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Fitzwilliam E, Steventon-Lorenzen N, Opar D, Schache AG, Maniar N. Lower Limb Joint Mechanics during Maximal Accelerative and Decelerative Running. Med Sci Sports Exerc 2024; 56:1655-1663. [PMID: 38600642 DOI: 10.1249/mss.0000000000003445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
INTRODUCTION Maximal acceleration and deceleration tasks are frequently required in team sports, often occurring rapidly in response to external stimuli. Accelerating and decelerating can be associated with lower limb injuries; thus, knowledge of joint mechanics during these tasks can improve the understanding of both human high performance and injury mechanisms. The current study investigated the fundamental differences in lower limb joint mechanics when accelerating and decelerating by directly comparing the hip, knee, and ankle joint moments and work done between the two tasks. METHODS Twenty participants performed maximal effort acceleration and deceleration trials, with three-dimensional marker trajectories and ground reaction forces collected simultaneously. Experimental data were combined with inverse dynamics analysis to compute joint moments and work. RESULTS Net joint work for all lower limb joints was positive during acceleration and negative during deceleration. This occurred because of significantly greater positive work production from the ankle and hip during acceleration and significantly greater negative work production from all joints during deceleration. The largest contributions to positive work during acceleration came from the ankle, followed by the hip and knee joints, whereas the largest contributions to negative work during deceleration came from the knee and hip joints, followed by the ankle. Peak joint moments were significantly greater when decelerating compared with accelerating, except for the peak ankle plantarflexion and hip flexion moments, which were significantly greater when accelerating. CONCLUSIONS Our findings may help to guide training interventions, which aim to enhance the performance of acceleration and deceleration tasks, while also mitigating the associated injury risk.
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Affiliation(s)
| | | | | | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre (LASEM), La Trobe University, Melbourne, Victoria, AUSTRALIA
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García-Angulo FJ, Palao JM, Giménez-Egido JM, Ortega-Toro E. Effect of Rule Modifications on Kinematic Parameters Using Maturity Stage as a Moderating Variable in U-10 Football Players. SENSORS (BASEL, SWITZERLAND) 2024; 24:2462. [PMID: 38676078 PMCID: PMC11053628 DOI: 10.3390/s24082462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 04/06/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
The aim of the present study was to analyse the effects of regulatory modifications in competitive situations on cinematic variables, considering maturity stage as a moderating factor, in youth football players. A quasi-experimental study was conducted in which 45 players with a mean age of 9.47 ± 0.54 participated. The independent variable analysed was the modification of rules (playing time, scoring, and specific rules). The dependent variables analysed were cinematic variables. These variables were recorded with WimuTM. The maturity stage was considered a moderating factor in this effect. The main results indicate that the modified competition reduced the total distance covered, maximum acceleration speed, and distance covered in acceleration and deceleration in different speed zones. In addition, the maturity stage was found to moderate the effect of the intervention on the total distance covered, distance covered by accelerating in zone 3, and distance covered by decelerating in zone 3. Thus, the proposed modification appeared to reduce the physical demand for competition. Furthermore, it reduced the differences between players with early maturational development and those with late maturational development.
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Affiliation(s)
- Francisco Javier García-Angulo
- Department of Physical Activity and Sport, Faculty of Sport Science, University of Murcia, 30720 Murcia, Spain; (F.J.G.-A.); (J.M.G.-E.)
- Sport Performance Analysis Association, 30720 Murcia, Spain;
| | - José Manuel Palao
- Sport Performance Analysis Association, 30720 Murcia, Spain;
- Department of Health, Exercise and Sport Management, University of Wisconsin-Parkside, Kenosha, WI 53144, USA
| | - José María Giménez-Egido
- Department of Physical Activity and Sport, Faculty of Sport Science, University of Murcia, 30720 Murcia, Spain; (F.J.G.-A.); (J.M.G.-E.)
- Sport Performance Analysis Association, 30720 Murcia, Spain;
| | - Enrique Ortega-Toro
- Department of Physical Activity and Sport, Faculty of Sport Science, University of Murcia, 30720 Murcia, Spain; (F.J.G.-A.); (J.M.G.-E.)
