Calf muscle wasting after tibial shaft fracture

Objectives

To study the long term effect of tibial shaft fractures treated by immobilisation in a long leg cast on the calf muscle bulk.

Methods

Computed tomography scans were performed at fixed points on the lower legs of 23 non‐professional athletes who sustained closed tibial fractures 16 years previously. Length of immobilisation was determined from the hospital records. All the fractures were treated non‐operatively. The cross sectional area of the various leg compartments was measured and compared with the non‐injured leg.

Results

There was a significant reduction in cross sectional area of the posterior compartment (p<0.001, Student''s t test). No such difference was seen in the anterolateral compartment.

Conclusion

Tibial fractures treated non‐operatively are associated with significant long term calf muscle wasting.     

Navicular stress fractures: outcomes of surgical and conservative management

Objective

To compare the long term outcomes of the two treatment options for navicular stress fractures: non‐weightbearing cast immobilisation and surgical fixation.

Design

Retrospective case study.

Participants

Subjects aged 18 years and older who had been treated for a navicular stress fracture more than two years previously.

Main outcome measures

Questionnaire based analogue pain score and function score; tenderness on palpation; abnormality detected on computed tomography (CT).

Results

In all, 32 fractures in 26 subjects were investigated. No significant differences were found between surgical and conservative management for current pain (p = 0.984), current function (p = 0.170), or abnormality on CT (p = 0.173). However, surgically treated patients more often remained tender over the “N spot” (p = 0.005), even after returning to competition for two years or more.

Conclusions

Surgical fixation of navicular stress fractures appears to be as effective as conservative management over the longer term. However, there remains a small but measurable degree of pain and loss of function over this period. The value of using “N spot” tenderness as the sole clinical predictor of treatment success requires further investigation, as some patients remained tender despite successful completion of treatment and return to competition.     

Converging evidence for the under-reporting of concussions in youth ice hockey

Background

Concussions are potentially serious injuries. The few investigations of prevalence or incidence in youth ice hockey have typically relied on prospective reports from physicians or trainers and did not survey players, despite the knowledge that many athletes do not report probable concussions.

Objective

This study sought to compare concussion rates in youth ice hockey that were estimated from a variety of reporting strategies.

Methods

Rates were calculated from British Columbia Amateur Hockey Association (BCAHA) official injury reports, from direct game observation by minor hockey volunteers (such as coaches and managers), as well as from retrospective surveys of both elite and non‐elite youth players. All research was conducted within the BCAHA.

Results

Estimates from official injury reports for male players were between 0.25 and 0.61 concussions per 1000 player game hours (PGH). Concussion estimates from volunteer reports were between 4.44 and 7.94 per 1000 PGH. Player survey estimates were between 6.65 and 8.32 per 1000 PGH, and 9.72 and 24.30 per 1000 PGH for elite and non‐elite male youth hockey, respectively.

Conclusion

It was found that concussions are considerably under‐reported to the BCAHA by youth hockey players and team personnel.     

An analysis of injuries resulting from professional horse racing in France during 1991-2001: a comparison with injuries resulting from professional horse racing in Great Britain during 1992-2001

Background

It has been previously shown that professional jockeys suffer high rates of fatal and non‐fatal injuries in the pursuit of their occupation. Little is known, however, about differences in injury rates between countries.

Aim

To determine the rate of fatal and non‐fatal injuries in flat and jump jockeys in France and to compare the injury rates with those in Great Britain and Ireland

Method

Prospectively collected injury data on professional jockeys were used as the basis of the analysis.

Results

Limb fractures occur four times more often in both flat and jump racing in France than in Great Britain. Similarly dislocations are diagnosed 20 times more often in flat and three times more often in jump racing. This difference is surprising given that French jockeys have fewer falls per ride than their British counterparts in flat racing, although they do have more falls than the British in jump racing. Similarly concussion rates seem to be higher in French jockeys, although there may be a difference in the diagnostic methods used in the different countries. By contrast, soft tissue injuries account for a far smaller percentage of injuries than in Great Britain.

Conclusion

There are striking differences in injury rates between countries which may be explained in part by a difference in track conditions—for example, harder tracks in France—or different styles of racing—for example, larger fields of horses per race in France.     

Dorsal calcaneocuboid ligament versus lateral ankle ligament repair: a case-control study

Objective

Anatomic reconstruction is the treatment of choice for lateral ankle ligament instability. A similar technique has recently been described for stabilisation of a chronic unstable calcaneocuboid joint as an alternative to the previously proposed tenodesis and arthrodesis procedures.

