Article Text

Prize Winning Abstracts from BASEM Congress 2016Prognostic factors for musculoskeletal injury identified through medical screening and training load monitoring in professional football (soccer): a systematic reviewThe heart of the matter: cardiac assessment in professional footballersDoes treadmill running performance, heart rate and breathing rate response during maximal graded exercise improve after volitional respiratory muscle training?Subcategories of tendinopathy using ultrasound tissue characterization (utc): dorsal mid-portion achilles tendinopathy is more severe than ventral achilles tendinopathyAnxiety, depression and perceived sporting performance among professional cricket players
  1. T Hughes1,2,
  2. JC Sergeant2,3,
  3. M Parkes2,3,
  4. M Callaghan1,2,4
  1. 1Manchester United Football Club, UK
  2. 2Arthritis Research UK Centre for Epidemiology, Manchester, UK
  3. 3NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK
  4. 4Department of Health Professions, Manchester Metropolitan University, Manchester, UK
  1. C Speers,
  2. A Seth,
  3. K Patel,
  4. M Gillett,
  5. D Rakhit
  1. Queen Elizabeth Hospital Birmingham, UK
  1. K Radhakrishnan,
  2. VK Sharma,
  3. SK Subramanian
  1. Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
  1. W Wynter Bee,
  2. J Ubhi,
  3. B Kumar
  1. Institute of Sport, Exercise & Health, London, UK
  1. M Sahni1,
  2. G Bhogal2
  1. 1College of Medical and Dental Sciences, The University of Birmingham, Birmingham, UK
  2. 2Centre for Musculoskeletal Medicine, Royal Orthopaedic Hospital, Birmingham, UK


Objectives To identify prognostic factors and models for spinal and lower extremity injuries in adult professional/elite football players from medical screening and training load monitoring processes.

Methods The MEDLINE, AMED, EMBASE, CINAHL Plus, SPORTDiscus electronic bibliographic databases and the Cochrane Database of Systematic Reviews were searched from inception to July 2016. Searches were limited to original research, published in peer reviewed journals of any language. The Quality in Prognostic Studies (QUIPS) tool was used for appraisal and the modified GRADE approach was used for synthesis. Prospective and retrospective cohort study designs of spinal and lower extremity injury incidence were found from populations of adult professional/elite football players, between 16 and 40 years. Non-football or mixed sports were excluded.

Results 858 manuscripts were identified. Removing duplications left 551 studies, which were screened for eligibility by title and abstract. Of these, 531 studies were not eligible and were excluded. The full text of the remaining 20 studies were obtained; a further 10 studies were excluded. 10 studies were included for appraisal and analysis, for 3344 participants.

Conclusions Due to the paucity and heterogeneity of the literature, and shortcomings in methodology and reporting, the evidence is of very low or low quality and therefore cannot be deemed robust enough to suggest conclusive prognostic factors for all lower limb musculoskeletal injury outcomes identified. No studies were identified that examined spinal injury outcomes or prognostic models.


Aim Sudden cardiac death is the leading medical cause of death during exercise.1 Our objective was to retrospectively analyse the routine cardiac assessment of professional footballers to aid physician management and improve player safety.

Methods Footballers from five professional clubs between March 2012 and October 2014 were included (n=265). All were performed in line with the recommendations of the Football Association Cardiology Committee, incorporating clinical examination, 12-lead ECG, echocardiography and health questionnaire.2 Data was retrospectively collected, inspected and analysed using Excel spreadsheets. Findings were classified as ‘normal’ or ‘not normal’, and not normal assessments were further broken down into ‘clear-cut pathology’ (pathology with widely accepted guidance on management) or ‘grey screen’.

Results Footballers were aged 13 to 37 years, with 69% aged over 18 and 31% under. The majority of the review population was White European (66%). Of the review population 11% had ‘not normal’ assessments, of these assessments 83% were considered grey screens (by Consultant Cardiologist) requiring further investigation or surveillance. Overall clear-cut pathology was identified in 2%.

Conclusions A high proportion of the players (9%) had grey screens. The majority of these were due to ECG or structural abnormalities, which are clinically challenging to differentiate from physiological adaptation of the athletic heart and potentially fatal conditions. The extent to which these findings put the athlete at risk of a life threatening cardiac event is un-?quantified. Team physician’s need to be aware of managing the on-going risk with these patients and ensure suitable ?follow up and assessment on a regular basis to mitigate this.


Aim Maximal physical exertion in sports usually causes fatigue in the exercising muscles, but not in the respiratory muscles due to triggering of the Respiratory muscle metabo-reflex, a sympathetic vasoconstrictor response leading to preferential increment in blood flow to respiratory muscles.1 We planned to investigate whether a six week yogic pranayama based Volitional Respiratory Muscle Training (VRMT) can improve maximal Graded Exercise Treadmill Test (GXTT) performance in healthy adult recreational sportspersons.

