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Pedret C, Mecho S, Balius R, Ahmad G. Calf injury in a padel player. Br J Sports Med 2024; 58:567-568. [PMID: 38503470 DOI: 10.1136/bjsports-2024-108064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 03/13/2024] [Indexed: 03/21/2024]
Affiliation(s)
- Carles Pedret
- Sports Medicine and Imaging, Clinica de Medicina Integral Diagonal SLU, Esplugues de Llobregat, Spain
| | | | - Ramon Balius
- Sports Medicine Department, Consell Català de l'Esport. Generalitat of Catalonia. Barcelona, Barcelona, Spain
| | - Gulraiz Ahmad
- Radiology department, Manchester University NHS Foundation Trust, Manchester, UK
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2
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Palermi S, Vittadini F, Vecchiato M, Corsini A, Demeco A, Massa B, Pedret C, Dorigo A, Gallo M, Pasta G, Nanni G, Vascellari A, Marchini A, Lempainen L, Sirico F. Managing Lower Limb Muscle Reinjuries in Athletes: From Risk Factors to Return-to-Play Strategies. J Funct Morphol Kinesiol 2023; 8:155. [PMID: 37987491 PMCID: PMC10660751 DOI: 10.3390/jfmk8040155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Revised: 10/31/2023] [Accepted: 11/02/2023] [Indexed: 11/22/2023] Open
Abstract
Muscle injuries and subsequent reinjuries significantly impact athletes, especially in football. These injuries lead to time loss, performance impairment, and long-term health concerns. This review aims to provide a comprehensive overview of the current understanding of muscle reinjuries, delving into their epidemiology, risk factors, clinical management, and prevention strategies. Despite advancements in rehabilitation programs and return-to-play criteria, reinjury rates remain alarmingly high. Age and previous muscle injuries are nonmodifiable risk factors contributing to a high reinjury rate. Clinical management, which involves accurate diagnosis, individualized rehabilitation plans, and the establishment of return-to-training and return-to-play criteria, plays a pivotal role during the sports season. Eccentric exercises, optimal loading, and training load monitoring are key elements in preventing reinjuries. The potential of artificial intelligence (AI) in predicting and preventing reinjuries offers a promising avenue, emphasizing the need for a multidisciplinary approach to managing these injuries. While current strategies offer some mitigation, there is a pressing need for innovative solutions, possibly leveraging AI, to reduce the incidence of muscle reinjuries in football players. Future research should focus on this direction, aiming to enhance athletes' well-being and performance.
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Affiliation(s)
- Stefano Palermi
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | | | - Marco Vecchiato
- Sports and Exercise Medicine Division, Department of Medicine, University of Padova, 35128 Padova, Italy
| | | | - Andrea Demeco
- Department of Medicine and Surgery, University of Parma, 43126 Parma, Italy
| | - Bruno Massa
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal, 08950 Barcelona, Spain;
| | - Alberto Dorigo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | - Mauro Gallo
- Radiology Unit, Casa di Cura Giovanni XXIII, 31050 Monastier, Italy
| | | | | | | | | | - Lasse Lempainen
- FinnOrthopaedics, Hospital Pihlajalinna, 20520 Turku, Finland;
| | - Felice Sirico
- Public Health Department, University of Naples Federico II, 80131 Naples, Italy
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3
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Challoumas D, Crosbie G, O'Neill S, Pedret C, Millar NL. Effectiveness of Exercise Treatments with or without Adjuncts for Common Lower Limb Tendinopathies: A Living Systematic Review and Network Meta-analysis. Sports Med Open 2023; 9:71. [PMID: 37553459 PMCID: PMC10409676 DOI: 10.1186/s40798-023-00616-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 07/16/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Exercise therapy is usually prescribed as first-line treatment for lower limb tendinopathies. The multitude of exercise- and non-exercise-based management options can be overwhelming for the treating sports professional and patient alike. We chose to investigate the comparative effectiveness of exercise therapy with or without adjuncts for managing the commonest lower limb tendinopathies. METHODS Through an extensive systematic literature search using multiple databases, we aimed to identify eligible randomised controlled trials (RCTs) on Achilles tendinopathy, patellar tendinopathy or greater trochanteric pain syndrome (GTPS) that included at least one exercise intervention in their treatment arms. Our primary outcomes were patient-reported pain and function (Victorian Institute of Sport Assessment; VISA). Follow-up was defined as short-term (≤ 12 weeks), mid-term (> 12 weeks to < 12 months) and long-term (≥ 12 months). The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE-NMA tools, respectively. Analyses were performed separately for each one of the three tendinopathies. RESULTS A total of 68 RCTs were included in the systematic review. All pairwise comparisons that demonstrated statistically and clinically significant differences between interventions were based on low or very low strength of evidence. Based on evidence of moderate strength, the addition of extracorporeal shockwave therapy to eccentric exercise in patellar tendinopathy was associated with no short-term benefit in pain or VISA-P. From the network meta-analyses, promising interventions such as slow resistance exercise and therapies administered alongside eccentric exercise, such as topical glyceryl trinitrate for patellar tendinopathy and high-volume injection with corticosteroid for Achilles tendinopathy were based on low/very low strength of evidence. CONCLUSION In this network meta-analysis, we found no convincing evidence that any adjuncts administered on their own or alongside exercise are more effective than exercise alone. Therefore, we recommend that exercise monotherapy continues to be offered as first-line treatment for patients with Achilles and patellar tendinopathies and GTPS for at least 3 months before an adjunct is considered. We provide treatment recommendations for each tendinopathy. PROSPERO registration number CRD42021289534.
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Affiliation(s)
- Dimitris Challoumas
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, UK
| | - Gearoid Crosbie
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, UK
| | - Seth O'Neill
- Department of Physiotherapy, School of Allied Health Professionals, University of Leicester, Leicester, UK
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal,, C/San Mateu, Esplugues de Llobregat, Spain
| | - Neal L Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, UK.
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Crowe LAN, Akbar M, de Vos RJ, Kirwan PD, Kjaer M, Pedret C, McInnes IB, Siebert S, Millar NL. Pathways driving tendinopathy and enthesitis: siblings or distant cousins in musculoskeletal medicine? Lancet Rheumatol 2023; 5:e293-e304. [PMID: 38251592 DOI: 10.1016/s2665-9913(23)00074-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 02/19/2023] [Accepted: 03/02/2023] [Indexed: 01/23/2024]
Abstract
Tendinopathy and enthesitis share clinical, anatomical, and molecular parallels. However, their relationship is complex, presenting challenges in diagnosis and treatment. The biomechanics underlying these pathologies, together with relative immune and stromal contributions to pathology, are characterised by crucial comparative elements. However, methodologies used to study enthesitis and tendinopathy have been divergent, which could account for discrepancies in how these conditions are perceived and treated. In this Review, we summarise key clinical parallels between these two common presentations in musculoskeletal medicine and address factors that currently preclude development of more effective therapeutics. Furthermore, we describe molecular similarities and disparities that govern pathological mechanisms in tendinopathy and enthesitis, thus informing translational studies and treatment strategies.
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Affiliation(s)
- Lindsay A N Crowe
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Moeed Akbar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Netherlands
| | - Paul D Kirwan
- Discipline of Physiotherapy, School of Medicine, Trinity College Dublin, Dublin, Ireland; Physiotherapy Department, Connolly Hospital, Blanchardstown, Dublin, Ireland
| | - Michael Kjaer
- Institute of Sports Medicine, Copenhagen University Hospital-Bispebjerg Frederiksberg, Copenhagen, Denmark
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Mapfre de Medicina del Tenis C/Muntaner, Barcelona, Spain
| | - Iain B McInnes
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Siebert
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Neal L Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK.
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Delen M, Şendil A, Kaux JF, Pedret C, Le Sant G, Pawson J, Miller SC, Birn-Jeffery A, Morrissey D. Self-reported bio-psycho-social factors partially distinguish rotator cuff tendinopathy from other shoulder problems and explain shoulder severity: A case-control study. Musculoskeletal Care 2023; 21:175-188. [PMID: 35983898 DOI: 10.1002/msc.1679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/05/2022] [Accepted: 07/19/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Examine how rotator cuff (RC) tendinopathy differed from other shoulder problems (OSP) by measuring a variety of self-reported bio-psycho-social factors, and establish which explain severity. METHODS A validated online survey battery was used to collect self-reported biopsychosocial variables in an international population. Diagnostic group and severity were the dependent variables. Multiple logistic and linear regression analyses were utilised to generate explanatory models for group differences and severity after group comparison and univariate regression analysis. RESULTS 82 people with RC tendinopathy (50 female, 42.8 ± 13.9 years) and 54 with OSP (33 female, 40.2 ± 14.1 years) were recruited. Both groups had comparable severity results (Shoulder Pain and Disability Index = 37.3 ± 24.5 vs. 33.7 ± 22.5). Seven factors individually differentiated RC tendinopathy from OSP. The multivariable model included 4 factors: activity effect on pain (OR(95%CI) = 2.24(1.02-4.90)), previous injury in the shoulder (OR(95% CI) = 0.30(0.13-0.69)), activity level (moderate OR(95% CI) = 3.97(1.29-12.18), high OR(95% CI) = 3.66(1.41-9.48)) and self-efficacy (OR(95%CI) = 1.12(1.02-1.22)) demonstrating acceptable accuracy. The second multivariable model for RC tendinopathy severity included one demographic, three psychological and two biomedical variables (β(range) = 0.19-0.38) and explained 68% of the variance. CONCLUSION Self-reported bio-psycho-social variables may be beneficial for further detailed clinical assessment as they partially distinguish RC tendinopathy from OSP, even when the groups have comparable overall pain and functional problems. Moreover, these variables were shown to be substantially associated with RC tendinopathy severity variance, implying that the clinical evaluation might be improved, perhaps by pre-consultation online data collection. The models should be validated in the future and considered alongside data from physical and imaging examinations.
