The authors of this study suggest that the 2d:4d ratio is an
important predictor of sporting ability in women. The interpretation is
based on the beta-coefficients and p-values from regression analyses of
different sports and the authors cite several works that hypothesize about
biological mechanisms.
I have several questions about the methods. First, if one is a high
level running athlete, th...
The authors of this study suggest that the 2d:4d ratio is an
important predictor of sporting ability in women. The interpretation is
based on the beta-coefficients and p-values from regression analyses of
different sports and the authors cite several works that hypothesize about
biological mechanisms.
I have several questions about the methods. First, if one is a high
level running athlete, then they might only play recreational soccer. Did
the authors include an elite runner as a recreational soccer player? It
would also be helpful for the authors to clarify whether subjects who
didn't participate in a sport were excluded from that particular analysis,
and if so, they should indicate the number of subjects for each sport.
Another concern regards the statistical analysis. Unfortunately, one
needs to know more than the beta coefficient and p-value from a
correlation to appropriately interpret the results. At the least, one
needs to know the r-squared value, and even more appropriate would be for
the authors to indicate that they conducted the appropriate tests showing
that the data fulfills the assumptions of linear regression. Actually
seeing the data in a scatter plot for each sport (or one scatter plot with
different symbols for each sport) would also be helpful but with so many
sports, this may have been limited by journal space.
Even assuming all of these are correct, one should examine the
relationships between sports. Why do soccer and running have large
negative correlations but gymnastics does not? How is golf similar to
soccer and running, but not cricket? How come there was no correlation for
skiing in this analysis whereas there was a correlation in the Manning
article cited by the authors (reference #11)? The requirements of
badminton are similar to those of squash but the correlations were quite
different. Given the proposed mechanisms by the authors, why would Martial
Arts have a reverse correlation?
I look forward to reading the authors' response.
Ian Shrier MD, PhD, Dip Sport Med, FACSM
Centre for Clinical Epidemiology and Community Studies
Lady Davis Institute for Medical Research, SMBD-Jewish General Hospital,
McGill University
I read with interest this work..But from the radiological
point of view the in line technique for injection is much effective for
attacking the color spots which represent the neovessls. There are two
types for this technique.First the long in line technique which enable us
to see the entire path of the needle in its way to attack the target. We
inject from the medial side in the direction of the lon...
I read with interest this work..But from the radiological
point of view the in line technique for injection is much effective for
attacking the color spots which represent the neovessls. There are two
types for this technique.First the long in line technique which enable us
to see the entire path of the needle in its way to attack the target. We
inject from the medial side in the direction of the long axis of the
tendon with a shallow angle to attack several spots. The injection is done
during withdrawal of the needle. Here the position of the probe is
identical to the figure 1. In short line technique the probe is
perpendicular to the short axis of the tendon. And the needle is at a
shallow angle to the probe. The injection also is done from the medial
side. We see the distal part of the needle attacking the target. The
needle in the perpendicular plain to the tendon and to the long axis of
the probe will appear as an echogenic dot with posterior artifact. This
echogenic dot will appear after a certain distance from the edge of the
probe. We cannot accurately know whether it is inside the color spot or, before or after it at the same plain .The immediate disappearance of the
color spots may be simply from pressure of our material on the vessels not
to it's direct effect on it. . so the in-line technique is more accurate and enables us to directly attack multiple colour spots with one injection.....Thanks
In line with the previous work of their laboratory, Tucker et al [1]
recently proposed a new point of view on the dynamic control mechanisms of
the athlete during self-paced exercise. The authors should be thanked for
their innovative contribution to exercise physiology, and we think that
the tools they used need some complements.
Firstly, some methodological caution should be taken into accou...
In line with the previous work of their laboratory, Tucker et al [1]
recently proposed a new point of view on the dynamic control mechanisms of
the athlete during self-paced exercise. The authors should be thanked for
their innovative contribution to exercise physiology, and we think that
the tools they used need some complements.
Firstly, some methodological caution should be taken into account for
forthcoming studies. Indeed, the number of analyzed data points (100 for
the entire trial and only 20 for each interval) seems insufficient for non-linear analyses. A recent study showed a dramatical decrease in
performance of spectral analysis with short series. [2] So we suggest that
a minimum of 512 points should be considered to improve the validity of
the method. Furthermore, the authors also used the Higuchi method for the
determination of a fractal dimension on the number of available points.