Methods Consecutive, consenting healthy adult recreational sportspersons aged 20.56±2.49 years (n=30), volunteered to ‘baseline recording’ of resting heart rate (HR), blood pressure (BP), respiratory rate (RR), and Bruce ramp protocol maximal GXTT until volitional exhaustion providing total test time (TTT), derived VO2max, Metabolic Equivalent of Task (METs), HR and BP response during maximal GXTT and drop in recovery HR data. After six weeks of observation, they underwent ‘pre-intervention recording’ followed by supervised VRMT intervention for 6 weeks (30 minutes a day; 5 days a week) and then ‘post-intervention recording’. Repeated measures ANOVA with pairwise t statistical comparison was used to analyse the data.

Results After supervised VRMT, we observed significant decrease in their resting supine RR (p<0.001), resting supine HR (p=0.001), HR after 5 minutes of assuming standing posture (p=0.003); significant increase in TTT (p<0.001), derived VO2max (p<0.001), METs (p<0.001) and drop in recovery HR (p=0.038); altered HR response and BP response during exercise.

Conclusions We hypothesize that these changes are probably due to VRMT induced learnt behaviour to control the breathing pattern that improves breathing economy, improvement in respiratory muscle aerobic capacity, attenuation of respiratory muscle metabo-reflex, increase in cardiac stroke volume and autonomic resetting towards parasympatho-dominance. Yogic Pranayama based VRMT can be used in sports conditioning programme of athletes to further improve their maximal exercise performance, and as part of rehabilitation training during return from injury.


Aim To evaluate the association between tendon structure and clinical severity. Looking specifically at location of pathology, comparing ventral versus dorsal tendinopathy.

Methods Patients were recruited from a tertiary tendinopathy center between Jan 2015 – June 2016. Inclusion criteria included patients with midportion Achilles tendinopathy, aged between 1870. Patients with insertional Achilles tendinopathy or other suspected etiology were excluded. Patients were assessed using ultrasound tissue characterization (UTC) scanning. UTC software was used to analyse a 2 cm block 24 cm from the calcaneum for percentage of echo type I, II, III and IV. With percentage echo type I+II used as the primary outcome. A doctor also categorised patients into predominately dorsal or ventral pathology based on UTC imaging. VISAA and VAS scores were used for clinical outcome measures. Statistics were undertaken using SPSS, data was not normally distributed

Results Overall 33 tendons with mid portion Achilles tendinopathy were analysed, the overall percentage echo type I+II showed no correlation to either VISAA (p=0.745, r=0.0600) or VAS (p=0.157, r=0.248). When divided into dorsal and ventral Achilles tendinopathy there was a significant difference between baseline VISAA scores with a lower VISAA score 35 (SD±19) in dorsal group compared with the ventral group 60 (SD±17.1) (p=0.009). There was also a higher VAS score in the dorsal group (mean = 6, SD±2.28) at baseline compared with ventral (mean = 5, SD±3.07), although this was not significant (p=0.416).

Conclusions This highlights the possibility of using UTC to subcategories patients into ventral and dorsal which seems to correlate to increased clinical severity in the dorsal group. This is perhaps due to increased tension and stretching acting through this part of the tendon on loading and thus more nociceptive stimulation and greater dysfunction of the tendon. This could be used to help determine differing rehabilitation interventions in future with differing intensities for the two groups. It further highlights as previous studies1,2 have that there is no direct correlation between overall structure and clinical severity.


Background Mental health in sport is a hard-hitting topic that is frequently the subject of news coverage and increasingly a theme for avid research. Some suggest that cricketers, participating in a game unique in its statistical analysis of individual performance, prolonged periods of play away from home and extended solitary game time to reflect on errors, may be especially prone to developing depression. This hypothesis is supported by a higher rate of suicide among male Test cricketers when compared with the UK male general population.1

Methods This study ascertained rates of anxiety and depression by screening professional cricket players using the Generalised Anxiety Disorder Questionnaire (GAD–7) and Patient Health Questionnaire (PHQ–9). It also investigate whether professional cricket players perceive stress and anxiety to be beneficial to their sporting performance. 21 male professional cricketers were included in this anonymous questionnaire based study.

Results Six players had a positive depression screen, five scoring mild and one scoring moderate. Additionally, six players had a positive anxiety screen, four scoring mild and two ?players within the moderate range. Fifteen players thought pre-match stress and anxiety was beneficial to their sporting performance. Of these, nine thought slight, five thought fair and one thought considerable levels were optimal.

Conclusions Undiagnosed anxiety and depression may exist in professional cricket teams and as such better screening is required. The majority of players feel some level of stress and tension are beneficial for their performance, with a slight amount being the most common perceived optimum.

Statistics from

Prognostic factors for musculoskeletal injury identified through medical screening and training load monitoring in professional football (soccer): a systematic review

The heart of the matter: cardiac assessment in professional footballers

Does treadmill running performance, heart rate and breathing rate response during maximal graded exercise improve after volitional respiratory muscle training?

Subcategories of tendinopathy using ultrasound tissue characterization (utc): dorsal mid-portion achilles tendinopathy is more severe than ventral achilles tendinopathy

Anxiety, depression and perceived sporting performance among professional cricket players

View Full Text

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.