Methods

Five consecutive young females experiencing recurrent giving way of six calcaneocuboid joints were treated operatively during a 4 year period using anatomic ligament repair reinforced by a periosteal flap. Results were compared to five patients who underwent anatomic lateral ankle ligament repair in a case‐control design. Outcome was measured using the Foot and Ankle Outcome Score, physical examination, and stress radiographic and MRI (calcaneocuboid group) investigation. Functional neuromuscular performance was evaluated by isokinetic torque measurements, posturometry, single‐leg drop jumps, and single‐leg long jumps.

Results

Outcome scores at follow up (5–61 months after surgery) revealed excellent results for both groups. No relevant difference was found between the affected legs and the non‐affected legs or between groups with respect to the outcome measures. MRI exhibited ligament‐like structures at the repaired dorsal calcaneocuboid joints in five out of six joints.

Conclusions

Results of anatomic repair of unstable lateral ankle and isolated calcaneocuboid joint instability equally lead to excellent results.     

Shoulder strength profile in elite junior tennis players: horizontal adduction and abduction isokinetic evaluation

Objective

To establish normative data for muscle performance during isokinetic horizontal abduction and adduction of the shoulder in elite junior tennis players.

Methods

Thirty six tennis players were evaluated (23 male, 13 female; mean age 14 years (range 12–18)). An isokinetic dynamometer was used to test the shoulder horizontal abductors and adductors at 60 and 180°/s. Absolute and relative peak torque (PT and PT/BW), total work (TW), endurance ratio (ER), and the ratio of the peak torque between horizontal abductors and adductors (HAB/HAD ratio) were recorded. Data were compared for the dominant and non‐dominant shoulders, horizontal abductor and adductor muscles, and between players grouped according to age.

Results

The dominant shoulder was significantly (p<0.05) stronger than the non‐dominant shoulder in all variables except ER and HAB/HAD ratio. The abductors were significantly (p<0.05) weaker than the adductors in all subjects. The type of backhand (one handed or two handed) did not influence the strength of the shoulder horizontal abductors on the dominant side. The number of years of tennis practice had an effect on muscle strength as evaluated by absolute data (PT and TW) but not relative measurements (PT/BW and TW/BW).

Conclusion

The findings confirm that horizontal abduction and adduction are stronger in the dominant shoulder of junior tennis players. The clinical relevance of these findings is not established, and more studies are needed to compare tennis players with athletes from other sports and non‐athletes.     

Non-fatal horse related injuries treated in emergency departments in the United States, 2001-2003

Objective

To characterise and provide nationally representative estimates of persons with non‐fatal horse related injuries treated in American emergency departments.

Methods

The National Electronic Injury Surveillance System All Injury Program (NEISS–AIP) is a stratified probability sample comprising 66 hospitals. Data on injuries treated in these emergency departments are collected and reported. NEISS–AIP data on all types (horseback riding and otherwise) of non‐fatal horse related injuries from 2001 to 2003 were analysed.

Results

An estimated 102 904 persons with non‐fatal horse related injuries (35.7 per 100 000 population) were treated in American emergency departments each year from 2001 to 2003 inclusive. Non‐fatal injury rates were higher for females (41.5 per 100 000) than for males (29.8 per 100 000). Most patients were injured while mounted on a horse (66.1%), commonly from falling or being thrown by the horse; while not mounted, injuries most often resulted from being kicked by the horse. The body parts most often injured were the head/neck region (23.2%), lower extremity (22.2%), and upper extremity (21.5%). The most common principal diagnoses were contusions/abrasions (31.4%) and fractures (25.2%). For each year that was studied, an estimated 11 502 people sustained traumatic brain injuries from horse related incidents. Overall, more than 11% of those injured were admitted to hospital.

Conclusions

Horse related injuries are a public health concern not just for riders but for anyone in close contact with horses. Prevention programmes should target horseback riders and horse caregivers to promote helmet use and educate participants about horse behaviour, proper handling of horses, and safe riding practices.     

A multidisciplinary selection model for youth soccer: the Ghent Youth Soccer Project

Objectives

To determine the relationships between physical and performance characteristics and level of skill in youth soccer players aged 12–16 years.

