculotendinous junction, at first glance the athlete appears to report pain within a muscle belly. In addition to the musculotendinous injury being a site of pathology, the intramuscular tendon itself is occasionally injured. These injuries have a variety of appearances on MRIs. There is some evidence that these injuries require a prolonged rehabilitation time and may have higher recurrence rates. Therefore, it is important to recognise the tendon component of a thigh 'muscle strain'.
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Affiliation(s)
- Peter Brukner
- La Trobe University, Melbourne, Victoria, Australia Imaging @ Olympic Park, Melbourne, Victoria, Australia
| | - David Connell
- Imaging @ Olympic Park, Melbourne, Victoria, Australia Monash University, Melbourne, Victoria, Australia
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Abstract
Despite increased knowledge of hamstring muscle injuries, the incidence has not diminished. We now know that not all hamstring injuries are the same and that certain types of injuries require prolonged rehabilitation and return to play. The slow stretch type of injury and injuries involving the central tendon both require longer times to return to play. A number of factors have been proposed as being indicators of time taken to return to play, but the evidence for these is conflicting. Recurrence rates remain high and it is now thought that strength deficits may be an important factor. Strengthening exercise should be performed with the hamstrings in a lengthened position. There is conflicting evidence regarding the efficacy of platelet-rich plasma injection in the treatment of hamstring injuries so at this stage we cannot advise their use. Various tests have been proposed as predictors of hamstring injury and the use of the Nordboard is an interesting addition to the testing process. Prevention of these injuries is the ultimate aim and there is increasing evidence that Nordic hamstring exercises are effective in reducing the incidence.
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Orchard JW, Blanch P, Paoloni J, Kountouris A, Sims K, Orchard JJ, Brukner P. Cricket fast bowling workload patterns as risk factors for tendon, muscle, bone and joint injuries. Br J Sports Med 2015; 49:1064-8. [PMID: 25755276 DOI: 10.1136/bjsports-2014-093683] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [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: 02/17/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To assess workload-related risk factors for injuries to particular tissue types in cricket fast bowlers. DESIGN 235 fast bowlers who bowled in 14600 player innings over a period of 15 years were followed in a prospective cohort risk factor study to compare overs bowled in each match (including preceding workload patterns) and injury risk in the 3-4 weeks subsequent to the match. Injuries were categorised according to the affected tissue type as either: bone stress, tendon injuries, muscle strain or joint injuries. Workload risk factors were examined using binomial logistic regression multivariate analysis, with a forward stepwise procedure requiring a significance of <0.05. RESULTS High acute match workload and high previous season workload were risk factors for tendon injuries, but high medium term (3-month workload) was protective. For bone stress injuries, high medium term workload and low career workload were risk factors. For joint injuries, high previous season and career workload were risk factors. There was little relationship between muscle injury and workload although high previous season workload was slightly protective. CONCLUSIONS The level of injury risk for some tissue types varies in response to preceding fast bowling workload, with tendon injuries most affected by workload patterns. Workload planning may need to be individualised, depending on individual susceptibility to various injury types. This study supports the theory that tendons are at lowest risk with consistent workloads and susceptible to injury with sudden upgrades in workload. Gradual upgrades are recommended, particularly at the start of a bowler's career to reduce the risk of bone stress injury.