- Sport Performance Analysis Association, 30720 Murcia, Spain;
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Tong S, Sun Y, Kuang B, Wang M, Chen Z, Zhang W, Chen J. A Comprehensive Review of Muscle-Tendon Junction: Structure, Function, Injury and Repair. Biomedicines 2024; 12:423. [PMID: 38398025 PMCID: PMC10886980 DOI: 10.3390/biomedicines12020423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/31/2024] [Accepted: 02/08/2024] [Indexed: 02/25/2024] Open
Abstract
The muscle-tendon junction (MTJ) is a highly specific tissue interface where the muscle's fascia intersects with the extracellular matrix of the tendon. The MTJ functions as the particular structure facilitating the transmission of force from contractive muscle fibers to the skeletal system, enabling movement. Considering that the MTJ is continuously exposed to constant mechanical forces during physical activity, it is susceptible to injuries. Ruptures at the MTJ often accompany damage to both tendon and muscle tissues. In this review, we attempt to provide a precise definition of the MTJ, describe its subtle structure in detail, and introduce therapeutic approaches related to MTJ tissue engineering. We hope that our detailed illustration of the MTJ and summary of the representative research achievements will help researchers gain a deeper understanding of the MTJ and inspire fresh insights and breakthroughs for future research.
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Affiliation(s)
- Siqi Tong
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Yuzhi Sun
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
- Department of Orthopaedic Surgery, Institute of Digital Medicine, Nanjing First Hospital, Nanjing Medical University, Nanjing 210006, China
| | - Baian Kuang
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Mingyue Wang
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Zhixuan Chen
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
| | - Wei Zhang
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing 210096, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou 310058, China
| | - Jialin Chen
- School of Medicine, Southeast University, Nanjing 210009, China
- Center for Stem Cell and Regenerative Medicine, Southeast University, Nanjing 210009, China
- Jiangsu Key Laboratory for Biomaterials and Devices, Southeast University, Nanjing 210096, China
- China Orthopedic Regenerative Medicine Group (CORMed), Hangzhou 310058, China
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Pietsch S, Green B, Schache AG, Pizzari T. Epidemiology of quadriceps muscle strain injuries in elite male Australian football players. Scand J Med Sci Sports 2024; 34:e14542. [PMID: 37994173 DOI: 10.1111/sms.14542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 10/24/2023] [Accepted: 11/12/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE To describe the epidemiology of quadriceps muscle strain injury (QMSI) in elite Australian Football League (AFL) players, explore recovery milestones and determine whether recovery is impacted by factors such as injury type (index vs. re-injury), the primary muscle injured and the mechanism of injury. MEASURES All QMSI data reported to the Soft Tissue Injury Registry of the AFL from the 2014 to 2020 seasons were evaluated. Player demographic data, circumstances of injury, MRI reports and recovery outcomes following injury were extracted. Descriptive statistics and frequency distributions are presented. Recovery outcomes for injury type, primary muscle injured and the mechanism of injury were compared using univariate analyses. RESULTS There were 164 QMSIs from 122 players reported (134 index; 30 re-injuries). Almost all (91.3%) QMSIs involved the rectus femoris. Half (48.4%) of the QMSIs occurred during kicking and most commonly affected the dominant kicking leg (72%). The majority occurred at training (64.6%). All re-injuries involved the rectus femoris, most occurred from kicking (63.0%) and within 6 months of the preceding injury (70%). The mean return to play (RTP) time was 25.4 days (95%CI = 22.6-28.2) and rectus femoris injuries took around 14 days longer to RTP than vastii injuries (p = 0.001). QMSIs with a kicking mechanism took the longest to RTP of all injury mechanisms. CONCLUSION In AFL players, QMSIs occur mostly in the dominant leg from a kicking mechanism. Rectus femoris injuries are more prevalent and result in longer RTP time frames. Re-injuries exclusively involved the rectus femoris, primarily from kicking.