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Affiliation(s)
- Mehmet Delen
- Bart's and the London School of Medicine and Dentistry, Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Ateş Şendil
- School of Physical Education and Sports, Cyprus Health and Social Sciences University, Güzelyurt, Cyprus
| | - Jean-François Kaux
- Physical Medicine and Sport Traumatology Department, University and University Hospital of Liège, Liège, Belgium
| | - Carles Pedret
- Sports Medicine and Clinical Ultrasound Department, Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain
| | - Guillaume Le Sant
- University of Nantes, Movement, Interactions, Performance, Nantes, France
| | | | - Stuart Charles Miller
- Bart's and the London School of Medicine and Dentistry, Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK
| | - Aleksandra Birn-Jeffery
- School of Engineering and Materials Science, Institute of Bioengineering, Queen Mary University London, London, UK
| | - Dylan Morrissey
- Bart's and the London School of Medicine and Dentistry, Sports and Exercise Medicine, William Harvey Research Institute, Queen Mary University of London, Mile End Hospital, London, UK.,Barts Health NHS Trust, London, UK
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Mechó S, Balius R, Bossy M, Valle X, Pedret C, Ruiz-Cotorro Á, Rodas G. Isolated Adductor Magnus Injuries in Athletes: A Case Series. Orthop J Sports Med 2023; 11:23259671221138806. [PMID: 36698789 PMCID: PMC9869219 DOI: 10.1177/23259671221138806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background Little is known about injuries to the adductor magnus (AM) muscle and how to manage them. Purpose To describe the injury mechanisms of the AM and its histoarchitecture, clinical characteristics, and imaging features in elite athletes. Study Design Case series; Level of evidence, 4. Methods A total of 11 competitive athletes with an AM injury were included in the study. Each case was clinically assessed, and the diagnosis and classification were made by magnetic resonance imaging (MRI) according to the British Athletics Muscle Injury Classification (BAMIC) and mechanism, location, grade, and reinjury (MLG-R) classification. A 1-year follow-up was performed, and return-to-play (RTP) time was recorded. Results Different mechanisms of injury were found; most of the athletes (10/11) had flexion and internal rotation of the hip with extension or slight flexion of the knee. Symptoms consisted of pain in the posteromedial (7/11) or medial (4/11) thigh during adduction and flexion of the knee. Clinically, there was a suspicion of an injury to the AM in only 3 athletes. According to MRI, 5 lesions were located in the ischiocondylar portion (3 in the proximal and 2 in the distal myoconnective junction) and 6 in the pubofemoral portion (4 in the distal and 2 in the proximal myoconnective junction). Most of the ischiocondylar lesions were myotendinous (3/5), and most of the pubofemoral lesions were myofascial (5/6). The BAMIC and MLG-R classification coincided in distinguishing injuries of moderate and mild severity. The management was nonoperative in all cases. The mean RTP time was 14 days (range, 0-35 days) and was longer in the ischiocondylar cases than in the pubofemoral cases (21 vs 8 days, respectively). Only 1 recurrence, at <10 months, was recorded. Conclusion Posteromedial thigh pain after an eccentric contraction during forced adduction of the thigh from hip internal rotation should raise a suspicion of AM lesions. The identification of the affected portion was possible on MRI. An injury in the ischiocondylar portion entailed a longer RTP time than an injury in the pubofemoral portion.
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Affiliation(s)
- Sandra Mechó
- Department of Radiology, Hospital of Barcelona, Barcelona, Spain.,Medical Department, Football Club Barcelona, Barcelona, Spain.,Department of Surgery and Orthopedics, Autonomous University of Barcelona, Barcelona, Spain.,Sandra Mechó, MD, Department of Radiology, Hospital of Barcelona, Avinguda Diagonal 660, 08034 Barcelona, Spain () (Twitter: @mechomeca)
| | - Ramon Balius
- Catalan Sports Council, Government of Catalonia, Barcelona, Spain
| | - Mireia Bossy
- Clínica Creu Blanca, Barcelona, Spain.,Sports Medicine and Imaging Department, Clínica Diagonal, Barcelona, Spain.,Quiron Hospital, Barcelona, Spain
| | - Xavier Valle
- Medical Department, Football Club Barcelona, Barcelona, Spain.,Department of Surgery and Orthopedics, Autonomous University of Barcelona, Barcelona, Spain.,Dexeus University Hospital, Barcelona, Spain
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clínica Diagonal, Barcelona, Spain
| | - Ángel Ruiz-Cotorro
- Royal Spanish Tennis Federation, Barcelona, Spain.,Clínica Mapfre de Medicina del Tenis, Barcelona, Spain
| | - Gil Rodas
- Medical Department, Football Club Barcelona, Barcelona, Spain.,Barça Innovation Hub, Football Club Barcelona, Barcelona, Spain.,Sports Medicine Unit, Sant Joan de Déu Hospital, Barcelona, Spain
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Isern-Kebschull J, Pedret C, Mechó S, Pruna R, Alomar X, Yanguas X, Valle X, Kassarjian A, Martínez J, Tomas X, Rodas G. MRI findings prior to return to play as predictors of reinjury in professional athletes: a novel decision-making tool. Insights Imaging 2022; 13:203. [PMID: 36575363 PMCID: PMC9794673 DOI: 10.1186/s13244-022-01341-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 11/20/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Because MRI has shown great accuracy in assessing acute muscle injuries, identification of risk factors for reinjury before return to play (RTP) in professional athletes during the healing process could be very relevant. We assessed the value of MRI findings prior to RTP as predictors of reinjury. METHODS Retrospective observational study of 59 professional athletes, mean age 26 years, with first-time acute muscle injury and successful rehabilitation ready to RTP. They underwent MRI within 6 days of the injury and within 7 days prior to RTP. The primary outcome was reinjury. Risk of reinjury was assessed using radiological signs in control MRI scans before RTP. The risk was classified as low, medium or high when none, one or two radiological signs were observed, respectively. RESULTS Reinjury occurred in 9 participants, with a rate of 15.2%. None of the baseline MRI-related variables was significantly associated with reinjury. In the control MRI scan performed within 7 days prior to RTP, three independent findings were significantly associated with reinjury. These included transversal and/or mixed connective tissue gap (p = 0.002), intermuscular oedema (p = 0.015) and callus gap (p = 0.046). In the predictive model of the risk of reinjury, the presence of two of these radiological signs, together with interstitial feathery oedema, was associated with a high risk of recurrence (OR 29.58, 95% CI 3.86-226.64; p = 0.001). CONCLUSIONS In professional athletes with acute muscle injuries of the lower limbs successfully rehabilitated, some radiological signs on MRI performed shortly before RTP were associated with a high risk of reinjury.
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Affiliation(s)
- Jaime Isern-Kebschull
- grid.5841.80000 0004 1937 0247Department of Radiology, Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
| | | | - Sandra Mechó
- Department of Radiology, Hospital de Barcelona, Barcelona, Spain
| | - Ricard Pruna
- FCBarcelona Medical Department, Barcelona, Spain
| | - Xavier Alomar
- Department of Radiology, Centres Mèdics Creu Blanca, Barcelona, Spain
| | | | - Xavier Valle
- FCBarcelona Medical Department, Barcelona, Spain
| | - Ara Kassarjian
- Musculoskeletal Radiology, Elite Sports Imaging, SL, Pozuelo de Alarcón, Madrid, Spain
| | | | - Xavier Tomas
- grid.5841.80000 0004 1937 0247Department of Radiology, Hospital Clinic, University of Barcelona, C/Villarroel 170, 08036 Barcelona, Spain
| | - Gil Rodas
- FCBarcelona Medical Department, Barcelona, Spain ,grid.410458.c0000 0000 9635 9413Medicine Sport Unit, Hospital Clínic-Sant Joan de Déu, Barcelona, Spain
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Balius R, Pedret C, Estrada-Alarcón P, Corominas H. Overview of Thigh and Leg Anatomical and Sonographic Landmarks in Rheumatic Patients. Eur J Rheumatol 2022. [PMID: 36052637 DOI: 10.5152/eurjrheum.2022.21131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Musculoskeletal ultrasound has become a practical and accessible diagnostic tool for musculoskeletal diseases. It is used to examine joints, tendons, vessels, and nerves due to its wide availability in rheumatology practice. Ultrasound has also been applied for years in other areas such as muscular injuries in sports activities and rheumatic diseases with inflammation such as myositis. The knowledge among rheumatologists about muscle ultrasound is increasingly growing taking into account it is not the main target of their ultrasound activity but mainly based on the evaluation of joint, synovitis, tenosynovitis, vasculitis in giant cell arteritis, and parotid gland evaluation in Sjögren´s syndrome. Thus, the present review describes anatomical and ultrasound findings including all muscles of the thigh (anterior, posterior, medial aspects) and leg (anterior, lateral, posterior superficial, deep posterior compartments) of lower limb structures to ease a comprehensive clinical and sonographic evaluation.
