Expert opinion and controversies in sports and musculoskeletal medicine: the diagnosis and treatment of spondylolysis in adolescent athletes

Standaert CJ, Herring SA. Expert opinion and controversies in sports and musculoskeletal medicine: the diagnosis and treatment of spondylolysis in adolescent athletes.Although spondylolysis is relatively common in adolescent athletes, there are substantial disagreements in the literature concerning the best methods for diagnosing and treating the condition. Controversy particularly arises regarding the optimal use of available imaging modalities in the diagnosis of athletes with suspected pars defects and the extent of activity restriction or brace use required for appropriate treatment. Because there have been no controlled trials on the treatment of spondylolysis and only a very limited number of studies addressing potential imaging strategies, it is difficult to develop true evidence-based guidelines for this condition. Given the current state of the literature, it is our impression that nuclear imaging with single photon emission computed tomography followed by computed tomography, with a limited role for plain radiography, remains the standard for appropriately diagnosing a symptomatic pars lesion. Treatment hinges on activity restriction for an amount of time adequate to allow for symptom resolution and, when possible, potential bony healing followed by a progressive sport-specific rehabilitation program. The biomechanic effects of brace use in this population are not well understood, but there may be some detrimental effects to the use of a brace and there currently is no evidence that the routine use of a rigid brace results in any significant improvement in radiographic or functional outcome.     

Expert opinion and controversies in musculoskeletal and sports medicine: core stabilization as a treatment for low back pain

Standaert CJ, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: core stabilization as a treatment for low back pain.Although there are a wide variety of therapeutic exercises that have been proposed as treatments for low back pain (LBP), the last 20 years have seen the development of a substantial focus on the use of exercises that are intended to address intersegmental stability in the lumbar spine. These exercise programs are varyingly referred to as lumbar stabilization, segmental stabilization, or core stabilization, among other terms, and are aimed at improving the neuromuscular control, strength, and endurance of a number of muscles in the trunk and pelvic floor that are believed to play important roles in the dynamic stability of the spine. Although it is difficult to quantify, there appears to have been a tremendous degree of penetration of these treatment concepts into the therapeutic arena, the medical literature, and the lay press. Despite this, there are few prospective studies on patients with LBP, and there is even more limited discussion of the concepts of patient selection, dose-response, and long-term outcome associated with these approaches. There also is a significant lack of uniformity regarding the meaning of “core stabilization” and what therapeutic exercises may be most effective.     

枕叶皮质MR频谱对脑震荡的应用价值

目的用绝对定量对脑震荡患者进行枕叶皮质质子MR频谱(1H-MRS)研究,探讨脑震荡后脑代谢物的变化。材料与方法对轻度脑外伤,符合脑震荡临床诊断的36例患者进行研究,10名正常志愿者作为对照组,行常规MRI平扫及1H-MRS检查。主要观察的代谢物指标为N-乙酰天冬氨酸(NAA)、胆碱(Cho)、肌酸(Cr)等,采用LCModel软件进行代谢物绝对浓度定量,获取NAA、Cr、Cho浓度,以及NAA/Cr、Cho/Cr比值。结果与对照组对比,脑震荡组NAA浓度、NAA/Cr降低,差异有统计学意义(P<0.05),Cho浓度和Cho/Cr比值略升高,无统计学意义。结论 1H-MRS能够反映脑震荡患者损伤后脑代谢物的变化。     

Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Preventing Sudden Cardiac Death in Young Athletes

Rao AL, Standaert CJ, Drezner JA, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: preventing sudden cardiac death in young athletes.Sudden cardiac death in young athletes has become a highly visible public health concern. Over the past 2 decades, unexplained or premature deaths of numerous athletes at the youth, collegiate, and professional levels have garnered extensive media coverage and stimulated a discussion centered on prevention of such tragic events. A number of issues related to the prevention and management of sudden cardiac arrest on the playing field are currently debated in the medical literature, including the true incidence of sudden death in the young athletic population, the adequacy of the preparticipation physical evaluation, and the emergency response and effectiveness of secondary prevention strategies such as use of automated external defibrillators in the athletic setting. Clinicians who care for competitive athletes and/or cover youth sporting events must be aware of the benefits and limitations of different preparticipation screening programs to identify at-risk athletes, and they must be prepared to respond to life-threatening emergencies during athletic participation.     

Expert Opinion and Controversies in Musculoskeletal and Sports Medicine: Stingers

Standaert CJ, Herring SA. Expert opinion and controversies in musculoskeletal and sports medicine: stingers.Stingers are a common injury in contact sports and are characterized by acute lancinating pain in 1 upper extremity with or without associated weakness and neck pain. Appropriate on-field evaluation is necessary to identify the extent of injury and rule out structural injuries to the head, spine, or shoulder girdle. Although athletes can often return to play after a single acute event that resolves rapidly, those who have recurrent events, persisting pain, or strength deficits require a thorough diagnostic evaluation before return-to-play decisions can be made. In some circumstances, players sustaining a single stinger or multiple recurrent stingers may be permanently removed from participation in collision or contact sports.     

