The relationship of hip muscle performance to leg,ankle and foot injuries: a systematic review

Objectives: Hip control affects movement and muscle firing patterns in the leg, ankle and foot, and may contribute to overuse injuries. Muscle performance can be measured as strength, endurance or muscle activation patterns. Our objective was to systematically review whether hip muscle performance is associated with leg, ankle and foot injuries.

Data sources: A structured and comprehensive search of six medical literature databases was combined with forward and backward citation tracking (AMED, CINAHL, EMBASE, Medline, Scopus and SportDiscus).

Study selection: Eligible studies measured hip muscle performance in individuals with musculoskeletal injuries below the tibial tuberosity, using dynamometry or electromyography (EMG). All studies compared an injured group with a control group or compared the injured and non-injured limb in the same individual.

Data extraction: Data was extracted from each study independently by two authors.

Data synthesis: Twenty case-control and four prospective studies (n = 24) met the inclusion criteria. Injury classifications included chronic ankle instability (n = 18), Achilles tendinopathy (n = 2), medial tibial stress syndrome and tibial stress fracture (n = 1), posterior tibial tendon dysfunction (n = 1), and exertional medial tibial pain (n = 2). Eleven of the studies revealed differences in hip muscle performance indicating less strength, delayed onset activation and decreased duration of activation in the injured groups. Two studies found evidence for differences between groups only in some of their measurements. Three out of the four prospective studies revealed that hip muscle performance was not a risk factor for leg, ankle and foot injuries.

Conclusions: This review provides limited evidence that hip muscle performance variables are related to leg, ankle and foot injuries. Emerging evidence indicates this might be a result of the injury rather than a contributor to the injury.     

A prospective cohort study investigating the effect of generalized joint hypermobility on outcomes after arthroscopic anterior shoulder stabilization

Objectives: Generalized joint laxity has been proposed as a significant risk factor for failure after arthroscopic anterior shoulder stabilization. The purpose of this study was to prospectively measure joint mobility in patients undergoing arthroscopic anterior shoulder stabilization and to determine whether hypermobility is a risk factor for worse outcomes compared with patients having normal joint mobility.

Methods: Patients with anterior shoulder instability were prospectively enrolled. Generalized joint hypermobility was measured using the Beighton Hypermobility Score and the Rowe, UCLA, SANE, SST, and WOSI scores were administered and reported as patient outcomes preoperatively and following arthroscopic anterior shoulder stabilization at 6 weeks, 6 months, 12 months, and 24 months postoperatively. Patients were stratified into two groups based on their Beighton Hypermobility Score, with scores ≥ 4/9 indicative of joint hypermobility.

Results: Sixteen patients with joint hypermobility (JH) and 18 non-hypermobile patients (NJH) were enrolled. At baseline, there were no significant differences in demographic characteristics or baseline patient-reported outcomes. Significantly more patients in the NJH group had SLAP tears (n = 10) compared to the JH group (n = 2) (p = .013). At all follow-up times, there were no significant differences between the NJH and JH groups with regard to patient-reported outcome scores (p > .05). In the JH group, 17% of patients reported recurrent instability at two years postoperatively compared to 25% of patients in the NJH group. There was no significant difference in failure rate (p = .67).

Conclusion: There was no significant difference in patient-reported outcomes or recurrent instability in patients with versus without joint hypermobility undergoing arthroscopic anterior shoulder stabilization.     

Polydeoxyribonucleotide injection in the patients with partial-thickness tear of supraspinatus tendon: a prospective and pilot study using ultrasound

Objective: Polydeoxyribonucleotide as adenosine receptor (A_2A) agonist has been used in plastic surgery and dermatology related to its regenerative property. The aim of this pilot study is to evaluate the safety and efficacy of polydeoxynucleotide injection in patients with rotator cuff tears by a variety of outcomes including pain, disability, physical performance test, and ultrasonography (US).

