Gender Differences and Biomechanics in the 3000M Steeplechase Water Jump

Since 1996, women have been competing in the 3000m steeplechase race internationally. Whenever women and men both compete in similar events with different equipment (the barriers are lower for women) consideration should be given as to how techniques should be coached differently. This study investigated the differences in water-jump technique between men and women after accounting for differences in running speed and which techniques led to maintenance of race pace through the water-jump. Eighteen men and 18 women were filmed at two major track and field meets during the 2004 season. Peak Motus 8.2 was used to digitize all seven jumps from each athlete. Various characteristics of water-jump technique were measured or calculated and compared using two multiple linear regressions (one for men and one for women) to determine which characteristics led to maintaining race pace speeds through the water jump obstacle. Repeated measures ANOVA was used to determine any differences between men and women in the measured characteristics of technique.Velocity through the jump divided by race pace was predicted very well by approach velocity and landing distance for men and women. Other characteristics of the movement were non-significant. Differences between genders were found in: approach velocity, take-off distance, landing distance, push-off angle, velocity through jump, and exit velocity. Men and women steeplechasers must focus on approach velocity and landing distance to complete the water-jump close to their race pace. Coaches need to consider many characteristics of technique that differ between men and women.

Key points

• Women may need to be coached differently than men in the steeplechase water jump due to different techniques required.
• Men and women must focus on a high approach velocity to complete the steeplechase water jump successfully.
• Men and women must generate a relatively long landing distance to maintain velocity and keep from having to use extra energy exiting the water pit.
• Women''s race paces were affected more than men''s by the water jump in a negative way.

Key words: Track and field, athletics, hurdling, running, biomechanics.     

A randomized crossover trial of a wedged insole for treatment of knee osteoarthritis

OBJECTIVE: In uncontrolled studies, a lateral-wedge insole has reduced knee pain in patients with medial knee osteoarthritis (OA). The aim of this study was to test the efficacy of this simple, low-cost intervention for pain in patients with medial knee OA. METHODS: We conducted a double-blind, randomized, crossover trial designed to detect a small effect of treatment. Participants were at least 50 years of age and had medial joint space narrowing on posteroanterior semiflexed radiographs and scores indicating moderate pain for 2 of the 5 items on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain scale. Participants were randomized to receive a 5 degrees lateral-wedge insole or a neutral insole for 6 weeks. Following a 4-week washout period, participants crossed over to the other treatment for 6 weeks. Knee pain, the primary outcome, was assessed by the WOMAC pain scale (visual analog scale version). Secondary outcomes included the WOMAC disability subscale, overall knee pain, 50-feet walk time, chair-stand time, and use of medications for knee pain. RESULTS: Ninety patients were randomized. The mean difference in pain between the 2 treatments was 13.8 points on the WOMAC pain scale (95% confidence interval -3.9, 31.4 [P=0.13]). We observed similar small effects for the secondary outcomes. CONCLUSION: The effect of treatment with a lateral-wedge insole for knee OA was neither statistically significant nor clinically important.     

Combination therapy with sulfasalazine and methotrexate is more effective than either drug alone in patients with rheumatoid arthritis with a suboptimal response to sulfasalazine: results from the double-blind placebo-controlled MASCOT study

BACKGROUND: Optimal use of disease-modifying antirheumatic drugs (DMARDs) in rheumatoid arthritis is vital if progression of disease is to be reduced. Methotrexate (MTX) and sulfasalazine (SASP) are widely used inexpensive DMARDs, recently often combined despite no firm evidence of benefit from previous studies. Aim: To establish whether a combination of SASP and MTX is superior to either drug alone in patients with rheumatoid arthritis with a suboptimal response to 6 months of SASP. METHODS: A randomised controlled study of step-up DMARD treatment in early rheumatoid arthritis. In phase I, 687 patients received SASP for 6 months. Those with a disease activity score (DAS) > or =2.4 were offered additional treatment in phase II (SASP alone, MTX alone or a combination of the two). The primary outcome measure was change in DAS. RESULTS: At 6 months, 191 (28%) patients had a DAS <2.4, 123 (18%) were eligible but did not wish to enter phase II, 130 (19%) stopped SASP because of reversible adverse events and 165 (24%) entered phase II. DAS at 18 months was significantly lower in those who received combination treatment compared with those who received either SASP or MTX: monotherapy arms did not differ. Improvement in European League Against Rheumatism and American College of Rheumatology 20, 50 and 70 scores favoured combination therapy. CONCLUSIONS: In this "true-to-life" study, an inexpensive combination of DMARDs proved more effective than monotherapy in patients with rheumatoid arthritis with a suboptimal response to SASP. There was no increase in toxicity. These results provide an evidence base for the use of this combination as a component of tight control strategies.     