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Affiliation(s)
- Ramon Balius
- Consell Català de l´Esport, Generalitat de Catalunya; Servei d´ecografía clínica, Clínica Diagonal, Barcelona
| | - Carles Pedret
- Servei d´ecografía clínica, Clínica Diagonal, Barcelona
| | - Paula Estrada-Alarcón
- Servei d´ecografía clínica, Clínica Diagonal, Barcelona; Servei de Reumatologia, Hospital Moisès Broggi Sant Joan Despí, Barcelona
| | - Hèctor Corominas
- Servei d´ecografía clínica, Clínica Diagonal, Barcelona; Servei de Reumatologia, Hospital de Santa Creu i Sant Pau and Hospital Dos de Maig, Barcelona. Universitat Autònoma de Barcelona (UAB)
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Edgar N, Clifford C, O'Neill S, Pedret C, Kirwan P, Millar NL. Biopsychosocial approach to tendinopathy. BMJ Open Sport Exerc Med 2022; 8:e001326. [PMID: 35990762 PMCID: PMC9345071 DOI: 10.1136/bmjsem-2022-001326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/15/2022] [Indexed: 12/15/2022] Open
Abstract
Tendinopathy describes a spectrum of changes that occur in damaged tendons, leading to pain and reduced function that remains extremely challenging for all clinicians. There is an increasing awareness of the influence that psychological and psychosocial components, such as self-efficacy and fear-avoidance, have on rehabilitation outcomes in musculoskeletal medicine. Although it is widely accepted that psychological/psychosocial factors exist in tendinopathy, there is currently a distinct lack of trials measuring how these factors affect clinical outcomes. Biopsychosocial treatments acknowledge and address the biological, psychological and social contributions to pain and disability are currently seen as the most efficacious approach to chronic pain. Addressing and modulating these factors are crucial in the pathway of personalised treatments in tendinopathy and offer a real opportunity to drive positive outcomes in patients. In this education review, we also provide the current evidence-based guidance on psychological and psychosocial developments in musculoskeletal medicine and how these may be translated to treating tendinopathy using a biopsychosocial model.
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Affiliation(s)
- Nathan Edgar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Christopher Clifford
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK,Department of Physiotherapy, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Seth O'Neill
- Department of Physiotherapy, School of Allied Health Professionals, University of Leicester, Leicester, UK
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Mapfre de Medicina del Tenis C/Muntaner, Barcelona, Spain
| | - Paul Kirwan
- Discipline of Physiotherapy, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Delen M, Şendil A, Jean-François K, Pedret C, Le Sant G, Pawson J, Miller S, Birn-Jeffery A, Morrissey D. Do bio-psycho-social self-reported factors distinguish rotator cuff tendinopathy from other shoulder problems and explain shoulder severity? A case–control study. Physiotherapy 2022. [DOI: 10.1016/j.physio.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Docherty S, Harley R, McAuley JJ, Crowe LAN, Pedret C, Kirwan PD, Siebert S, Millar NL. The effect of exercise on cytokines: implications for musculoskeletal health: a narrative review. BMC Sports Sci Med Rehabil 2022; 14:5. [PMID: 34991697 PMCID: PMC8740100 DOI: 10.1186/s13102-022-00397-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 12/31/2021] [Indexed: 02/07/2023]
Abstract
The physiological effects of physical exercise are ubiquitously reported as beneficial to the cardiovascular and musculoskeletal systems. Exercise is widely promoted by medical professionals to aid both physical and emotional wellbeing; however, mechanisms through which this is achieved are less well understood. Despite numerous beneficial attributes, certain types of exercise can inflict significant significant physiological stress. Several studies document a key relationship between exercise and immune activation. Activation of the innate immune system occurs in response to exercise and it is proposed this is largely mediated by cytokine signalling. Cytokines are typically classified according to their inflammatory properties and evidence has shown that cytokines expressed in response to exercise are diverse and may act to propagate, modulate or mitigate inflammation in musculoskeletal health. The review summarizes the existing literature on the relationship between exercise and the immune system with emphasis on how exercise-induced cytokine expression modulates inflammation and the immune response.
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Affiliation(s)
- Sophie Docherty
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, Scotland, UK
| | - Rachael Harley
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, Scotland, UK
| | - Joseph J McAuley
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, Scotland, UK
| | - Lindsay A N Crowe
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, Scotland, UK
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Diagonal, C/Sant Mateu 24-26, 08950, Esplugues de Llobregat, Spain
| | - Paul D Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland
- Physiotherapy Department, Connolly Hospital, Dublin, Ireland
| | - Stefan Siebert
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, Scotland, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, College of Medicine, Veterinary and Life Sciences, University of Glasgow, 120 University Avenue, Glasgow, G12 8TA, Scotland, UK.
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Santín I, Vilanova R, Pedret C, Barbu M. New approach for regulation of the internal recirculation flow rate by fuzzy logic in biological wastewater treatments. ISA Trans 2022; 120:167-189. [PMID: 33810842 DOI: 10.1016/j.isatra.2021.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 03/17/2021] [Accepted: 03/17/2021] [Indexed: 06/12/2023]
Abstract
The internal recirculation plays an important role on the different biological processes of wastewater treatment plants because it has a great influence on the concentration of pollutants, especially nutrients. Usually, the internal recirculation flow rate is kept fixed or manipulated by control techniques to maintain a fixed nitrate set-point in the last anoxic tank. This work proposes a new control strategy to manipulate the internal recirculation flow rate by applying a fuzzy controller. The proposed controller takes into account the effects of the internal recirculation flow rate on the inlet of the biological treatment and on the denitrification and nitrification processes with the aim of reducing violations of legally established limits of nitrogen and ammonia and also reducing operational costs. The proposed fuzzy controller is tested by simulation with the internationally known benchmark simulation model no. 2. The objective is to apply the proposed fuzzy controller in any control strategy, only replacing the manipulation of the internal recirculation flow rate, to improve the plant operation.Therefore, it has been implemented in five operation strategies from the literature, replacing their original internal recirculation flow rate control, and simulation results are compared with those of the original strategies. Results show improvements with the application of the proposed fuzzy controller of between 2.25 and 57.94% in reduction of total nitrogen limit violations, between 55.22 and 79.69% in reduction of ammonia limit violations and between 0.84 and 38.06% in cost reduction of pumping energy.
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Affiliation(s)
- I Santín
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | - R Vilanova
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | - C Pedret
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | - M Barbu
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; Department of Automatic Control and Electrical Engineering, "Dunarea de Jos" University of Galati, 800008 Galati, Romania.
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13
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Challoumas D, Pedret C, Biddle M, Ng NYB, Kirwan P, Cooper B, Nicholas P, Wilson S, Clifford C, Millar NL. Management of patellar tendinopathy: a systematic review and network meta-analysis of randomised studies. BMJ Open Sport Exerc Med 2021; 7:e001110. [PMID: 34900334 PMCID: PMC8634001 DOI: 10.1136/bmjsem-2021-001110] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/15/2021] [Indexed: 11/24/2022] Open
Abstract
Objectives We performed a systematic review and network meta-analysis (NMA) of randomised controlled trials (RCTs) to provide insights into the effectiveness of available treatment modalities in patellar tendinopathy(PT). Methods Several databases were searched in May 2021 for RCTs assessing the effectiveness of any intervention compared with any other intervention, placebo or no treatment for pain and/or function in PT. The risk of bias and strength of evidence were assessed with the Cochrane Collaboration and GRADE (Grading of Recommendations, Assessment, Development and Evaluations)/GRADE-NMA tools. Results A total of 37 RCTs were eligible that assessed 33 different interventions and their combinations, most represented by single studies. Based on pairwise meta-analyses of two RCTs, extracorporeal shockwave therapy (ESWT) does not appear to be superior to sham ESWT (eccentric exercise in both groups) for short-term pain (mean differences (MD) +0.1, 95% CI (−0.8 to 1), p=0.84) or function (MD −1.8, 95% CI (–8 to 4.4), p=0.57). Based on a pairwise meta-analysis of three RCTs, isometric exercise appears as effective as isotonic exercise for immediate postintervention pain relief (MD −1.03, 95% CI (−2.6 to 0.5), p=0.19). Our NMA showed that topical glyceryl trinitrate (GTN) and hyaluronic acid injection, both combined with eccentric exercise and moderate, slow resistance exercise had the highest probability of being the most effective interventions (low/very low strength of evidence). Conclusions Promising interventions with inadequate evidence, such as topical GTN, hyaluronic acid injections and isometric and slow resistance exercise, should be further investigated through high-quality RCTs. Meanwhile, eccentric loading with or without adjuncts should remain the first-line treatment for all individuals with patellar tendinopathy.
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Affiliation(s)
- Dimitris Challoumas
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clinica Mapfre de Medicina del Tenis, Barcelona, Spain
| | - Mairiosa Biddle
- Department of Trauma & Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Nigel Yong Boon Ng
- Department of Trauma & Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Paul Kirwan
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.,Physiotherapy Department, Connolly Hospital Blanchardstown, Blanchardstown, Ireland
| | - Blair Cooper
- Department of Trauma & Orthopaedic Surgery, Ayr University Hospital, Ayr, UK
| | - Patrick Nicholas
- Department of Trauma & Orthopaedic Surgery, Ayr University Hospital, Ayr, UK
| | - Scott Wilson
- Department of Trauma & Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
| | - Chris Clifford
- Physiotherapy Department, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Neal L Millar
- Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK.,Department of Trauma & Orthopaedic Surgery, Queen Elizabeth University Hospital, Glasgow, UK
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14
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Balius R, Bossy M, Pedret C, Porcar C, Valle X, Corominas H. Heel fat pad syndrome beyond acute plantar fascitis. Foot (Edinb) 2021; 48:101829. [PMID: 34399148 DOI: 10.1016/j.foot.2021.101829] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 05/06/2021] [Accepted: 05/22/2021] [Indexed: 02/04/2023]
Abstract
Heel pain is a frequent cause of pain and disability in adult active population. In patients with this clinical presentation, several causes must be ruled out, among them plantar fasciitis the most common. Other etiologies of plantar heel pain are the entrapment of muscular branch of the lateral plantar nerve (Baxter nerve) or fat pad atrophy, being the last one the second cause of heel pain after plantar fasciitis. A case series of patients with pathological findings of the heel fat pad area using MRI and US to provide a differential diagnosis of heel pain. Observational case series study. Nine patients visited presented with pain in the plantar aspect of the heel. The plantar aspect of the heel was evaluated in detail with US and MRI. Main inclusion criteria were to present acute or chronic pain on the plantar aspect. In five cases the right heel was affected, in three cases the left heel. One case presented bilateral complaints. All patients presented mechanical pain. Specifically, four of them also described a constant clunk during footstep. Heel fat pad lesion was confirmed with MRI and US in the medial aspect, observed in five patients. In four patients, the heel fat pad was globally affected respectively. This case series tries to put some light on other heel conflicts beside plantar fasciitis that should be ruled out, being one of those, heel fat pad atrophy. Our presentation highlight the role that bed side ultrasound can play in the definition of a specific pattern confirmed with MRI after the US.