Methods: Seventeen patients (9 men, 8 women, age: 57.9 ± 9.1) with partial-thickness tear of supraspinatus tendon were evaluated in a prospective, open-label, and pre-and-post study. Seventeen patients underwent 3 times intra-lesional polydeoxynucleotide injection under ultrasound (US) guidance on weeks 0, 2 and 4. The safety and efficacy were assessed on weeks 0, 6 and 12. Main outcome measures included shoulder pain on Visual Analogue Scale (VAS) and DASH (disabilities of arm, hand, shoulder) score, range of motion in shoulder, shoulder strength and tear volume (cm³) by US. Adverse events were monitored. (CRIS: https://www.cris.nih.go.kr, KCT0000767).

Results: Active shoulder pain on VAS reduced from 5.53 to 3.53 (P = 0.016), and acting pain, one of DASH questionnaires, reduced from 3.35 to 2.00 (P < 0.001). However, resting shoulder pain on VAS and total DASH scores were not significantly different. Forward flexion and internal rotation in range of motion improved significantly (from 169.41 to 178.13 degrees [P = 0.004] and from 83.53 to 88.75 degrees [P = 0.014], respectively). The volume of torn lesion decreased during the study period, however it was not significant. There were no significant adverse events leading to hospitalization.

Conclusions: Minimally invasive procedure through polydeoxynucleotide injection into torn area of supraspinatus tendon on US could be candidate for the safe and effective treatment on shoulder pain and limited range of motion in patients with rotator cuff tear.     

Preemptive analgesia by using celecoxib combined with tramadol/APAP alleviates post-operative pain of patients undergoing total knee arthroplasty

Objective: This study was aimed to evaluate the efficacy of preemptive analgesia (PA) by using celecoxib combined with low-dose tramadol/acetaminophen (tramadol/APAP) in treating post-operative pain of patients undergoing unilateral total knee arthroplasty (TKA).

Methods: A total of 132 patients scheduled for TKA were included in this study. Three-day pre-operative medication was administrated in PA group with subsequent effective intra- and post-operative multimodal analgesia, while control patients received multimodal analgesia without PA. Visual analog scale (VAS) was utilized to assess the pain intensity at rest and during movement. VAS scores of participants were recorded 3 days before surgery, 1 day, 3 days, 1 week, 3 weeks, 6 weeks, 3 months, 6 months, and 12 months postoperatively. Moreover, the length of hospital stay, expense of hospitalization, C-reactive protein (CRP) values during hospitalization, and complications during medication were also recorded.

Results: PA showed superiority over control at 3 weeks (P = 0.013) and 6 weeks (P = 0.046) in resting pain, and 1 week (P = 0.015), 3 weeks (P = 0.003), 6 weeks (P = 0.003) and 3 months (P = 0.012) postoperatively in movement pain. There was no statistically significant difference in the length of hospital stay, total expense, CRP values, as well as complications.

Conclusions: Based on satisfactory intra- and post-operative analgesia, PA by 3-day administration of celecoxib and low-dose tramadol/APAP might be an effective and safe therapy regarding patients undergoing TKA in terms of alleviating post-operative pain.     

Nutrition behaviors,perceptions, and beliefs of recent marathon finishers

Objectives: To describe the nutrition behaviors, perceptions, and beliefs of marathoners.

Methods: A survey-based study was conducted with 422 recent marathon finishers (199 men, 223 women). Participants reported their running background, demographics, diets followed, supplements used, and food/fluid intake during their most recent marathon (median 7 days prior), as well as beliefs about hydration, fueling, and sources of nutrition information.

Results: Median finishing times were 3:53 (3:26–4:35) and 4:25 (3:50–4:59) h:min for men and women during their most recent marathon. Most participants (66.1%) reported typically following a moderate-carbohydrate, moderate-fat diet, while 66.4% carbohydrate-loaded prior to their most recent marathon. Among 139 participants following a specific diet over the past year, the most common were vegetarian/vegan/pescatarian (n = 39), Paleolithic (n = 16), gluten-free (n = 15), and low-carbohydrate (n = 12). Roughly 35% of participants took a supplement intended to improve running performance over the past month. Women were more likely to follow specific diets (39.0% vs. 26.1%), while men were more likely to recently use performance-enhancing supplements (40.2% vs. 30.0%). Most participants (68.3%) indicated they were likely or very likely to rely on a structured plan to determine fluid intake, and 75% were confident in their ability to hydrate. At least 35.6% of participants thought they could improve marathon performance by 8% or more with nutrition interventions. Scientific journals ranked as the most reliable source of nutrition information, while running coaches ranked as the most likely source to be utilized.