However Higuchi's algorithm primarily assesses geometric fractal
properties, and much more relevant methods for the assessment of
statistical fractal properties have widely been developed. So we suggest
that a temporal method as Detrended Fluctuation Analysis (DFA) should be
associated to spectral analysis, and completed by a method like
ARFIMA/ARMA modeling, which provides a statistical probability for series
to be fractal.
Secondly, data showed the presence of an endspurt leading the non-stationary of the signal. The authors concluded themselves that "the
dominant low frequency cycle is probably caused by, or related to, the
decrease in power output evident in most athletes during the middle period
of the event, and the endspurt which occurs at the end of the event". That
is precisely the reason why fractal analysis have to be applied on
stationary signals. So we suggest that the drift of the data across the
events should be corrected. The absence of steady-state is confirmed by
the facts that "the dominant frequency spikes found when analyzing shorter
time epochs at the beginning, middle and end of the time trial were
different to those found when analyzing the frequency spectrum of the
entire time trial". This result seems in contradiction with the self-similarity properties of fractal series. [4-5] In the same line, data
reporting multiple peaks frequency peaks seems fundamentally opposed to
1/f-like scaling properties. [4-5] From a general point of view, non
random fluctuations are not automatically fractal [3], and even if series
in this study were indeed fractal, fractal properties are conceived to be
generated by the interaction of several subsystems [4-5] and do not allow
to conclude to the presence of one central governor.
References
1 Tucker R, Bester A, Lambert EV, et al. Non-random fluctuations in
power output during self-paced exercise. Br J Sports Med. 2006, 40: 912-917.
2 Delignieres D, Ramdani S, Lemoine L, et al. Fractal analyses for
‘short’ time series: A re-assessment of classical methods. J Math Psychol.
In press
3 Torre K, Delignières D, Lemoine L. Detection of long-range
dependence and estimation of fractal exponents through ARFIMA modeling.
Brit J Math Stat Psy. In press
4 Beltz BC, Kello CT. On the intrinsic fluctuations of human
behavior. In: Sohob SP, ed. Trends in Cognitive Psychology. New York: Nova
Publishers 2006.
5 Goldberger AL. Nonlinear dynamics, fractals and chaos theory:
Implications for neuroautonomic heart control in health and disease. In:
Bolis CL, Licinio J, eds. The Autonomic Nervous System. Genova: World
Health Organization 1999.
We appreciate the electronic letter from Dickinson and McConnell who
refer to our review “Inhaled beta 2-agonists and performance in
competitive athletes”. They make the point that maintaining the formal
requirement to apply for a TUE (therapeutic use exemption) before the
start of therapy with inhaled beta 2-agonists in asthmatic athletes in the
long term leads to improved medical care and diagnost...
We appreciate the electronic letter from Dickinson and McConnell who
refer to our review “Inhaled beta 2-agonists and performance in
competitive athletes”. They make the point that maintaining the formal
requirement to apply for a TUE (therapeutic use exemption) before the
start of therapy with inhaled beta 2-agonists in asthmatic athletes in the
long term leads to improved medical care and diagnostic techniques.
However, this argument leads to the consideration whether such aims are
worth the bureaucratic burden brought up by the application process – a
view that we challenge. In addition, we do not agree that improvement of
medical care and refinement of diagnostic techniques are worthwhile
targets for the formulation of prohibited lists within doping control
efforts. In contrast, optimal medical care and innovation of diagnostic
tools represent natural issues for physicians dealing with elite athletes
as well as for sports medical science.
I read with great concern the opinions expressed in the commentary by
DiPietro and Stachenfeld published in the June issue of the British
Journal of Sports Medicine (1). As a competitive athlete who has
experienced both oligomenorrhea and amenorrhea, I applaud the American
College of Sports Medicine for leading the way to educate girls and women
about the Female Athlete Triad (2). Like man...
I read with great concern the opinions expressed in the commentary by
DiPietro and Stachenfeld published in the June issue of the British
Journal of Sports Medicine (1). As a competitive athlete who has
experienced both oligomenorrhea and amenorrhea, I applaud the American
College of Sports Medicine for leading the way to educate girls and women
about the Female Athlete Triad (2). Like many competitive athletes, I too
was unaware of the clinical consequences of energy deficiency on
reproductive function and bone health. During my undergraduate course
work, I was fortunate to have my education include information on the
Female Athlete Triad. As I continued to read the literature surrounding
Triad related issues I began to understand how an energy deficit disrupts
metabolic homeostasis and contributes to reproductive dysfunction
ultimately causing complete ovarian suppression and bone loss (2,3).