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Affiliation(s)
- Ramon Balius
- Consell Català de L'Esport, Generalitat de Catalunya, Barcelona, Catalonia, Spain; Clínica Diagonal, Barcelona, Catalonia, Spain
| | - Mireia Bossy
- Clínica Diagonal, Barcelona, Catalonia, Spain; Clínica Creu Blanca, Barcelona, Catalonia, Spain
| | - Carles Pedret
- Clínica Diagonal, Barcelona, Catalonia, Spain; Clínica Creu Blanca, Barcelona, Catalonia, Spain
| | - Carme Porcar
- Centre Alt Rendiment, Sant Cugat del Vallès, Catalonia, Spain
| | - Xavier Valle
- Futbol Club Barcelona, Serveis Mèdics, Barcelona, Catalonia, Spain
| | - Hèctor Corominas
- Clínica Diagonal, Barcelona, Catalonia, Spain; Servei de Reumatologia, Hospital Universitari de Sant Pau, Barcelona, Catalonia, Spain.
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15
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Balius R, Pedret C, Kassarjian A. Muscle Madness and Making a Case for Muscle-Specific Classification Systems: A Leap from Tissue Injury to Organ Injury and System Dysfunction. Sports Med 2020; 51:193-197. [PMID: 33332013 DOI: 10.1007/s40279-020-01387-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/28/2022]
Abstract
Despite the recent publication and subsequent clinical application of several muscle injury classification systems, none has been able to address the varying and often unique/complex types of injuries that occur in different muscles. Although there are advantages of using a unified classification, there are significant differences between certain muscles and muscle groups. These differences may complicate the clinical effectiveness of using a unified injury classification. This narrative explores the difficulties in using a single classification to describe the heterogeneous nature of muscle injuries. Within that context, the possibility of viewing muscles and muscle injuries in the same manner as other biological tissues, structures, organs, and systems is discussed. Perhaps, in addition to a unified classification, subclassifications or muscle specific classifications should be considered for certain muscles. Having a more specific (granular) approach to some of the more commonly injured muscles may prove beneficial for more accurately and effectively diagnosing and treating muscle injuries. Ideally, this will also lead to more accurate determination of the prognosis of specific muscle injuries.
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Affiliation(s)
- Ramon Balius
- Consell Català de L'Esport, Generalitat de Catalunya, Barcelona, Spain.,Sports Medicine and Clinical Ultrasound Department, Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain
| | - Carles Pedret
- Sports Medicine and Clinical Ultrasound Department, Clínica Diagonal, Esplugues de Llobregat, Barcelona, Spain.
| | - Ara Kassarjian
- Elite Sports Imaging, Madrid, Spain.,Corades, LLC, Brookline, MA, USA
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16
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Pedret C, Balius R, Blasi M, Dávila F, Aramendi JF, Masci L, Fuente J. Ultrasound classification of medial gastrocnemious injuries. Scand J Med Sci Sports 2020; 30:2456-2465. [DOI: 10.1111/sms.13812] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 08/17/2020] [Indexed: 12/12/2022]
Affiliation(s)
- Carles Pedret
- Sports Medicine Department Clínica Diagonal Barcelona Spain
- Sports Medicine and Imaging Department Clínica Creu Blanca Barcelona Spain
| | - Ramon Balius
- Sports Medicine Department Clínica Diagonal Barcelona Spain
- Consell Català de l’Esport Generalitat de Catalunya Barcelona Spain
| | - Marc Blasi
- Plastic Surgery Department Hospital Germans Trias i Pujol Badalona Spain
| | - Fernando Dávila
- Orthopedic Department Clínica Pakea—Mutualia San Sebastián Spain
| | - José F. Aramendi
- Orthopedic Department Clínica Pakea—Mutualia San Sebastián Spain
| | - Lorenzo Masci
- Institute of Sports Exercise and Health (ISEH) London UK
| | - Javier Fuente
- Orthopedic Department Clínica Pakea—Mutualia San Sebastián Spain
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17
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Balius R, Blasi M, Pedret C, Alomar X, Peña-Amaro J, Vega JA, Pruna R, Ardèvol J, Álvarez G, de la Fuente J, Fernández-Jaén T, Järvinen TA, Rodas G. A Histoarchitectural Approach to Skeletal Muscle Injury: Searching for a Common Nomenclature. Orthop J Sports Med 2020; 8:2325967120909090. [PMID: 32232071 PMCID: PMC7092384 DOI: 10.1177/2325967120909090] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 12/12/2022] Open
Abstract
In recent years, different classifications for muscle injuries have been proposed based on the topographic location of the injury within the bone-tendon-muscle chain. We hereby propose that in addition to the topographic classification of muscle injuries, a histoarchitectonic (description of the damage to connective tissue structures) definition of the injury be included within the nomenclature. Thus, the nomenclature should focus not only on the macroscopic anatomy but also on the histoarchitectonic features of the injury.
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Affiliation(s)
| | - Ramon Balius
- Ramon Balius, MD, PhD, Consell Català de l’Esport, Generalitat de Catalunya, Av. dels Països Catalans, 12, 08950 Esplugues de Llobregat, Barcelona, Spain ()
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18
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Florit D, Pedret C, Casals M, Malliaras P, Sugimoto D, Rodas G. Incidence of Tendinopathy in Team Sports in a Multidisciplinary Sports Club Over 8 Seasons. J Sports Sci Med 2019; 18:780-788. [PMID: 31827363 PMCID: PMC6873129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 10/14/2019] [Indexed: 06/10/2023]
Abstract
Tendinopathy is a critical medical condition that often hinders level of participation for professional and young athletes in many sports. The purpose of the study was to describe the incidence and severity of tendinopathy in a multi-sport club with professional and youth teams. We performed a retrospective epidemiological study. Incidence of tendinopathy in players (n = 3839; 8-38 years, professional and youth) was reviewed over 8 seasons (2008-2016) in 5 team sports: football, basketball, handball, roller hockey, and futsal. Team physicians diagnosed and classified tendinopathies according to anatomical location, sport types, playing category, sex, playing surface, lost training time, and severity (time to return to play). Injuries were coded using OSICS-10, and incidence of tendinopathies were calculated as the number of injuries per 100 players per season. The total relative frequency of tendinopathy (versus total injuries) was 22% (843/3839) over 8 seasons from 360 in youth and 483 in professional teams. The incidence of injury was the highest in professional basketball [69.9, 95%CI: (58.0-81.4)] followed by professional roller hockey [64.4, 95%CI: (47.3-85.6)], and professional futsal [36.2, 95%CI: (27.3-47.1)]. The most incidences commonly affected tendons were the patellar [11.7, 95%CI: (10.0-13.5)] and Achilles [10.3, 95%CI: (8.5-12.5)]. Tendinopathies represent a significant number of injuries in team sports and are more common in professional than youth teams, especially basketball and roller hockey. Additional studies are needed to understand associated time-loss and impact on performance, and to develop prevention strategies for high risk sports.
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Affiliation(s)
- Daniel Florit
- Medical Department, Futbol Club Barcelona, Barça Innovation Hub, Spain
- Doctorando de la Facultad de Medicina de la Universidad Autónoma de Barcelona, Spain
| | - Carles Pedret
- Medicine and Imaging Department, Clinica Mapfre de Medicina del Tenis, Barcelona, Spain
- Ultrasonography Department, Clinica Diagonal, Esplugues de Llobregat, Spain
| | - Martí Casals
- Medical Department, Futbol Club Barcelona, Barça Innovation Hub, Spain
- Sport and Physical Activity Studies Centre (CEEAF), University of Vic-Central University of Catalonia, Spain
| | - Peter Malliaras
- Department of Physiotherapy, School of Primary and Allied Health Care, Monash University, Australia
| | - Dai Sugimoto
- The Micheli Center for Sports Injury Prevention, Waltham, MA, USA
- Division of Sports Medicine, Department of Orthopedics, Boston Children's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Gil Rodas
- Medical Department, Futbol Club Barcelona, Barça Innovation Hub, Spain
- Sports Medicine Department. Clinic hospital /Sant Joan de Deu Hospital, Barcelona, Spain
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19
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Santín I, Barbu M, Pedret C, Vilanova R. Dissolved Oxygen Control in Biological Wastewater Treatments with Non-Ideal Sensors and Actuators. Ind Eng Chem Res 2019. [DOI: 10.1021/acs.iecr.9b02572] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- I. Santín
- Departament de Telecomunicació i d’Enginyeria de Sistemes, Escola d’Enginyeria, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
- Escola Universitria Salesiana de Sarrià, 08017 Barcelona, Spain
| | - M. Barbu
- Department of Automatic Control and Electrical Engineering, ”Dunarea de Jos” University of Galati, 800008 Galati, Romania
| | - C. Pedret
- Departament de Telecomunicació i d’Enginyeria de Sistemes, Escola d’Enginyeria, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
| | - R. Vilanova
- Departament de Telecomunicació i d’Enginyeria de Sistemes, Escola d’Enginyeria, Universitat Autònoma de Barcelona, Bellaterra, 08193 Barcelona, Spain
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20
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Abstract
The ultrasound examination of hamstrings inspires respect due to the connective complexity of their structures, particularly for sonographers who are not used to this kind of study. Therefore, it is important to know the specific ultrasound reference points that facilitate the location of the hamstring structures, dividing them into four areas of interest: (a) tendinous origin of the hamstring, (b) the proximal half, (c) distal and medial half, and (d) distal and lateral half. The origin of the hamstrings is found at the level of the ischial tuberosity. Here, the connective structures under study are the common tendon and the semimembranosus tendon, together with the muscle fibers more proximal to the semitendinosus, which can also be assessed through ultrasound locating the ischial tuberosity. The proximal half of the thigh consists of a characteristic structure made up by the common tendon, the sciatic nerve and the semimembranosus tendon, enabling to define the biceps femoris and the semitendinosus, respectively. To identify the distal and medial section, the volumetric relationship between the ST and SM muscle masses is used, where it is also possible to identify the three muscles in the knee that make up the pes anserine. To identify the distal and lateral sections, the sciatic nerve pathway is followed until identifying both heads of the biceps femoris. These four areas of interest, with their specific landmarks, show a tuning fork that enables the comprehensive study of hamstrings through ultrasound.