Conclusions: Findings from this investigation, such as diets and supplements utilized by marathoners, can be used by practitioners and researchers alike to improve the dissemination of scientifically-based information on nutrition and marathon running.     

Effect of position,time in the season,and playing surface on Achilles tendon ruptures in NFL games: a 2009-10 to 2016-17 review

Objectives: Achilles tendon (AT) ruptures are a potentially career-altering and ending injury. Achilles tendon ruptures have a below average return-to-play rate compared to other common orthopaedic procedures for National Football League (NFL) players. The objective of this study was to monitor the incidence and injury rates (IR) of AT ruptures that occurred during the regular season in order to evaluate the influence of player position, time of injury, and playing surface on rupture rates.

Methods: A thorough online review was completed to identify published injury reports and public information regarding AT ruptures sustained during regular season and post-season games in the National Football League (NFL) during the 2009–10 to 2016–17 seasons. Team schedules, player position details and stadium information was used to determine period of the season of injury and playing surface. IRs were calculated per 100 team games (TG). Injury rate ratios (IRR) were utilized to compare IRs.

Results: During eight monitored seasons, there were 44 AT ruptures in NFL games. A majority of AT ruptures were sustained in the first eight games of the regular season (n = 32, 72.7%). There was a significant rate difference for the first and second four-game segments of the regular season compared to the last two four-game segments of the regular season. Defensive players suffered a majority of AT ruptures (n = 32, 72.7%). The IR on grass was 1.00 per 100 TG compared to 1.08 per 100 TG on artificial turf (IRR: 0.93, p = .80).

Conclusion: A significant increase in AT ruptures occurred in the first and second four game segments of the regular season compared to the last two-four game segments of the regular season. Defensive players suffered a majority of AT ruptures compared to offensive or specialist players. There was no difference between AT rupture rates and playing surface in games.     

Epidemiology of shoulder and elbow pain in youth baseball players

Objectives: There are relatively few published epidemiological studies examining the differences in the risk of shoulder and elbow pain in young baseball players. The purpose of this study was to investigate risk factors for shoulder and elbow pain in child and adolescent baseball players.

Methods: A total of 1563 players aged 7 to 12 years participated in this investigation. Subjects were asked whether they had experienced episodes of shoulder or elbow pain. We investigated the following risk factors for shoulder and elbow pain: age, position, years of baseball experience, and training hours per week. Data from the groups with and without shoulder and elbow pain were analyzed using multivariate logistic regression models.

Results: Among the 1563 participants, 15.9% and 29.2% reported episodes of shoulder and elbow pain, respectively. Multivariate analysis showed that shoulder pain was associated with age 10, 11, and 12 years, and that elbow pain was associated with age 10, 11, and 12 years, playing catcher, and >2 years of baseball experience. Training hours per week were not associated with either shoulder or elbow pain.

Conclusion: In over 1000 baseball players aged 7 to 12 years, 15.9% reported episodes of shoulder pain, while 29.2% reported elbow pain in the throwing arm. The associated risk factors were different for each type of pain. Shoulder pain was associated with increased age while elbow pain was associated with increased age, increased years of baseball experience, and playing catcher.     

Competitive bass anglers: a new concern in sports medicine

Objective: Competitive bass angling involves sport fishing against other anglers while targeting a species of fish known as the black basses. Due to the rapidly growing popularity of high school competitive bass angling in Alabama and the nature of the casting motion similar to that of overhead athletes, we sought to examine the prevalence of sports type injuries in this population.

Methods: In spring 2016, an anonymous survey was distributed across two large scale competitive high school fishing tournaments, allowing for a broad sampling of anglers throughout the state of Alabama. Survey items included demographic information, relevant past medical history, and various pains associated with the shoulder, elbow and wrist. Results were recorded and analyzed electronically using Microsoft Excel and IBM SPSS statistical software.

Results: A total of 257 surveys were recorded. The response rate was 61%. The mean age of participating anglers was 15 ± 1.61 years. The majority (42%) of anglers fished year round. On average, anglers casted nearly 1,000 more times while competing versus fishing recreationally. Approximately 15% of anglers experienced shoulder, elbow, and wrist pain. The most common factors associated with pain included higher tournament cast counts, number of competitive years, number of tournaments/year, number of tournaments, and use of light weight lures.