The information generated from Triad related research, education and
advocacy programs empowered me to develop an intellectual understanding of
the etiology of Triad related clinical sequelae, thus enabling me to make
healthy behavior changes. I strongly object to the inappropriate comments
of DiPietro and Stachenfeld. Their suggestion that Triad related research
will “discourage sport participation for women and girls” is misleading.
Moreover, I remain dumbfounded by their suggestion that the Triad does not
exist among athletes. As an athlete who has successfully improved my
health by learning to understand the volume of calories necessary for my
energetic demands, I find the comments of DiPietro and Stachenfeld
irresponsible. Clearly, Triad related research has successfully impacted
my health and sport performance, and I can testify to the healthy outcomes
of increased awareness and education programming. Educating athletes,
coaches, and parents to help them recognize the signs and symptoms of the
Triad may prevent an unnecessary tragedy, such as the death of a 20 year
runner recently reported in the New York Times (4).
References
1. DiPietro, L., Stachenfield, NS. The myth of the female athlete
triad. Br J Sports Med 40:490-493, 2006.
2. Otis C.L., Drinkwater B., Johnson M., Loucks A., Wilmore J.
American College of Sports Medicine position stand. The Female Athlete
Triad. Med Sci Sports Exerc. 29:i-ix, 1997.
3. Zanker, C.L., & C.B. Cooke. Energy Balance, Bone Turnover, and
Skeletal Health in Physically Active Individuals. Med. Sci. Sports Exerc.
36 (8): 1372–1381, 2004. or maybe the Zanker paper in the same issue in
BJSM
4. Scott, P. When being varsity-fit masks an eating disorder.
www.nytimes.com, September 14, 2006. Accessed on September 15, 2006.
We read with great interest the recent review from Kinderman and
Meyer in the recent supplement in the BJSM entitled ‘Inhaled ß2-agonists
and performance in competitive athletes’. They raise the issue as to
whether it is appropriate for inhaled ß2-agonists to require an
abbreviated TUE before an athlete is allowed to use them in order to
attenuate their asthma/EIA. They put fo...
We read with great interest the recent review from Kinderman and
Meyer in the recent supplement in the BJSM entitled ‘Inhaled ß2-agonists
and performance in competitive athletes’. They raise the issue as to
whether it is appropriate for inhaled ß2-agonists to require an
abbreviated TUE before an athlete is allowed to use them in order to
attenuate their asthma/EIA. They put forward the suggestion inhaled ß2-agonists are inappropriately on the WADA prohibited list due to the lack
of evidence in the literature suggesting a performance enhancing effect of
inhaled ß2-agonists. Although the process of acquiring a TUE can cause
administrative burden we would like to point out that our work in this
area has demonstrated marked improvement in the quality of care elite
athletes receive regarding respiratory issues. In the build up to the 2004 Athens Olympic
Games we reported that 20% of British elite athletes using asthma
medication where doing so inappropriately [1].
Furthermore, screening elite athletes for asthma/EIA appears warranted as
reports have suggested many athletes fail to recognise the symptoms of
asthma and even those athletes who do report symptoms do not necessarily
have EIA and may suffer from other conditions such as inspiratory stridor
[2;5,4;3].
Therefore diagnosis without specific tests for EIA may result in false
positive and false negative diagnosis.