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Affiliation(s)
- Ramon Balius
- Consell Català de l'Esport, Generalitat de Catalunya, Barcelona, Spain.
- Sports Medicine and Imaging Department, Clínica Diagonal, Barcelona, Spain.
| | - Carles Pedret
- Sports Medicine and Imaging Department, Clínica Diagonal, Barcelona, Spain
- Clínica Mapfre de Medicina del Tenis, Barcelona, Spain
| | - Iñigo Iriarte
- Department of Rehabilitation, Clinica Ars, Bilbao, Spain
| | - Rubén Sáiz
- Department of Rehabilitation, Clinica Ars, Bilbao, Spain
| | - Luis Cerezal
- Department of Radiology, Diagnóstico Médico Cantabria (DMC), Santander, Cantabria, Spain
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21
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Balius R, Alomar X, Pedret C, Blasi M, Rodas G, Pruna R, Peña-Amaro J, Fernández-Jaén T. Role of the Extracellular Matrix in Muscle Injuries: Histoarchitectural Considerations for Muscle Injuries. Orthop J Sports Med 2018; 6:2325967118795863. [PMID: 30246041 PMCID: PMC6144525 DOI: 10.1177/2325967118795863] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- Ramon Balius
- Consell Català de l'Esport, Generalitat de Catalunya, Barcelona, Spain.,Sports Medicine Department, Clínica Diagonal, Barcelona, Spain
| | | | - Carles Pedret
- Sports Medicine Department, Clínica Diagonal, Barcelona, Spain.,Sports Medicine and Imaging Department, Clínica Mapfre de Medicina del Tenis, Barcelona, Spain
| | - Marc Blasi
- Department of Fundamental Care and Medical-Surgical Nursing, Faculty of Medicine and Health Sciences (Bellvitge Campus), University of Barcelona, Barcelona, Spain.,Àrea d'Estructura i Funció del Cos Humà, Facultat de Medicina i Ciències de la Salut, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Gil Rodas
- FC Barcelona Medical Services, FIFA Medical Center of Excellence, Barcelona, Spain
| | - Ricard Pruna
- FC Barcelona Medical Services, FIFA Medical Center of Excellence, Barcelona, Spain
| | - Jose Peña-Amaro
- Department of Morphological Sciences, Histology Section, Faculty of Medicine, University of Córdoba, Maimónides Institute for Biomedical Research IMIBIC, Córdoba, Spain
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22
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Santín I, Barbu M, Pedret C, Vilanova R. Fuzzy logic for plant-wide control of biological wastewater treatment process including greenhouse gas emissions. ISA Trans 2018; 77:146-166. [PMID: 29703628 DOI: 10.1016/j.isatra.2018.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Revised: 04/09/2018] [Accepted: 04/13/2018] [Indexed: 06/08/2023]
Abstract
The application of control strategies is increasingly used in wastewater treatment plants with the aim of improving effluent quality and reducing operating costs. Due to concerns about the progressive growth of greenhouse gas emissions (GHG), these are also currently being evaluated in wastewater treatment plants. The present article proposes a fuzzy controller for plant-wide control of the biological wastewater treatment process. Its design is based on 14 inputs and 6 outputs in order to reduce GHG emissions, nutrient concentration in the effluent and operational costs. The article explains and shows the effect of each one of the inputs and outputs of the fuzzy controller, as well as the relationship between them. Benchmark Simulation Model no 2 Gas is used for testing the proposed control strategy. The results of simulation results show that the fuzzy controller is able to reduce GHG emissions while improving, at the same time, the common criteria of effluent quality and operational costs.
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Affiliation(s)
- I Santín
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Escola Universitria Salesiana de Sarrià, Passeig Sant Joan Bosco 74, 08017 Barcelona, Spain.
| | - M Barbu
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain; Department of Automatic Control and Electrical Engineering, "Dunarea de Jos" University of Galati, 800008 Galati, Romania.
| | - C Pedret
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
| | - R Vilanova
- Department of Telecommunications and Systems Engineering, School of Engineering, Universitat Autònoma de Barcelona, 08193, Bellaterra, Barcelona, Spain.
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23
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Santín I, Barbu M, Pedret C, Vilanova R. Control strategies for nitrous oxide emissions reduction on wastewater treatment plants operation. Water Res 2017; 125:466-477. [PMID: 28903087 DOI: 10.1016/j.watres.2017.08.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Revised: 08/22/2017] [Accepted: 08/23/2017] [Indexed: 06/07/2023]
Abstract
The present paper focused on reducing greenhouse gases emissions in wastewater treatment plants operation by application of suitable control strategies. Specifically, the objective is to reduce nitrous oxide emissions during the nitrification process. Incomplete nitrification in the aerobic tanks can lead to an accumulation of nitrite that triggers the nitrous oxide emissions. In order to avoid the peaks of nitrous oxide emissions, this paper proposes a cascade control configuration by manipulating the dissolved oxygen set-points in the aerobic tanks. This control strategy is combined with ammonia cascade control already applied in the literature. This is performed with the objective to take also into account effluent pollutants and operational costs. In addition, other greenhouse gases emissions sources are also evaluated. Results have been obtained by simulation, using a modified version of Benchmark Simulation Model no. 2, which takes into account greenhouse gases emissions. This is called Benchmark Simulation Model no. 2 Gas. The results show that the proposed control strategies are able to reduce by 29.86% of nitrous oxide emissions compared to the default control strategy, while maintaining a satisfactory trade-off between water quality and costs.
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Affiliation(s)
- I Santín
- Departament de Telecomunicació i d'Enginyeria de Sistemes, Escola d'Enginyeria, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | - M Barbu
- Departament de Telecomunicació i d'Enginyeria de Sistemes, Escola d'Enginyeria, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; Department of Automatic Control and Electrical Engineering, "Dunarea de Jos" University of Galati, 800008 Galati, Romania.
| | - C Pedret
- Departament de Telecomunicació i d'Enginyeria de Sistemes, Escola d'Enginyeria, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
| | - R Vilanova
- Departament de Telecomunicació i d'Enginyeria de Sistemes, Escola d'Enginyeria, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain.
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24
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Fernandez-Jaén T, Rey GÁ, Angulo F, Cuesta JA, Loureda RA, España FÁ, Ayala J, Matas RB, Pazos FB, de Dios Beas Jiménez J, Rosell JC, Fernandez CC, del Pilar Doñoro Cuevas M, Ros FE, Colmenero JE, de Prado JF, García Cota JJ, Garrido González JI, de Vega CG, Santander MG, Herrador Munilla MÁ, Ruiz FI, Díaz FJ, Fernandez AM, Marqueta PM, Muñoz Benito JJ, Vilás RO, Pedret C, Teres XP, Amaro JP, Grifell JP, San Roque JP, Parenteu CR, Serna JR, Rodas G, Álvarez MS, Marchori CS, Perez LT, Durán RU, del Valle Soto M, Villalón Alonso JM, García PG. Spanish Consensus Statement: Clinical Management and Treatment of Tendinopathies in Sport. Orthop J Sports Med 2017; 5:2325967117734127. [PMID: 29119124 PMCID: PMC5666520 DOI: 10.1177/2325967117734127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
On October 15, 2016, experts met at Clínica CEMTRO in Madrid, Spain, under the patronage of the Spanish Society for Sports Traumatology (SETRADE), the Spanish Society of Sports Medicine (SEMED), the Spanish Association of Medical Services for Football Clubs (AEMEF), the Spanish Association of Medical Services for Basketball Clubs (AEMB), F.C. Barcelona, and Clínica CEMTRO. The purpose was to consider the most appropriate clinical management and treatment of tendinopathies in sports, based on proven scientific data described in the medical literature as well as on each expert’s experience. Prior to the meeting, each expert received a questionnaire regarding clinical management and treatment of tendinopathies in sports. The present consensus document summarizes the answers to the questionnaire and the resulting discussion and consensus regarding current concepts on tendinopathies in sports.
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Affiliation(s)
| | - Tomas Fernandez-Jaén
- Tomas F. Fernandez-Jaén, MD, PhD, Clínica CEMTRO, Ventisquero de la Condesa 42, Madrid 28035, Spain ()
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Balius R, Bossy M, Pedret C, Capdevila L, Alomar X, Heiderscheit B, Rodas G. Semimembranosus Muscle Injuries In Sport. A Practical MRI use for Prognosis. Sports Med Int Open 2017; 1:E94-E100. [PMID: 30539092 PMCID: PMC6226085 DOI: 10.1055/s-0043-111587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 04/26/2017] [Accepted: 05/08/2017] [Indexed: 11/30/2022] Open
Abstract
The aim of this work was to study semimembranosus musculotendinous injuries (SMMTI) and return to play (RTP). The hypothesis is that some related anatomic variables of the SM could contribute to the prognosis of RTP. The retrospective study was done with 19 athletes who suffered SMMTI from 2010 to 2013 and in whose cases a 3.0T MRI was performed. We evaluated the A, B, C SM regions damaged and calculated the relative length and percentage of cross-sectional area (CSA) affected. We found the correlation of these variables with RTP. The data was regrouped in those cases where the part C of the injury was of interest and those in which the C region was unscathed (pooled parts). We used the Mann-Whitney U test and there was a higher RTP when the injury involved the C part of SM (49.1 days; 95% CI [27.6– 70.6]) compared to non-C-part involvement (27.8 days; 95% CI [19.5–36.0]). The SMMTI with longer RTP typically involves the C part with or without participation of the B part. In daily practice, the appearance on MRI of an altered proximal tendon of the SM indicates that the injury affects the C region and therefore has a longer RTP.