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Affiliation(s)
- Samuel Pietsch
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Brady Green
- School of Health Sciences and Physiotherapy, University of Notre Dame Australia, Fremantle, Western Australia, Australia
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre. School of Allied Health, Human Services and Sport, College of Science, Health and Engineering, La Trobe University, Melbourne, Victoria, Australia
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Gurau TV, Gurau G, Musat CL, Voinescu DC, Anghel L, Onose G, Munteanu C, Onu I, Iordan DA. Epidemiology of Injuries in Professional and Amateur Football Men (Part II). J Clin Med 2023; 12:6293. [PMID: 37834937 PMCID: PMC10573283 DOI: 10.3390/jcm12196293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Revised: 09/24/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
Background (1): Men's football is a physically demanding contact sport that involves intermittent bouts of sprinting, jogging, walking, jumping and changes of direction. The physical demands of the game vary by level of play (amateur club, sub-elite and open club or international), but injury rates at all levels of the men's football game remain the highest of all sports. Objective: The aim of this study is to conduct a systematic review of data from the epidemiological literature regarding the profile, severity and mechanisms of injuries and the frequency of recurrent injuries in professional and amateur football players. Methods (2): A systematic review, according to PRISMA guidelines, was performed up to June 2023 in the databases of PubMed, Web of Science, Google academic, Google scholar and the Diva portal. Twenty-seven studies that reported data on the type, severity, recurrence and mechanisms of injury in professional and amateur men's football were selected and analyzed. Two reviewers independently audited data and assessed the study quality using the additional and adapted version of the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement and the Newcastle Ottawa Scale (NOS) to assess risk of bias for the quality of external validity. Results (3): In professional male football players, the mean prevalence of muscle/tendon injuries was 39.78%, followed by joint and ligament injuries-21.13%, contusions-17.86%, and fractures-3.27%, and for amateur football players, the prevalence's were 44.56% (muscle/tendon injuries), 27.62% (joint and ligament injuries), 15.0% (contusions) and 3.05% (fracture), respectively. The frequency of traumatic injuries was higher in amateur football players (76.88%) compared to professional football players (64.16%), the situation being reversed in the case of overuse injuries: 27.62% in professional football players and 21.13% in amateur football players. Most contact injuries were found in professional footballers (50.70%), with non-contact injuries predominating in amateur footballers (54.04%). The analysis of the severity of injuries showed that moderate injuries dominated in the two categories of footballers; the severe injuries in amateur footballers exceeded the severe injuries recorded in professional footballers by 9.60%. Recurrence proportions showed an inverse relationship with the level of play, being higher in amateur footballers (16.66%) compared to professional footballers (15.25%). Conclusions (4): Football-related injuries have a significant impact on professional and amateur football players and their short- and long-term health status. Knowing the frequency of severe diagnoses, such as strains, tears and cramps of the thigh muscles, ankle ligament sprains and hip/groin muscle strain requires the establishment of adequate programs to prevent them, especially in amateur football players, who are more prone to serious injuries.
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Affiliation(s)
- Tudor Vladimir Gurau
- Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania;
| | - Gabriela Gurau
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania;
| | - Carmina Liana Musat
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University, 800008 Galati, Romania;
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (D.C.V.); (L.A.)
| | - Doina Carina Voinescu
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (D.C.V.); (L.A.)
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania
| | - Lucretia Anghel
- ‘Sf. Apostol Andrei’ Clinical Emergency County Hospital, 800578 Galati, Romania; (D.C.V.); (L.A.)
