I am just a concerned father of a 13 year old girl who has been
playing competitive soccer for four years now.At what age do girls become
more at risk to acl injuries and can anyone suggest what exercises she can
do to minimize the chances of this happening.
Webborn's [1] articulation of the different injury prevention needs
across an athlete' sporting lifetime emphasises that a "one-size-fits all"
does not apply for sport safety and that researchers and practitioners
will need to be creative in developing solutions to the varying injury
problems for different age-groups of athletes. His recognition that
addressing these life-course stage injury risks will require the input o...
Webborn's [1] articulation of the different injury prevention needs
across an athlete' sporting lifetime emphasises that a "one-size-fits all"
does not apply for sport safety and that researchers and practitioners
will need to be creative in developing solutions to the varying injury
problems for different age-groups of athletes. His recognition that
addressing these life-course stage injury risks will require the input of
a range of professionals from both the health and sporting sector is
particularly welcome.
Whilst the model has largely been developed for professional
athletes, it can easily be extended to more recreational sports
participants and others involved in physical activity of an organised,
unorganised, informal, casual and incidental nature. In fact, the major
mechanisms of most injury morbidity (as represented by the International
Classification of Diseases [ICD] external cause codes) also vary across
the lifespan, and correlate highly with physical activity patterns at each
stage.[2] Accordingly, there has been a call to include consideration of
changes in lifespan injury risk more globally in injury prevention
research agenda.[3]
So how is injury across the lifespan related to changing physical
activity? It is well recognized that the major external causes of
injuries in childhood (through the early years to late adolescence) are
closely related to their increased mobility and development of physical
activity habits [4]:
0-1 year olds are beginning their movement patterns and exploration of
their surroundings and injuries are commonly associated with a lack of
supervision in particularly hazardous environments (e.g. around water);
1-4 year olds start to develop gross motor skills and the ability to
crawl, walk and climb and hazards become within their reach; falls are
their major injury mechanism;
5-9 year olds further develop their gross motor skills during active play
and immature bone development increases their risk of fractures; falls are
the major cause of injury, particularly from playground equipment and
trampolines;
10-14 year olds commence participation in formal sport either
recreationally or at school and their gross motor skills development and
activity often involves use of wheeled recreational devices and other
"movement toys" that move at speed; sport and active recreational injuries
are common as are those sustained during active transportation such as
bicycling, inline skating and skate boarding;
15-19 years olds start to participate in more competitive forms of sport,
including at higher levels of play and with increased duration/frequency.
They use more active transportation devices including those used at faster
speeds, and have increased exposure to more hazardous environments such as
riding/skating/blading on roads. Talented children can often play more
than one sport and train/play for increasingly more hours leading to
tissue overload. Common injuries in this age group are related to sport
and recreational injuries and most forms of active transportation such as
bicycling, inline skating and skate boarding.
But age-related injury patterns linked to common physical activities
do not just apply to children. At the broad population level, 20-39 year
olds also commonly experience sports/active recreational injuries, but are
at increased of road trauma due to being vehicle drivers or when engaging
in active transportation on roadways. This group is also at highest risk
of workplace injury, particularly associated with physical occupations.
People aged 40-59 years spend more time in their home settings and can
become more involved in home repairs and maintenance, such as gardening;
there is a significant increase in injury risk in the home in this group
associated with more leisure and incidental physical in this setting. In
older people, physical functionality and balance decline and this can
manifest in an increased risk of falls and associated fractures,
particularly as aspects of their mobility declines.
It is well known that there is a strong link between injury risk and
physical activity,[5] but less recognition of how these links change with
age. If physical activity strategies aimed at different population age-
groups, do not also address the changing nature of the injury risks for
those age-groups, there is a strong likelihood that they will not be
sustainable and lead to lifelong health gains for all.
As exercise medicine researchers and professionals, we need to take
Webborn's [1] call for establishing a lifetime model of injury occurrence
for both professional and amateur levels of sport and extend that to
encompass all forms of health-achieving physical activity, irrespective of
the context in which it occurs.
References
1. Webborn N. Lifetime injury prevention: the sport profile model. Br
J Sports Med. 2012;46:193-7.
