Causal inference did not detect any effect of jump load on knee complaints in elite men's volleyball

The aim was to determine how jump load affects knee complaints in elite men's volleyball. We collected data from four men's premier league volleyball teams through three seasons in a prospective cohort study (65 players, 102 player-seasons). Vert inertial measurement devices captured the jump load (jump frequency and jump height) from 21 088 daily player sessions, and knee complaints were reported in 3568 weekly OSTRC-O questionnaires. Mixed complementary log-log regression models described the probability of (i) experiencing symptoms if players were currently asymptomatic, (ii) worsening symptoms if players had symptoms, and (iii) recovery from knee complaints. Based on our causal assumptions, weekly jump load was modeled as the independent variable, adjusted for age (years), weight (kg), position on volleyball team, and past jump load. No certain evidence of an association was found between weekly jump load and probability of (i) knee complaints (p from 0.10 to 0.32 for three restricted cubic splines of load), (ii) worsening symptoms if the player already had symptoms (p from 0.11 to 0.97), (iii) recovery (p from 0.36 to 0.63). The probability of knee complaints was highest for above-average weekly jump load (~1.2% for an outside hitter with mean age and height) compared with low loads (~1%) and very high loads (→ ~ 0%). The association between jump load and knee complaints risk remains unclear. Small differences in risk across observed jump load levels were observed. It would likely require substantially increased sample sizes to detect this association with certainty.

Acute clinical evaluation for the diagnosis of lateral ankle ligament injuries is useful: A comparison between the acute and delayed settings

PURPOSE

To determine the diagnostic value of seven injury history variables, nine clinical tests (including the combination thereof) and overall clinical suspicion for complete discontinuity of the lateral ankle ligaments in the acute (0-2 days post-injury) and delayed setting (5-8 days post-injury).

METHODS

All acute ankle injuries in adult athletes (≥18 years) presenting up to 2 days post-injury were assessed for eligibility. Athletes were excluded if imaging studies demonstrated a frank fracture or 3 T MRI could not be acquired within 10 days post-injury. Using standardized history variables and clinical tests, acute clinical evaluation was performed within 2 days post-injury. Delayed clinical evaluation was performed 5-8 days post-injury. Overall, clinical suspicion was recorded after clinical evaluation. MRI was used as the reference standard.

RESULTS

Between February 2018 and February 2020, a total of 117 acute ankle injuries were screened for eligibility, of which 43 were included in this study. Complete discontinuity of lateral ankle ligaments was observed in 23 (53%) acute ankle injuries. In the acute setting, lateral swelling had 100% (95% confidence interval [CI]: 82-100) sensitivity, haematoma had 85% (95% CI: 61-96) specificity and the anterior drawer test had 100% (95% CI: 77-100) specificity. In the delayed setting, sensitivity for the presence of haematoma improved from 43% (95% CI: 24-65) to 91% (95% CI: 70-98; p < 0.01) and the sensitivity of the anterior drawer test improved from 21% (95% CI: 7-46) to 61% (95% CI: 39-80; p = 0.02). Clinical suspicion had a positive likelihood ratio (LR) of 4.35 (95% CI: 0.55-34.17) in the acute setting and a positive LR of 6.09 (95% CI: 1.57-23.60) in the delayed setting.

CONCLUSIONS

In the acute setting, clinical evaluation can exclude complete discontinuity (e.g., absent lateral swelling) and identify athletes with a high probability of complete discontinuity (e.g., positive anterior drawer test) of the lateral ankle ligaments. In the delayed setting, the sensitivity of common clinical findings increases resulting in an improved diagnostic accuracy. In clinical practice, this study underlines the importance of meticulous clinical evaluation in the acute setting.

LEVEL OF EVIDENCE

Level III.

Skeletal muscle oxidative adaptations following localized heat therapy

Repeated heat treatment has been shown to induce oxidative adaptations in cell cultures and rodents, but similar work within human models is scarce. This study investigated the effects of 6 weeks of localized heat therapy on near-infrared spectroscopy-(NIRS) derived indices of muscle oxidative and microvascular function. Twelve physically active participants (8 males and 4 females, age: 34.9 ± 5.9 years, stature: 175 ± 7 cm, body mass: 76.7 ± 13.3 kg) undertook a 6-week intervention, where adhesive heat pads were applied for 8 h/day, 5 days/week, on one calf of each participant, while the contralateral leg acted as control. Prior to and following the intervention, the microvascular function was assessed using NIRS-based methods, where 5 min of popliteal artery occlusion was applied, and the reperfusion (i.e., re-saturation rate, re-saturation amplitude, and hyperemic response) was monitored for 2 min upon release. Participants also performed a 1-min isometric contraction of the plantar flexors (30% maximal voluntary contraction), following which a further 2 min interval was undertaken for the assessment of recovery kinetics. A 20-min time interval was allowed before the assessment protocol was repeated on the contralateral leg. Repeated localized heating of the gastrocnemius did not influence any of the NIRS-derive indices of microvascular or oxidative function (p > 0.05) following 6 weeks of treatment. Our findings indicate that localized heating via the use of adhesive heat pads may not be a potent stimulus for muscle adaptations in physically active humans.