Conclusion: A large portion of high school competitive anglers experience upper extremity pain. Knowledge of angling factors associated with pain allow for the creation of a modifiable routine to help reduce pain in affected anglers and prevent pain in healthy anglers.     

Review of the literature examining the association between physical activity and retinopathy

The main aim of this review was to evaluate the association between physical activity and retinopathy. Secondary aims included evaluating the association between sedentary behavior and retinopathy, and evaluating the association between physical activity/sedentary behavior on health outcomes among patients with existing retinopathy.

Twenty-one articles met our criteria for inclusion in this review.

Among the 19 studies evaluating the main aim (physical activity and retinopathy), 53% (n = 10/19) demonstrated evidence of a favorable (inverse) association between physical activity and retinopathy, 42% (n = 8/19) reported a null association physical activity and retinopathy, and 5% (n = 1/19) presented evidence for a detrimental association between physical activity and retinopathy. Regarding the secondary aims, one study demonstrated a detrimental association between sedentary behavior and retinopathy. Similarly, one study demonstrated that physical activity was protective against early mortality among those with mild retinopathy.

This review identifies an ‘indeterminate’ association between physical activity and retinopathy. Too few studies evaluated the association between sedentary behavior and retinopathy or the effects of physical activity on health outcomes among those with existing retinopathy.     

The effects of exercise on mastalgia

Objective: Mastalgia is often ignored by physicians although it is the most common breast-related complaint among women. The effectiveness of exercise therapy for mastalgia is unclear. The aim of this study is to investigate the effects of exercise on mastalgia.

Methods: A randomized controlled trial was conducted with twenty women with complaints of mastalgia fulfilling the inclusion and exclusion criteria. Patients were randomly assigned to the control group and to the exercise group. Sports brassiere, refraining from caffeine- and methylxanthine-containing foods, and simple analgesics were recommended for two groups. In the exercise group, an exercise program was conducted three times a week for 6 weeks. Participants in both groups were evaluated for breast pain and using the Short-Form Health Survey (SF-36) questionnaire before and six weeks after study. Serum cytokine levels were also collected and analyzed.

Results: No significant differences were detected with respect to age, body mass index, menopausal status, psychiatric condition, and existence of unexplained pain syndromes between the groups. Total breast pain scores were similar in both groups. The sensory component of breast pain questionnaire and visual analogue scale values significantly improved via exercise in only exercise group (p = 0.012 and p = 0.016). There was no significant difference between groups in serum levels of cytokines. SF-36 subscale scores for general health and social functioning significantly improved in the control group and scores for role physical, bodily pain, and social functioning improved in exercise group.

Conclusions: Based on our preliminary findings, exercise treatment is beneficial for patients with mastalgia and it can be suggested by clinicians.     

Autonomic modulations of heart rate variability are associated with sports injury incidence in sprint swimmers

Objectives: Young athletes’ participation in competitive sports is becoming increasingly common, and this increased involvement raises concerns about the occurrence of overtraining and sports injuries. Since these issues are poorly understood, this study analyzed heart rate variability, stress/recovery relationship, and sports injury incidence during a training macrocycle of young sprint and endurance swimmers.

Methods: Thirty teenage swimmers (aged 12 to 17 years) were divided into two groups as follows: Sprint (n = 17) and Endurance (n = 13). Subjects were evaluated over 20 weeks, based on the following three schedules: general, specific, and competitive. In addition to heart rate variability and sports injury incidence, the Recovery-Stress-Questionnaire of Athletes was used to analyse stress/recovery states in athletes. All procedures were developed at the initial moment and at the end of each periodization step.