- Clinical Medical Department, Faculty of Medicine and Pharmacy, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania
| | - Gelu Onose
- Neuromuscular Rehabilitation Clinic Division, Teaching Emergency Hospital “Bagdasar-Ar-seni”, 041915 Bucharest, Romania;
- Faculty of Medicine, University of Medicine and Pharmacy “Carol Davila”, 020022 Bucharest, Romania
| | - Constantin Munteanu
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, 700454 Iasi, Romania;
| | - Ilie Onu
- Department of Biomedical Sciences, Faculty of Medical Bioengineering, University of Medicine and Pharmacy “Grigore T. Popa” Iasi, 700454 Iasi, Romania;
| | - Daniel Andrei Iordan
- Department of Individual Sports and Kinetotherapy, Faculty of Physical Education and Sport, ‘Dunarea de Jos’ University of Galati, 800008 Galati, Romania;
- Center of Physical Therapy and Rehabilitation, ‘Dunărea de Jos’ University of Galati, 800008 Galati, Romania
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Aiello F, Di Claudio C, Fanchini M, Impellizzeri FM, McCall A, Sharp C, Brown SJ. Do non-contact injuries occur during high-speed running in elite football? Preliminary results from a novel GPS and video-based method. J Sci Med Sport 2023; 26:465-470. [PMID: 37544819 DOI: 10.1016/j.jsams.2023.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 07/12/2023] [Accepted: 07/17/2023] [Indexed: 08/08/2023]
Abstract
OBJECTIVES Understanding how injuries occur (inciting circumstances) is useful for developing etiological hypotheses and prevention strategies. The aims of this study were 1) to evaluate the feasibility of a method combining video and Global Positioning System data to estimate the speed and acceleration of activities leading to injuries and 2) to use this method to analyse the inciting circumstances leading to non-contact injuries. DESIGN Retrospective descriptive study. METHODS Injury inciting circumstances from 46 elite players over three seasons were analysed from video recordings and from external load measures collected through Catapult Vector S7 Global Positioning System. RESULTS In total 34 non-contact injuries were analysed. Sixteen out of the seventeen hamstring injuries occurred when players were running for (median and interquartile range) 16.75 m (8.42-26.65 m) and achieved a peak speed of 29.28 km·h-1 (26.61-31.13 km·h-1) which corresponded to 87.55 % of players' maximal speed (78.5 %-89.75 %). Of the three adductor injuries, one occurred whilst the player was decelerating without the ball, one occurred whilst the player was accelerating and controlling the ball at knee level, and one occurred whilst the player was performing an instep kick. Two quadriceps injuries occurred whilst the players were kicking either whilst walking or running. CONCLUSIONS From the preliminary results reported in this study most hamstring injuries occurred when players ran >25 km·h-1 and above 80 % of their maximal speed. This study suggests that this novel approach can allow a detailed and standardised analysis of injury inciting circumstances.
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Affiliation(s)
- Francesco Aiello
- Arsenal Performance and Research Team, Arsenal Football Club, UK; School of Applied Sciences, Edinburgh Napier University, UK. https://twitter.com/Fr_Aiello
| | | | - Maurizio Fanchini
- AS Roma Football Club, Roma, Italy; University of Verona, Italy. https://twitter.com/Maurizi13707619
| | - Franco M Impellizzeri
- Faculty of Health, Sport and Exercise Discipline Group, University of Technology Sydney, Australia. https://twitter.com/francoimpell
| | - Alan McCall
- Arsenal Performance and Research Team, Arsenal Football Club, UK; School of Applied Sciences, Edinburgh Napier University, UK. https://twitter.com/Alan_McCall_
| | | | - Susan J Brown
- School of Applied Sciences, Edinburgh Napier University, UK.
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Lee M, Lancaster M, Tulloch L, O'Leary B, Power E, Howes D, Sourbuts B, Berry A, Maher F, O'Neill S. Normative isometric plantarflexion strength values for professional level, male rugby union athletes. Phys Ther Sport 2023; 61:114-121. [PMID: 37003219 DOI: 10.1016/j.ptsp.2023.03.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 03/22/2023] [Accepted: 03/22/2023] [Indexed: 03/28/2023]
Abstract
OBJECTIVES The primary aim was to establish normative values of isometric plantarflexor muscle strength in professional male rugby union players and compare forwards with backs. The secondary aims were to examine how individual playing position or age influences isometric plantarflexor strength. DESIGN Cross-sectional. SETTING Testing at professional rugby clubs. PARTICIPANTS 355 players (201 forwards and 154 backs) from 9 clubs in the English Premiership club competition. MAIN OUTCOME MEASURES Maximal unilateral isometric plantarflexion strength was measured, using a Fysiometer C-Station, in a seated position with a flexed knee and in maximal available dorsiflexion. Values are reported normalised to body mass and specific to playing position. RESULTS Mean combined limb isometric plantarflexion strength for the group was 193.1 kg (SD 32) or 1.86 xBW. (SD 0.31). Forwards were significantly weaker than backs (forwards = 1.75xBW (SD 0.26), backs = 2.00xBW (SD 0.28) (p=<0.0001)). Age category revealed no influence on plantarflexor strength. CONCLUSION This study presents normative isometric plantarflexion strength values for professional male rugby union players. Forwards are typically relatively weaker than backs.