Methods

Anthropometry, maturity status, functional and sport‐specific parameters were assessed in elite, sub‐elite, and non‐elite youth players in four age groups: U13 (n = 117), U14 (n = 136), U15 (n = 138) and U16 (n = 99).

Results

Multivariate analyses of covariance by age group with maturity status as the covariate showed that elite players scored better than the non‐elite players on strength, flexibility, speed, aerobic endurance, anaerobic capacity and several technical skills (p<0.05). Stepwise discriminant analyses showed that running speed and technical skills were the most important characteristics in U13 and U14 players, while cardiorespiratory endurance was more important in U15 and U16 players. The results suggest that discriminating characteristics change with competitive age levels.

Conclusions

Characteristics that discriminate youth soccer players vary by age group. Talent identification models should thus be dynamic and provide opportunities for changing parameters in a long‐term developmental context.     

No neurochemical evidence for brain injury caused by heading in soccer

Background

The possible injurious effect to the brain of heading in soccer is a matter of discussion.

Objective

To determine whether standardised headings in soccer are associated with increased levels of biochemical markers for neuronal injury in cerebrospinal fluid (CSF) and serum.

Methods

23 male amateur soccer players took part in a heading training session involving heading a ball kicked from a distance of 30 m at least 10 m forward. Ten players performed 10 and 13 players performed 20 approved headings. The players underwent lumbar puncture and serum sampling 7–10 days after the headings. The study also included 10 healthy male non‐athletic control subjects. CSF was analysed for neurofilament light protein, total tau, glial fibrillary acidic protein, S‐100B and albumin concentrations. Serum was analysed for S‐100B and albumin.

Results

None of the biomarker levels were abnormal and there were no significant differences between any of the three groups, except for a slightly increased CSF S‐100B concentration in controls compared with headers. Biomarker levels did not correlate with the number of headings performed.

Conclusion

Repeated low‐severity head impacts due to heading in soccer are not associated with any neurochemical signs of injury to the brain.     

Classification of functional recovery of anterior cruciate ligament copers, non-copers, and adapters

Objectives

(a) To identify whether differences exist in the pattern of recovery with respect to functional outcomes for acutely ruptured anterior cruciate ligament deficient (ACLD) copers, adapters, and non‐copers. (b) To identify clinically relevant outcomes that could distinguish between three functional subgroups.

Methods

A longitudinal study was used to measure gait variables and distance hop at regular intervals after injury using a digital camcorder and computer for quantitative analysis. A sample of 63 ACLD subjects entered the study; 42 subjects were measured at least three times. At 12–36 months after injury, subjects were classified as functional copers, adapters, or non‐copers on the basis of which of their preinjury activities they had resumed. To determine the pattern of recovery, repeated measurements were analysed using a least squares fit of the data.

Results

17% of ACLD subjects were classified as functional copers, 45% as adapters, and 38% as non‐copers. Only 5% of those who participated in high demand activities before injury returned to them. ACLD copers had recovered above the control mean for all gait variables by 40 days after the injury. Hopping distance did not recover to the control mean. Non‐copers struggled to recover to control limits and remained borderline for all the gait variables.

Conclusions

Distinctive patterns of functional recovery for three subgroups of ACLD subjects have been identified. Gait variables and activity level before injury were the most useful variables for distinguishing between the subgroups. If potential for recovery is identified early after injury, then appropriate treatment can be given.     

Use of the one-legged hyperextension test and magnetic resonance imaging in the diagnosis of active spondylolysis

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.     

Concussion management by primary care providers

Objective

To assess current concussion management practices of primary care providers.

Methods

An 11 item questionnaire was mailed to primary care providers in the state of Maine, with serial mailings to non‐respondents.

Results

Over 50% of the questionnaires were completed, with nearly 70% of primary care providers indicating that they routinely use published guidelines as a tool in managing patients with concussion. Nearly two thirds of providers were aware that neuropsychological tests could be used, but only 16% had access to such tests within a week of injury.

Conclusions

Primary care providers are using published concussion management guidelines with high frequency, but many are unable to access neuropsychological testing when it is required.     

Biochemical evidence of myocardial fibrosis in veteran endurance athletes

Background

Studies on exercise‐induced left ventricular hypertrophy (LVH) in veteran athletes suggest the presence of abnormal diastolic filling and incomplete regression of LVH on cessation of exercise.

Hypothesis

Myocardial fibrosis occurs in exercise induced LVH in veteran athletes.

