The section reporting the pain/SES scores on page 962, table 3 and
Figure 4 appear to contain many errors.
The authors state scores in the control group as follows:-
Before: SES (affective) 18.3 + (sensory)13.3 = 31.6
After: SES (affective) 19.9 + (sensory)13.3 = 33.2
this represents an increase of 1.6
In the text they have quoted a figure of 32.5, and this error is
repeated in the SES Control group section of table 3 (which appears to
contain a misprint). IN figure 4 the W8 point appears around the 35.5
level?!
This means the difference in improvement in pain scores between
treatment (+1.6) and controls (29.9-25.9 = -4) is only 5.6, not nearly 10
as suggested in point M2 in figure 4.
I'm not sure if this difference would be statistically or clinically
significant. Given that this trial was neither blinded or placebo
controlled, I'm not sure it supports the use of orthosis.
This study provides a useful additional information with regard to the merits of injection therapy in the management of resistant elbow tendinopathy. It would have been helpful if the authors had commented on the relative costs (time/money) of the treatments given the current pressures on minimising health care costs. There are variety of systems available for producing platelet rich plasma injections which can result in a signifi...
This study provides a useful additional information with regard to the merits of injection therapy in the management of resistant elbow tendinopathy. It would have been helpful if the authors had commented on the relative costs (time/money) of the treatments given the current pressures on minimising health care costs. There are variety of systems available for producing platelet rich plasma injections which can result in a significant cost burden to the health care provider or patient. Studies such of this will be picked up by manufacturers of these systems and used in their marketing.However if there is no significant difference in clinical outcome by using simple autologous blood injections then the authors should conclude that there is no enhanced benefit from using PRP and its associated costs are not justified.
The volume of blood injected was not described in the section on "technique" and this should be corrected to make the methodology clear and reproducible. It is assumed that the 1.5 mL 'siphoned from the buffy coat layer' was used for the PRP injectionbut this needs to be clarified.
Finally,whether it is the injection procedure and physical disruption of the tissue or the contents of the syringe that are important in stimulating a response remains unclear.
Re. Stephanie J Hollis, Mark R Stevenson, Andrew S McIntosh, et al.
Compliance with return-to-play regulations following concussion in
Australian schoolboy and community rugby union players. Br J Sports Med
published online June 24, 2011. doi: 10.1136/bjsm.2011.085332.
We read with interest the findings of this investigation by Hollis et
al.(1) The conclusion that there is a clear failure of...
Re. Stephanie J Hollis, Mark R Stevenson, Andrew S McIntosh, et al.
Compliance with return-to-play regulations following concussion in
Australian schoolboy and community rugby union players. Br J Sports Med
published online June 24, 2011. doi: 10.1136/bjsm.2011.085332.
We read with interest the findings of this investigation by Hollis et
al.(1) The conclusion that there is a clear failure of translation and
implementation of concussion return-to-play regulations within community
rugby is well supported by the data presented in the study. The next
obvious question is why?
In a recent survey of community rugby union coaches undertaken in the
same Australian state as the research by Hollis et al, 23% of community
coaches (14 of the 62 coaches who answered the question) reported that
they were not aware of, or were unsure of their awareness of, the
Australian Rugby Union (ARU) concussion guidelines. This is despite the
fact that all rugby union coaches in Australia must be SmartRugby
accredited and the SmartRugby training program includes written
information with a clear statement that "a player who has suffered
concussion shall not participate in any match or training session for a
minimum period of three weeks from the time of injury, and may only do so
when symptom free and declared fit after proper medical examination".(2)
Other results from this survey indicated that of the 44 coaches who
were aware of the guidelines and responded to further questions, 59% did
not think that the guidelines were very effective in preventing injuries
(rating of 3 or less on a 5 point scale) and 25% either did not or were
not sure if they had informed their players about the guidelines in the
previous season. In addition, 23% of coaches reported that they had not
adhered very well (rating of 3 or less on a 5 point scale) to the ARU
concussion guidelines in the previous season and that 45% of the players
they coached had not adhered very well to these guidelines.