2. National Public Health Partnership (NPHP). The National Injury
Prevention and Safety Promotion Plan: 2004-2014. Canberra: NPHP:
Commonwealth of Australia2004.
3. Villaveces A, Christiansen A, Hargarten S. Developing a global research
agenda on violence and injury prevention: a modest proposal. Inj Prev.
2010;16:190-3.
4. Finch C, Twomey D. Chapter 10. The biomechanical basis of injury during
childhood. In: de Ste Croix M, Korff T, editors. Paediatric biomechanics
and motor control Theory and application: Routledge Research in Sport and
Exercise Science; 2012. 209-32.
5. Finch CF, Owen N. Injury prevention and the promotion of physical
activity: What is the nexus? J Sci Med Sport. 2001;4:77-87.
Caroline Finch is an injury prevention researcher from the Australian
Centre for Research into Injury in Sport and its Prevention (ACRISP)
within the Monash Injury Research Institute (MIRI), Monash University,
Australia. She specialises in implementation and dissemination science
applications for sports injury prevention. She is the Senior Associate
Editor for Implementation & Dissemination for the British Journal of
Sports Medicine and a member of the Editorial Board of Injury Prevention;
both journals are published by the BMJ Group. Caroline can be followed on
Twitter @CarolineFinch
The dorsal horns are not merely passive transmission stations but
sites at which dynamic activities (inhibition, excitation and modulation)
occur. [18]
Via a series of filters and amplifiers, the nociceptive message is
integrated and analysed in the cerebral cortex, with interconnections with
various areas. [1]
The processing of pain takes place in an integrated matrix throughout...
The dorsal horns are not merely passive transmission stations but
sites at which dynamic activities (inhibition, excitation and modulation)
occur. [18]
Via a series of filters and amplifiers, the nociceptive message is
integrated and analysed in the cerebral cortex, with interconnections with
various areas. [1]
The processing of pain takes place in an integrated matrix throughout
the neuroaxis and occurs on at least three levels, at peripheral, spinal,
and supraspinal sites. [9]
Knowledge of the modalities of pain control is essential to correctly
adapt treatment strategies (drugs, neurostimulation, psycho-behavioural
therapy, etc.).
Dysfunction of pain control systems causes neuropathic pain. [1]
Spinal Cord Stimulation modalities evolved from the gate-control
theory postulating a spinal modulation of noxious inflow. [16] [2] [7]
[11] [12] [15] [17] [20] [22] [23] [24] [25] [26]
It has been demonstrated in multiple studies that dorsal horn
neuronal activity caused by peripheral noxious stimuli could be inhibited
by concomitant stimulation of the dorsal columns. [8]
Pain relief was more prominent at pain ascending through C fibers
than pain ascending through Adelta fibers. [21]
Many theories on the mechanism of action of Spinal Cord Stimulation
have been suggested, including activation of gate control mechanisms,
conductance blockade of the spinothalamic tracts, activation of
supraspinal mechanisms, blockade of supraspinal sympathetic mechanisms,
and activation or release of putative neuromodulators. [14]
At present, Spinal Cord Stimulation is a well established form of
treatment for failed back surgery syndrome, complex regional pain
syndromes (CRPS), low back pain with radiculopathy and refractory pain due
to ischemia. [4] [3] [8] [13]
Stimulation produced analgesia can provide a level of analgesia and
efficacy that is unattainable by other treatment modalities. [19]
Spinal Cord Stimulation for the treatment of chronic pain is cost-
effective when used in the context of a pain treatment continuum. [14]
Precise subcutaneous field stimulation is targeted to specific areas
of neuropathic pain. [6]
We aim at attenuation or blockade of pain through intervention at the
periphery, by activation of inhibitory processes that gate pain at the
spinal cord and brain. [9]
Segmental noxious stimulation produces a stronger analgesic effect
than segmental innocuous stimulation. [10]
That is exactly what intradermal sterile water injections do!
This therapeutic approach should not be limited only to elite
athletes.
It can work for every patient with back pain.
