Les ruptures du tendon du muscle tibial antérieur

In sports medicine, tears of the tibialis anterior are exceptional. We describe our experience with one case. Two types of injury can be observed: true tears involving the main body of the muscle under the pulley or the more distal portion at the insertion and fissurations. These injuries usually occur in a context of longstanding tenosynovitis or tendinopathy and are generally observed in runners. The mechanism requires stretching with the foot in forced plantar flexion and external rotation (fall backward with forefoot blocked). The diagnosis is clinical. Complementary explorations, excepting plain X-rays to search for a distal detachment from the bone, are not indispensable. In sports medicine, surgical treatment is required for full thickness tears. A plasty is usually performed with the third toe extensor. Recovery is long and progressive. In our experience, corticosteroid injections do not provoke these tears but can be useful for more rapid recovery in the athlete. After an injection, we immobilize the ankle for three weeks in a walking cast in order to “limit” the motivated athlete.     

Möglichkeiten und Grenzen der Manualmedizin im Sport

Manual medicine techniques are thought to have positive effects in treating athletes. Most of the users believe that they can reduce rehabilitation time after sports injuries, can reduce sports related injuries, and can cause improvements in athlete’s sports performance. This mention is based on neurophysiologic models, suggesting that restricted joint motion can cause abnormal mechanics and reflex muscular incoordination which in turn could result in a higher risk of injuries and reduced performance. Positive effects of manual medicine are evident in the rehabilitation of sports injuries. Referring to the prophylaxis of sports injuries and sport performance enhancement, there are only a small number of studies with inconsistent results. Therefore, no definitive answer can yet be postulated as to whether manual medicine techniques have an appreciable effect in this area and additional research is clearly warranted.     

Muscle soléaire accessoire. À propos d'un cas et revue de la littérature

The soleus accessory muscle is an anatomical congenital variation, responsible for a soft tissue mass posteromedial to the ankle that can be source of a functional disorder while physical activity. Differents hypothesis have been proposed to explain the physiopathology of the clinical picture. Magnetic resonance imaging is the most accurate investigation to establish the diagnosis. In case of an important functional limitation, especially in athletes, surgical excision is necessary. In the following we present the case of a 15 years old athlete and a review of the literature concerning this pathological entity.     

Intérêt des infiltrations du « mur méniscal » par les corticoïdes dans les douleurs méniscales du genou. À propos de 214 cas

Femorotibial pain is a common manifestation of meniscal injury or microtrauma. In this situation, meniscectomy does not appear to accelerate joint degeneration. Meniscal wall steroid injections have been proposed for consenting patients suffering from degenerative or post-traumatic meniscal pain. The technique consists in injecting corticosteroids into a juxtameniscal zone after identification of the painful area by palpation of the joint space and radiographically. We conducted two non comparative studies: a first retrospective analysis of 178 patients aged 44 years on average and a second prospective series of 36 patients aged 39 years on average who were treated with one to three injections for meniscal pain. The main outcome assessment combined pain relief and return to prior activities at 60/90 days. Results were favorable in the retrospective series: 106 responders versus 46 non-responders (26 lost to follow-up) and also for the prospective series: 28 responders versus six non-responders (two lost to follow-up). Neither series yielded a clinical or radiographic finding predictive of outcome. The pattern of a “good” responder to treatment could not be identified. It was noted, however, that meniscal pain associated with a blocked knee appeared to be a poor indication for corticosteroid injections and that injections of hyaluronic acid should be associated in cases with cartilage damage. Meniscal wall injections thus appear to be a new perspective for the medical treatment of meniscal pain. Comparative studies versus arthroscopy will be needed to determine the role of this method in our therapeutic armamentarium.     

Adaptation de la force isocinétique des muscles rotateurs de l’épaule à la pratique sportive

Physiological, anatomy and biomechanical adaptations of the shoulder joint to the stresses induced by the throwing gesture, which allow performance, could be the cause of “desadaptation” that can lead to injury by microtrauma. Thus, exploration of any adaptations or changes in internal (IR) and external (ER) muscle strength (and/or agonist/antagonist balance represented by the ratio ER/IR) to solicitations sports is relevant in order to better understand the pathophysiology of shoulder injury. Many studies have focused on identifying patterns of IR and ER muscle strength according to the practice of overhead sports. Despite the methodological limitations, although an increase in the IR strength of the dominant side was reported, it does not seem to exist an “imbalance” in muscle strength between the IR and ER, induced by overhead sports, which could be a “desadaptaion” in the origin of shoulder pathologies. There is no imbalance that could be implicated as a risk factor predisposing to shoulder pathologies.     