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia Cricket Australia, Melbourne, Australia
| | | | - Justin Paoloni
- Cricket Australia, Melbourne, Australia Orthopaedic Research Institute, University of New South Wales, Sydney, Australia
| | | | | | - Jessica J Orchard
- School of Public Health, University of Sydney, Sydney, New South Wales, Australia
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Olivier B, Stewart A, Taljaard T, Burger E, Brukner P, Orchard J, Gray J, Botha N, Mckinon W. Extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers: a systematic review protocol. JBI Database System Rev Implement Rep 2015; 13:3-13. [PMID: 26447003 DOI: 10.11124/jbisrir-2015-1387] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE Review question: which extrinsic and intrinsic factors are associated with non-contact injury in adult cricket pace bowlers?Review objective: the objective of this review is to determine the extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers. BACKGROUND Cricket is generally considered to be a sport of low injury risk compared to other sports. In cricket, the pace bowler strives towards the adoption of a bowling technique with a relatively low injury threat that will, at the same time, allow for a fast (>120km/hr) and accurate delivery to the opposing batsman. However, of all the various roles of the cricket player, the pace bowler has the highest risk of injury, especially for low back and lower limb (lower quarter) injury. The reason for this high risk of injury is due to the inherent, high-load biomechanical nature of the pace bowling action. The high prevalence of injury amongst pace bowlers highlights the great need for research into factors associated with injury.Both extrinsic and intrinsic factors work in combination to predispose the bowler to injury. Extrinsic or environment-related factors include bowling workload (the numbers of overs a bowler bowls), player position (first, second or third change) and time of play (morning or afternoon). A high bowling workload has been linked with a higher risk of injury in pace bowlers. Foster et al. found in an observational study that bowling too many overs in a single spell or bowling too many spells may increase the pace bowler's risk of sustaining a low back injury. In another observational study, Dennis et al. found that an exceptionally high bowling workload as well as an uncommonly low bowling workload is associated with injury risk. The major extrinsic factors for bowling injury identified by Orchard et al. are a high number of match overs bowled in the previous week, number of days of play and bowling second (batting first) in a match. Extrinsic factors are known to make the bowler more susceptible to injury, especially in the presence of intrinsic factors.Intrinsic, or person-related, factors include muscle strength, flexibility, balance and biomechanics. Intrinsic, strength-related factors, such as shoulder depression, horizontal flexion strength for the preferred limb and quadriceps power in the non-preferred limb are also significantly related to back injuries in fast bowlers. Both upper limb and lower limb-related intrinsic factors are known to be associated with injury. A prospective study by Dennis et al. aimed to identify the risk factors for injury in adolescent cricket fast bowlers. Their findings concluded that bowlers with a hip internal rotation range of motion of ≤30° on the leg ipsilateral to the bowling arm were at a significantly reduced risk of injury compared with bowlers with >40° of rotation. Moreover, bowlers with ankle dorsiflexion lunge of 12.1-14.0 cm on the leg contralateral to the bowling arm were at a significantly increased risk of injury compared to bowlers with a lunge of >14 cm. Reduced hamstring flexibility was also associated with lumbar disc abnormalities. Bowling-related biomechanical risk factors for injury have been established such as trunk rotation of the shoulders by to a more side-on position during the delivery stride. Portus et al. also reported that shoulder counter-rotation was significantly higher in bowlers who reported lumbar spine stress fractures, while the non-trunk injured group displayed a more flexed knee at front foot contact and ball release. In addition to the above kinematic risk factors, there are high ground reaction forces associated with the power phase - between the front foot placement and ball release components of the pace bowling action. A combination of kinematic bowling related issues as described above and high ground reaction forces may predispose the bowler to injury.Morton et al. conducted a systematic review on pace bowlers between the ages of 13.7 and 22.5 years on risk factors and successful interventions for cricket-related low back pain. Young cricketers between the ages of 13 and 18 years are different to adults in terms of their physiology which impacts on their predisposition to injury and phases of healing. Young cricketers may differ from an adult population in that young pace bowlers who sustain injuries during their bowling career may have given up on the sport by the time they approach adulthood, and the composition of the adult pace bowler population group is therefore affected by natural selection which may cause this group to differ from the original population. Caution is thus advised when generalizing findings from this young population group to adult pace bowlers which emphasizes the need for studies amongst adult pace bowlers. Furthermore, the review by Morton et al. included articles that specifically investigated factors associated with low back pain. However, due to the interconnectedness between the spine and the lower limbs, kinematic variables affecting the spine will also affect the load placed on the lower limbs with subsequent risk of injury. The interdependent mechanical interactions in a linked segment system such as the system of motion of the low back can be caused by movement coordination patterns in other body segments. The systematic review by Morton et al. only included intrinsic factors while the proposed review will also look at extrinsic factors. Therefore, the primary objective of this review is to determine extrinsic and intrinsic factors associated with non-contact injury in adult pace bowlers.