References
[1] Prog Urol. 2010 Nov;20(12):843-52. Epub 2010 Oct 20.
Anatomy and physiology of chronic pelvic and perineal pain.
Labat JJ, Robert R, Delavierre D, Sibert L, Rigaud J.
Centre federatif de pelviperineologie, clinique urologique, CHU Hotel-
Dieu, 1, place Alexis-Ricordeau, 44093 Nantes, France.
http://www.ncbi.nlm.nih.gov/pubmed/21056357
[2] Int J Rehabil Res. 2010 Sep;33(3):211-7.
Effect of transcutaneous electrical nerve stimulation on sensation
thresholds in patients with painful diabetic neuropathy: an observational
study.
Moharic M, Burger H.
Department of Physical and Rehabilitation Medicine, Linhartova 51, SI-1000
Ljubljana, Slovenia.
http://www.ncbi.nlm.nih.gov/pubmed/20042866
[3] Conf Proc IEEE Eng Med Biol Soc. 2009;2009:2033-6.
Spinal cord stimulation for complex regional pain syndrome.
Shrivastav M, Musley S.
Medtronic Neuromodulation, 7000 Central Ave NE, Minneapolis, Minnesota,
55432 USA.
http://www.ncbi.nlm.nih.gov/pubmed/19964771
[4] J Clin Monit Comput. 2009 Oct;23(5):333-9.
Spinal cord stimulation: principles of past, present and future practice:
a review.
Kunnumpurath S, Srinivasagopalan R, Vadivelu N.
St George's School of Anaesthesia, Tooting, London, UK.
http://www.ncbi.nlm.nih.gov/pubmed/19728120
[5] Brain Res Rev. 2009 Apr;60(1):149-70. Epub 2008 Dec 31.
Chloride regulation in the pain pathway.
Price TJ, Cervero F, Gold MS, Hammond DL, Prescott SA.
University of Arizona, Department of Pharmacology, USA.
[6] Curr Pain Headache Rep. 2008 Jan;12(1):28-31.
Peripheral nerve stimulation for chronic pain.
Henderson JM.
Stereotactic and Functional Neurosurgery, Stanford University School of
Medicine, 300 Pasteur Drive, Edwards Building/R-227, Stanford, CA 94305,
USA.
http://www.ncbi.nlm.nih.gov/pubmed/18417020
[7] Schmerz. 2007 Aug;21(4):307-10, 312-7.
From Descartes to fMRI. Pain theories and pain concepts.
Handwerker HO.
Institut fur Physiologie und Pathophysiologie, Universitat
Erlangen/Nurnberg, Deutschland.
http://www.ncbi.nlm.nih.gov/pubmed/17674057
[8] Pain Physician. 2002 Apr;5(2):156-66.
Spinal cord stimulation.
Stojanovic MP, Abdi S.
Interventional Pain Program, MGH Pain Center, Department of Anesthesia and
Critical Care, Massachusetts General Hospital, Harvard Medical School,
Cambridge, MA 02135, USA.
http://www.ncbi.nlm.nih.gov/pubmed/16902666
[9] J Bone Joint Surg Am. 2006 Apr;88 Suppl 2:58-62.
Basic science of pain.
DeLeo JA.
Dartmouth-Hitchcock Medical Center, Dartmouth Medical School, Neuroscience
Center at Dartmouth, Department of Anesthesiology, Lebanon, NH 03756, USA.
http://www.ncbi.nlm.nih.gov/pubmed/16595445
[10] Pain. 2005 May;115(1-2):152-60.
Segmental noxious versus innocuous electrical stimulation for chronic pain
relief and the effect of fading sensation during treatment.
Defrin R, Ariel E, Peretz C.
Department of Physical Therapy, School of Allied Health Professions,
Sackler Faculty of Medicine, Tel-Aviv University, 69978 Ramat Aviv,
Israel.
http://www.ncbi.nlm.nih.gov/pubmed/15836978
[11] Annu Rev Neurosci. 2003;26:1-30. Epub 2003 Mar 6.
Pain mechanisms: labeled lines versus convergence in central processing.
Craig AD.