Results: The Sprint group presented a reduced standard deviation of normal-normal beats (73.0 ± 6.6 vs. 54.1 ± 3.5 ms; p < 0.05) and root mean square of the successive differences (55.3 ± 6.2 vs. 42.0 ± 3.7 ms; p < 0.01) from the period of general preparation until the time of competition. Recovery-stress monitoring was affected only by the swimming training periodization (p < 0.05). During the general period, differences between recovery and stress scales were correlated directly with the root mean square of the successive differences (r = 0.576; p = 0.001), the standard deviation of instantaneous variability beat-to-beat (r = 0.521; p = 0.003) and the triangular index (r = 0.476; p = 0.008). Differences between general recovery and stress scales were inversely correlated with geometric indexes after the specific training period. Moreover, the Sprint group showed a higher incidence of sports injury than the Endurance group (0.0214 ± 0.0068 vs. 0.0136 ± 0.0050 cases/1000 hours).

Conclusion: Sprint training was associated with progressive activation of the sympathetic nervous system as well as a higher incidence of sports injury in comparison to endurance swimming during a training macrocycle.     

Heart rate recovery time in metabolically healthy and metabolically unhealthy obese children

Background: Autonomic dysfunction is an emerging non-traditional cardiovascular risk factor that correlates with obesity, components of metabolic syndrome, as well as cardiorespiratory fitness. As a simple and validated index of autonomic balance, heart rate recovery (HRR) has been reported as a useful biomarker for predicting cardiovascular morbidity and mortality.

Objectives: The aim of this study was to compare HRR in metabolically healthy vs. metabolically unhealthy obese children.

Methods: A total of 56 obese children of whom 31 had metabolic syndrome were examined. All the participants underwent the multistage submaximal cycle ergometer test and HRR was determined one minute after the test.

Results: The HRR was significantly lower (18.9 ± 3.7) in a group of metabolically unhealthy obese children compared to metabolically healthy obese children (24 ± 4.1) p < 0.001. Logistic regression analysis showed that reduction in HRR was also influenced by higher BMI.

Conclusion: Our findings implicate the presence of the autonomic dysfunction as reflected by impaired heart rate recovery (HRR) in obese children with metabolic syndrome.     

The relationship between the use of running applications and running-related injuries

Objectives: Training errors are suggested to be an important cause of running-related injuries (RRIs). As most runners train individually, digital coaching using running applications is becoming increasingly popular. However, the quality of these applications is unknown. The aim of the present cross-sectional study was to evaluate the relationship between the use of running applications and RRIs.

Methods: An online questionnaire was used to collect data on running activities of 1,029 runners, their injuries, and the association between the use of running applications and RRIs. Parametric and non-parametric tests for independent samples were used to analyze the baseline characteristics of the participants. Univariate logistic regression analyses and multiple logistic regression analysis (Enter procedure) were used to determine the association between the use of running applications and RRIs, while adjusting for confounding effects.

Results: Of all the 1,029 runners included in this study, 31% (n = 319) got injured and 44% (n = 453) used an application in the previous 12 months. Multiple logistic regression analysis showed no statistically significant association between the use of running applications and RRIs.

Conclusions: Based on this study, the use of running applications was not associated with an increased or decreased risk of RRIs. Running applications can be used by runners without any further implications to guide their training activities. However, runners should be aware that the use of predefined running schemes is associated with RRI risk. It is important that following a previous RRI, athletes should be fully recovered before resuming their training sessions as hindrance from a previous RRI is highly associated with the occurrence of a new RRI.     

Arthroscopic suture bridge rotator cuff repair: functional outcome,repair integrity,and preoperative factors related to postoperative outcome

Objectives: To assess the retear rate, retear size and location, the clinical impact of a retear, and preoperative patient factors related to postoperative outcome after arthroscopic suture bridge rotator cuff repair.

Methods: Fifty six patients with an isolated, full-thickness supraspinatus tendon tear who underwent arthroscopic suture bridge rotator cuff repair were retrospectively identified. Patients were evaluated and rotator cuff integrity was assessed using ultrasonography. Visual analog score (VAS), the American Shoulder and Elbow Surgeon (ASES) score, shoulder range of motion and strength were used for clinical evaluation. Retears were assessed for size and location on ultrasonography.