In summary we agree with Kinderman and Meyer that there is no
conclusive evidence that inhaled ß2-agonists improves athletic
performance. However, the requirement of abbreviated TUE’s has resulted in
improved diagnostic techniques being used on a more regular basis with
elite athletes and has lead to an improvement in the quality of care
athletes receive. In the future if inhaled ß2-agonists are removed from
the WADA prohibited list we hope this will not result in deterioration of
the support athletes have started to receive since the TUE requirement
came into effect in 2002
Yours Sincerely,
Dr. John Dickinson
English Institute of Sport
Prof. Alison McConnell
Sports Science, Brunel University
References
1. Dickinson, J., Whyte, G., McConnell, A. et al. The Impact of the IOC-
MC changes in asthma criteria: A British Perspective. Thorax 2005; 60: 629
-632
2. Dickinson, J., Whyte, G., McConnell, A. et al. Screening elite winter
athletes for exercise-induced asthma: a comparison of three challenge
methods. British Journal of Sports Medicine 2006; 40: 179-183
3. Holzer, K. and Brukner, P. Screening of athletes for exercise-induced
bronchoconstriction. Clinical Journal of Sports Medicine 2004; 14: 134-8
4. Rundell, K. Im, J. Mayers, L. et al. Self-reported symptoms and
exercise-induced asthma in the elite athlete. Medicine and Science in
Sports and Exercise 2001; 33: 208-213
5. Rundell, K. and Spiering, B. Inspiratory Stridor in Elite Athletes.
Chest 2003; 123: 468-74
I read with interest the recent systematic review examining the
effectiveness of stretch on ankle range of motion. The authors are to be
commended for such an important piece of work. The treatment effects are
very small and in keeping with a number of randomised controlled trials
looking at the effects of stretch in patients with neurological
conditions. I suspect few clinicians would consider a t...
I read with interest the recent systematic review examining the
effectiveness of stretch on ankle range of motion. The authors are to be
commended for such an important piece of work. The treatment effects are
very small and in keeping with a number of randomised controlled trials
looking at the effects of stretch in patients with neurological
conditions. I suspect few clinicians would consider a treatment effect
possibly as low as 1 degree as worthwhile. However, I think the effect
size would have been even smaller, and possibly non-existent, if a
distinction was made between the immediate and lasting effects of stretch.
If measurements are made soon after the cessation of the last stretch
intervention, range of motion reflects the immediate response of soft
tissue structure to stretch. This is due to the effects of viscous
deformation. However, presumably, what is of far more importance to
clinicians is the lasting effects of stretch. That is, does stretch induce
structural and morphological change with a resultant increase in range of
motion that lasts for more than a day after the cessation of stretch. Are
the authors able to comment on whether the five randomised controlled
trials included in the systematic review made this distinction?
Noakes and Speedy, in the article, “Case proven: exercise associated
hyponatremia is due to overdrinking,” deliver a shot at the 1996 ACSM
Exercise and Fluid Replacement Position Stand that is off the mark. Much
as the popular 1960’s television cartoon series Rocky and Bullwinckle Show
presented Aesop’s Fables in “Fractured Fairy Tales;” a key element of the
story is missing.
Noakes and Speedy, in the article, “Case proven: exercise associated
hyponatremia is due to overdrinking,” deliver a shot at the 1996 ACSM
Exercise and Fluid Replacement Position Stand that is off the mark. Much
as the popular 1960’s television cartoon series Rocky and Bullwinckle Show
presented Aesop’s Fables in “Fractured Fairy Tales;” a key element of the
story is missing.
The ACSM position stand recommends that athletes
“consume the maximal amount of fluids during exercise that can be
tolerated without gastrointestinal discomfort up to a rate equal to that
lost from sweating,” not "drink as much as you can,” as is stated in the
text of “Case Proven.” The recommendation is briefly summarized in the
abstract of the position stand, which creates a possibility for
misunderstanding or misquoting if one reads only the abstract and not the
Position Stand itself. Reading the entire document is required to avoid a
“fractured” message. Attributing “drink as much as you can” to the 1996
American College of Sports Medicine (ACSM) Exercise and Fluid Replacement
Position Stand is a recurring theme in the works of a few authors, but the
problem is simply misapplication of the ACSM advice.
I have copied the
pertinent section of the ACSM position stand to illustrate the
recommendations:
“As such, individuals participating in prolonged intense exercise must
rely on strategies such as monitoring body weight loss and ingesting
volumes of fluid during exercise at a rate equal to that lost from
sweating, i.e., body weight reduction, to ensure complete fluid
replacement. This can be accomplished by ingesting beverages that enhance
drinking at a rate of one pint of fluid per pound of body weight
reduction. While gastrointestinal discomfort has been reported by
individuals who have attempted to drink at rates equal to their sweat
rates, especially in excess of 1 L/h, this response appears to be
individual and there is no clear association between the volume of
ingested fluid and symptoms of gastrointestinal distress. Further, failure
to maintain hydration during exercise by drinking appropriate amounts of
fluid may contribute to gastrointestinal symptoms. Therefore, individuals
should be encouraged to consume the maximal amount of fluids during
exercise that can be tolerated without gastrointestinal discomfort up to a
rate equal to that lost from sweating.”
