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Rasmusen HK, Aarøe M, Madsen CV, Gudmundsdottir HL, Mertz KH, Mikkelsen AD, Dall CH, Brushøj C, Andersen JL, Vall-Lamora MHD, Bovin A, Magnusson SP, Thune JJ, Pecini R, Pedersen L. The COVID-19 in athletes (COVA) study: a national study on cardio-pulmonary involvement of SARS-CoV-2 infection among elite athletes. Eur Clin Respir J 2023; 10:2149919. [PMCID: PMC9744211 DOI: 10.1080/20018525.2022.2149919] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 12/13/2022] Open
Abstract
Background COVID-19 can cause cardiopulmonary involvement. Physical activity and cardiac complications can worsen prognosis, while pulmonary complications can reduce performance. Aims To determine the prevalence and clinical implications of SARS-CoV-2 cardiopulmonary involvement in elite athletes. Methods An observational study between 1 July 2020 and 30 June 2021 with the assessment of coronary biomarkers, electrocardiogram, echocardiography, Holter-monitoring, spirometry, and chest X-ray in Danish elite athletes showed that PCR-tested positive for SARS-CoV-2. The cohort consisted of male football players screened weekly (cohort I) and elite athletes on an international level only tested if they had symptoms, were near-contact, or participated in international competitions (cohort II). All athletes were categorized into two groups based on symptoms and duration of COVID-19: Group 1 had no cardiopulmonary symptoms and duration ≤7 days, and; Group 2 had cardiopulmonary symptoms or disease duration >7 days. Results In total 121 athletes who tested positive for SARS-CoV-2 were investigated. Cardiac involvement was identified in 2/121 (2%) and pulmonary involvement in 15/121 (12%) participants. In group 1, 87 (72%), no athletes presented with signs of cardiac involvement, and 8 (7%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. In group 2, 34 (28%), two had myocarditis (6%), and 8 (24%) were diagnosed with radiological COVID-19-related findings or obstructive lung function. Conclusions These clinically-driven data show no signs of cardiac involvement among athletes who tested positive for SARS-CoV-2 infection without cardiopulmonary symptoms and duration <7 days. Athletes with cardiopulmonary symptoms or prolonged duration of COVID-19 display, exercise-limiting cardiopulmonary involvement.
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Affiliation(s)
- Hanne Kruuse Rasmusen
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark,CONTACT Hanne Kruuse Rasmusen Clinic of Sports Cardiology, Department of Cardiology, University of Copenhagen Hospital - Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, Building 67, DK-2200Copenhagen, Denmark
| | - Mikkel Aarøe
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Valdorff Madsen
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Kenneth Hudlebusch Mertz
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Astrid Duus Mikkelsen
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christian Have Dall
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Brushøj
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Jesper Løvind Andersen
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | | | - Ann Bovin
- Department of Cardiology, Vejle Hospital, Part of Lillebaelt Hospital, Vejle, Denmark
| | - S. Peter Magnusson
- Institute of Sports medicine, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jens Jakob Thune
- Department of Cardiology, Copenhagen University Hospital – Bispebjerg and Frederiksberg, Copenhagen, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Redi Pecini
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Lars Pedersen
- Department of Respiratory Medicine and Infectious Diseases, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
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Hansen R, Brushøj C, Rathleff MS, Magnusson SP, Henriksen M. Quadriceps or hip exercises for patellofemoral pain? A randomised controlled equivalence trial. Br J Sports Med 2023; 57:1287-1294. [PMID: 37137673 DOI: 10.1136/bjsports-2022-106197] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2023] [Indexed: 05/05/2023]
Abstract
OBJECTIVE To assess effectiveness equivalence between two commonly prescribed 12-week exercise programmes targeting either the quadriceps or the hip muscles in patients with patellofemoral pain (PFP). METHODS This randomised controlled equivalence trial included patients with a clinical diagnosis of PFP. Participants were randomly assigned to either a 12-week quadriceps-focused exercise (QE) or a hip-focused exercise (HE) programme. The primary outcome was the change in Anterior Knee Pain Scale (AKPS) (0-100) from baseline to 12-week follow-up. Prespecified equivalence margins of ±8 points on the AKPS were chosen to demonstrate comparable effectiveness. Key secondary outcomes were the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire pain, physical function and knee-related quality of life subscales. RESULTS 200 participants underwent randomisation; 100 assigned to QE and 100 to HE (mean age 27.2 years (SD 6.4); 69% women). The least squares mean changes in AKPS (primary outcome) were 7.6 for QE and 7.0 for HE (difference 0.6 points, 95% CI -2.0 to 3.2; test for equivalence p<0.0001), although neither programme surpassed the minimal clinically important change threshold. None of the group differences in key secondary outcomes exceeded predefined equivalence margins. CONCLUSION The 12-week QE and HE protocols provided equivalent improvements in symptoms and function for patients with PFP. TRIAL REGISTRATION NUMBER NCT03069547.