Results: Forty two patients (75%) aged a mean 59.7 ± 8.6 years (range 41–79 years) were available for follow-up at a mean 13.5 months. Postoperative evaluation indicated significant improvements in ASES score (49.76 ± 18.2 to 86.57 ± 13.4, P < 0.001), VAS pain score (4.69 ± 2.17 to 0.63 ± 1.29, P < 0.001), forward elevation range of motion (144.1° ± 29.9 to 159.69 ° ± 13.9, P = 0.002), and internal rotation ROM (44.13° ± 12.0 to 52.09° ± 12.0, P = 0.003). The retear rate was 14.28% (6/42). Patients with retears were not older (P = 0.526) but had a larger preoperative tear size (3.25 cm ± 0.5 vs 2.05 cm ± 0.48, P < 0.001). Preoperative tear size was significantly associated with a postoperative retear (P < 0.001). The duration of preoperative symptoms was significantly associated with pain (P = 0.029), pain improvement (P = 0.013), internal rotation ROM (P = 0.002), and internal rotation strength (P = 0.004).

Conclusions: Arthroscopic suture bridge repair provides good clinical results with a low retear rate. The duration of preoperative symptoms was associated with postoperative outcome, indicating that delaying surgery may result in inferior outcomes.

Level of Evidence: IV, Case Series     

The use of continuous vs. intermittent cold water immersion as a recovery method in basketball players after training: a randomized controlled trial

Objectives: The main objective of this study was to compare two cold water immersion protocols, continuous or intermittent, on recovery in basketball players.

Methods: Ten male basketball players (age: 14 ± 0.4 years, body mass: 65.4 ± 9.1 kg, height: 175 ± 7.3 cm, body fat %: 10.3 ± 4) were included in the study. After three 90-minute training sessions (avg. heart rate 158 ± 11.92, 156 ± 7.06 and 151 ± 10.44 bpm), participants were grouped into a continuous immersion (12 min at 12 ± 0.4°C) group, intermittent immersion (4 x 2 min immersion at 12 ± 0.4 °C + 1 min out of water) group and a control group (CG). Countermovement jump (CMJ), muscle pain and thigh volume were measured.

Results: Both cold water immersion protocols were effective in reducing the pain 24 and 48 hours after training compared with the CG (F (3.54) = 2.91, p = 0.016, η_p² = .24). Concerning CMJ change, % differences occurred at 24 (Z = 11.04, p = 0.004) and 48 hours (Z = 14.01, p < 0.001) in comparison with the CG. Regarding the muscle volume, the statistical analysis did not report a significant interaction (F (3.54) = 2.42, p = 0.058).

Conclusion: Both cold water immersion CWI protocols are effective in improving recovery in basketball players.     

Evaluation of postural stability in youth athletes: the relationship between two rating systems

Objectives: The Balance Error Scoring System (BESS) has been documented as a useful way to evaluate postural control following sport-related concussions sustained by youth athletes. However, limitations have been reported with its use due to the reliance on visual observation as the primary measurement outcome. The primary purpose of this study was to examine the correlation between the modified BESS (mBESS) as rated by a clinician and a simultaneous analysis performed by an integrated video-force plate system. The secondary purpose was to assess if a history of prior concussion affected postural control.

Methods: A group of healthy youth athletes (n = 398; mean age 13.7 ± 2.4 years) completed the mBESS while simultaneously undergoing an integrated video-force plate evaluation to measure postural stability. Spearman rank-order correlations were used to determine the strength of correlation between the 2 rating systems. In addition, performance on the mBESS between those with and without a history of concussion was compared using univariate ANCOVAs.

Results: A moderately high correlation was found during single-leg stance (ρ = -0.64, p < .001), while a weak correlation was found during tandem stance (ρ = -0.30, p < .001). No postural control differences were found between groups with and without a concussion history.

Conclusion: The video-force plate rating system correlates well with the clinician rating during the single-leg stance of the mBESS, but not during double-leg or tandem stances. A history of concussion did not affect mBESS scores.     

Risk factors associated with self-reported injury history in female youth soccer players

Background: studies that investigate risk factors for musculoskeletal injuries in female youth athletes are limited, especially related to training attributes and position status.

Objective: to determine risk factors including training attributes and position status for a self-reported musculoskeletal injury history in female youth soccer players.