Atkinson Pain Research Laboratory, Barrow Neurological Institute, 350
W.Thomas Road, Phoenix, AZ 85013, USA.
http://www.ncbi.nlm.nih.gov/pubmed/12651967
[12] Sports Med. 2002;32(4):251-67.
Return-to-work interventions for low back pain: a descriptive review of
contents and concepts of working mechanisms.
Staal JB, Hlobil H, van Tulder MW, K?ke AJ, Smid T, van Mechelen W.
Department of Social Medicine and Research Centre on Work, Physical
Activity and Health, VU University Medical Center, Van der Boechorststraat
7, Amsterdam, The Netherlands.
http://www.ncbi.nlm.nih.gov/pubmed/11929354
[13] Curr Pain Headache Rep. 2001 Apr;5(2):130-7.
Stimulation methods for neuropathic pain control.
Stojanovic MP.
MGH Pain Center, Department of Anesthesia and Critical Care, Massachusetts
General Hospital, Boston, MA 02114, USA.
http://www.ncbi.nlm.nih.gov/pubmed/11252147
[14] Curr Rev Pain. 1999;3(6):419-426.
Spinal Cord Stimulation: Indications, Mechanism of Action, and Efficacy.
Krames E.
Pacific Pain Treatment Centers, 2000 Van Ness Avenue, Suite 402, San
Francisco, CA 94109, USA.
http://www.ncbi.nlm.nih.gov/pubmed/10998699
[15] Ann Pharm Fr. 2000 Mar;58(2):77-83.
Pain and its main transmitters.
Costentin J.
Unite de Neuropsychopharmacologie Experimentale, ESA 6036 CNRS, Institut
Federatif de Recherches Multidisciplinaires sur les Peptides=IFR 23,
Faculte de Medecine et Pharmacie, 22, bd Gambetta, F 76000 Rouen.
http://www.ncbi.nlm.nih.gov/pubmed/10790600
[16] Neurol Res. 2000 Apr;22(3):285-92.
Mechanisms of spinal cord stimulation in neuropathic pain.
Meyerson BA, Linderoth B.
Department of Clinical Neuroscience, Karolinska Institute, Stockholm,
Sweden.
http://www.ncbi.nlm.nih.gov/pubmed/10769822
[17] Pain. 1999 Aug;Suppl 6:S149-52.
Regulation of spinal nociceptive processing: where we went when we
wandered onto the path marked by the gate.
Yaksh TL.
Department of Anesthesiology, University of California, San Diego, USA.
http://www.ncbi.nlm.nih.gov/pubmed/10491984
[18] Pain. 1999 Aug;Suppl 6:S121-6.
From the gate to the neuromatrix.
Melzack R.
Department of Psychology, McGill University, Montreal, Quebec, Canada.
http://www.ncbi.nlm.nih.gov/pubmed/10491980
[19] J Clin Neurophysiol. 1997 Jan;14(1):46-62.
Stimulation of the central and peripheral nervous system for the control
of pain.
Stanton-Hicks M, Salamon J.
Anaesthesia Pain Management Center, Cleveland Clinic Foundation, OH 44195,
USA.
http://www.ncbi.nlm.nih.gov/pubmed/9013359
[20] Percept Psychophys. 1996 Jul;58(5):693-703.
An investigation of the gate control theory of pain using the experimental
pain stimulus of potassium iontophoresis.
Humphries SA, Johnson MH, Long NR.
Department of Psychology, Massey University, Palmerston North, New
Zealand.
http://www.ncbi.nlm.nih.gov/pubmed/8710448
[21] J Peripher Nerv Syst. 1996;1(3):189-98.
Pain relief by various kinds of interference stimulation applied to the
peripheral skin in humans: pain-related brain potentials following CO2
laser stimulation.
Kakigi R, Watanabe S.
Department of Integrative Physiology, National Institute for Physiological
Sciences, Okazaki, Japan.
http://www.ncbi.nlm.nih.gov/pubmed/10970109
[22] Nurs Stand. 1993 Jul 28-Aug 3;7(45):25-7.
Pain: opening up the gate control theory.