There may be many reasons why there is poor compliance among
community players with the ARU return-to-play regulations following
concussion. Perhaps community level sports participants and coaches are
influenced more by what they see and hear about concussion in professional
sport in the media than they are by the policies and procedures promoted
by sports' governing bodies.(3) Increasingly, policy translation and
implementation is being considered both an art and a science(4) and
perhaps the strategies used by the International Rugby Board (IRB) and the
ARU to support translation and implementation of the return-to-play
regulations were not well designed or planned. One suspects this is a
contributing factor when the IRB concussion guidelines are 12 pages long,
divided into two stages which contain three tables and three diagrams, the
smallest of which contains 13 steps connected by 14 arrows.(5) Certainly,
within an ecological framework of influences on behaviour of
individuals,(6) our preliminary research suggests that one possible reason
for lack of player compliance with the ARU return-to-play regulations is
that the message has not reached all community level community rugby
coaches (an acknowledged influence on participant behaviour),(7) and even
those whom it has reached do not always believe in the effectiveness of
the intervention nor do they adopt it with fidelity.
References
1. Hollis SJ, Stevenson MR, McIntosh AS, Shores EA, Finch CF.
Compliance with return-to-play regulations following concussion in
Australian schoolboy and community rugby union players. Br. J. Sports Med.
2011. Published Online First: 24 June 2011 doi:10.1136/bjsm.2011.085332.
2. Australian Rugby Union. ARU SmartRugby: Confidence in contact. A
guide to the SmartRugby program, Not dated: page 36.
3. McLellan TL, McKinlay A. Does the way concussion is portrayed
affect public awareness of appropriate concussion management: the case of
rugby league. Br. J. Sports Med. 2011;45(12):993-96.
4. Finch CF. No longer lost in translation: The art and science of
sports injury prevention implementation research. Br. J. Sports Med. 2011.
Published Online First: 22 June 2011 doi:10.1136/bjsports-2011-090230
5. International Rugby Board. Putting players first: IRB Concussion
Guidelines: International Rugby Board, 24 May 2011. Available from
http://www.irbplayerwelfare.com/pdfs/IRB_Concussion_Guidelines_EN.pdf.
Accessed 11 September 2011
6. Finch CF, Donaldson A. A sports setting matrix for understanding
the implementation context for community sport. Br. J. Sports Med.
2010;44(13):973-78.
7. Emery CA, Hagel B, Morrongiello BA. Injury prevention in child and
adolescent sport: Whose responsibility is it? Clin. J. Sport Med.
2006;16(6):514-41.
I was very excited to receive the September issue of your journal and
observe that there were a number of articles on chronic exertional
compartment syndrome. As Hutchinson quite rightly states: - "key questions
remain regarding the specific protocol a clinician should undergo when
performing intracompartmental pressure testing".
I was very excited to receive the September issue of your journal and
observe that there were a number of articles on chronic exertional
compartment syndrome. As Hutchinson quite rightly states: - "key questions
remain regarding the specific protocol a clinician should undergo when
performing intracompartmental pressure testing".
Although one can not be 100% sure of the diagnosis by only performing
a thorough history and clinical examination, it is quite a painful and
invasive procedure. I am therefore quite reluctant to do the procedure as
suggested by Hutchinson i.e. both legs, pre- and post exertional, and all
four compartments. Much to my surprise the next article by Hislop and Batt
advised the exact opposite, i.e. one leg should suffice, resting pressures
can be misleading and it is not necessary to test asymptomatic
compartments.
I am now more confused than before reading these articles and would
really appreciate guidance.
Kind regards
DR DC JANSE VAN RENSBURG
HEAD: SECTION SPORTS MEDICINE
DEPARTMENT OF ORTHOPAEDICS
I note that the description of the Hawkins Kennedy impingement test
in Moen's article uses the words "with arm in 90 degrees in forward
elevation in the scapular plane". The description by Hawkins and Kennedy
(1980) has the patient in "approximately 90 degrees of forward flexion".
The picture in the Moen article is clearly different from that in Hawkins
and Kennedy's article.
I note that the description of the Hawkins Kennedy impingement test
in Moen's article uses the words "with arm in 90 degrees in forward
elevation in the scapular plane". The description by Hawkins and Kennedy
(1980) has the patient in "approximately 90 degrees of forward flexion".
The picture in the Moen article is clearly different from that in Hawkins
and Kennedy's article.
Yours sincerely
David Young
References:
Hawkins, R. J. Kennedy, J. C. Impingement syndrome in athletes. Am J
Sports Med, 1980, 8, 3 151-8.