Lésions musculo-aponévrotiques et tendineuses. Classification–explorations radiologiques

The aim of this paper is to remind the classifications of sport-related myofascial and myotendinous lesions and to discuss the place of medical imaging (MRI and sonography). Muscular lesions are divided in extrinsic and intrinsic ones, whether they result from a direct impact or a brutal contraction or extension. O'Donoghue classification evaluates injury severity. Myofascial lesions may be peri-muscular, inter-muscular or intra-muscular. In tendinous lesions, we distinguish tendinosis, longitudinal intra-tendinous tears, partial and full-thickness tears. They occur from several origins: overuse tendinopathy, brutal pulling, direct impact, paratendinopathy by repetitive frictions or snapping. Medical imaging provides differential and positive diagnosis as well as injury severity, allowing evaluation of sports intermission. It allows evaluation of healing (doppler sonography and post-Gadolinium MR imaging). Doppler sonography performed by musculoskeletal radiologists has become more and more efficient and sufficient in a lot of cases. MR imaging is used in first or second intent, especially in professional sports and in serious conditions. It remains more accurate in small acute lesions, and in complex lesions, which are not rare in sport-related injuries.     

Les lésions de la jonction myotendineuse du psoas-iliaque en traumatologie du sport

The psoas muscle, the main flexor of the hip joint, is highly solicited in sports activities. Sports injuries are however rarely encountered and described. We report a retrospective series of 33 cases of psoas musculotendinous tears at the point where the muscle changes direction over the iliopectineal eminence. History taking is essential to identify anterior hip pain with rapid or progressive onset. The physical examination searches for pain at hip flexion against resistance, observed in 78% of our cases, and a less sensitive sign, pain at muscle stretching. The morphology should be explored with ultrasound, which is highly contributive in the acute phase. MRI can provide complementary information if the injury is older or recurrent. If there is doubt about the diagnosis, the examination should be able to rule out other hypotheses: traumatic injury to the lower tendons, associated or not with bone detachment, abscess formation, or the more widely encountered psoas hematoma. Early management should focus on puncture aspiration of a hematoma associated with selective rest then rehabilitation over 4 to 6 weeks. Chronic and recurrent injuries may require local injections. An analysis of the sports movement should enable a specific management for each sport.     

Are Diagnostic Lumbar Facet Injections Influenced by Pain of Muscular Origin?

Introduction: Nonradicular low back pain can be a difficult entity to accurately diagnose and treat. Facet joints, muscle, ligaments, and fascia have all been reported to be etiologies of acute and chronic low back pain. However, the facet joint as a source of low back pain is controversial. The diagnosis of facet joint pain is made by diagnostic facet joint or median nerve branch injections with a local anesthetic. The purpose of this study was to determine if the results of diagnostic facet joint injections are influenced by the technique used to perform these injections. Methods: Seventy‐five male patients aged 45 years or younger and 18 years or older who were injured while performing heavy work with nonradicular low back pain were included in this study. Diagnostic injection therapy was performed following Institutional Review Board approval and the patient's informed consent. Patients were assigned to one of five groups to receive diagnostic injections in a double‐blinded fashion as follows: Group I: facet joint injection with continuous lidocaine administration from the skin to the facet joint as the needle was advanced; Group II: facet joint injection with saline administration from the skin to the facet joint as the needle was advanced; Group III: median nerve branch injection with a lidocaine advancing needle technique; Group IV: median nerve branch injection with saline advancing needle technique; and Group V: injection of the paraspinous muscles with local anesthetic and steroid following noted areas of pain diagnosed with saline injection and radiopaque contrast. After one week, the patients in Groups I to IV who had no pain relief with facet joint or median nerve block injections subsequently received paraspinous muscle injections, while the patients in Group V who had no long‐term relief with muscle injections were given facet joint injections. The appropriate parametric and nonparametric tests were performed with statistical significance defined as P ≤ 0.05. Results: There were no differences among the groups demographically. The incidence of pain relief was significantly higher in subjects who had a continuous injection of local anesthetic into their musculature than in those individuals who received continuous saline followed by an injection of local anesthetic into their facet joint or median nerve branch. Discussion: The results of this study demonstrated that local anesthetic injections are useful for the diagnosis of nonradicular low back pain but may yield false positive results with respect to lumbar facet pain depending upon the technique utilized.     