Davis P.
http://www.ncbi.nlm.nih.gov/pubmed/8398721
[23] Bull Acad Natl Med. 1989 Oct;173(7):855-60; discussion 860-1.
Gate control of the nociceptive message: applications to the treatment of
pain.
Cambier J.
http://www.ncbi.nlm.nih.gov/pubmed/2620243
[24] Brain Res. 1983 Dec 5;280(2):217-31.
Thalamic nucleus ventro-postero-lateralis inhibits nucleus
parafascicularis response to noxious stimuli through a non-opioid pathway.
Benabid AL, Henriksen SJ, McGinty JF, Bloom FE.
http://www.ncbi.nlm.nih.gov/pubmed/6652483
[25] Psychosom Med. 1979 Mar;41(2):101-8.
A signal detection analysis of the effects of transcutaneous stimulation
on pain.
Malow RM, Dougher MJ.
http://www.ncbi.nlm.nih.gov/pubmed/441227
[26] GATE CONTROL OF ION FLUX IN AXONS.
GOLDMAN DE.
J Gen Physiol. 1965 May;48:SUPPL:75-7.
We read with interest the recent article by Sulheim et al. [1]
entitled "Risk factors for injuries in alpine skiing, telemark skiing and
snowboarding - case-control study". We congratulate these authors for
their well conducted study to explore the effects of a number of potential
risk factors for injury, including age, gender and ability.
However, there are a few points we would like to comment. In general, ski
injury r...
We read with interest the recent article by Sulheim et al. [1]
entitled "Risk factors for injuries in alpine skiing, telemark skiing and
snowboarding - case-control study". We congratulate these authors for
their well conducted study to explore the effects of a number of potential
risk factors for injury, including age, gender and ability.
However, there are a few points we would like to comment. In general, ski
injury risk decreased over the past 30 years from 5-8 to less than 2
injuries per 1000 ski days [2,3], statistically meaning 1 injury in 35
years assuming an average of 14 skiing days per season. Not the injury
risk is high as noted by Sulheim et al. [1] but the total number of
injured winter sport participants because of the huge population at risk.
Sulheim et al. [1] stated that the data analysed in their study were
collected in 2002 and thus the authors do not know how changes in
equipment or skier/snowboarder behaviour over the past years may impact on
the relevance of their study. However, there are some remarkable changes
in the past decade concerning, e.g. equipment, ski helmet use, and the
occurrence of fun parks. A study by Burtscher et al. [2] reported that the
introduction of carving skis and related equipment has decreased the
overall injury rate by 9% in Austria. While knee injuries were not
negatively affected by the introduction of carving skis shoulder injuries
increased probably due to more backward falls caused by the shorter tail
of the carving skis [2]. In addition, ski helmet use in the study by
Sulheim et al. [1] was about 23% while there was a dramatic increase
during the past ten years accounting nowadays for about 60% in Norway [3]
and about 70% in Austria and Switzerland [4]. This might be of interest as
there is an ongoing debate whether ski helmet use increases risk taking
behaviour according to the so called risk compensation theory which is
based on the assumption that safety appliances as ski helmets cause a
false sense of security in their users [5]. If the risk compensation
theory would work an increase in skiing injuries could be expected.
Also, in the past ten years so called terrain or snow parks containing
half-pipes, jumps, and metal features such as rails and boxes allowing
aerial manoeuvres were built in many ski areas [6]. Studies reported that
19-27% of injuries occurred in terrain parks [3,6] and that these injuries
were more likely to be severe, involving the head or back compared to
injuries sustained on ski slopes [3,6].
In our opinion, conditions as terrain parks or changes in equipment and
protective gear as helmets and back protectors should be considered to
provide preventive recommendations being on the pulse of time.
References
(1) Sulheim S, Holme I, Rodven A, et al. Risk factors for injuries in
alpine skiing, telemark skiing and snowboarding - case-control study. Br J
Sports Med 2011;45:1303-1309.
(2) Burtscher M, Gatterer H, Flatz N, et al. Effects of modern ski
equipment on the overall injury rate and the pattern of injury location in
alpine skiing. Clin J Sports Med 2008;18:355-357.