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Affiliation(s)
- Ramon Balius
- Clinica Diagonal, Sports Medicine and Imaging, Esplugues de Llobregat, Spain
| | - Mireia Bossy
- Centros Medicos Creu Blanca, Ultrasound, Barcelona, Spain
| | - Carles Pedret
- Clinica Diagonal, Sports Medicine and Imaging, Esplugues de Llobregat, Spain
| | - Lluís Capdevila
- Universitat Autonoma de Barcelona, Laboratory of Sport Psychology Autonoma University de Barcelona, Spain, Bellaterra, Catalunya, Spain
| | - Xavier Alomar
- Centres Mèdics Creu Blanca, Department of Radiology, Barcelona, Spain
| | - Bryan Heiderscheit
- University of Wisconsin School of Medicine and Public Health, Orthopedics and Rehabilitation, Madison, United States
| | - Gil Rodas
- F.C. Barcelona, Medical Services F.C. Barcelona, Barcelona, Spain
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Balius R, Álvarez G, Baró F, Jiménez F, Pedret C, Costa E, Martínez-Puig D. A 3-Arm Randomized Trial for Achilles Tendinopathy: Eccentric Training, Eccentric Training Plus a Dietary Supplement Containing Mucopolysaccharides, or Passive Stretching Plus a Dietary Supplement Containing Mucopolysaccharides. Curr Ther Res Clin Exp 2016; 78:1-7. [PMID: 28053674 PMCID: PMC5198794 DOI: 10.1016/j.curtheres.2016.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 11/07/2016] [Indexed: 10/27/2022]
Abstract
BACKGROUND Tendinopathy is an overuse tendon injury that occurs in loaded tendons and results in pain and functional impairment. Although many treatments for painful tendons are described, the scientific evidence for most of the conservative and surgical treatments is not always conclusive. OBJECTIVES This study was designed to evaluate the efficacy of 3 different interventions in patients with Achilles tendinopathy. The interventions include the combination of 2 physical therapy programs (eccentric training [EC] or passive stretching [PS]) with a supplement containing mucopolisaccharides. The efficacy of the interventions was evaluated depending on the stage of the disease. METHODS Fifty-nine patients were randomly assigned to 1 of 3 treatment groups, and classified according to the disease stage: reactive versus degenerative tendinopathy. Treatment groups were EC; EC + a dietary supplement containing mucopolisaccharides, type I collagen, and vitamin C (MCVC); and a passive stretching program + MCVC. Patients were evaluated at baseline, 6 weeks, and 12 weeks with the Victorian Institute of Sports Assessment-Achilles questionnaire for function, a visual analog scale for pain, and ultrasound characterization for the evolution of tendon structure. RESULTS A significant improvement in Victorian Institute of Sports Assessment-Achilles questionnaire score, pain at rest, and pain during activity were detected in all 3 treatment groups at 6 and 12 weeks' follow-up when compared with baseline. In patients with reactive tendinopathy, the reduction in pain at rest was greater in the groups who took the supplemental MCVC than in the EC alone group (P < 0.05). CONCLUSIONS MCVC seems to be therapeutically useful for management of tendinopathies, providing some additional benefit to physical therapy. This is especially evident in early stages of the disease, when the tendon does not present severe matrix and vascular changes. CLINICALTRIALSGOV IDENTIFIER NCT01691716.
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Affiliation(s)
- Ramon Balius
- Centre de Estudios del Alto Rendimiento Deportivo, Barcelona, Spain; Clínica Centro Médico Internacional Diagonal, Esplugues de Llobregat, Spain
| | | | | | - Fernando Jiménez
- Clínica Centro de Medicina y Deporte, Toledo, Spain; Facultad de Ciencias del Deporte, Universidad de Castilla la Mancha, Toledo, Spain
| | - Carles Pedret
- Clínica Centro Médico Internacional Diagonal, Esplugues de Llobregat, Spain
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Balius R, Bong DA, Ardèvol J, Pedret C, Codina D, Dalmau A. Ultrasound-Guided Fasciotomy for Anterior Chronic Exertional Compartment Syndrome of the Leg. J Ultrasound Med 2016; 35:823-829. [PMID: 26960800 DOI: 10.7863/ultra.15.04058] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Chronic exertional compartment syndrome is characterized by exertional pain and elevated intracompartmental pressures affecting the leg in physically active young people. In patients who have failed conservative measures, fasciotomy is the treatment of choice. This study presents a new method for performing fasciotomy using high-resolution ultrasound (US) guidance and reports on the clinical outcomes in a group of these patients. Over a 3-year period, 7 consecutive patients with a total of 9 involved legs presented clinically with anterior compartment chronic exertional compartment syndrome, which was confirmed by intracompartmental pressure measurements before and after exercise. After a US examination, fasciotomy under US guidance was performed. Preoperative and postoperative pain and activity levels were assessed as well as number of days needed to “return to play.” All patients had a decrease in pain, and all except 1 returned to presymptomatic exercise levels with a median return to play of 35 days.
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Abstract
Background Soleus muscle injuries are common in different sports disciplines. The time required for recovery is often difficult to predict, and reinjury is common. The length of recovery time might be influenced by different variables, such as the involved part of the muscle. Hypothesis Injuries in the central aponeurosis have a worse prognosis than injuries of the lateral or medial aponeurosis as well as myofascial injuries. Study Design Case series; Level of evidence, 4. Methods A total of 61 high-level or professional athletes from several sports disciplines (soccer, tennis, track and field, basketball, triathlon, and field hockey) were reviewed prospectively to determine the recovery time for soleus muscle injuries. Clinical and magnetic resonance imaging evaluation was performed on 44 soleus muscle injuries. The association between the different characteristics of the 5 typical muscle sites, including the anterior and posterior myofascial and the lateral, central, and medial aponeurosis disruption, as well as the injury recovery time, were determined. Recovery time was correlated with age, sport, extent of edema, volume, cross-sectional area, and retraction extension or gap. Results Of the 44 patients with muscle injuries who were analyzed, there were 32 (72.7%) strains affecting the myotendinous junction (MT) and 12 (23.7%) strains of the myofascial junction. There were 13 injuries involving the myotendinous medial (MTM), 7 affecting the MT central (MTC), 12 the MT lateral (MTL), 8 the myofascial anterior (MFA), and 4 the myofascial posterior (MFP). The median recovery time (±SD) for all injuries was 29.1 ± 18.8 days. There were no statistically significant differences between the myotendinous and myofascial injuries regarding recovery time. The site with the worst prognosis was the MTC aponeurosis, with a mean recovery time of 44.3 ± 23.0 days. The site with the best prognosis was the MTL, with a mean recovery time of 19.2 ± 13.5 days (P < .05). There was a statistically significant correlation between recovery time and age (P < .001) and between recovery time and the extent of retraction (P < .05). Conclusion Wide variation exists among the different types of soleus injuries and the corresponding recovery time for return to the same level of competitive sports. Injuries in the central aponeurosis have a significantly longer recovery time than do injuries in the lateral and medial aponeurosis and myofascial sites.
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Affiliation(s)
- Carles Pedret
- Clínica Mapfre de Medicina del Tenis, Barcelona, Spain. ; Clínica CMI Diagonal, Barcelona, Spain. ; Clínica Creu Blanca, Barcelona, Spain
| | - Gil Rodas
- Medical Services, Futbol Club Barcelona, Ciutat Esportiva Futbol Club Barcelona, Barcelona, Spain. ; Leitat Foundation, Leitat Technological Center, Terrassa, Spain
| | - Ramon Balius
- Clínica CMI Diagonal, Barcelona, Spain. ; Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
| | - Lluis Capdevila
- Health & Sport Lab, Eureka Building, PRUAB, Autonomous University of Barcelona, Barcelona, Spain
| | - Mireia Bossy
- Clínica CMI Diagonal, Barcelona, Spain. ; Clínica Creu Blanca, Barcelona, Spain
| | - Robin W M Vernooij
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
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Pedret C, Balius R. Lesiones musculares en el deporte. Actualización de un artículo del Dr. Cabot, publicado en Apuntes de Medicina Deportiva en 1965. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.apunts.2015.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Santín I, Pedret C, Vilanova R. Fuzzy Control and Model Predictive Control Configurations for Effluent Violations Removal in Wastewater Treatment Plants. Ind Eng Chem Res 2015. [DOI: 10.1021/ie504079q] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- I. Santín
- Departament de Telecomunicació
i d′Enginyeria de Sistemes, Escola d′Enginyeria, 08193 Bellaterra, Barcelona, Spain
| | - C. Pedret
- Departament de Telecomunicació
i d′Enginyeria de Sistemes, Escola d′Enginyeria, 08193 Bellaterra, Barcelona, Spain
| | - R. Vilanova
- Departament de Telecomunicació
i d′Enginyeria de Sistemes, Escola d′Enginyeria, 08193 Bellaterra, Barcelona, Spain
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Balius R, Pedret C, Blasi M, Miguel M, Vallejo B, Margalet E, Bong DA, Martinoli C. Sonographic evaluation of the distal iliopsoas tendon using a new approach. J Ultrasound Med 2014; 33:2021-2030. [PMID: 25336491 DOI: 10.7863/ultra.33.11.2021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Sonography of the iliopsoas tendon plays an important role in the diagnosis and preoperative and postoperative management for the increasing number of patients under consideration for arthroscopically guided hip interventions such as iliopsoas tenotomy in a variety of conditions, including arthropathy, periarticular calcifications, and cam-type deformities of the femoral head. The ability to visualize the iliopsoas tendon pre-operatively can be helpful diagnostically in patients presenting with hip pain and can aid in planning surgery, while evaluating the tendon postoperatively is important in the assessment of causes of postoperative pain and other potential complications. We present a novel technique for visualizing the distal iliopsoas tendon complex in the longitudinal axis at its insertion on the lesser trochanter on sonography.