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Affiliation(s)
- Matt Lee
- Northampton Saints RFC, Northampton, UK; University of Leicester, Leicester, UK.
| | | | | | | | | | | | | | - Amber Berry
- University Hospitals of Leicestershire NHS Trust, Leicester, UK
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Ultrasound-Guided Percutaneous Needle Electrolysis Combined With Therapeutic Exercise May Add Benefit in the Management of Soleus Injury in Female Soccer Players: A Pilot Study. J Sport Rehabil 2023; 32:265-271. [PMID: 36410342 DOI: 10.1123/jsr.2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 09/13/2022] [Accepted: 09/13/2022] [Indexed: 11/22/2022]
Abstract
CONTEXT The performance of sprints during male soccer matches usually is slow medium paced, where the soleus and gastrocnemius (ankle plantar flexors) play a very important role. As in male soccer, soleus injuries should be considered in female soccer; but the scientific evidence is very limited in this case. DESIGN Pilot clinical trial study. OBJECTIVE To determine whether adding an ultrasound-guided percutaneous needle electrolysis (US-guided PNE) technique to a specific exercise program improved perceived pain at stretching and at palpation, ankle dorsiflexion range of motion, muscle fatigue, and sport performance in women soccer players with soleus injury. METHODS This pilot study recruited 20 female players with chronic soleus injury (type 1, characterized by hypoechoic image) who were assigned to one of 2 groups: an experimental group (exercise program + US-guided PNE; n = 10) or a control group (exercise program + sham stimulation; n = 10). Pain intensity, dorsiflexion range of motion, knee-flexion heel raise test, curve sprint test, and the global rating of change scale were analyzed at baseline and after treatment (4 wk) and there was no further follow-up. RESULTS Pain intensity at palpation and at stretching, dorsiflexion range of motion, and heel raise test values showed significant improvements (P < .05) between pretreatment and posttreatment for both groups, however, no significant differences were observed between groups. Curve sprint tests did not show significant differences between pretreatment and posttreatment for either group or between groups. However, the percentage of changes always revealed better values in favor of the PNE group. Both groups showed good player satisfaction with the therapies. CONCLUSION The application of the US-guided PNE combined with a specific exercise program may cause clinical benefits in the treatment of female soccer players with soleus injury.
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Green B, McClelland JA, Semciw AI, Schache AG, McCall A, Pizzari T. The Assessment, Management and Prevention of Calf Muscle Strain Injuries: A Qualitative Study of the Practices and Perspectives of 20 Expert Sports Clinicians. SPORTS MEDICINE - OPEN 2022; 8:10. [PMID: 35032233 PMCID: PMC8761182 DOI: 10.1186/s40798-021-00364-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Background Despite calf muscle strain injuries (CMSI) being problematic in many sports, there is a dearth of research to guide clinicians dealing with these injuries. The aim of this study was to evaluate the current practices and perspectives of a select group of international experts regarding the assessment, management and prevention of CMSI using in-depth semi-structured interviews. Results Twenty expert clinicians working in elite sport and/or clinician-researchers specialising in the field completed interviews. A number of key points emerged from the interviews. Characteristics of CMSI were considered unique compared to other muscle strains. Rigor in the clinical approach clarifies the diagnosis, whereas ongoing monitoring of calf capacity and responses to loading exposure provides the most accurate estimate of prognosis. Athlete intrinsic characteristics, injury factors and sport demands shaped rehabilitation across six management phases, which were guided by key principles to optimise performance at return to play (RTP) while avoiding subsequent injury or recurrence. To prevent CMSI, periodic monitoring is common, but practices vary and data are collected to inform load-management and exercise selection rather than predict future CMSI. A universal injury prevention program for CMSI may not exist. Instead, individualised strategies should reflect athlete intrinsic characteristics and sport demands. Conclusions Information provided by experts enabled a recommended approach to clinically evaluate CMSI to be outlined, highlighting the injury characteristics considered most important for diagnosis and prognosis. Principles for optimal management after CMSI were also identified, which involved a systematic approach to rehabilitation and the RTP decision. Although CMSI were reportedly difficult to prevent, on- and off-field strategies were implemented by experts to mitigate risk, particularly in susceptible athletes. Supplementary Information The online version contains supplementary material available at 10.1186/s40798-021-00364-0.