Aim

To document non‐invasively the presence of fibrosis in veteran athletes

Design

Prospective case–control study.

Setting

City centre district general hospital.

Participants

45 normotensive elite veteran athletes and 45 normal sedentary subjects.

Interventions

Echocardiographic assessment was made of LV mass, LV systolic and LV diastolic function. Plasma carboxyterminal propeptide of collagen type I (PICP), carboxyterminal telopeptide of collagen type I (CITP) and tissue inhibitor of matrix metalloproteinase type I (TIMP‐1) were measured as markers of collagen synthesis, degradation and inhibition of degradation, respectively.

Results

Veteran athletes had significant elevation in LV dimensions and calculated LV mass index (LVMI). Diastolic and systolic function was normal. Plasma PICP (259 vs 166 μg/l, p<0.001), CITP (5.4 vs 2.9 μg/l, p<0.001) and TIMP‐1 (350 vs 253 ng/ml, p = 0.01) were elevated in the cohort of athletes. There was a further elevation of TIMP‐1 in athletes with echocardiographic LVH, defined as an LVMI >130 g/m² (417 vs 266 ng/ml, p = 0.02).

Conclusion

There is biochemical evidence of disruption of the collagen equilibrium favouring fibrosis in veteran athletes with LVH. This may suggest that fibrosis occurs as part of the hypertrophic process in veteran athletes.Chronic high‐intensity exercise results in structural cardiac changes in the human heart. Henschen¹ first described this at the end of the nineteenth century. The changes are characterised by an increase in left ventricular chamber dimensions and an increase in left ventricular wall thickness.² This is traditionally thought to be non‐pathological, as the hypertrophy regresses on cessation of exercise,^3,4 it is thought to consist mostly of myocyte hypertrophy, and Doppler indices of diastolic filling are on the whole within age‐matched limits.^5,6This situation may, however, be different in veteran athletes. The limited data available for this cohort suggest that diastolic function is abnormal, and, more importantly, that incomplete regression of LVH occurs on cessation of exercise.^7,8 Our hypothesis was that these findings could be explained by the presence of co‐existent fibrosis.Fibrosis occurring in the context of LVH has important pathological consequences,⁹ and therefore the demonstration of fibrosis present in exercise‐induced LVH would be a key finding in our understanding of the clinical significance and potential long‐term consequences of LVH.The biochemical assessment of fibrosis using collagen markers represents a practical, validated and non‐invasive method for the assessment of fibrosis in this cohort of veteran athletes. The clinical utility of this technique in the context of left ventricular hypertrophy has been demonstrated by our group,¹⁰ and also, most notably, by Diez et al.^11,12,13The aim of this study was to show, using biochemical markers, the presence of fibrosis in exercise‐induced LVH in a cohort of veteran athletes.     

Effect of aging on the stride pattern of veteran marathon runners

Objective

To investigate the stride pattern of different age groups of veteran runners in a marathon road race.

Methods

This kinematic study investigated the stride pattern (stride length, stride period, velocity, stance time, and non‐stance time) for 151 runners (78 men aged up to 75–80, 73 women aged up to 60–64) at the 7 mile point.

Results

Significant declines for men with aging were found for mean stride length (from 2.4 m at age 40–49 to 2.0 m at age 60+), velocity, and non‐stance time (p<0.05), whereas stride period changed little. The findings indicate that the lower velocities of older runners are associated with shorter strides whereas cadence changes little. However, when a statistical adjustment was made for the variation in runners'' velocity, it was found that older runners did not have a significantly shorter stride length at any given velocity.

Conclusion

Although a shorter stride is the mechanical route by which older runners lose velocity, the shorter stride may not be the fundamental cause of the velocity reduction with age. This has implications for researchers and coaches when investigating and training veteran distance runners.     

Movement discrimination after intra-articular local anaesthetic of the ankle joint

Background

The effect on clinical safety of dampening articular mechanoreceptor feedback at the ankle is unknown. Injection of the ankle joint for pain control may result in such dampening. Athletes receiving intra‐articular local anaesthetic may therefore be at increased risk of sustaining ankle injuries, which are a common reason for missed sporting participation.

Objective

To determine the effect of intra‐articular local anaesthetic on movement discrimination at the ankle joint.

Design

Prospective, randomised, double‐blinded, placebo‐controlled, cross‐over trial.