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Affiliation(s)
- Rudi Hansen
- Department of Physical and Occupational Therapy, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Christoffer Brushøj
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Michael Skovdal Rathleff
- Center for General Practice, Aalborg University, Aalborg, Denmark
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - S Peter Magnusson
- Institute of Sports Medicine Copenhagen, Department of Orthopedic Surgery, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
- Center for Healthy Aging, Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marius Henriksen
- The Parker Institute, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Frederiksberg, Denmark
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Rathleff MS, Richter C, Brushøj C, Bencke J, Bandholm T, Hölmich P, Thorborg K. Increased medial foot loading during drop jump in subjects with patellofemoral pain. Knee Surg Sports Traumatol Arthrosc 2014; 22:2301-7. [PMID: 24658150 DOI: 10.1007/s00167-014-2943-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 09/17/2013] [Accepted: 03/10/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To compare medial-to-lateral plantar forces during drop jump and single leg squat in individuals with and without patellofemoral pain. METHODS This cross-sectional study compared 23 young adults with patellofemoral pain to 20 age- and sex-matched controls without knee pain. The plantar pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total forefoot during drop jump. Secondary outcomes included peak medial-to-lateral force during single leg squat and mean forces during drop jump and single leg squat. RESULTS The primary outcome showed that individuals with patellofemoral pain had a 22% higher medial-to-lateral peak force during drop jump, (p=0.03). Secondary outcomes showed 32% higher medial-to-lateral peak force during single leg squat (p=0.01) and 19-23% higher medial-to-lateral mean force during drop jump and single leg squat (p=0.02-0.04). CONCLUSION These findings indicate that individuals with patellofemoral pain display a more medially oriented loading pattern of the forefoot compared to individuals without knee pain. This loading pattern may be associated with the distribution of forces acting on the patellofemoral joint and suggest treatment of PFP should consider interventions that target normalisation of foot loading. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Michael S Rathleff
- Orthopeadic Surgery Research Unit, Research and Innovation Centre, Aalborg University Hospital, 15 Soendre Skovvej, 9000, Aalborg, Denmark,
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Brushøj C, Larsen K, Albrecht-Beste E, Nielsen MB, Løye F, Hölmich P. Prevention of overuse injuries by a concurrent exercise program in subjects exposed to an increase in training load: a randomized controlled trial of 1020 army recruits. Am J Sports Med 2008; 36:663-70. [PMID: 18337359 DOI: 10.1177/0363546508315469] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [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 It is unknown whether an exercise program can prevent overuse injuries in the lower extremity. An often encountered and important risk factor for the development of lower extremity overuse injuries is an abrupt increase in activity level. HYPOTHESIS A preventive training program based on a literature review of intrinsic risk factors, and performed concurrent with an increase in physical activity, can reduce the incidence of overuse knee injuries and medial tibial stress syndrome, as well as increase running distance. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS A total of 1020 soldiers aged 20.9 years (range, 19-26 years) undergoing 3 months of basic military training consecutively enrolled from December 2004 to December 2005. The prevention program consisted of an exercise program of 15 minutes' duration 3 times a week, including 5 exercises for strength, flexibility, and coordination; the placebo program consisted of 5 exercises for the upper body. RESULTS During the observation period, 223 subjects sustained an injury, with 50 and 48 of these fulfilling the study criteria for overuse knee injuries or medial tibial stress syndrome, respectively. There were no significant differences in incidence of injury between the prevention group and the placebo group (incidence, 0.22 vs 0.19; P = .162; relative risk = 1.05 [range, 0.98-1.11]). The soldiers in the prevention group had the greater improvement in running distance in 12-minute run tests (82 vs 43 m; P = .037). CONCLUSION An exercise program with an emphasis on muscular strengthening, coordination, and flexibility based on intrinsic risk factors identified through a literature review did not influence the risk of developing overuse knee injuries or medial tibial stress syndrome in subjects undergoing an increase in physical activity. The program increased maximal running distance in a 12-minute test.