Moen, M et al. Clinical tests in shoulder examination: how to perform
them. BJSM 2010,44:370-375
Thank you for your thought-provoking questions about the health dis-
benefits of tennis. While it is true that the manuscript focused on the
health benefits related to tennis, if you browse down to the end of the
article, there is a section discussing the injurious aspects of tennis.
Within that section, it is acknowledged that tennis is a vigorous high
impact sport with it's fair share of s...
Thank you for your thought-provoking questions about the health dis-
benefits of tennis. While it is true that the manuscript focused on the
health benefits related to tennis, if you browse down to the end of the
article, there is a section discussing the injurious aspects of tennis.
Within that section, it is acknowledged that tennis is a vigorous high
impact sport with it's fair share of sport-related injuries and health
concerns (references 80-88). It is difficult to ascertain if musculo-
skeletal conditions commonly seen in older age are due to previous sport
participation or would have occurred anyways due to either genetic
predisposition or other non-sport related orthopedic injuries. To answer
this question, extensive biological long-term tracking from youth sport
participation onwards would be required and I am unaware of any such
records being published. This would be a highly controversial area of
research due to health privacy issues. That said, as with any sport or
physical activity, tennis must be undertaken by individuals of any age
with caution in respect to their particular health condition(s). It is
certainly not a sport claiming to be a cure-all; if anything, if one does
not take sufficient care, tennis, and any sport endeavor, can contribute
to or exacerbate pre-existing medical conditions. Only the individual, in
consult with his/her medical doctor, can determine if tennis (either
singles or doubles) is a sport that would be beneficial, rather than
detrimental to one's overall health. Then it is up to the individual
whether to head their doctor's advice.
Your abstract appears to focus exclusively on "health BENEFITS". Do
you know of any contrary paper that considers and proposes conclusions
about the possible and/or recognised DISBENEFITS.
Now aged 78, I seem to be a mess of worn-out joints, bone-alignment
and sciatic nerve problems which osteopaths, physiotherapists and "allied
trades" all tend to attribute 'most likely' to the heavy wear-...
Your abstract appears to focus exclusively on "health BENEFITS". Do
you know of any contrary paper that considers and proposes conclusions
about the possible and/or recognised DISBENEFITS.
Now aged 78, I seem to be a mess of worn-out joints, bone-alignment
and sciatic nerve problems which osteopaths, physiotherapists and "allied
trades" all tend to attribute 'most likely' to the heavy wear-and-tear of
playing high-level tennis for something of the order of 40 years from age
c.15 to age c.55.
I am not disputing what they say. In fact it seems very likely. And -
- alas and alack -- I have no consolidated documentation recording what I
have to call "my progressive decay" ... my recourse to 'medical
assistance' has been pretty sporadic and, over the years, has spread
across consultations in Kenya, Hong Kong, Brunei, Cyprus, West Germany,
Warwickshire, Argyllshire, the south of Spain and Morocco.
I am here looking at the BJSM simply because my poor lady wife wanted
me to look for browser references that might have something to say about
the ultimate "bottom line" I could reach in my advancing decrepitude, so
that she can prepare herself for what might be "the worst."
Any references which you could suggest would be greatly appreciated.
Bauman et al (1) provide an appealing overview of the potential role
of cycling in healthy living. The successful and sustained promotion of
cycling is well illustrated by the examples of the Netherlands and
neighbouring states. However, elsewhere there seem to be deep-rooted
problems: my own experience is of the UK and, specifically, Northern
Ireland. One problem here has been a belief that cycling - particularly in
the...
Bauman et al (1) provide an appealing overview of the potential role
of cycling in healthy living. The successful and sustained promotion of
cycling is well illustrated by the examples of the Netherlands and
neighbouring states. However, elsewhere there seem to be deep-rooted
problems: my own experience is of the UK and, specifically, Northern
Ireland. One problem here has been a belief that cycling - particularly in
the context of everyday commuting - never successfully addresses the
parallel discomforts of heat and sweat on the one hand, and adequate
protection against the weather on the other hand. However, the most
pertinent disincentive must be the obvious dangers in loss of control of a
bike, particularly that occasioned by collision with a motor-vehicle. A
crucial issue here is the fourth-power relationship between motor-vehicle
speed and fatality rates (2,3).