Some confusion may arise from reading only the abstract, which
states, “During exercise, athletes should start drinking early and at
regular intervals in an attempt to consume fluids at a rate sufficient to
replace all the water lost through sweating (i.e., body weight loss), or
consume the maximal amount that can be tolerated.” In light of the main
text, this statement was intended to mean “replace up to sweat losses.”
The abstract summary statement apparently opened the door to
misinterpretation. The point is clearly stated and correct in the body of
the document and leads to the moral of the tale. First, read the entire
document, and second, ACSM has cautioned its Position Stand authors to
make absolutely sure their abstracts represent clearly and accurately the
main conclusions, since summaries by their nature are incomplete and can
lead to confusion or worse. Since Dr. Noakes was a reviewer of the 1996
ACSM fluid position stand, he should be familiar with the entire Position
Stand.
While most involved in the care and study of athletes agree that
ingesting too much hypotonic fluid, either water or sports drink,
predisposes certain athletes to hypervolemic hypernatremic encephalopathy
and pulmonary edema, the exercise associated hyponatremia case is not
closed. As Dancaster demonstrates in his 1971 publication, hypovolemic
hyponatremia did, and from my clinical experience still does, occur in
long duration events, probably as a combined result of sweat sodium and
water losses. Eight hyponatremic cases with 4-7% decreases in body weight
in one race, as Dancaster outlines from a relatively cool Comrades
Marathon, would be a rarity today, probably because we have changed the
culture of fluid replacement since the 60’s and early 70’s when
replacement fluids on the sidelines and at races were non existent. Now
fluids are freely available to athletes and there is less severe
dehydration than in the past. Fluid availability is good to a point as
Noakes and Speedy outline in their paper, but too much of a good thing can
be disastrous for a select few.
While the number of hyponatremic cases has increased since 1971,
mostly from the hypervolemic class, replace only your sweat losses remains
the best advice today. Giving ranges, whether it is 600-1200 ml/h in the
ACSM Position Stand or 400-800 ml/hr as suggested by Noakes, the
individual variability in sweat rates leave some underhydrated and others
overhydrated A prime example is the case presented by Dugas and Noakes
of a woman who repeatedly developed hyponatremia during prolonged
activities and had a sweat rate of 270 ml/hour. She was destined to
overhydrate with any of the published volume recommendations because she
has a sweat rate that falls far below the usual sweat rate ranges during
exercise. Replacing sweat losses is her safest route to successful
participation, because her kidneys do not respond with appropriate
diuresis during activity. The wide variation in fluid requirements across
the entire athlete population makes it nearly impossible to give a precise
recommendation that includes specific fluid volumes. The best advice still
remains to “replace the sweat losses” as outlined in the 1996 ACSM
Position Stand. We are all interested in athlete safety and a “fractured”
misunderstood or misstated message does not advance that goal.
ACSM’s Exercise and Fluid Replacement Position Stand is currently in
revision and should be published in the near future with updates that
reflect changes in the area since 1996.
William O Roberts MD, MS, FACSM Past President, American College of
Sports Medicine (I have no financial or advisory ties to any water or
sports drink companies. I did receive an honorarium from the Gatorade
Company for appearing on an educational film clip regarding exertional
heat stroke in 2003.)
References
Convertino VA, Armstong LE, Coyle EF, et al. American College of
Sports Medicine Position Stand: Exercise and Fluid Replacement. Med Sci
Sports Exerc 1996; 28: R1-7.
Dancaster CP and Whereat SJ: Fluid and electrolyte balance during
the Comrades Marathon. S Afr Med J 45:147-50, 1971.
Dugas JP and Noakes TD. Hyponatremia encephalopathy despite a modest
rate of fluid intake during a 109 km cycle race. Brit J Sports Med 2005;
39;e38 [http//bjsportmed.com/cgi/content/ful/39/10/e38].
Noakes TD and Speedy DB. Case proven: exercise associated
hyponatremia is due to overdrinking. Brit J Sports Med 2006; 40(7):567-
572.
In the article about how older runner's strides are shorter which I
have included below my comment, one has to seriously take into account the
body fat percentage of each runner otherwise such a test won't mean that
much.
Most of us tend to put on more weight as we get older. Weight has a
serious effect on stride length. It has a serious effect on stride length
regardless of age. But even g...
In the article about how older runner's strides are shorter which I
have included below my comment, one has to seriously take into account the
body fat percentage of each runner otherwise such a test won't mean that
much.
Most of us tend to put on more weight as we get older. Weight has a
serious effect on stride length. It has a serious effect on stride length
regardless of age. But even great athletes put on weight as they get
older. Weight destroys stride length big time.