Rugby à XV,sport de combat,rachis lombaire et croissance. Réflexion sur croissance,sport précoce de haut niveau et atteintes rachidiennes lombaires précoces

We conducted a retrospective analysis of the lumbar spine in young rugby players. The series included 62 young players enrolled in high-level training programs and 33 players in a training school. The medial files of these players showed a significant number with lumbar spine lesions, 42% and 85% respectively. We propose here an anatomic analysis focusing on temporary mechanical incompetence of the lumbar segment during periods of rapid growth. Based on data in the literature, we show that when practised intensively by young athletes, sports such as rugby implying spinal stress have a traumatic effect on the lumbar vertebro-discal system with subsequent deleterious mid-term effects. In our opinion, this problem should be examined closely for categories aged under 15 years so that the conditions of sports’ practice can be adapted using modern high-performance diagnostic methods to enable harmonious growth and avoid early disc and spine degeneration. The lesions we discovered started earlier to be visible in the current study and will evolve later. All were not symptomatic. This spinal involvement may not have a deleterious effect until a few years later. The risk is to compromise later participation in high-level professional sports. Undeniably, if complementary studies confirm these early findings, sports’ practice in growing youth will have to be adapted.     

Sonographically Guided Posteromedial Approach for Intra‐articular Knee Injections

Osteoarthritis of the knee can be a debilitating and extremely painful condition. In patients who desire to postpone knee arthroplasty or in those who are not surgical candidates, percutaneous knee injection therapies have the potential to reduce pain and swelling, maintain joint mobility, and minimize disability. Published studies cite poor accuracy of intra‐articular knee joint injections without imaging guidance. We present a sonographically guided posteromedial approach to intra‐articular knee joint injections with 100% accuracy and no complications in a consecutive series of 67 patients undergoing subsequent computed tomographic or magnetic resonance arthrography. Although many other standard approaches are available, a posteromedial intra‐articular technique is particularly useful in patients with a large body habitus and theoretically allows for simultaneous aspiration of Baker cysts with a single sterile preparation and without changing the patient's position. The posteromedial technique described in this paper is not compared or deemed superior to other standard approaches but, rather, is presented as a potentially safe and efficient alternative.     

Revue de la littérature des différentes techniques de réduction de la luxation glénohumérale antéro-interne,employées de l’Antiquité à nos jours

The glenohumeral joint is the most mobile articulation of the human body. Its anatomy makes it particularly vulnerable. Anteromedial dislocation is a very common traumatic event. Since antiquity, many methods for reduction have been described, all are far from obsolete. Many can still be used today. Is there an ideal method?     

Athletes returning to play after cervical spine or neurobrachial injury

The treatment algorithms for athletes with spine injuries follow similar guidelines as those for non-athletes in terms of deciding between surgical intervention and non-operative management. However, the athlete has unique postoperative demands and the decision to “allow” an athlete to return to competitive sports after a spinal or plexus injury can be difficult. This article reviews the several studies, available guidelines and peer-reviewed publications to aid in the decisions to allow athletes to return to sports. A set of recommendations concerning return to play after a spinal injury is provided.     

Image Guidance Technologies for Interventional Pain Procedures: Ultrasound,Fluoroscopy, and CT