(3) Ekeland A, Rodven A. Skiing and boarding injuries on Norwegian slopes
during to winter seasons. In: Johnson RJ, Shealy JE, Senner V, eds.
Skiing, Trauma and Safety,18th Vol. J. ASTM Intl. 2011;4:139-149.
doi:10.1520/JAI102817.
(4) Ruedl G, Brunner F, Kopp M, Burtscher M. Impact of ski helmet
mandatory on helmet use on Austrian ski slopes. J Trauma 2011;71:1085-
1087.
(5) Ruedl G, E Pocecco, R Sommersacher, H Gatterer, M Kopp, W Nachbauer, M
Burtscher. Factors associated with self reported risk taking behaviour on
ski slopes. Br J Sports Med 2010;44:204-206.
(6) Brooks MA, Evans MD, Rivara FP. Evaluation of skiing and snowboarding
injuries in terrain parks versus traditional slopes. Injury Prevention
2010;16:199-122.
Subjective measure of monitoring exercise performance: Borg scale
VIKRAM MOHAN 1 SRIJIT DAS 2
1.Department of Physiotherapy, Faculty of Health Sciences, Universiti
Teknologi MARA, 42300, Puncak Alam,Malaysia
2.Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan
Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur,Malaysia
Subjective measure of monitoring exercise performance: Borg scale...
Subjective measure of monitoring exercise performance: Borg scale
VIKRAM MOHAN 1 SRIJIT DAS 2
1.Department of Physiotherapy, Faculty of Health Sciences, Universiti
Teknologi MARA, 42300, Puncak Alam,Malaysia
2.Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan
Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur,Malaysia
Subjective measure of monitoring exercise performance: Borg scale
We read with much interest the published article 'Manipulation
effects of prior exercise intensity feedback by the Borg scale during open
-loop cycling' by Pires and Hammond (1). We wish to share few scientific
facts related to the article. Employment of rate of perceived exertion
scale for prescribing exercise intensity in deception and on informed
conditions was well portrayed in this article carried out by the authors.
Functional exercise tolerance test such as six minute walk test and
shuttle walk test were used to predict the functional limitation of the
patients. These tests can be terminated by using the rate of perceived
exertion (RPE) scale or Borg's scale when the subjects reach exhaustion.
Prediction of functional limitation and termination of exercise was purely
based on patient's subjective interpretation of ranges of scale. We would
like to add some thoughts and suggestions on the methodology employed in
this study such as on training protocol and later on, the Borg's scale. In
the training protocol, it was mentioned that they underwent regular
recreational physical conditioning programs for a period of six months.
Even though it was mentioned as recreational physical conditioning
programs, we are eager under which intensity, duration and frequency,
these physical conditioning programs were carried out.
Next, on the Borg's scale, we would like to query about the educational
standards being considered for including the subjects for the study. This
is because it needs a certain level of understanding to comprehend the
range of scale. The authors suggest that their Borg's scale strategy
failed to deceive subjects. Even though it failed to deceive subjects in
the present study in which healthy subjects were recruited, our thoughts
are aimed to carry out a study in chronic obstructive pulmonary disease
subjects, in which the patients may have a tendency to develop exertion
even when they walk for few meters or to perform basic activities of daily
living. Moreover, healthy subjects may not be much aware of the exertion
like pulmonary subjects whose condition may progress day by day. Hence, we
suggest that centrally regulated effort model and psychological model
which was explained in the present study, could be better explained in the
deceived subjects when it was applied to patient population.
Apart from that, we support the author's views that future studies are
needed with more of objective measures such as functional magnetic
resonance imaging (MRI) and physiological variables on the rate of
perceived exertion. Rate pressure product (RPP) is one such physiological
variable which can be used easily in the clinical set up to know the
measure of energy consumption of the heart (2). Hence, in order to further
explore this area of research, it can be added that RPP can also be
utilized as one such an objective measures in future for prescribing
exercise along with RPE scale. We applaud the meticulous work by the
authors and appreciate the editor for publishing such an important work.
REFERENCES
1.Pires FO, Hammond J. Manipulation effects of prior exercise intensity
feedback by the Borg scale during open-loop cycling. Br J Sports Med 2012;
46:18-22.