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Affiliation(s)
- Benita Olivier
- 1 The Witwatersrand Centre for Evidence-based Practice: a Collaborating Centre of the Joanna Briggs Institute, South Africa2 Neuromusculoskeletal Physiotherapy, South Africa3 Sports Medicine, La Trobe University, Melbourne; Cricket Australia4 School of Public Health, University of Sydney, Australia5 Cricket South Africa6 Faculty of Health Sciences, University of Southampton, Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, United Kingdom7 School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, South Africa
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Orchard JW, Blanch P, Paoloni J, Kountouris A, Sims K, Orchard JJ, Brukner P. Fast bowling match workloads over 5-26 days and risk of injury in the following month. J Sci Med Sport 2014; 18:26-30. [PMID: 25245426 DOI: 10.1016/j.jsams.2014.09.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2014] [Revised: 07/18/2014] [Accepted: 09/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVES This study examined whether high match fast bowling workloads in the short to medium term were associated with increased bowling injury rates. DESIGN Prospective cohort study. METHODS Over a 15 year period, workload patterns for 235 individual fast bowlers during time periods from 5 to 26 days were examined to consider whether there was an increased injury rate during the month (28 days) subsequent to the workload. RESULTS Fast bowlers who bowled more than 50 match overs in a 5 day period had a significant increase in injury over the next month compared to bowlers who bowled 50 overs or less RR 1.54 (95% CI 1.04-2.29). For periods ranging from 12 to 26 days, there was no statistically-significant increase in injury over the next month from exceeding thresholds of certain amounts of overs, although bowlers who bowled more than 100 overs in 17 days had a non-significant increase in injury over the next month RR 1.78 (95% CI 0.90-3.50). CONCLUSION There were no statistically-significant increases in subsequent injury risk for high workloads for periods of 12-26 days, although exceeding 100 overs in 17 days (or less) was associated with higher injury rates. Compression of cricket fixtures is likely to have only a minimal contribution to increased fast bowling injury rates being seen in the T20 era (along with sudden workload increases due to transferring between forms of the game, which has been previously established as a major contributor).
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Affiliation(s)
- John W Orchard
- School of Public Health, University of Sydney, Australia; Cricket Australia, Melbourne, Australia.
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Brukner P, Nealon A, Morgan C, Burgess D, Dunn A. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Br J Sports Med 2013; 48:929-38. [PMID: 23322894 PMCID: PMC4033203 DOI: 10.1136/bjsports-2012-091400] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [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] [Indexed: 12/14/2022]
Abstract
Recurrent hamstring injuries are a major problem in sports such as football. The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent hamstring injuries and examine the evidence for each intervention. A professional footballer sustained five hamstring injuries in a relatively short period of time. The injury was managed successfully with a seven-point programme—biomechanical assessment and correction, neurodynamics, core stability, eccentric strengthening, an overload running programme, injection therapies and stretching/relaxation. The evidence for each of these treatment options is reviewed. It is impossible to be definite about which aspects of the programme contributed to a successful outcome. Only limited evidence is available in most cases; therefore, decisions regarding the use of different treatment modalities must be made by using a combination of clinical experience and research evidence.