Chronic pain is a common medical condition. Patients who suffer uncontrolled chronic pain may require interventions including spinal injections and various nerve blocks. Interventional procedures have evolved and improved over time since epidural injection was first introduced for low back pain and sciatica in 1901. One of the major contributors in the improvement of these interventions is the advancement of imaging guidance technologies. The utilization of image guidance has dramatically improved the accuracy and safety of these interventions. The first image guidance technology adopted by pain specialists was fluoroscopy. This was followed by CT and ultrasound. Fluoroscopy can be used to visualize bony structures of the spine. It is still the most commonly used guidance technology in spinal injections. In the recent years, ultrasound guidance has been increasingly adopted by interventionists to perform various injections. Because its ability to visualize soft tissue, vessels, and nerves, this guidance technology appears to be a better option than fluoroscopy for interventions including SGB and celiac plexus blocks, when visualization of the vessels may prevent intravascular injection. The current evidence indicates the efficacies of these interventions are similar between ultrasound guidance and fluoroscopy guidance for SGB and celiac plexus blocks. For facet injections and interlaminar epidural steroid injections, it is important to visualize bony structures in order to perform these procedures accurately and safely. It is worth noting that facet joint injections can be done under ultrasound guidance with equivalent efficacy to fluoroscopic guidance. However, obese patients may present challenge for ultrasound guidance due to its poor visualization of deep anatomical structures. Regarding transforaminal epidural steroid injections, there are limited evidence to support that ultrasound guidance technology has equivalent efficacy and less complications comparing to fluoroscopy. However, further studies are required to prove the efficacy of ultrasound-guided transforaminal epidural injections. SI joint is unique due to its multiplanar orientation, irregular joint gap, partial ankylosis, and thick dorsal and interosseous ligament. Therefore, it can be difficult to access the joint space with fluoroscopic guidance and ultrasound guidance. CT scan, with its cross-sectional images, can identify posterior joint gap, is most likely the best guidance technology for this intervention. Intercostal nerves lie in the subcostal grove close to the plural space. Significant risk of pneumothorax is associated with intercostal blocks. Ultrasound can provide visualization of ribs and pleura. Therefore, it may improve the accuracy of the injection and reduce the risk of pneumothorax. At present time, most pain specialists are familiar with fluoroscopic guidance techniques, and fluoroscopic machines are readily available in the pain clinics. In the contrast, CT guidance can only be performed in specially equipped facilities. Ultrasound machine is generally portable and inexpensive in comparison to CT scanner and fluoroscopic machine. As pain specialists continue to improve their patient care, ultrasound and CT guidance will undoubtedly be incorporated more into the pain management practice. This review is based on a paucity of clinical evidence to compare these guidance technologies; clearly, more clinical studies is needed to further elucidate the pro and cons of each guidance method for various pain management interventions.     

Amateur Sports and The Family Physician

The practice of sports medicine differs little from regular family practice as far as ongoing care and support of the individual athlete is concerned. If we are looking for a sports medicine specialist, the one readiest for this role is the family physician. He should be prepared to influence communities and governments to provide recreation programs which have regard for the individual's health and enjoyment, not simply competition. Various ways in which the family physician can make sports participation more enjoyable and less stressful are suggested.     

Diagnostic and therapeutic injection of the shoulder region

The shoulder is the site of multiple injuries and inflammatory conditions that lend themselves to diagnostic and therapeutic injection. Joint injection should be considered after other therapeutic interventions such as nonsteroidal anti-inflammatory drugs, physical therapy, and activity-modification have been tried. Indications for glenohumeral joint injection include osteoarthritis, adhesive capsulitis, and rheumatoid arthritis. For the acromioclavicular joint, injection may be used for diagnosis and treatment of osteoarthritis and distal clavicular osteolysis. Subacromial injections are useful for a range of conditions including adhesive capsulitis, subdeltoid bursitis, impingement syndrome, and rotator cuff tendinosis. Scapulothoracic injections are reserved for inflammation of the involved bursa. Persistent pain related to inflammatory conditions of the long head of the biceps responds well to injection in the region. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.     

Triathlon

From its roots in San Diego to its Olympic debut in Sydney in 2000, triathlon has emerged as a popular sport with a wide variety of participants. Because of the nature of the sport, excessive training resulting in overuse injuries is common. Triathlon injuries can also be unique from the individual sports involved in that they are attributed to a cumulative effect of multi-sport training. Because many triathletes have not grown up participating in the individual sports, biomechanics in each of the disciplines must also be considered as a source of injury. Nutrition and environmental factors and the role that they play in the endurance athlete should also not be overlooked. The sport of triathlon is rapidly growing, and the ability to recognize the unique aspects of these injuries can help the multisport athlete to train properly and be healthier and more successful.     