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Meek WM, Kucharik MP, Eberlin CT, Naessig SA, Rudisill SS, Martin SD. Calf Strain in Athletes. JBJS Rev 2022; 10:01874474-202203000-00015. [PMID: 35316243 DOI: 10.2106/jbjs.rvw.21.00183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Calf strain is a common condition. In high-performance athletes, calf strain contributes to a substantial absence from competition. » Player age and history of a calf strain or other leg injury are the strongest risk factors for calf strain injury and reinjury. » Although the diagnosis is often clinical, magnetic resonance imaging and ultrasound are valuable to confirm the location of the strain and the grade of injury. » Nonoperative treatment is effective for most calf strain injuries. Operative management, although rarely indicated, may be appropriate for severe cases with grade-III rupture or complications. » Further investigation is necessary to elucidate the benefits of blood flow restriction therapy, deep water running, lower-body positive pressure therapy, platelet-rich plasma, and stem cell therapy for calf strain rehabilitation.
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Muscular Echovariation as a New Biomarker for the Classification of Soleus Muscle Pathology: A Cross-Sectional Study. Diagnostics (Basel) 2021; 11:diagnostics11101884. [PMID: 34679582 PMCID: PMC8534715 DOI: 10.3390/diagnostics11101884] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/10/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Soleus injury is one of the most common soft tissue tears during sport activities. Current classifications of muscle tears are based on symptoms and tear size and they do not contribute suitable evidence-based treatment protocols. The objective of this study was to analyze the most frequent echotexture findings of patients with soleus muscle injury, located in the central intramuscular tendon (IMT), and healthy people to determine whether they behave differently and to propose an ultrasound (US)-based classification. Methods: eighty-four athletes, who played in sport activities comprising lower limbs. Echotexture characteristics of soleus muscle were reviewed for 84 subjects. They were divided based on the muscle echogenicity in three groups (Injury Type 1 group, Injury type 2 group and healthy group). Echointensity (EI) and Echovariation (EV) were taken in all groups like quantitative US variable. Results. The Injury Type 1 group was identified by a hypoechoic area and characterized by a higher EV; and Injury Type 2 group was identified by a fibrotic area and characterized by a lower EV. The echogenic pattern of healthy people obtained an intermediate value of EV between both injured soleus types. Conclusions. EV may be useful to classify different types of soleus muscle pathology according to the echogenicity pattern. An innovative proposed US-based classification system for soleus tears may be used to guide treatment decisions for patients with central tendon injury of soleus muscle.
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Clark NC, Campbell SD. Preseason weight-bearing ankle dorsiflexion in male professional football players with and without a history of severe ankle injury: A novel analysis in an English Premier League club. Phys Ther Sport 2021; 52:21-29. [PMID: 34365086 DOI: 10.1016/j.ptsp.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 07/22/2021] [Accepted: 07/23/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Ankle injuries are common in professional football and have profound player/team/club consequences. The weight-bearing lunge-test (WBLT) assesses ankle dorsiflexion range-of-motion in football primary/secondary injury prevention and performance contexts. Data for uninjured and previously ankle-injured players in the English Premier League (EPL) is not available. This study analysed WBLT measurements (cm) within and between uninjured and previously severe ankle-injured players (injured-stiff group, injured-lax group) in one EPL club. DESIGN Cross-sectional. SETTING Preseason. PARTICIPANTS Forty-nine players (age 22.9 ± 4.6 yr; height 181.6 ± 5.2 cm; mass 77.7 ± 7.6 kg). MAIN OUTCOME MEASURES Prevalence (%) of previous unilateral severe ankle injury (USAI). Side-to-side (right/left, dominant/nondominant, injured/uninjured) WBLT comparisons at group-level (t-test [within-group]; Welch's ANOVA [between-group]; effect sizes [within-/between-group]) and individual-level (limb symmetry index [%]; absolute-asymmetry [%]). RESULTS Prevalence of USAI was 38.7%. There were no statistically-significant side-to-side differences for within-/between-group comparisons. Effect sizes: just-below-large (injured-stiff) and extremely-large (injured-lax) for within-group injured-side/uninjured-side comparisons; just-below-medium (injured-lax) to just-above-medium (injured-stiff) for injured-side comparisons to uninjured players. Absolute-asymmetries: uninjured players, 15.4±13.2%; injured-stiff, 21.8±33.6%; injured-lax 20.4±13.6%. CONCLUSIONS Over one-third of players had previous USAI. Effect sizes indicate substantial within-group side-to-side differences and less substantial between-group differences. Across groups, some players had absolute-asymmetries that may elicit concern in ankle primary/secondary injury prevention and performance contexts.