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Affiliation(s)
- Peter Brukner
- Departmernt of Sports Medicine and Sports Science, Liverpool Football Club, , Liverpool, UK
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Crossley K, Lai C, Lentzos J, Gabbe B, Morris H, Tan C, Pandy M, Brukner P, Makdissi M. Hamstring tendon autograft does not protect the patellofemoral joint from osteoarthritis after anterior cruciate ligament reconstruction: 7 year follow-up. J Sci Med Sport 2010. [DOI: 10.1016/j.jsams.2010.10.470] [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: 11/29/2022]
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Makdissi M, Darby D, Maruff P, Ugoni A, Brukner P, McCrory PR. Natural history of concussion in sport: markers of severity and implications for management. Am J Sports Med 2010; 38:464-71. [PMID: 20194953 DOI: 10.1177/0363546509349491] [Citation(s) in RCA: 182] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Evidence-based clinical data are required for safe return to play after concussion in sport. PURPOSE The objective of this study was to describe the natural history of concussion in sport and identify clinical features associated with more severe concussive injury, using return-to-sport decisions as a surrogate measure of injury severity. STUDY DESIGN Cohort study (prognosis); Level of evidence, 3. METHODS Male elite senior, elite junior, and community-based Australian Rules football players had preseason baseline cognitive testing (Digit Symbol Substitution Test, Trail-Making Test-Part B, and CogSport computerized test battery). Players were recruited into the study after a concussive injury sustained while playing football. Concussed players were tested serially until all clinical features of their injury had resolved. RESULTS Of 1015 players, 88 concussions were observed in 78 players. Concussion-associated symptoms lasted an average of 48.6 hours (95% confidence interval, 39.5-57.7 hours) with delayed return to sport correlated with > or = 4 symptoms, headache lasting > or = 60 hours, or self-reported "fatigue/fogginess." Cognitive deficits using the Digit Symbol Substitution Test and Trail-Making Test-part B recovered concomitantly with symptoms, but computerized test results recovered 2 to 3 days later and remained impaired in 35% of concussed players after symptom resolution. CONCLUSION Delayed return to sport was associated with initially greater symptom load, prolonged headache, or subjective concentration deficits. Cognitive testing recovery varied, taking 2 to 3 days longer for computerized tests, suggesting greater sensitivity to impairment. Therefore, symptom assessment alone may be predictive of but may underestimate time to complete recovery, which may be better estimated with computerized cognitive testing.
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Affiliation(s)
- Michael Makdissi
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia.
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Slimmon D, Brukner P. Sports ankle injuries - assessment and management. Aust Fam Physician 2010; 39:18-22. [PMID: 20369129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND Sports ankle injuries present commonly in the general practice setting. The majority of these injuries are inversion and plantar flexion injuries that result in damage to the lateral ligament complex. OBJECTIVE The aim of this article is to review the assessment and management of sports ankle injuries in the general practice setting. DISCUSSION Assessment of an ankle injury begins with a detailed history to determine the severity, mechanism and velocity of the injury, what happened immediately after and whether there is a past history of inadequately rehabilitated ankle injury. Examination involves assessment of weight bearing, inspection, palpation, movement, and application of special examination tests. Plain X-rays may be helpful to exclude a fracture. If the diagnosis is uncertain, consider second line investigations including bone scan, computerised tomography or magnetic resonance imaging, and referral to a sports physician. Manage all lateral ligament complex ankle sprains with ice, compression, elevation where possible and analgesia. Severe ligament sprains or rupture benefit from a brief period of immobilisation. After initial management, the athlete should complete a 6 week guided rehabilitation program. Athletes with moderate to severe lateral ankle ligament sprains should wear a semirigid or rigid ankle orthosis for at least 6 months following injury.