Setting

Australian Institute of Sport Medical Centre, Canberra, Australia.

Patients

Twenty two healthy subjects (44 ankles) aged 18–26 were recruited for the three visits of the study.

Interventions

Subjects were tested for their initial movement discrimination scores using the active movement extent discrimination apparatus (AMEDA). They then received ultrasound‐guided intra‐articular injections of local anaesthetic (2% lignocaine hydrochloride) or normal saline, on two separate later occasions, before further AMEDA assessment.

Main outcome measures

Change in movement discrimination scores after intra‐articular injection of local anaesthetic or saline.

Results

Movement discrimination scores were not significantly different from control ankles after injection of either local anaesthetic or saline into the ankle joint.

Conclusions

The intra‐articular injection of neither 2 ml lignocaine nor an equivalent amount of normal saline resulted in significant effects on movement discrimination at the ankle joint. These results suggest that injections of local anaesthetic into the ankle joint are unlikely to significantly affect proprioception and thereby increase injury risk.     

Stress injury of the lunate in tennis players: a case series and related biomechanical considerations

Objective

To investigate clinical and imaging differential diagnosis and tennis stroke biomechanics potentially involved in lunate stress injury pathogenesis.

Methods

The present report describes five competitive tennis players with overuse‐related dorsal wrist pain assessed by magnetic resonance imaging.

Results

Magnetic resonance imaging revealed the presence of lunate stress injury. All players were treated conservatively, with symptom resolution and complete functional recovery achieved at 14 weeks.

Conclusions

Lunate stress injuries should be considered in the differential diagnosis of overuse‐related dorsal wrist pain in tennis players.Wrist injuries are common among tennis players. They have been reported as the cause of 12.6% of on‐site withdrawals from the professional men''s circuit,¹ and the wrist is also the upper limb joint most often affected during Grand Slam tournaments.² In tennis players in general, most wrist injuries occur due to chronic overuse.³Players often complain of dorsal wrist pain, which can in turn disrupt training and competition. The present report describes five cases of overuse‐related dorsal wrist pain in tennis players, in whom MRI imaging studies revealed the presence of a lunate stress injury. To the best of our knowledge, this entity has not been previously analysed. Differential diagnoses and tennis stroke biomechanics potentially involved in lunate stress injuries pathogenesis are also discussed.     

The big finger: the second to fourth digit ratio is a predictor of sporting ability in women

Background

The second to fourth finger length ratio (2d:4d) is thought to be related to diverse traits including cognitive ability, disease susceptibility, and sexuality.

Objective

To examine the relationship between 2d:4d and sports ability in women.

Methods

Hand radiographs from 607 women (mean age 54 years) were used to estimate 2d:4d. Ranking of sports ability was on a scale (1–5).

Results

The highest achieved level of participation in any sport was significantly negatively associated with 2d:4d (b  =  −4.93, p  =  0.01) as was the relationship between 2d:4d and running level (b  =  −6.81, p  =  0.034). Ability in other sports also showed a negative relationship albeit non‐significant.

Conclusions

These results suggest that a low 2d:4d ratio is related to increased female sports ability. It can be postulated that this ratio may predict potential sports ability. Understanding the mechanisms underpinning this relationship may give important insights into musculoskeletal fitness, health and disease.     

Another fractured neck of femur: do we need a lateral X-ray?

Objective

This study aimed to define the role of the lateral X-ray in the assessment and treatment planning of proximal femoral fractures. Occult fractures were not included.

Methods

Radiographs from 359 consecutive patients with proximal femoral fractures admitted to our emergency department over a 12 month period were divided into anteroposterior (AP) views and lateral views. Three blinded reviewers independently assessed the radiographs, first AP views alone then AP plus lateral views, noting the fracture classification for each radiograph. These assessments were then compared with the intra-operative diagnosis, which was used as the gold standard. A 2 × 2 contingency square table was created and Pearson''s χ² test was used for statistical analysis.

Results

The rate of correct classification by the reviewers was improved by the assessment of the lateral X-ray in addition to the AP view for intracapsular fractures (p<0.013) but not for extracapsular fractures (p=0.27). However, the only advantage obtained by assessing the lateral view in intracapsular fractures was the detection of displacement where the fracture appeared undisplaced on the initial AP view.