Relevanz von Nervenblockaden bei der Diagnose und Therapie von Rückenschmerzen

Diagnostic nerve blocks: The popularity of neural blockade as a diagnostic tool in painful conditions, especially in the spine, is due to features like the unspecific character of spinal pain, the irrelevance of radiological findings and the purely subjective character of pain. It is said that apart from specific causes of pain and clear radicular involvement with obvious neurological deficits and corresponding findings of a prolapsed disc in MRI or CT pictures, a diagnosis of the anatomical cause of the pain can only be established if invasive tests are used [5]. These include zygapophyseal joint blocks, sacroiliacal joint blocks, disc stimulation and nerve root blocks. Under controlled conditions, it has been shown that among patients with chronic nonradicular low back pain, some 10-15% have zygapophyseal joint pain [58], some 15-20% have sacroiliacal joint pain [36, 59] and 40% have pain from internal disc disruption [60]. The diagnostic use of neural blockade rests on three premises. First, pathology causing pain is located in an exact peripheral location, and impulses from this site travel via a unique and consistent neural root. Second, injection of local aneasthetic totally abolishes sensory function of intended nerves and does not affect other nerves. Third, relief of pain after local anaesthetic block is attributable solely to block of the target afferent neural pathway. The validity of these assumptions is limited by complexities of anatomy, physiology, and psychology of pain perception and the effect of local anaesthetics on impulse conduction [28]. Facet joints: The prevalence of zygapophyseal joint pain among patients with low back pain seems to be between 15% and 40% [62], but apparently only 7% of patients have pure facet pain [8, 29]. Facet blockade is achieved either by injection of local anaesthetic into the joint space or around the medial branches of the posterior medial rami of the spinal nerves that innervate the joint. There are several problems with intraarticular facet injections, mainly failure to enter the joint capsule and rupture of the capsule during the injection [11]. There is no physiological means to test the adaequacy of medial nerve block, because the lower branches have no cutaneous innervation. Medial ramus blocks (for one joint two nerves have to be infiltrated) are as effective as intraarticular joint blocks [37]. Reproducibility of the test is not high, the specifity is only 65% [61]. For diagnosis of facet pain fluoroscopic control is always necessary as in the other diagnostic blocks. Sacroiliacal joint: Definitely the sacroiliacal joint can be the source of low back pain. Stimulation of the joint by injection in subjects without pain produces pain in the buttock, in the posterior thigh and the knee. There are many clinical tests which confirm the diagnosis, but the interrater reliability is moderate [53]. Intraarticular injection can be achieved in the lower part of the joint with fluoroscopic guidance only, but an accurate intraarticular injection, which is confirmed by contrast medium, even at this place is often difficult. It is not clear whether intraarticular spread is necessary to achieve efficacy. Discography: Two primary syndromes concerning the ventral compartment have been described: anular fissures of the disc and instability of the motion segment. In the syndrome of anular tear, leakage of nucleus pulposus material into the anulus fibrosus is considered to be the source of pain. The studies of Vaharanta [71] and Moneta [41] show a clear and significant correlation between disc pain and grade 3 fissures of the anulus fibrosus. intervertebral discs are difficult to anaesthetize. Intradiskal injections of local anaesthetics may succeed in relieving the patient's pain, but such injections are liable to yield false negative results if the injected agent fails to adequately infiltrate the nerve endings in the outer anulus fibrosus that mediate the patient's pain. In the majority of cases MRI provide adaequate information, but discography may be superior in early stages of anular tear and in clarifying the relation between imaging data and pain [71]. Selective spinal nerve injection: In patients with complicated radiculopathy, the contribution of root inflammation to pain may not be certain, or the level of pathology may be unclear. Diagnostic root blocks are indicated in the following situations: atypical topography of radicular pain, disc prolapses or central spinal stenosis at more than one level and monoradicular pain, lateral spinal stenosis, postnucleotomysyndrome. Injection of individual spinal nerves by paravertebral approach has to be used to elucidate the mechanism and source of pain in this unclear situations. The premise is that needle contact will identify the nerve that produces the patient's characteristic pain and that local anaesthetic delivered to the pathogenic nerve will be uniquely analgesic. Often, this method is used for surgical planning, such as determining the site of foraminotomy. All diagnostic nerve root blocks have to be done under fluoroscopic guidance. Pain relief with blockade of a spinal nerve cannot distinguish between pathology of the proximal nerve in the intervertebral foramen or pain transmitted from distal sites by that nerve. Besides, the tissue injury in the nerve's distribution and neuropathic pain (for instance as a result of root injury) likewise would be relieved by a proximal block of the nerve. Satisfactory needle placement could not be achieved in 10% of patient's at L4, 15% at L5 and 30% at S1 [28]. The positive predictive value of indicated radiculopathy confirmed by surgery ranged between 87-100% [14, 22]. The negative predictive value is poorly studied, because few patients in the negative test group had surgery. Negative predictive values were 27% and 38% of the small number of patients operated on despite a negative test. Only one prospective study was published, which showed a positive predictive value of 95% and an untested negative predictive value [66]. Some studies repeatedly demonstrated that pain relief by nerve root block does not predict success by neuroablative procedures, neither by dorsal rhyzotomy nor by dorsal gangliectomy [46]. Therapeutic nerve blocks - facet joints: Intraarticular injection of steroids offer no greater benefit than injections of normal saline [8, 15] and long lasting success is lacking. In this case, a denervation of the medial branches can be considered. To date three randomized controlled studies of radiofrequency facet denervation have been published. One study [20] reported only modest outcomes and its results remained inconclusive, another study [72] with a double blind controlled design showed some effects in a small selected group of patients (adjusted odds ratio 4.8) 3, 6 and 12 months after treatment, concerning not only reduction of pain but alleviating functional disability also. The third study (34a) showed no effect 3 months after treatment. Discogenic pain: Intradiscal radiofrequency lesions, intradiscal injections of steroids and phenol have been advocated, but there are no well controlled studies. Just recently, intradiscal lesion and denervation of the anulus has been described with promising results, but a randomized controlled study is lacking up to now [31, 55]. Epidural Steroids: Steroids relieve pain by reducing inflammation and by blocking transmission of nociceptive C-fiber input. Koes et al. [33] reviewed the randomized trials of epidural steroids: To date, 15 trials have been performed to evaluate the efficacy, 11 of which showed method scores of 50 points (from 100) ore more. The trials showed inconsistent results of epidural injections. Of the 15 trials, 8 reported positive results and 7 others reported negative results. Consequently the efficacy of epidural steroid injections has not yet been established. The benefits of epidural steroid injections seem to be of short duration only. Future efficacy studies, which are clearly needed, should take into account the apparent methological shortcomings. Furthermore, it is unclear which patients benefit from these injections. In our hands the injection technique can be much improved by fluoroscopic guidance of the needle, with a prone position of the patient, and lateral injection at the relevant level and with a small volume (1-2 ml) and low dose of corticosteroid (20 mg triamcinolone in the case of a monoradicular pain, for example). In the case of epidural adhesions in postoperative radicular pain [50], the study of Heafner showed that the additional effect of hyaloronidase and hypertonic saline to steroids was minimal. In our hands there was no effect in chronic radicular pain 3 months after the injection.     