Body fat weight percentage needs to be seriously taken into account
when doing such an analysis.
I personally would like to see a test on runners stride length based
on body fat percentage because I seriously feel this is something whose
effects are completely underestimated.
Dr Dyson Sport, Exercise and Health Sciences
University of Chichester
College Lane
Chichester, PO19 6PE
West Sussex
UK
email: r.dyson@chi.ac.uk
Objective: To investigate the stride pattern of different age groups of veteran runners in a marathon road race.
Methods: This kinematic study investigated the stride pattern (stride
length, stride period, velocity, stance time, and non-stance time) for 151
runners (78 men aged up to 75-80, 73 women aged up to 60-64) at the 7
mile point.
Results: Significant declines for men with aging were found for mean stride length (from 2.4 m at age 40-49 to 2.0 m at age 60+), velocity, and non-stance time (p<0.05), whereas stride period changed little. The
findings indicate that the lower velocities of older runners are
associated with shorter strides whereas cadence changes little. However,
when a statistical adjustment was made for the variation in runners'
velocity, it was found that older runners did not have a significantly
shorter stride length at any given velocity.
Conclusion: Although a shorter stride is the mechanical route by which older runners lose velocity, the shorter stride may not be the
fundamental cause of the velocity reduction with age. This has
implications for researchers and coaches when investigating and training
veteran distance runner.
It is with interest that I read the article entitled "Calcific
tendonitis of the quadriceps" by Varghese et al [1]. The authors
reported a 46-yr-old healthy man presented with acute on chronic knee pain
immediately after stumble with a history of rugby-related injury to the
same knee seven years earlier. Lateral radiograph shows hyperostosis
anterior to patella with whiskering in the superior pole a...
It is with interest that I read the article entitled "Calcific
tendonitis of the quadriceps" by Varghese et al [1]. The authors
reported a 46-yr-old healthy man presented with acute on chronic knee pain
immediately after stumble with a history of rugby-related injury to the
same knee seven years earlier. Lateral radiograph shows hyperostosis
anterior to patella with whiskering in the superior pole and ossification
of tendon in the inferior pole of patella. These radiological findings are
consistent with diffuse idiopathic skeletal hyperostosis (DISH) and can be
overlooked. However, whiskers of DISH should be differentiated with
amorphous calcification of calcific tendinitis. The latter does not have
hyperostosis and ossification of entheses and/or tendons. Furthermore,
its calcific deposits may be invisible in acute phase and on follow-up
radiographs [2].
DISH is a disorder of middle-aged and elderly persons predominantly
in males. The radiological features are characteristic consisting of
ossification/calcification of entheses, the regions of insertion of
tendons, ligaments, and joint capsules into whiskers, bony spurs, and
hyperostosis in the spinal and/or extraspinal skeleton with normal
adjacent joint space. Frequently, the radiographic appearance of DISH in
peripheral skeleton is distinctive to suggest the correct diagnosis even
without axial radiography [3]. Nevertheless, the differential
radiological diagnosis of extraspinal enthesopathies with
spondyloarthropaties and other conditions such as acromegaly should be
considered.
Clinically, DISH is characterized with a broad spectrum of
presentations ranging from episodes of chronic low-grade pain and/or
stiffness of the involved spinal and/or extraspinal sites such as neck
pain and knee pain to acute localized pain of enthesitis and
"periarthritis", dysphagia, and compressive myelopathy; however, some
patient may be completely asymptomatic. Extraspinal manifestations
associated with DISH are not infrequent. Patella is one the most commonly
involved sites. Entheses and/or tendons are commonly subject to overuse
injuries such as quadriceps tendinitis in athletic and occupational
settings. Whether repetitive micro-trauma and/or acute trauma such as
stumbles or rugby-related falls or knee contusions precipitate chronic
enthesopathy to acute simple isolated calcific tendinitis, or "whiskers"
are not known. Calcific tendinitis is a primary reactive tendninopathy
and not progressive but self-healing; increased awareness and knowledge of
calcific tendinitis may avoid unnecessary surgical intervention [4].
Interestingly, vertebral hyperostosis was reported in 54% of 46 cases of
calcific tendinitis of the shoulder [5]. The possible association between
calcific tendinitis and DISH should be considered and investigated.