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Affiliation(s)
- Ramon Balius
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
| | - Carles Pedret
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.).
| | - Marc Blasi
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
| | - Maribel Miguel
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
| | - Beatriz Vallejo
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
| | - Eric Margalet
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
| | - David A Bong
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
| | - Carlo Martinoli
- Catalan Sport Council, Generalitat de Catalunya, Barcelona, Spain (R.B.); Clínica Diagonal, Barcelona, Spain (R.B., C.P.); Centre de Diagnòstic per la Imatge de Tarragona, Tarragona, Spain (C.P.); Clínica Mapfre de Medicina del Tenis, Barcelona, Spain (C.P.); Department of Fundamental Care and Medical-Surgical Nursing, University School of Nursing, Bellvitge Health Sciences Campus, University of Barcelona, Barcelona, Spain (M.B.); Human Anatomy and Embryology Unit, Department of Experimental Pathology and Therapeutics, Faculty of Medicine, Bellvitge Campus, University of Barcelona, Barcelona, Spain (M.M.); Institut Margalet de Cirurgia Artroscòpica i Traumatologia, Barcelona, Spain (B.V., E.M.); Instituto Poal de Reumatologia, Barcelona, Spain (D.A.B.); and Department of Radiology, Dipartmento di Discipline Chirurgiche, Morfologiche e Metodologie Integrate, University of Genoa, Genoa, Italy (C.M.)
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Balius R, Άlvarez G, Barό F, Jiménez F, Pedret C, Pujol M, Lόpez D, Martínez D, Ramirez P, Martinez-Puig D. THU0339 Management of Achilles Tendinopathy in Reactive VS Degenerative Stage: A Prospective, Randomized, Controlled Trial Evaluating the Efficacy of A Dietary Supplement Associated to Eccentric Training or Passive Stretching. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.5533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Balius R, Rodas G, Pedret C, Capdevila L, Alomar X, Bong DA. Soleus muscle injury: sensitivity of ultrasound patterns. Skeletal Radiol 2014; 43:805-12. [PMID: 24627005 DOI: 10.1007/s00256-014-1856-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 02/07/2014] [Accepted: 02/21/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the sensitivity of ultrasound in detecting soleus muscle lesions diagnosed on magnetic resonance imaging (MRI) and to characterize their location, ultrasound pattern, and evolution. MATERIALS AND METHODS Ultrasound and MRI studies were performed between May 2009 and February 2013 on all patients who presented to the Medical Services Clinic of the Catalan Sport Council with the initial onset of sharp pain in the calf compatible with injury of the soleus muscle. An inter-observer ultrasound reliability study was also performed. RESULTS A total of 55 cases of soleus injury were studied prospectively (22 with right leg involvement, 33 left) by ultrasound and MRI, which was utilized as the "gold standard." In MRI studies, 24 cases (43.7%) had myofascial injuries that were localized in the posterior aponeurosis (PMF) in 15 cases (27.3%) and in the anterior aponeurosis (AMF) in 9 (16.4%). Thirty-one cases (56.3%) were musculotendinous injuries, with 9 cases (16.4%) in the medial aponeurosis (MMT), 11 cases (20%) in the lateral aponeurosis (LMT), and 11 cases (20%) in the central tendon (CMT). In comparison to MRI, ultrasound was able to detect injury to the soleus in 27.2% of cases. No injuries were detected by ultrasound alone. Posterior myofascial injuries were more likely to be detected by ultrasound than anterior myofascial injuries or all types of musculotendinous injuries. Ultrasound patterns for each type of injury were described. CONCLUSION Ultrasound is not a sensitive technique for detecting and assessing soleus traumatic tears compared with MRI, although the sensitivity is enhanced by a thorough anatomically based ultrasound examination. Timing of the ultrasound examination may be of importance. Each type of soleus injury appears to have a characteristic ultrasound pattern based on a defect of connective expansions, the existence of small myofascial filiform collections, and the rarefaction of the fibrillar area.
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Affiliation(s)
- Ramon Balius
- Sport Catalan Council, Generalitat de Catalunya, Barcelona, Spain
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Turmo-Garuz A, Rodas G, Balius R, Til L, Miguel-Perez M, Pedret C, Del Buono A, Maffulli N. Can local corticosteroid injection in the retrocalcaneal bursa lead to rupture of the Achilles tendon and the medial head of the gastrocnemius muscle? Musculoskelet Surg 2013; 98:121-6. [PMID: 24222527 DOI: 10.1007/s12306-013-0305-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Accepted: 11/04/2013] [Indexed: 01/19/2023]
Abstract
PURPOSE The purpose of the study is to explain the cause-effect relationship in three patients who reported combined ruptures of the Achilles tendon and the gastrosoleus complex 6 months after they had received corticosteroids injections for the management of retrocalcaneal bursitis. METHODS Three cryopreserved cadavers (three men, three left legs) were examined to assess the anatomic connection between the retrocalcaneal bursa and the Achilles tendon (distal and anterior fibers). Blue triptan medium contrast was injected. RESULTS An unexpected connection between the retrocalcaneal bursa and the anterior fibers of the Achilles tendon was found in all instances. CONCLUSIONS Local corticosteroid injection of the retrocalcaneal bursa may help the symptoms of retrocalcanear bursitis, but pose a risk of Achilles tendon rupture. This risk-benefit has to be taken into account when corticosteroid injections are prescribed to professional and high-level athletes.
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Affiliation(s)
- A Turmo-Garuz
- High Performance Center (CAR de Sant Cugat Consorci Sanitari de Terrassa), Barcelona, Spain
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Rodas G, Pedret C, Català J, Soler R, Orozco L, Cusi M. Intratendinous gouty tophus mimics patellar tendonitis in an athlete. J Clin Ultrasound 2013; 41:178-182. [PMID: 22457228 DOI: 10.1002/jcu.21910] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2011] [Accepted: 02/10/2012] [Indexed: 05/31/2023]
Abstract
We describe the imaging and pathologic features of a case of intratendinous patellar gouty tophus incidentally discovered in a patient with knee pain. The possibility of intratendinous gouty tophus must be kept in mind by sports physicians, especially in the management of patellar tendinopathy in athletes. It may be associated with other injuries, such as enthesopathies or partial tendon tears.
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Affiliation(s)
- Gil Rodas
- Medical Services, Barcelona Football Club, Barcelona, Spain
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Balius R, Pedret C, Galilea P, Idoate F, Ruiz-Cotorro A. Ultrasound assessment of asymmetric hypertrophy of the rectus abdominis muscle and prevalence of associated injury in professional tennis players. Skeletal Radiol 2012; 41:1575-81. [PMID: 22618761 DOI: 10.1007/s00256-012-1429-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Revised: 04/11/2012] [Accepted: 04/23/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess rectus abdominis (RA) thickness and injury prevalence using ultrasound in a group of professional tennis players. Observations with regard to muscle fiber repair is described. We likewise studied the potential link between RA volume asymmetry and the risk of muscle strain. MATERIALS AND METHODS The degree of asymmetry between the different RA slices was assessed using ultrasound in 61 professional tennis players. The history of RA injury in these tennis players was likewise studied, taking into account the following factors: dominant vs non-dominant arm, history of RA strains, duration thereof and number of recurrences. Ultrasound examination was performed with an 8- to 12-MHz linear multi-frequency transducer. RESULTS Ultrasound revealed the presence of fibrous scar tissue in the RA muscle in 18 cases (29.5%). In all instances, the lesion was located in the RA on the side of the nondominant arm. In 16 of the cases, the lesion was infra-umbilical and L2 was affected in two cases. The mean maximum width of the fibrous repair tissue was 9 mm (range 5-16). The mean distance between the umbilicus and the scar was 5.8 cm (range 2.9-11.4). Statistical study of the ultrasound measurements obtained for the different slices revealed statistically significant differences between the different depths and according to arm dominance. CONCLUSIONS In the series studied, the prevalence of RA muscle lesion in professional tennis players was 29.5%. Asymmetric hypertrophy of the RA muscle appears to constitute a risk factor for suffering an injury in this location.
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Affiliation(s)
- Ramon Balius
- Consell Català de l'Esport. Generalitat of Catalonia, Barcelona, Spain
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De Cabo-Francés F, Alcolea J, Bové-Farré I, Pedret C, Trelles M. Ecografía de los materiales de relleno inyectables y su interés en el seguimiento diagnóstico. Cir plást iberolatinoam 2012. [DOI: 10.4321/s0376-78922012000200012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
The purpose of this study was to demonstrate the short-term effects of different stretching exercises during the warm-up period on the lower limbs. A controlled, crossover clinical study involving 49 volunteers (14 women and 35 men; mean age: 20.4 years) enrolled in a "physical and sporting activities monitor" program. The explosive force was assessed using the Bosco test. The protocol was as follows: The test involved a (pre) jump test, general warm-up, intervention and (post) jump test. Each volunteer was subjected to each of the 5 interventions (no stretching [NS] and stretching: static passive stretching [P]; proprioceptive neuromuscular facilitation [PNF] techniques; static active stretching in passive tension [PT]; static active stretching in active tension [AT]) in a random order. The jump test was used to assess the squat jump, countermovement jump (CMJ), elasticity index (EI), and drop jump. An intragroup statistical analysis was performed before and after each intervention to compare the differences between the different stretching exercises. An intergroup analysis was also performed. Significant differences (p < 0.05) were found between all variables for the interventions "P," "PNF," and "TA" in the intragroup analysis, with each value being higher in the postjump test. Only the "P" intervention showed a significant difference (p = 0.046) for "EI," with the postvalue being lower. Likewise, significant differences (p < 0.05) were observed for the "CMJ" measurements during the intergroup analysis, especially between "NS" and the interventions "P," "PNF," "AT," and "PT," with each value, particularly that for "AT," being higher after stretching. The results of this study suggest that static active stretching in AT can be recommended during the warm-up for explosive force disciplines.