Non-pharmacological rehabilitation interventions for concussion in children: a scoping review

Purpose: To summarise the extent, nature, and quality of current scholarly literature related to non-pharmacological, rehabilitation interventions following concussion, or mild traumatic brain injury in children.

Methods: An electronic search was conducted from 1987 to 24 October 2017. Studies were included if they met the following criteria: (1) full text, peer reviewed, and written in English, (2) original research, (3) diagnosed concussion or mild traumatic brain injury, (4) described the evaluation of an intervention, (5) the outcome was a concussion impairment, and (6) the mean/median age was under 19. Quality assessment using the Down’s and Black criteria was conducted.

Results: Twenty-six studies published between 2001 and 2017 were identified. Interventions included rest, active rehabilitation, exercise, vestibular, oculomotor, cervicospinal therapy, education, early intervention, telephone counselling, mobile health application, Web-based Self-Management program, multimodal physical therapy, cognitive behavioural therapy, transcranial direct current stimulation, and acupuncture. The quality assessments ranged from poor to good.

Conclusions: The literature describing interventions following concussion in children is scarce. While both positive and negative results were obtained, there were methodological concerns in most studies limiting the ability to draw conclusions. Interventions incorporating aerobic exercise show promise as a concussion management strategy.

• Implications for rehabilitation

• Few studies have examined rehabilitation interventions for youth following concussion.

• Research ranging from rest to exercise highlights the uncertainty of the field.

• Low quality research limits the generalizability of results.

• The use of physical activity appears to be an emerging area of interest.

• Individualised, aerobic exercise should be used as part of clinical management.

     

Imaging techniques for muscle injury in sports medicine and clinical relevance

Magnetic resonance imaging (MRI) and ultrasound are the imaging modalities of choice to assess muscle injuries in athletes. Most authors consider MRI as the reference standard for evaluation of muscle injuries, since it superiorly depicts the extent of injuries independently of its temporal evolution, and due to the fact that MRI seems to be more sensitive for the detection of minimal injuries. Furthermore, MRI may potentially allow sports medicine physicians to more accurately estimate recovery times of athletes sustaining muscle injuries in the lower limbs, as well as the risk of re-injury. However, based on data available, the specific utility of imaging (including MRI) regarding its prognostic value remains limited and controversial. Although high-quality imaging is systematically performed in professional athletes and data extracted from it may potentially help to plan and guide management of muscle injuries, clinical (and functional) assessment is still the most valuable tool to guide return to competition decisions.     

脑震荡患者血清中神经元特异性烯醇化酶的变化及其临床意义

目的探讨脑震荡患者血清神经元特异性烯化酶(NSE)的变化及其临床意义。方法用酶联免疫吸附测试法测定52例脑震荡患者和30例健康体检者血清NSE水平。结果脑震荡患者在伤后24 h内血清NSE浓度明显高于对照组(P<0.01),经治疗后浓度有降低。结论血清中NSE的检测可反映出脑组织的损伤情况,可作为脑震荡诊断中的神经生化学指标。     

运动医学科住院患者对不同方式健康教育的效果评价

目的 探讨不同健康教育方式对运动医学科住院患者健康教育的效果,确立最为适合的健康教育方式.方法 通过问卷调查了解某三级甲等医院60例运动医学科住院患者对7种不同健康教育方式的可接受性、易理解性、实用性、生动形象性、指导性、内容满意度等10个方面的效果.调查采用0～10级量化评分,应用SPSSl 1.5统计分析软件进行数据处理和分析.结果 7种健康教育方式的评分比较,差异有统计学意义,DVD情景剧的健康教育得分最高;其次为个别讲解;广播的评分最低.不同健康教育方式评分结果的差异主要体现在健康教育方式的互动性、生动形象性、记忆的保持性上,而教育方式的实用性和指导性的差异无统计学意义.结论 在临床工作中的健康教育方式多种多样且各有裨益,只有将各种健康教育方式结合在一起,针对运动医学病房特点,开展以DVD为主,个别讲解、集体讲解、多媒体授课教育为辅的健康教育方式,才能获得更为满意的健康教育效果.     