Chun-Cheung Woo 23 Holland Street
Chatswood
NSW 2067
Australia
chuncheungwoo@hotmail.com
Competing interests: none declared
References
1. Varghese B, Radcliffe GS, Groves C, Luke AC, Curtis MJ. Calcific
tendonitis of the quadriceps. Br J Sports Med 2006; 40: 652-654.
2. Macurak RB, Goldman JA, Heirsh E et al. Acute calcific quadriceps
tendinitis. South Med J 1980; 73:322-325.
3. Resnick D, Shaul SR, Robins JM. Diffuse idiopathic skeletal
hyperostosis (DISH): Forestier¡¦s disease with extraspinal manifestations.
Radiology 1975; 115:513-524.
4. Deshmukh NV, Deshmukh RG, Greenough C. Acute calcific quadriceps
tendinitis: a case report. The Knee 2000; 7:45-47.
5. Mathieu P, Beaume T, Conrozier T, Vignon E. Incidence of vertebral
hyperostosis in patients with calcified tendinitis of the shoulder. Rev
Rhum Mal Osteoartic 1990; 57:177-180.
Dear Editor
The authors of this study suggest that the 2d:4d ratio is an important predictor of sporting ability in women. The interpretation is based on the beta-coefficients and p-values from regression analyses of different sports and the authors cite several works that hypothesize about biological mechanisms.
I have several questions about the methods. First, if one is a high level running athlete, th...
Dear Editor
I read with interest this work..But from the radiological point of view the in line technique for injection is much effective for attacking the color spots which represent the neovessls. There are two types for this technique.First the long in line technique which enable us to see the entire path of the needle in its way to attack the target. We inject from the medial side in the direction of the lon...
Dear Editor
In line with the previous work of their laboratory, Tucker et al [1] recently proposed a new point of view on the dynamic control mechanisms of the athlete during self-paced exercise. The authors should be thanked for their innovative contribution to exercise physiology, and we think that the tools they used need some complements.
Firstly, some methodological caution should be taken into accou...
Dear Editor,
We appreciate the electronic letter from Dickinson and McConnell who refer to our review “Inhaled beta 2-agonists and performance in competitive athletes”. They make the point that maintaining the formal requirement to apply for a TUE (therapeutic use exemption) before the start of therapy with inhaled beta 2-agonists in asthmatic athletes in the long term leads to improved medical care and diagnost...
Dear Editor-in Chief
I read with great concern the opinions expressed in the commentary by DiPietro and Stachenfeld published in the June issue of the British Journal of Sports Medicine (1). As a competitive athlete who has experienced both oligomenorrhea and amenorrhea, I applaud the American College of Sports Medicine for leading the way to educate girls and women about the Female Athlete Triad (2). Like man...
Dear Editor,
We read with great interest the recent review from Kinderman and Meyer in the recent supplement in the BJSM entitled ‘Inhaled ß2-agonists and performance in competitive athletes’. They raise the issue as to whether it is appropriate for inhaled ß2-agonists to require an abbreviated TUE before an athlete is allowed to use them in order to attenuate their asthma/EIA. They put fo...
Dear editor,
I read with interest the recent systematic review examining the effectiveness of stretch on ankle range of motion. The authors are to be commended for such an important piece of work. The treatment effects are very small and in keeping with a number of randomised controlled trials looking at the effects of stretch in patients with neurological conditions. I suspect few clinicians would consider a t...
Dear Editor,
Noakes and Speedy, in the article, “Case proven: exercise associated hyponatremia is due to overdrinking,” deliver a shot at the 1996 ACSM Exercise and Fluid Replacement Position Stand that is off the mark. Much as the popular 1960’s television cartoon series Rocky and Bullwinckle Show presented Aesop’s Fables in “Fractured Fairy Tales;” a key element of the story is missing.
The ACSM po...
Dear Editor,
In the article about how older runner's strides are shorter which I have included below my comment, one has to seriously take into account the body fat percentage of each runner otherwise such a test won't mean that much.
Most of us tend to put on more weight as we get older. Weight has a serious effect on stride length. It has a serious effect on stride length regardless of age. But even g...
Dear Editor,
It is with interest that I read the article entitled "Calcific tendonitis of the quadriceps" by Varghese et al [1]. The authors reported a 46-yr-old healthy man presented with acute on chronic knee pain immediately after stumble with a history of rugby-related injury to the same knee seven years earlier. Lateral radiograph shows hyperostosis anterior to patella with whiskering in the superior pole a...
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