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Affiliation(s)
- Nicholas C Clark
- School of Sport, Rehabilitation, and Exercise Sciences. University of Essex. Wivenhoe Park, Colchester, Essex, CO4 3SQ, UK.
| | - Stuart D Campbell
- Tottenham Hotspur Football Club. Hotspur Way, Enfield, Middlesex, EN2 9AP, UK.
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Jakobsen JR, Krogsgaard MR. The Myotendinous Junction-A Vulnerable Companion in Sports. A Narrative Review. Front Physiol 2021; 12:635561. [PMID: 33841171 PMCID: PMC8032995 DOI: 10.3389/fphys.2021.635561] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 02/15/2021] [Indexed: 01/17/2023] Open
Abstract
The incidence of strain injuries continues to be high in many popular sports, especially hamstring strain injuries in football, despite a documented important effect of eccentric exercise to prevent strains. Studies investigating the anatomical properties of these injuries in humans are sparse. The majority of strains are seen at the interface between muscle fibers and tendon: the myotendinous junction (MTJ). It has a unique morphology with a highly folded muscle membrane filled with invaginations of collagen fibrils from the tendon, establishing an increased area of force transmission between muscle and tendon. There is a very high rate of remodeling of the muscle cells approaching the MTJ, but little is known about how the tissue adapts to exercise and which structural changes heavy eccentric exercise may introduce. This review summarizes the current knowledge about the anatomy, composition and adaptability of the MTJ, and discusses reasons why strain injuries can be prevented by eccentric exercise.
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Affiliation(s)
- Jens Rithamer Jakobsen
- Section of Sports Traumatology, M51, A Part of IOC Research Center, Bispebjerg and Frederiksberg Hospital, Copenhagen University Hospital, Copenhagen, Denmark
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Green B, Lin M, McClelland JA, Semciw AI, Schache AG, Rotstein AH, Cook J, Pizzari T. Return to Play and Recurrence After Calf Muscle Strain Injuries in Elite Australian Football Players. Am J Sports Med 2020; 48:3306-3315. [PMID: 33030961 DOI: 10.1177/0363546520959327] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Calf muscle strain injuries (CMSI) are prevalent in sport, but information about factors associated with time to return to play (RTP) and recurrence is limited. PURPOSE To determine whether clinical and magnetic resonance imaging (MRI) data are associated with RTP and recurrence after CMSI. STUDY DESIGN Case-control study; Level of evidence, 3. METHODS Data of 149 CMSI reported to the Soft Tissue injury Registry of the Australian Football League were explored to evaluate the impact of clinical data and index injury MRI findings on RTP and recurrence. Clinical data included age, previous injury history, ethnicity, and the mechanism of injury. RESULTS Irrespective of the anatomical location, players with CMSI with severe aponeurotic disruption (AD) took longer to RTP than players with CMSI with no AD: 31.3 ± 12.6 days vs 19.4 ± 10.8 days (mean ± SD; P = .003). A running-related mechanism of injury was associated with a longer RTP period for CMSI overall (adjusted hazard ratio [AHR], 0.59; P = .02). The presence of AD was associated with a longer RTP period for soleus injuries (AHR, 0.6; P = .025). Early recurrence (ie, ≤2 months of the index injury) was associated with older age (AHR, 1.3; P = .001) and a history of ankle injury (AHR, 3.9; P = .032). Older age (AHR, 1.1; P = .013) and a history of CMSI (AHR, 6.7; P = .002) increased the risk of recurrence within 2 seasons. The index injury MRI findings were not associated with risk of recurrence. CONCLUSION A running-related mechanism of injury and the presence of AD on MRI were associated with a longer RTP period. Clinical rather than MRI data best indicate the risk of recurrent CMSI.
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Affiliation(s)
- Brady Green
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Monica Lin
- Victoria House Medical Imaging, Melbourne, Australia
| | - Jodie A McClelland
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Adam I Semciw
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia.,Northern Centre for Health Education and Research, Northern Health, Victoria, Australia
| | - Anthony G Schache
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | | | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
| | - Tania Pizzari
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Australia
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