Potential amelioration could reside in the mass slowing of motor
traffic. After all road-humps and chicanes can ease the lot of
pedestrians; unfortunately, cyclists would likely have to negotiate the
same obstacles designed to control motorists.
Instead, engineering to promote cycling has typically entailed some
measure of separation from motor traffic. However, poorly designed and
policed facilities may render the situation for cyclists worse than if no
attempt at amelioration is provided. This has arguable been the case in
Northern Irelan. Cycle lanes are provided. Despite official prohibition
(4), motor-vehicles frequently park on or straddle cycle-lanes before
undertaking manoeuvres: junctions are particularly problematic regarding
rights-of-way. Furthermore, cycle lanes are often well short of any
plausible journey. Cyclists are free to use other traffic lanes (4) - but
motorists seem unaware of this and often evince hostility towards cyclists
exercising this freedom. The poor cyclist is uncomfortable on any part of
the road, whether designated solely for cycle-use or not. Not
infrequently, cyclists will resort to the sidewalk. However, by law
sidewalks are solely for pedestrians: cycling and driving are outlawed
(4). The conclusion is that the development of mass cycle-use is
discouraged, despite what the authorites may say they intend.
Dedicated paths are also available, although these are shared with
pedestrians. Pedestrians no doubt provide better fellow-travellers for
cyclists than do motor vehicles, but the two groups are nevertheless
imcompatible: cycling through groups of pedestrians or walking through
streams of cyclists are both uncomfortable experiences. As intimated in
the last paragraph, these dedicated paths - however well-intentioned -
represent a lack of joined-up thinking, given that sidewalks are for the
exclusive use of pedestrians.
Perhaps real change will ultimately arise from the reduced
availability of fuel, coupled with its ever-increasing cost. This may
force reduced speeds on motorists in order to save fuel - with a
comcomitant saving in road-casualties. Perhaps many motorists will fully
adopt cycling, eschewing car-ownership altogether. These suggestions are
given support by the fuel-crises of the 1970s, when amongst other measures
the UK goverenment reduced the maximum speed to 50 mph; casualty rates
tumbled as an unintended consequence(5). Unfortunately, no thought was
given to maintaining such measures after the fuel-crises passed.
REFERENCES
(1) Bauman A, Titze S, Rissel C, Oja P. Changing gears: bicycling as
the panacea for physical inactivity? BJSM doi:10.1136/bjsm.2010.085951.
(2) Hyden C, Varhelyi A. The effects of safety, time consumption and
environment of large scale use of roundabouts in an urban area: A case
study. Accident Anal Prev 2000;32: 11-23.
(3) Finch D J, Kompfner P, Lockwood C R, Maycick G. Speed, speed
limits and accidents. Project Report 58. TRL: Crowthorne UK, 1994.
(4) Anon. The Highway Code. Basingstoke: AA Publishing, 2008.
(5) Harrison I. Travel 1900-2000. London: Harper-Collins, 2000.
We have a slight disagreement with the methodology used in the
experiment. Following is a comment we shared with members of the
international tandeming community regarding the article.
What is obvious is that none of the researchers know a lot about
tandeming. For starters they don't discuss the pedal setup. My guess is
that none of the tandems used in the study were setup out-of-phase (OOP),
hence the capta...
We have a slight disagreement with the methodology used in the
experiment. Following is a comment we shared with members of the
international tandeming community regarding the article.
What is obvious is that none of the researchers know a lot about
tandeming. For starters they don't discuss the pedal setup. My guess is
that none of the tandems used in the study were setup out-of-phase (OOP),
hence the captain and stoker were doing the same pedal stroke at the same
time as opposed to alternating the energy requirements to move the mass of
the tandem though the air.
Team Wells has a long history of being 90-degrees OOP and we can,
albeit without scientific validation, attest to the fact that having a
separate pedal stroke works the stokers muscles, and given the uneven
weight distribution, the stoker probably works harder than the captain.
Team Wells has observed that our tandem gross vehicle weight is around 315
pounds. Therefore, each pedal stroke has to add to or maintain the
velocity of moving that 315 pound mass as well as air resistance. On
those occasions when either Linda or George slacks off for a few pedal
strokes, the result is a rapid drop in speed.
The report claims that the stoker is drafting and therefore doesn't
work as hard. I don't accept that conclusion because they did not look at
the dynamic of pedal phasing.