Musculoskeletal US: examining the joints

Musculoskeletal ultrasound (US) is an excellent tool to diagnose muscle, tendon and ligament injuries, cystic structures and peripheral nerve compression, as well as soft tissue masses, without the risk of ionizing radiation. Musculoskeletal US is now routinely used by a growing number of rheumatology and sports medicine centres throughout UK. In standard clinical practice, US has an extremely useful application in differentiating fluid from soft tissue and identifying the severity of joint inflammation. The work described in this article was carried out to assess patients' feedback regarding the use of US guidance for intra-articular injections and/or the removal of fluid from their inflamed knee joints in a nurse-led clinic. Nineteen patients who had US-guided knee joint injection/aspiration in the clinic were asked to complete a questionnaire regarding their satisfaction with the procedure, and to rate their joint pain and patient global assessment (using numerical visual analogue scale) before the US-guided procedure, and 1 month after. Results revealed a significant improvement (p<0.001) of the joint injection outcome measures and the patients' satisfaction of the US-guided procedure. Therefore, musculoskeletal US can improve two fundamental clinical skills: the clinical diagnosis of joint inflammation, and the accuracy of joint injection/aspiration. This study supports the concept that incorporating musculoskeletal US into clinical practice leads to significant improvements in patient care. It also reveals that US-guided procedures are appreciated by patients.     

Strength training recommendations for the young athlete

In recent years there has been a significant increase in the number of youth participating in organized and competitive sports. Recent studies have supported the participation of preadolescent athletes in strength training to improve health and performance in sports. This article presents the most recent data available to help youth develop a safe and effective strength training program. Variables, such as the recommended rate of progression, the number of sets and repetitions an athlete should perform on each exercise, and how often an athlete needs to workout to avoid loss of strength achieved during a period of strength training are presented.