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Affiliation(s)
- Christoffer Brushøj
- Department of Orthopaedic Surgery, Amager Hospital, Italiensvej1, Copenhagen DK-2300, Denmark.
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Brushøj C, Hölmich P, Nielsen MB, Albrecht-Beste E. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings. Br J Sports Med 2007; 42:64-7; discussion 67. [PMID: 17562742 DOI: 10.1136/bjsm.2006.034215] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral pain syndrome (PFPS). METHODS In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. RESULTS On PSS typical knee loading activities were the most painful, while sitting with knee bend for prolonged time caused surprisingly little pain. Pain was most commonly perceived in the peripatellar area (25 patients (83%)). The most common site of pain on clinical examination was the peripatellar area (25 patients (83%)), but other synovial covered structures including the fat pad of Hoffa (12 patients (40%)), the medial plica and the joint line (12 patients (40%)) were also involved. Only eight patients (27%) experienced pain on the patellofemoral compression test. Only discrete changes was detected on MRI/ultrasound. CONCLUSIONS Acute anterior knee pain should be regarded as a subgroup of PFPS as both symptoms and clinical examination suggests this. The clinical examination with disseminated pain in all synovial covered structures is consistent with ideas of the importance of synovium in the genesis of pain.
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Affiliation(s)
- C Brushøj
- Department of Orthopaedic Surgery, Amager Hospital, Italiensvej 1, Copenhagen DK-2300, Denmark.
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Brushøj C, Henriksen BM, Albrecht-Beste E, Hölmich P, Larsen K, Bachmann Nielsen M. Reproducibility of ultrasound and magnetic resonance imaging measurements of tendon size. Acta Radiol 2006; 47:954-9. [PMID: 17077048 DOI: 10.1080/02841850600854936] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE To investigate the intra- and inter-tester reproducibility of measurements of the Achilles tendon, tibialis anterior tendon, and the tibialis posterior tendon in football players using ultrasound (US) and magnetic resonance imaging (MRI). MATERIAL AND METHODS Eleven asymptomatic football players were examined. Using a standardized US scanning protocol, the tendons were examined by two observers with US for thickness, width, and cross-sectional area. One observer conducted the procedure twice. The subjects also underwent an MRI examination, and the assessment of tendon size was conducted twice by two observers. RESULTS The best reproducibility judged by coefficient of variation (CV) and 95% confidence interval was determined for the Achilles tendon on both US and MRI. The variability of US on measurements on the tibialis anterior and tibialis posterior tendons was less than that when using MRI. In 12 out of 18 measurements, there were systematic differences between observers as judged by one-sided F-test. CONCLUSION The reproducibility of the three tendons was limited. Precaution should be taken when looking for minor quantitative changes, i.e., training-induced hypertrophy, and when doing so, the Achilles tendon should be used.
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Affiliation(s)
- C Brushøj
- Department of Radiology, Section of Ultrasound, Rigshospitalet, Copenhagen, Denmark.
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Abstract
Shoulder pain is the most common musculo-skeletal complaint in competitive swimmers. It remains one of the shoulder pain syndromes in overhead athletes where no golden standard of treatment exists. Eighteen competitive swimmers who all had undergone shoulder arthroscopy for therapy-resistant shoulder pain were retrospectively evaluated with respect to operative findings and ability to return to their sport after the operation. The most common finding at arthroscopy was labral pathology in 11 (61%) and subacromial impingement in five shoulders (28%). Operative procedures included debridement in 11 swimmers, partial release of the coraco-acromial ligament in four, and bursectomy in four. Sixteen (89%) responded to the follow-up evaluation. Nine swimmers (56%) were able to compete at preinjury level after 4 (2-9) months. Findings at arthroscopy suggest that the term "Swimmer's shoulder" covers a variety of pathologies including labral wearing and subacromial impingement. Arthroscopic debridement of labral tears or bursectomy in swimmers with shoulder pain has a low success rate with regard to return to sport. Further understanding and investigation of this syndromes complex pathophysiology is needed.
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Affiliation(s)
- C Brushøj
- Division of Sports Orthopaedics, Department of Orthopaedic Surgery, Amager Hospital, Copenhagen, Denmark.
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