肌骨超声在运动损伤诊断中的进展

超声治疗因其时实、动态、无创、无痛、简便等特点,近年来在临床诊断中颇具应用价值.随着超声分辨率的提高,利用肌骨超声治疗诊断肌肉、骨骼、肌腱、韧带、滑囊损伤等细节诊断中,应用越来越广泛.肌骨超声是使用高频超声来提供清晰的动态图像,极其有利于临床的观察和引导治疗.笔者现就肌骨超声在运动损伤诊断治疗中的研究进展进行综述.     

Advances and utility of diagnostic ultrasound in musculoskeletal medicine

Musculoskeletal ultrasound (US) can serve as an excellent imaging modality for the musculoskeletal clinician. Although MRI is more commonly ordered in the United States for musculoskeletal problems, both of these imaging modalities have advantages and disadvantages and can be viewed as complementary rather than adversarial. For diagnostic US, relative recent advances in technology have improved ultrasound’s ability to diagnose a myriad of musculoskeletal problems with enhanced resolution. The structures most commonly imaged with diagnostic musculoskeletal US, include tendon, muscle, nerve, joint, and some osseous pathology. This brief review article will discuss the role of US in imaging various common musculoskeletal disorders and will highlight, where appropriate, how recent technological advances have improved this imaging modality in musculoskeletal medicine. Additionally, clinicians practicing musculoskeletal medicine should be aware of the ability as well as limitations of this unique imaging modality and become familiar with conditions where US may be more advantageous than MRI.     

A call for more psychological skills training: Examining the views of qualified and student sports therapists in the United Kingdom

ContextSports therapists can influence an athlete's psychological response to injury. At present it is unclear whether sports therapists are sufficiency trained in psychology.ObjectivesTo understand the views both of practising clinicians and students regarding the extent to which sports therapy education addresses psychological factors in injury management.DesignCross-sectional study. Setting: Online Questionnaire. Participants: Qualified sports therapists (n = 30) and sports therapy students, (n = 33).InterventionsSports Therapist and Sport Psychology Questionnaire.Main outcome measuresThe questionnaire included five subsets of questions (5-point Likert scale or multiple-choice). Internal consistency of each subset was rated via Cronbach's alpha (α, 95% confidence interval) as good (questions 5 & 6; α 0.81, 0.68 to 0.88) or as excellent (scale questions 3–4; α 0.91, 0.85–0.95, question 8, α 0.97, 9.6 to 9.8, questions 7, 11 & 12; α 0.94, 0.91–0.96; and questions 9 & 10, α 0.96, 9.4–9.8).ResultsBoth groups recognised psychological components as either ‘important’ or ‘very important’ in rehabilitation. They reported a need for psychological skills in injury management, and more psychology training during education. While 80% of qualified therapists identified a duty to treat psychological components, only 45% of students concurred.ConclusionsFuture sports therapy education should consider placing greater emphasis on the psychological components of injury management in order to sufficiently equip therapists with appropriate skills for practice.     

Applications of computer navigation in sports medicine knee surgery: an evidence-based review

Computer-assisted surgery (CAS) has been investigated in a number of sports medicine procedures in the knee. Current barriers to its widespread introduction include increased costs, duration, and invasiveness of surgery. Randomized trials on the use of CAS in anterior cruciate ligament reconstruction have failed to demonstrate a clinical benefit. Data on CAS use in high tibial osteotomy are more promising; however, long-term studies are lacking. CAS has a number of research applications in knee ligament surgery, and studies continue to explore its use in the treatment of osteochondral lesions. This article reviews the applications of CAS in sports medicine knee surgery and summarizes current literature on clinical outcomes.     

Second time around: Corticospinal responses following repeated sports-related concussions within the same season. A transcranial magnetic stimulation study

ObjectiveTo investigate the degree of neurophysiological and cognitive performance changes resulting from repeat concussions sustained in a single season of Australian Rules football.MethodsThree amateur football players were recruited after sustainingtwo concussions during a single season of playing. Each player was assessed at multiple time points by transcranial magnetic stimulation (TMS) and electromyography, as well as tested for fine motor and cognitive performance after each concussion.ResultsIn all three cases, concussions resulted in reduction in fine dexterity and visuomotor reaction time, cognitive attention performance and increase in intracortical inhibition from TMS. No changes in performance or TMS outcomes were found as a result of the order of the concussions. However, changes observed were dependent on the severity of the concussion.ConclusionsThis multiple-case study has demonstrated that concussion result in increased intracortical inhibition and reduction in cognitive and motor performance. Further, TMS, in conjunction with tests of cognitive and motor performance, can be useful as a prognostic technique in assessing recovery from acute concussion injury.     

Youth sports and concussions: preventing preventable brain injuries. One client, one cause, and a new law

Effective concussion prevention and management for youth athletes requires both education and legislation. Education alone effectively begins the awareness of an issue, but does not change behavior. Education and legislation are required to prevent preventable concussion and brain injuries in youth athletes.