2.White WB. Heart rate and the rate-pressure product as determinants of
cardiovascular risk in patients with hypertension. Am J Hypertens 1999;
12:50S-55S.
Injury surveillance on young elite athletes participating in the 1st
Winter Youth Olympic Games in Innsbruck/Austria
Gerhard Ruedl (1), Wolfgang Schobersberger (2)
(1) Department of Sport Science, University Innsbruck/Austria
(2) Chief Medical Officer of Winter Youth Olympic Games in Innsbruck;
Institute for Sports Medicine, Alpine Medicine & Health Tourism
Innsbruck/Austria
Injury surveillance on young elite athletes participating in the 1st
Winter Youth Olympic Games in Innsbruck/Austria
Gerhard Ruedl (1), Wolfgang Schobersberger (2)
(1) Department of Sport Science, University Innsbruck/Austria
(2) Chief Medical Officer of Winter Youth Olympic Games in Innsbruck;
Institute for Sports Medicine, Alpine Medicine & Health Tourism
Innsbruck/Austria
Do we really want to see our young promising talents go through a
major injury at one stage into their career? Definitely no! However, in
competitive alpine skiing and snowboarding and freestyle, the risk to get
major head and anterior cruciate ligament injuries is indeed high [1-4].
Therefore, training focussing on injury prevention should already start at
early age and should go along with the athletes' career. To implement
evidence based preventive measures, however, it is of utmost importance to
investigate first of all data on occurrence and severity of injuries
according to the 4-step model of injury prevention research [5]. At this
point of time, there is little data available concerning the injury risk
of youth elite athletes competing in winter sports [6, 7]. Therefore, we
will conduct a systematic injury and illness surveillance on young elite
athletes participating in the 1st Winter Youth Olympic Games in
Innsbruck/Austria in January 2012. Let us work together to get meaningful
data as a basis for further research on injury risk factors and injury
mechanisms and finally on injury prevention strategies among young elite
winter sport athletes. We are glad to welcome you in Innsbruck!
References
(1)Pujol N, Blanchi MP, Chambat P. The incidence of anterior cruciate
ligament injuries among competitive alpine skiers. Am J Sports Med 2007;
35: 1070-4.
(2)Florenes TW, Bere T, Nordsletten L et al. Injuries among male and
female World Cup alpine skiers. Br J Sports Med 2009; 43: 973-8.
(3)Florenes TW, Nordsletten L, Heir S et al. Injuries among World Cup
freestyle skiers. Br J Sports Med 2010; 44: 803-8.
(4)Florenes TW, Nordsletten L, Heir S et al. Injuries among World Cup ski
and snowboard atlethes. Scand J Med Sci Sports. 2010 Jun 18 [Epub ahead of
print].
(5)Bahr R, Krosshaug T. Understanding injury mechanisms: a key component
of preventing injuries in sport. Br J Sports Med 2005; 39: 324-9.
(6)Steffen K, Engebretsen L. The Youth Olympic Games and a new awakening
for sports and exercise medicine. Br J Sports Med 2011; 45: 1251-52.
(7)Steffen K, Engebretsen L. More data needed on injury risk among young
elite athletes. Br J Sports Med 2010; 44: 485-9.
Conflict of Interest:
The authors will conduct the injury and illness surveillance on young elite athletes participating in the 1st Winter Youth Olympic Games in Innsbruck/Austria in January 2012.
Exercise Induced lower leg pain is a common condition with a number
of differential diagnoses which commonly overlap, one of which is chronic
exertional compartment syndrome (CECS). Traditionally, CECS is thought to
be caused by elevated pressures in a muscular compartment and is commonly
diagnosed by measuring elevated intramuscular pressures.
However, as discussed by Hislop and Batt (2011), there continues to...
Exercise Induced lower leg pain is a common condition with a number
of differential diagnoses which commonly overlap, one of which is chronic
exertional compartment syndrome (CECS). Traditionally, CECS is thought to
be caused by elevated pressures in a muscular compartment and is commonly
diagnosed by measuring elevated intramuscular pressures.