Methods: we conducted a cross-sectional study of young female soccer players (mean age: 13.6 ± 2.3 years). we asked about their history of musculoskeletal injuries using an electronic questionnaire. the proportion of young female soccer players with and without a history of soccer-related musculoskeletal injuries were compared based on physical characteristics, training attributes, position status (single vs. multiple), lower extremity strength, and joint laxity. a binary logistic regression analysis was used to generate, and adjusted odds ratios adjusted for potential co-variates (aor). a 95% confidence interval (95%ci) that did not cross one or p < 0.05 were considered statistically significant.

Results: a total of 160 young female soccer players (mean age: 13.6 ± 2.3 years) participated in the study. an independent association was found between prior musculoskeletal injuries and older ages (aor: 1.60, 95%ci: 1.17, 2.20, p = 0.004), higher weight (aor: 1.10, 95%ci: 1.01, 1.20, p = 0.026), and greater bmi (aor: 1.43, 95%ci: 1.07, 1.90, p = 0.014).

Conclusions: musculoskeletal injuries were associated with age, weight, and bmi in female youth players. the current study indicates that maintaining proper body composition may be beneficial to reduce musculoskeletal injuries among female youth soccer players.     

Non-locomotive physical activity intervention using a tri-axial accelerometer reduces sedentary time in type 2 diabetes

Objectives: The purpose of this study is to examine whether the use of a tri-axial accelerometer can reduce sedentary time and increase non-locomotive physical activity (N-LPA), and to investigate the effect of this intervention on parameters of glucose and fat metabolism in patients with type 2 diabetes.

Methods: Thirty-eight patients with type 2 diabetes (Age: 61.8 ± 1.4 years, BMI: 24.8 ± 0.6, HbA_1c: 6.6 ± 0.1 %) participated in this 12-week randomized controlled study, and 31 patients were included in the final analyses. Patients were randomly assigned to one of three groups: control, N-LPA or locomotive physical activity (LPA). Patients in the N-LPA and LPA groups were asked to increase their N-LPA and LPA, respectively, using tri-axial accelerometer feedback. Glucose and fat metabolic parameters were evaluated before and after 12-week intervention.

Results: Only the N-LPA intervention significantly reduced sedentary time (p < 0.05) and increased N-LPA (p < 0.05). However, these changes were insufficient to improve parameters associated with glucose and fat metabolism (p > 0.05), despite a significant positive correlation between the change in sedentary time and HbA_1c levels (p < 0.05).

Conclusion: Our results showed that the N-LPA intervention using a tri-axial accelerometer successfully reduced sedentary time in patients with type 2 diabetes, however that induced no significant improvement of glucose and fat metabolism. Further research is required to determine the degree of reduction in sedentary time and increase in N-LPA needed to improve glucose and fat metabolism.     

Patient-related risk factors for requiring surgical intervention following a failed injection for the treatment of medial and lateral epicondylitis

Objectives: To identify risk factors for failure of a therapeutic injection leading to operative management of both medial and lateral epicondylitis.

Methods: A national database was used to query Medicare Standard Analytic Files from 2005–2012 for patients treated with therapeutic injections for medial or lateral epicondylitis using CPT codes for injections associated with corresponding ICD-9 diagnostic codes (726.31 and 726.32, respectively). Those who subsequently underwent surgical treatment following injection were identified. A multivariate binomial logistic regression analysis was utilized to evaluate patient-related risk factors for requiring surgery within 2 years after therapeutic injection.

Results: 1,837 patients received therapeutic injections for medial epicondylitis. 52 (2.8%) required ipsilateral surgery at a mean of 429 ± 28 days post-injection. Risk factors for requiring surgical intervention included age <65, obesity, and morbid obesity. 6,561 patients received therapeutic injections for lateral epicondylitis. 201 (3.1%) required subsequent surgery at a mean of 383 ± 128 days’ post-injection. Risk factors included age <65, tobacco use, diabetes mellitus and peripheral vascular disease.

Conclusion: The incidence of surgical intervention following a failed therapeutic injection for medial or lateral epicondylitis is low (~3%). Risk factors for failing a therapeutic injection include age <65 years and obesity (BMI > 30) for medial epicondylitis and age <65 years, smoking, diabetes mellitus and peripheral vascular disease for lateral epicondylitis. Patients with these identified risk factors presenting with medial or lateral epicondylitis should be cautioned that they carry a higher risk of subsequent surgical treatment. Level of Evidence: Therapeutic, III.