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Abstract
BACKGROUND Decisions regarding safe return to play after concussion in sport remain difficult. OBJECTIVE To determine whether a concussed player returned to play using an individual clinical management strategy is at risk of impaired performance or increased risk of injury or concussion. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS All elite Australian football players were followed for 4 seasons. Players were recruited into the study after sustaining a concussive injury. Outcome measures included performance statistics (disposals per hour match-time), injury rates, and recurrence of concussion on return to play. A subset of players had brief screening cognitive tests performed at baseline and after their concussion. Noninjured players matched for team, position, age, and size were chosen as controls. RESULTS A total of 199 concussive injuries were observed in 158 players. Sixty-one concussive injuries were excluded from analysis because of incomplete data (45 players) or presence of concurrent injury (16 players). Of the 138 concussive injuries assessed, 127 players returned to play without missing a game (92%). The remainder of concussed players returned to play after missing a single game (8%). Overall, there was no significant decline in disposal rates in concussed players on return to competition. Furthermore, there were no significant differences in injury rates between concussed and team, position, and game-matched controls. In the subset of players who had completed screening cognitive tests, all had returned to their individual baseline performance before being returned to play. CONCLUSION Return to play decisions based on individual clinical assessment of recovery allows safe and appropriate return to sport following a concussive injury.
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Affiliation(s)
- Michael Makdissi
- Centre for Health, Exercise, and Sports Medicine, University of Melbourne, Parkville, Victoria, Australia 3010.
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Castricum A, Holzer K, Brukner P, Irving L. The role of the bronchial provocation challenge tests in the diagnosis of exercise-induced bronchoconstriction in elite swimmers. Br J Sports Med 2008; 44:736-40. [PMID: 18948353 DOI: 10.1136/bjsm.2008.051169] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND The International Olympic Committee-Medical Commission (IOC-MC) accepts a number of bronchial provocation tests for the diagnosis of exercise-induced bronchoconstriction (EIB) in elite athletes, none of which have been studied in elite swimmers. With the suggestion of a different pathogenesis involved in the development of EIB in swimmers, there is a possibility that the recommended test for EIB in elite athletes, the eucapnic voluntary hyperpnoea (EVH) challenge, may be missing the diagnosis in elite swimmers. OBJECTIVE The aim of this study was to assess the effectiveness of the EVH challenge, the field swim challenge and the laboratory cycle challenge in the diagnosis of EIB in elite swimmers. DESIGN 33 elite swimmers were evaluated on separate days for the presence of EIB using 3 different bronchial provocation challenge tests: an 8 minute field swim challenge, a 6 minute laboratory EVH challenge, and an 8 minute laboratory cycle challenge. MAIN OUTCOME MEASUREMENTS Change in forced expiratory volume in 1 second (FEV(1)) pre and post test protocol. A fall in FEV(1) from baseline of > or =10% post challenge was diagnostic of EIB. RESULTS Only 1 of the 33 subjects (3%) had a positive field swim challenge with a fall in FEV(1) of 16% from baseline. 18 of the 33 subjects (55%) had a positive EVH challenge, with a mean fall in FEV(1) of 20.4 (SD 11.7)% from baseline. 4 of the subjects (12%) had a positive laboratory cycle challenge, with a mean fall in FEV(1) of 14.8 (4.7)% from baseline. Only 1 of the 33 subjects was positive to all 3 challenges. CONCLUSIONS These results suggest that the EVH challenge is a highly sensitive challenge for identifying EIB in elite swimmers, in contrast to the laboratory and field-based exercise challenge tests, which significantly underdiagnose the condition. The EVH challenge, a well-established and standardised test for EIB in elite winter and summer land-based athletes, should thus be used for the diagnosis of EIB in elite swimmers, as recommended by the IOC-MC.
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Affiliation(s)
- A Castricum
- Sports Physician, Olympic Park Sports Medicine Centre, Olympic Boulevarde, Melbourne, Victoria 3004, Australia.