However, as discussed by Hislop and Batt (2011), there continues to
remain uncertainties with regards to methodological issues, risks involved
and the necessity of resting and bilateral pressure measurements and
debate on the types of compartments measured. Roberts & Franklyn-
Millar (published online, 2011) found in their systematic review that the
pressures used to diagnose CECS overlap with normal healthy subjects
without symptoms.
Surely the question we need to ask is that, are we diagnosing,
investigating and treating these patients effectively? As clinicians, we
need to be sure that the intervention administered is necessary and
beneficial. Given uncertainties, it would be prudent to understand the
pathophysiology of the condition and the presenting symptoms.
Poor biomechanics can predispose to overload of muscular or tendon
structures resulting in overuse and pain. Correcting the biomechanical
element that is causing these symptoms can be a method to treat patients
who present with symptoms akin to CECS.
A study done in patients with patello-femoral syndrome found that
gait retraining resulted in significant improvement in hip mechanics that
was associated with a reduction in pain and improvements in function
(Noehran et.al, 2011). It is thought that the reduction in vertical load
rates may be protective for the knee and reduce the risk for other running
related injuries. It may be that this rationale can be extrapolated in
exercise induced lower leg pain and is a way forward to treating these
patients prior to subjecting them to invasive tests.
Noehren, Scholz & Davis (2011) The effect of real-time gait
retraining on hip kinematics, pain and function in subjects with
patellofemoral pain syndrome. Br J Sports Med; Vol 45 (9): 691-696
Roberts & Franklyn-Millar (2011) The Validity of the diagnostic
criteria used in Chronic Exertional Compartment Syndrome: A systematic
review. Scand J Med Sci Sports. First published online: 13 Sep 2011
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 am just a concerned father of a 13 year old girl who has been playing competitive soccer for four years now.At what age do girls become more at risk to acl injuries and can anyone suggest what exercises she can do to minimize the chances of this happening.
Conflict of Interest:
None declared
Webborn's [1] articulation of the different injury prevention needs across an athlete' sporting lifetime emphasises that a "one-size-fits all" does not apply for sport safety and that researchers and practitioners will need to be creative in developing solutions to the varying injury problems for different age-groups of athletes. His recognition that addressing these life-course stage injury risks will require the input o...
Dear Editors,
The dorsal horns are not merely passive transmission stations but sites at which dynamic activities (inhibition, excitation and modulation) occur. [18]
Via a series of filters and amplifiers, the nociceptive message is integrated and analysed in the cerebral cortex, with interconnections with various areas. [1]
The processing of pain takes place in an integrated matrix throughout...
We read with interest the recent article by Sulheim et al. [1] entitled "Risk factors for injuries in alpine skiing, telemark skiing and snowboarding - case-control study". We congratulate these authors for their well conducted study to explore the effects of a number of potential risk factors for injury, including age, gender and ability. However, there are a few points we would like to comment. In general, ski injury r...
Subjective measure of monitoring exercise performance: Borg scale VIKRAM MOHAN 1 SRIJIT DAS 2
1.Department of Physiotherapy, Faculty of Health Sciences, Universiti Teknologi MARA, 42300, Puncak Alam,Malaysia 2.Department of Anatomy, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur,Malaysia
Subjective measure of monitoring exercise performance: Borg scale...
Injury surveillance on young elite athletes participating in the 1st Winter Youth Olympic Games in Innsbruck/Austria
Gerhard Ruedl (1), Wolfgang Schobersberger (2)
(1) Department of Sport Science, University Innsbruck/Austria (2) Chief Medical Officer of Winter Youth Olympic Games in Innsbruck; Institute for Sports Medicine, Alpine Medicine & Health Tourism Innsbruck/Austria
Do we really w...
Exercise Induced lower leg pain is a common condition with a number of differential diagnoses which commonly overlap, one of which is chronic exertional compartment syndrome (CECS). Traditionally, CECS is thought to be caused by elevated pressures in a muscular compartment and is commonly diagnosed by measuring elevated intramuscular pressures.
However, as discussed by Hislop and Batt (2011), there continues to...
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...
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