Linda & George Wells
Leaders - Doubles Of the Garden State (DOGS)
166 Brook Drive
Dover, NJ 07801-4705
973.361.1776 (Home, forwards to cell on ring #5)
973.270.8135 (Cell)
Teamwells1@verizon.net
www.d-o-g-s.org
Conflict of Interest:
We are avid tandemists and leaders of New Jersey's Premier Tandem Bicycle Club
Thank you for your comment. We agree that a standing style workplace
could be a good solution for certain working environments and its
feasibility and efficacy for improving health should be explored. However,
for many this would still require costly modifications to the working
environment in the form of purchasing height adjustable desks. Also, from
a research perspective, accelerometers would be needed to assess time...
Thank you for your comment. We agree that a standing style workplace
could be a good solution for certain working environments and its
feasibility and efficacy for improving health should be explored. However,
for many this would still require costly modifications to the working
environment in the form of purchasing height adjustable desks. Also, from
a research perspective, accelerometers would be needed to assess time
spent standing. The appeal of the pedal machines used in this study (which
are already available on the commercial market) is that they allow the
user to continue working in a familiar position while providing the
opportunity to be active.
The section reporting the pain/SES scores on page 962, table 3 and Figure 4 appear to contain many errors.
The authors state scores in the control group as follows:-
Before: SES (affective) 18.3 + (sensory)13.3 = 31.6 After: SES (affective) 19.9 + (sensory)13.3 = 33.2 this represents an increase of 1.6
In the text they have quoted a figure of 32.5, and this error is repeated in the SES Contr...
Dear Editor
Re. Stephanie J Hollis, Mark R Stevenson, Andrew S McIntosh, et al. Compliance with return-to-play regulations following concussion in Australian schoolboy and community rugby union players. Br J Sports Med published online June 24, 2011. doi: 10.1136/bjsm.2011.085332.
We read with interest the findings of this investigation by Hollis et al.(1) The conclusion that there is a clear failure of...
The Editor British Journal of Sports Medicine
Dear Prof Khan
I was very excited to receive the September issue of your journal and observe that there were a number of articles on chronic exertional compartment syndrome. As Hutchinson quite rightly states: - "key questions remain regarding the specific protocol a clinician should undergo when performing intracompartmental pressure testing".
Alth...
Dear Editor,
I note that the description of the Hawkins Kennedy impingement test in Moen's article uses the words "with arm in 90 degrees in forward elevation in the scapular plane". The description by Hawkins and Kennedy (1980) has the patient in "approximately 90 degrees of forward flexion". The picture in the Moen article is clearly different from that in Hawkins and Kennedy's article.
Yours sincer...
Dear Mr. Chambers,
Thank you for your thought-provoking questions about the health dis- benefits of tennis. While it is true that the manuscript focused on the health benefits related to tennis, if you browse down to the end of the article, there is a section discussing the injurious aspects of tennis. Within that section, it is acknowledged that tennis is a vigorous high impact sport with it's fair share of s...
Gentlemen,
Your abstract appears to focus exclusively on "health BENEFITS". Do you know of any contrary paper that considers and proposes conclusions about the possible and/or recognised DISBENEFITS.
Now aged 78, I seem to be a mess of worn-out joints, bone-alignment and sciatic nerve problems which osteopaths, physiotherapists and "allied trades" all tend to attribute 'most likely' to the heavy wear-...
Bauman et al (1) provide an appealing overview of the potential role of cycling in healthy living. The successful and sustained promotion of cycling is well illustrated by the examples of the Netherlands and neighbouring states. However, elsewhere there seem to be deep-rooted problems: my own experience is of the UK and, specifically, Northern Ireland. One problem here has been a belief that cycling - particularly in the...
We have a slight disagreement with the methodology used in the experiment. Following is a comment we shared with members of the international tandeming community regarding the article.
What is obvious is that none of the researchers know a lot about tandeming. For starters they don't discuss the pedal setup. My guess is that none of the tandems used in the study were setup out-of-phase (OOP), hence the capta...
Thank you for your comment. We agree that a standing style workplace could be a good solution for certain working environments and its feasibility and efficacy for improving health should be explored. However, for many this would still require costly modifications to the working environment in the form of purchasing height adjustable desks. Also, from a research perspective, accelerometers would be needed to assess time...
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