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Koulouris G, Connell DA, Brukner P, Schneider-Kolsky M. Magnetic resonance imaging parameters for assessing risk of recurrent hamstring injuries in elite athletes. Am J Sports Med 2007; 35:1500-6. [PMID: 17426283 DOI: 10.1177/0363546507301258] [Citation(s) in RCA: 137] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Magnetic resonance (MR) imaging has established its usefulness in diagnosing hamstring muscle strain and identifying features correlating with the duration of rehabilitation in athletes; however, data are currently lacking that may predict which imaging parameters may be predictive of a repeat strain. PURPOSE This study was conducted to identify whether any MR imaging-identifiable parameters are predictive of athletes at risk of sustaining a recurrent hamstring strain in the same playing season. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Forty-one players of the Australian Football League who sustained a hamstring injury underwent MR examination within 3 days of injury between February and August 2002. The imaging parameters measured were the length of injury, cross-sectional area, the specific muscle involved, and the location of the injury within the muscle-tendon unit. Players who suffered a repeat injury during the same season were reimaged, and baseline and repeat injury measurements were compared. Comparison was also made between this group and those who sustained a single strain. RESULTS Forty-one players sustained hamstring strains that were positive on MR imaging, with 31 injured once and 10 suffering a second injury. The mean length of hamstring muscle injury for the isolated group was 83.4 mm, compared with 98.7 mm for the reinjury group (P = .35). In the reinjury group, the second strain was also of greater length than the original (mean, 107.5 mm; P = .07). Ninety percent of players sustaining a repeat injury demonstrated an injury length greater than 60 mm, compared with only 58% in the single strain group (P = .01). Only 7% of players (1 of 14) with a strain <60 mm suffered a repeat injury. Of the 27 players sustaining a hamstring strain >60 mm, 33% (9 of 27) suffered a repeat injury. Of all the parameters assessed, only a history of anterior cruciate ligament sprain was a statistically significant predictor for suffering a second strain during the same season of competition. CONCLUSION A history of anterior cruciate ligament injury was the only statistically significant risk factor for a recurrent hamstring strain in our study. Of the imaging parameters, the MR length of a strain had the strongest correlation association with a repeat hamstring strain and therefore may assist in identifying which athletes are more likely to suffer further reinjury.
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Affiliation(s)
- George Koulouris
- Department of Medical Imaging, Victoria House Hospital, Prahran, Australia.
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Holzer KE, Brukner P, Davies L, Irving L. Incidence of exercise-induced bronchoconstriction in sub-elite Australian rules football PLAYers. Med Sci Sports Exerc 2007. [DOI: 10.1249/01.mss.0000272997.78409.aa] [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: 11/21/2022]
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Abstract
OBJECTIVE To determine if ice-water immersion after eccentric quadriceps exercise minimises the symptoms of delayed-onset muscle soreness (DOMS). DESIGN A prospective randomised double-blind controlled trial was undertaken. 40 untrained volunteers performed an eccentric loading protocol with their non-dominant leg. INTERVENTIONS Participants were randomised to three 1-min immersions in either ice water (5+/-1 degrees C) or tepid water (24 degrees C). MAIN OUTCOME MEASURES Pain and tenderness (visual analogue scale), swelling (thigh circumference), function (one-legged hop for distance), maximal isometric strength and serum creatine kinase (CK) recorded at baseline, 24, 48 and 72 h after exercise. Changes in outcome measures over time were compared to determine the effect of group allocation using independent t tests or Mann-Whitney U tests. RESULTS No significant differences were observed between groups with regard to changes in most pain parameters, tenderness, isometric strength, swelling, hop-for-distance or serum CK over time. There was a significant difference in pain on sit-to-stand at 24 h, with the intervention group demonstrating a greater increase in pain than the control group (median change 8.0 vs 2.0 mm, respectively, p = 0.009). CONCLUSIONS The protocol of ice-water immersion used in this study was ineffectual in minimising markers of DOMS in untrained individuals. This study challenges the wide use of this intervention as a recovery strategy by athletes.