Conclusion

This study provides statistical evidence that one view is adequate and safe for the majority of hip fractures. The lateral radiograph should not be performed routinely in order to make considerable savings in money and time and to avoid unnecessary patient discomfort.Proximal femoral fractures form a major part of the trauma workload of a trauma and orthopaedic department [1]. Different hospitals have varying protocols for the initial radiographs taken in the emergency department. In most institutes, it is standard practice for every patient with a suspected proximal femur fracture to have hip radiographs providing both anteroposterior (AP) and lateral views [2]. The lateral view requires movement of the contralateral leg into a flexed and abducted position, which indirectly may cause movement at the fracture site.The correct positional diagnosis of proximal femoral fractures is vital to the selection of the implant with the best biomechanical and clinical profile for that fracture pattern.With the advent of “fast-tracking” systems [3,4], many patients may not be seen by an orthopaedic doctor until after transfer to a ward. This can make further imaging of the hip logistically difficult, and consequently any subsequent management decisions are often based on the views that are already available. Therefore, an important balance must be maintained between obtaining adequate radiographs to ensure that the correct diagnosis is made, and hence that the appropriate procedure is planned and carried out, and avoiding subjecting patients to unnecessary radiation and discomfort.The overall aim of this study was to assess whether there is a need for routine lateral hip radiographs of proximal femoral fractures and to examine the extent of their role in diagnosing the fractures type and in their subsequent management.     

Ultrasound guided dry needling and autologous blood injection for patellar tendinosis

Objective

To evaluate the efficacy of ultrasound guided dry needling and autologous blood injection for the treatment of patellar tendinosis.

Design

Prospective cohort study.

Setting

Hospital/clinic based.

Patients

47 knees in 44 patients (40 men, 7 women, mean age 34.5 years, age range 17 to 54 years) with refractory tendinosis underwent sonographic examination of the patellar tendon following referral with a clinical diagnosis of patellar tendinosis (mean symptom duration 12.9 months).

Interventions

Ultrasound guided dry needling and injection of autologous blood into the site of patellar tendinosis was performed on two occasions four weeks apart.

Main outcome measures

Pre‐ and post‐procedure Victorian Institute of Sport Assessment scores (VISA) were collected to assess patient response to treatment. Follow up ultrasound examination was done in 21 patients (22 knees).

Results

Therapeutic intervention led to a significant improvement in VISA score: mean pre‐procedure score = 39.8 (range 8 to 72) v mean post procedure score = 74.3 (range 29 to 100), p<0.001; mean follow up 14.8 months (range 6 to 22 months). Patients were able to return to their sporting interests. Follow up sonographic assessment showed a reduction in overall tendon thickness and in the size of the area of tendinosis (hypoechoic/anechoic areas within the proximal patellar tendon). A reduction was identified in interstitial tears within the tendon substance. Neovascularity did not reduce significantly or even increased.

Conclusions

Dry needling and autologous blood injection under ultrasound guidance shows promise as a treatment for patients with patellar tendinosis.     

Influence of vibration on delayed onset of muscle soreness following eccentric exercise

Delayed onset muscle soreness (DOMS), which may occur after eccentric exercise, may cause some reduction in ability in sport activities. For this reason, several studies have been designed on preventing and controlling DOMS. As vibration training (VT) may improve muscle performance, we designed this study to investigate the effect of VT on controlling and preventing DOMS after eccentric exercise.

Methods

Fifty healthy non‐athletic volunteers were assigned randomly into two experimental, VT (n = 25) and non‐VT (n = 25) groups. A vibrator was used to apply 50 Hz vibration on the left and right quadriceps, hamstring and calf muscles for 1 min in the VT group, while no vibration was applied in the non‐VT group. Then, both groups walked downhill on a 10° declined treadmill at a speed of 4 km/hour. The measurements included the isometric maximum voluntary contraction force (IMVC) of left and right quadriceps muscles, pressure pain threshold (PPT) 5, 10 and 15 cm above the patella and mid‐line of the calf muscles of both lower limbs before and the day after treadmill walking. After 24 hours, the serum levels of creatine‐kinase (CK), and DOMS level by visual analogue scale were measured.

Results

The results showed decreased IMVC force (P = 0.006), reduced PPT (P = 0.0001) and significantly increased mean of DOMS and CK levels in the non‐VT group, compared to the VT group (P = 0.001).

Conclusion

A comparison by experimental groups indicates that VT before eccentric exercise may prevent and control DOMS. Further studies should be undertaken to ascertain the stability and effectiveness of VT in athletics.