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Affiliation(s)
- Laura Pacheco
- International University of Catalunya, Sant Cugat del Valles, Spain.
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Alcántara S, Pedret C, Vilanova R, Skogestad S. Generalized Internal Model Control for Balancing Input/Output Disturbance Response. Ind Eng Chem Res 2011. [DOI: 10.1021/ie200717z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Alcántara
- Department of Telecommunications and Systems Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - C. Pedret
- Department of Telecommunications and Systems Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - R. Vilanova
- Department of Telecommunications and Systems Engineering, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain
| | - S. Skogestad
- Department of Chemical Engineering, Norwegian University of Science and Technology, N-7491 Trondheim, Norway
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Balius R, Pedret C, Pacheco L, Gutierrez JA, Vives J, Escoda J. Rectus abdominis muscle injuries in elite handball players: management and rehabilitation. Open Access J Sports Med 2011; 2:69-73. [PMID: 24198573 PMCID: PMC3781885 DOI: 10.2147/oajsm.s17504] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Muscle injuries generally occur in two-joint muscles with a high percentage of type II fibers during the performance of eccentric activity. Some muscle injuries, such as those located in the adductor longus, a monoarticular muscle, as well as rectus abdominis do not fully comply with these requirements. This study examines five cases of elite handball players with ruptured rectus abdominals. Sonographically, lesions in rectus abdominis are shown as a disruption of the fibrillar pattern with a hematic suffusion that invades the entire lesion. In some of the cases, the ultrasound study was complemented with a MRI. A unified rehabilitation protocol was applied and the return to play time of each handball player ranged between 16 and 22 days, with an average of 18.2 days. Follow-up at 15 months showed no evidence of re-injury or residual discomfort and all of them are playing at their highest level. The aim of this study was to illustrate a feature of handball injury that, as in tennis and volleyball, is uncommon and so far has not been specifically reported. The phenomenon of contralateral abdominal hypertrophy in handball appears in the dominant arm as in tennis and volleyball.
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Affiliation(s)
- Ramon Balius
- Consell Català de l’Esport, Generalitat de Catalunya, Barcelona
| | | | - Laura Pacheco
- Consell Català de l’Esport, Generalitat de Catalunya, Barcelona
| | | | - Joan Vives
- Granollers Handball Club, Granollers, Barcelona, Spain
| | - Jaume Escoda
- Consell Català de l’Esport, Generalitat de Catalunya, Barcelona
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Pedret C, Balius R, Idoate F. Sonography and MRI of latissimus dorsi strain injury in four elite athletes. Skeletal Radiol 2011; 40:603-8. [PMID: 20676637 DOI: 10.1007/s00256-010-1007-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2009] [Revised: 05/29/2010] [Accepted: 07/11/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The objective of this study was to describe the MR and sonographic findings in latissimus dorsi (LD) muscle strain in athletes, and to review the most common injuries described in the literature, most of which are humeral avulsions. MATERIAL AND METHODS Four injuries and two reinjuries of the myotendinous junction of the LD were followed from the day of injury until the return to play. Sonography (US) and MR imaging were performed in each case to confirm the diagnosis and to monitor the healing process. RESULTS All cases had acute and isolated pain in the back of the shoulder while performing an eccentric maneuver of the arm and the shoulder. US and MR images demonstrated that injuries were located in the middle and cranial portion of the latissimus dorsi surrounding the myotendinous junction. After rehabilitation, all players played at high level again. CONCLUSIONS Isolated lesions of LD are very rare. They can be demonstrated by US and MR images.
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Affiliation(s)
- Carles Pedret
- Unitat Medicina Esportiva Consorci Sanitari del Garraf, Barcelona, Spain.
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Abstract
BACKGROUND Although posterior thigh muscle strains are common in athletes, there are no reports regarding isolated gracilis muscle injuries. The authors present a case series of 7 elite athletes with isolated gracilis muscle ruptures. PURPOSE To present the injury pattern, clinical presentation, diagnosis, and outcome of gracilis muscle ruptures. STUDY DESIGN Case series; Level of evidence, 4. METHODS This is a retrospective review of 7 elite athletes with posterior thigh pain (3 dancers, 2 soccer players, 1 tae kwon do player, 1 tennis player). In all athletes, the injury occurred during thigh adduction with the hip internally rotated, as clearly evident at ultrasound scans performed 1 to 20 days after the injury. Management included an initial rest period, followed by physiotherapy and gradual return to sports activities. RESULTS According to the ultrasound scans, the lesions were in the proximal-middle third junction of the thigh, at the muscle-tendon junction. The lesions were classified as grade 2 (partial discontinuity). The muscle injury area was, on average, 17.1 × 23.7 mm (range, 10-31 × 9-46 mm). The average length of the lesions was 40.14 mm (range, 20-52 mm). All athletes recovered and returned to full performance within 6 weeks of the injury (average, 35.6 days). CONCLUSION Medial thigh pain after eccentric contraction during hip adduction should raise suspicion of a gracilis muscle tear. Ultrasound is useful, and full recovery occurs within 6 weeks from the injury.
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Affiliation(s)
- Carles Pedret
- Centre de Diagnòstic per Imatge de Tarragona, Tarragona, Spain
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Balius R, Pedret C, Estruch A, Hernández G, Ruiz-Cotorro A, Mota J. Stress fractures of the metacarpal bones in adolescent tennis players: a case series. Am J Sports Med 2010; 38:1215-20. [PMID: 20212101 DOI: 10.1177/0363546509358322] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal. PURPOSE The authors describe stress fracture of the second metacarpal bone in teenaged tennis players and the relationship with sport intensity and type of grip used. They also demonstrate that magnetic resonance imaging is the diagnostic study of choice to differentiate this entity from the most common cause of pain in this region of the hand in tennis players-the carpal boss. STUDY DESIGN Case series; Level of evidence, 4. METHODS Seven adolescent tennis players (mean age, 16.5 years; 6 female, 1 male) with dorsal hand pain produced by playing tennis were examined by radiographs and initial magnetic resonance imaging. In 2 cases, bone scintigraphy was performed. In the first 2 cases, the presumptive diagnosis was a carpal boss, but with this experience, the diagnostic evaluation of the last 5 cases was oriented toward a stress reaction at this level. Radiologic follow-up was performed. The authors also evaluated the grip type used by each tennis player. RESULTS Clinical evaluation and imaging studies resulted in a diagnosis of stress injury of the second metatarsal in 6 of 7 cases, with the seventh case involving the third metacarpal. Initial imaging was positive in 3 cases, revealing an increased signal in the marrow without hairline crack and cortical thickening of the shaft or simply an increased signal in the marrow. In all cases, there was a history of recent increase in the sport training load. Six of the 7 tennis players were using a semi-Western or Western grip. CONCLUSION Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip. Magnetic resonance imaging is the most useful tool for obtaining a definitive diagnosis.
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Affiliation(s)
- Ramon Balius
- Consell Català de l'Esport, Generalitat de Catalunya, Av. Paisos Catalans 12, Esplugues de Llobregat, Barcelona, Spain.
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Alcántara S, Pedret C, Vilanova R, Zhang WD. Simple Analytical min-max Model Matching Approach to Robust Proportional-Integrative-Derivative Tuning with Smooth Set-Point Response. Ind Eng Chem Res 2010. [DOI: 10.1021/ie100299m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Alcántara S, Pedret C, Vilanova R, Zhang WD. Simple Analytical min−max Model Matching Approach to Robust Proportional-Integrative-Derivative Tuning with Smooth Set-Point Response. Ind Eng Chem Res 2009. [DOI: 10.1021/ie9010194] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S. Alcántara
- Telecommunication and Systems Engineering Department, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain, and Department of Automation, Shanghai Jiaotong University, Shanghai 200030, People’s Republic of China
| | - C. Pedret
- Telecommunication and Systems Engineering Department, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain, and Department of Automation, Shanghai Jiaotong University, Shanghai 200030, People’s Republic of China
| | - R. Vilanova
- Telecommunication and Systems Engineering Department, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain, and Department of Automation, Shanghai Jiaotong University, Shanghai 200030, People’s Republic of China
| | - W. D. Zhang
- Telecommunication and Systems Engineering Department, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain, and Department of Automation, Shanghai Jiaotong University, Shanghai 200030, People’s Republic of China
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Affiliation(s)
- Carles Pedret
- Systems Engineering and Automatic Control Group, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Salva Alcántara
- Systems Engineering and Automatic Control Group, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Ramon Vilanova
- Systems Engineering and Automatic Control Group, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
| | - Asier Ibeas
- Systems Engineering and Automatic Control Group, ETSE, Universitat Autònoma de Barcelona, 08193 Bellaterra, Spain
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Balius R, Maestro A, Pedret C, Estruch A, Mota J, Rodriguez L, Garcia P, Mauri E. Central aponeurosis tears of the rectus femoris: practical sonographic prognosis. Br J Sports Med 2009; 43:818-24. [DOI: 10.1136/bjsm.2008.052332] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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