The following electronic only articles are published in conjunction with this issue of BJSM.

Abdominal pain in long distance runners: case report and analysis of the literature

F C Dimeo, J Peters, H Guderian

Abdominal pain is a common complaint among participants in endurance sports. It may be severe, recurrent, and resistant to treatment. There is no direct evidence of the cause of this phenomenon. This report is of a long distance runner who had severe pain in the upper right abdominal quadrant during strenuous exertion. The symptom had been present for several years and did not respond to conservative treatment. Laparoscopy showed congenital supernumerary ligaments binding the gallbladder to the abdominal wall. The complaint resolved after cholecystectomy and resection of adhesions. There was evidence of chronic cholecystitis on histopathological examination. Two years after the operation, he remains free of symptoms. The differential diagnosis of abdominal pain in athletes is discussed.

(Br J Sports Med 2004;38:e24) http://bjsm.bmjjournals.com/cgi/content/full/38/5/e24

Electrical twitch obtaining intramuscular stimulation (ETOIMS) for myofascial pain syndrome in a football player

J Chu, I Takehara, T-C Li, I Schwartz

Background: Flare up of acute lower back pain associated with myofascial pain syndrome (MPS) may require various forms of treatment including activity restriction and bracing.

Electrical twitch obtaining intramuscular stimulation (ETOIMS) is a promising new treatment. It involves the use of a strong monopolar electromyographic needle electrode for electrical stimulation of deep motor end plate zones in multiple muscles in order to elicit twitches.

Case report: An elite American football player with MPS symptoms failed to respond to standard treatments. He then received ETOIMS which completely alleviated the pain. After establishing pain control, the athlete continued with a further series of treatments to control symptoms of muscle tightness.

Conclusions: ETOIMS has a promising role in pain alleviation, increasing and maintaining range of motion, and in providing satisfactory athletic performance during long term follow up.

(Br J Sports Med 2004;38:e25) http://bjsm.bmjjournals.com/cgi/content/full/38/5/e25

Fracture shaft of clavicle, an indirect injury from bench pressing

I P S Gill, Chima Mbubaegbu

Injuries related to weight training are becoming increasingly common as the trend for body resistance training grows. There have been numerous injuries related to repeated stress, but this appears to be the first reported case of a fracture of the shaft of clavicle related to violent muscular contraction. It occurred in a 28 year old man during bench pressing. He was treated conservatively and the fracture united in six weeks. Resistant trainers should be made aware of the risks of heavy weight training and need proper supervision.

(Br J Sports Med 2004;38:e26) http://bjsm.bmjjournals.com/cgi/content/full/38/5/e26