Varus foot alignment and hip conditions in older adults

OBJECTIVE: Mechanical strain on the hip can result from varus malalignment of the foot. This study was undertaken to explore the cross-sectional relationship between varus foot alignment and hip conditions in a population of older adults. METHODS: The Framingham Osteoarthritis Study cohort consists of a population-based sample of older adults. Within this sample, we measured forefoot and rearfoot frontal plane alignment using photographs of a non-weight-bearing view of both feet of 385 men and women (mean age 63.1 years). Each foot segment was categorized according to the distribution of forefoot and rearfoot alignment among cases of ipsilateral hip pain, trochanter tenderness, hip pain or tenderness, and total hip replacement (THR). The relationship of foot alignment to these conditions was examined using logistic regression and generalized estimating equations, adjusting for age, body mass index, sex, and physical activity. RESULTS: The mean +/- SD rearfoot varus alignment was 0.7 +/- 5.5 degrees, and the mean +/- SD forefoot varus alignment was 9.9 +/- 9.9 degrees. Subjects in the highest category of forefoot varus alignment had 1.8 times the odds of having ipsilateral hip pain (P for trend = 0.06), 1.9 times the odds of having hip pain or tenderness (P for trend < 0.01), and 5.1 times the odds of having undergone THR (P for trend = 0.04) compared with those in the lowest category. No significant associations were found between rearfoot varus alignment and any hip conditions. CONCLUSION: Forefoot varus malalignment may be associated with ipsilateral hip pain or tenderness and THR in older adults. These findings have implications for treatment, since this risk factor is potentially modifiable with foot orthoses.     

Reduced-intensity conditioning for allogeneic haematopoietic stem cell transplantation in relapsed and refractory Hodgkin lymphoma: impact of alemtuzumab and donor lymphocyte infusions on long-term outcomes

The introduction of reduced-intensity conditioning (RIC) has enabled the role of allogeneic transplantation to be re-evaluated in Hodgkin lymphoma (HL). While T-cell depletion reduces graft-versus-host disease (GvHD), it potentially abrogates graft-versus-tumour activity and increases infective complications. We compared the results in 67 sibling donor transplantations following RIC in multiply relapsed patients from two national phase II studies conditioned with fludarabine/melphalan. One used cyclosporine/alemtuzumab (MF-A, n = 31), the other used cyclosporine/methotrexate (MF, n = 36) as GvHD prophylaxis. There was a small excess of chemorefractory cases in the MF cohort (P = NS). MF-A resulted in significantly lower incidences of non-relapse mortality, acute and chronic GvHD, but no significant excess of relapse/progression. Post donor lymphocyte infusion (DLI) disease responses occurred in 8/14 (57%) and 6/11 (55%) patients in the MF-A and MF groups, respectively. Current progression-free survival (CPFS) was superior with MF-A (univariate analysis), with durable responses to DLI contributing to the favourable outcome (43% vs. 25%, P = 0.0356). Disease status at transplantation significantly influenced overall survival (P = 0.0038) and CPFS (P = 0.0014), retaining significance in multivariate analyses, which demonstrated a trend towards improved CPFS with T-cell depletion (P = 0.0939). These data suggest that alemtuzumab significantly reduced GvHD without resulting in a deleterious impact on survival outcomes following RIC in HL, and that durable responses to DLI may be more common following the inclusion of alemtuzumab in the conditioning protocol.     

Salvaging locoregional recurrence with radiotherapy after surgery in early cervical cancer

AimsTo determine the outcome and morbidity after radiotherapy for locally recurrent cervical cancer.Materials and methodsWomen who presented with locally recurrent cervical cancer after surgery alone during 1985 and 1997 were identified from the hospital database. Data were collected and analysed to include the stage at first diagnosis, staging investigations before surgery, the surgical procedure, the indication for radiotherapy, the type of radiotherapy, morbidity and survival.ResultsIn total, 130 women had radical external beam radiotherapy and/or intracavitary brachytherapy for locoregional recurrence during the defined study period. The 5-year disease-specific survival for the study population was 40.2%. Women who were treated for vault recurrence had a significantly better 5-year disease-free survival compared with women who developed nodal recurrence alone (55.4% vs 12.5%). This group of women also had a significantly slower rate of disease progression after radiotherapy than women with nodal recurrence (48.7% vs 87.5%, P = 0.0001).ConclusionRadical radiotherapy alone is able to salvage 55% of vaginal vault recurrences after surgery for cervical cancer with minimal late toxicity. Salvage rates in women with pelvic nodal recurrences are considerably lower. Chemoradiotherapy using intensity-modulated radiotherapy to deliver an escalated radiotherapy dose needs to be pursued to improve locoregional control.     

Reducing Diagnostic Errors in Musculoskeletal Trauma by Reviewing Non-Admission Orthopaedic Referrals in the Next-Day Trauma Meeting

INTRODUCTION

Diagnostic errors in orthopaedics are usually caused by missing a fracture or misreading radiographs. The aim of this study was to document the pick-up rate of the wrong diagnoses by reviewing X-rays and casualty notes in the next-day trauma meeting.

PATIENTS AND METHODS

The casualty notes and radiographs of 503 patients were prospectively reviewed in the daily trauma meeting between August 2002 and December 2002 in a district general hospital. The relevant data were collected and analysed by a single assessor.

RESULTS

The false positive rate for making an orthopaedic diagnosis was 12.6% (i.e.) diagnosing a fracture, when none existed). The false negative (missing) rate was 4%, while 2.4% incidental findings were missed, or at least not documented, after reading the X-rays. There were 7.8% wrong diagnoses made. The majority of the patients were seen by the senior house officers.

CONCLUSIONS

The medicolegal significance of false negative diagnosis is obviously greater. In a busy emergency department, where a large number of patients are seen, there is a greater risk. This study shows the importance in a small-to-medium sized accident and emergency unit as well, where there is no senior cover available out-of-hours for final radiological interpretation. A morning trauma meeting which covers reviewing admitted patients as well as non-admission orthopaedic referrals has an effective risk management solution to early detection of missed and wrong diagnoses.