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Morris H, Brooker B, Brukner P. The infrapatellar fatpad of the knee. J Sci Med Sport 2006. [DOI: 10.1016/j.jsams.2006.12.008] [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: 11/25/2022]
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Masci L, Pike J, Malara F, Phillips B, Bennell K, Brukner P. Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis. Br J Sports Med 2006; 40:940-6; discussion 946. [PMID: 16980534 PMCID: PMC2465027 DOI: 10.1136/bjsm.2006.030023] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Active spondylolysis is an acquired lesion in the pars interarticularis and is a common cause of low back pain in the young athlete. OBJECTIVES To evaluate whether the one-legged hyperextension test can assist in the clinical detection of active spondylolysis and to determine whether magnetic resonance imaging (MRI) is equivalent to the clinical gold standard of bone scintigraphy and computed tomography in the radiological diagnosis of this condition. METHODS A prospective cohort design was used. Young active subjects with low back pain were recruited. Outcome measures included clinical assessment (one-legged hyperextension test) and radiological investigations including bone scintigraphy (with single photon emission computed tomography (SPECT)) and MRI. Computed tomography was performed if bone scintigraphy was positive. RESULTS Seventy one subjects were recruited. Fifty pars interarticulares in 39 subjects (55%) had evidence of active spondylolysis as defined by bone scintigraphy (with SPECT). Of these, 19 pars interarticulares in 14 subjects showed a fracture on computed tomography. The one-legged hyperextension test was neither sensitive nor specific for the detection of active spondylolysis. MRI revealed bone stress in 40 of the 50 pars interarticulares in which it was detected by bone scintigraphy (with SPECT), indicating reduced sensitivity in detecting bone stress compared with bone scintigraphy (p = 0.001). Conversely, MRI revealed 18 of the 19 pars interarticularis fractures detected by computed tomography, indicating concordance between imaging modalities (p = 0.345). There was a significant difference between MRI and the combination of bone scintigraphy (with SPECT)/computed tomography in the radiological visualisation of active spondylolysis (p = 0.002). CONCLUSIONS These results suggest that there is a high rate of active spondylolysis in active athletes with low back pain. The one-legged hyperextension test is not useful in detecting active spondylolysis and should not be relied on to exclude the diagnosis. MRI is inferior to bone scintigraphy (with SPECT)/computed tomography. Bone scintigraphy (with SPECT) should remain the first-line investigation of active athletes with low back pain followed by limited computed tomography if bone scintigraphy is positive.
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Affiliation(s)
- L Masci
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Melbourne, Victoria 3010, Australia.
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Bennett AN, Hinman RS, Crossley KM, Brukner P. Clinical Predictors of the Response to Glucosamine in Chronic Knee Pain. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-01031] [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: 11/21/2022]
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40
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Mitchell B, Colson E, Brukner P, Crossley K, Carrington E, Fehlberg M. The Area of Pain of Patients Undergoing Hip Arthroscopic Surgery. Med Sci Sports Exerc 2006. [DOI: 10.1249/00005768-200605001-00939] [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: 11/21/2022]
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41
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Neal A, Brukner P, Nicol A, Cowan S, Crossley K, Quinn J. 393 Comparison of the effectiveness of oral and intravenous rehydration in recovery following exercise. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30890-3] [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: 11/30/2022]
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Webb J, Morris H, Brukner P. 47 Displacement measurement of meniscus lesions: a kinematic study of meniscal tear behaviour in vitro. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30542-x] [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: 11/26/2022]
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Brukner P, Bermingham S, Holzer K. 190 The incidence of exercise-induced bronchospasm in sub-elite Australian Rules footballers. J Sci Med Sport 2005. [DOI: 10.1016/s1440-2440(17)30686-2] [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: 10/19/2022]
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Brukner P, Nicol A. Shin Pain - Running. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-02365] [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: 11/21/2022]
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Castricum A, Holzer K, Brukner P, Irving L, Dimitriadis T. The Role Of Bronchial Provocation Challenge Tests In The Diagnosis Of EIB In Elite Swimmers. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-00299] [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: 11/21/2022]
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Potter N, Brukner P, Makdissi M, Crossley K. Navicular Stress Fractures. Med Sci Sports Exerc 2005. [DOI: 10.1249/00005768-200505001-01718] [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: 11/21/2022]
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