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Preview: British Journal of Sports Medicine current issue

British Journal of Sports Medicine current issue



British Journal of Sports Medicine RSS feed -- current issue



 



Unapologetically patriotic - SMA shines the BJSM spotlight on Australian Research

2018-02-15T08:15:30-08:00

As we write this Warm Up for the Sports Medicine Australia (SMA) issue of the British Journal of Sports Medicine (BJSM), elite sport dominates both front and back pages of Australian newspapers. We have international cricket, tennis and both Women’s and Men’s Australian Football League (AFL) is around the corner. Along side elite sport, participation is rising in community level sport and this puts demands on clinicians who treat these weekend warriors.

Talent down under

SMA draws together under one banner all sports medicine, sports science and healthcare professionals who work in elite and community sports settings. SMA plays an active role in educating healthcare professionals and sports-minded community members to help individuals benefit from exercise, activity and competition. To reflect SMA’s membership, this BJSM edition includes papers from a broad range of disciplines on topics within both sport and physical activity from Australian authors and institutions.

To...



Patellar and Achilles tendinopathies are predominantly peripheral pain states: a blinded case control study of somatosensory and psychological profiles

2018-02-15T08:15:30-08:00

Study design

Case–control design.

Background

Tendinopathy is characterised by pain on tendon loading. In persistent cases of upper limb tendinopathy, it is frequently associated with central nervous system sensitisation, whereas less commonly linked in the case of persistent lower limb tendinopathies.

Objectives

Compare somatosensory and psychological profiles of participants with persistent patellar (PT) and Achilles tendinopathies (AT) with pain-free controls.

Methods

A comprehensive battery of Quantitative Sensory Testing (QST) was assessed at standardised sites of the affected tendon and remotely (lateral elbow) by a blinded assessor. Participants completed the Victorian Institute of Sports Assessment, a health-related quality of life questionnaire, the Hospital Anxiety and Depression Scale and the Active Australia Questionnaire. Independent t-test and analysis of covariance (sex-adjusted and age-adjusted) were performed to compare groups.

Results

Participants with PT and AT did not exhibit differences from controls for the QST at the remote site, but there were differences at the affected tendon site. Compared with controls, participants with PT displayed significantly lower pressure pain threshold locally at the tendon (p=0.012) and fewer single limb decline squats before pain onset, whereas participants with AT only displayed fewer single heel raises before pain onset, but this pain was of a higher intensity.

Conclusion

PT and AT appear to be predominantly local not widespread pain states related to loading of tendons without significant features of central sensitisation.

Level of evidence

Level 4.




Epidemiology of time loss groin injuries in a mens professional football league: a 2-year prospective study of 17 clubs and 606 players

2018-02-15T08:15:30-08:00

Background/Aim

Groin injury epidemiology has not previously been examined in an entire professional football league. We recorded and characterised time loss groin injuries sustained in the Qatar Stars League.

Methods

Male players were observed prospectively from July 2013 to June 2015. Time loss injuries, individual training and match play exposure were recorded by club doctors using standardised surveillance methods. Groin injury incidence per 1000 playing hours was calculated, and descriptive statistics used to determine the prevalence and characteristics of groin injuries. The Doha agreement classification system was used to categorise all groin injuries.

Results

606 footballers from 17 clubs were included, with 206/1145 (18%) time loss groin injuries sustained by 150 players, at an incidence of 1.0/1000 hours (95% CI 0.9 to 1.1). At a club level, 21% (IQR 10%–28%) of players experienced groin injuries each season and 6.6 (IQR 2.9–9.1) injuries were sustained per club per season. Of the 206 injuries, 16% were minimal (1–3 days), 25% mild (4–7 days), 41% moderate (8–28 days) and 18% severe (>28 days), with a median absence of 10 days/injury (IQR 5–22 days). The median days lost due to groin injury per club was 85 days per season (IQR 35–215 days). Adductor-related groin pain was the most common entity (68%) followed by iliopsoas (12%) and pubic-related (9%) groin pain.

Conclusion

Groin pain caused time loss for one in five players each season. Adductor-related groin pain comprised 2/3 of all groin injuries. Improving treatment outcomes and preventing adductor-related groin pain has the potential to improve player availability in professional football.




Effectiveness of foot orthoses for the prevention of lower limb overuse injuries in naval recruits: a randomised controlled trial

2018-02-15T08:15:30-08:00

Objectives

To evaluate the effectiveness of prefabricated foot orthoses for the prevention of lower limb overuse injuries in naval recruits.

Methods

This study was a participant-blinded and assessor-blinded, parallel-group randomised controlled trial. Three-hundred and six participants aged 17–50 years who undertook 11 weeks of initial defence training at the Royal Australian Navy Recruit School (Cerberus, Australia) were randomised to a control group (flat insoles, n=153) or an intervention group (contoured, prefabricated foot orthoses, n=153). The combined incidence of medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy and plantar fasciitis/plantar heel pain during the 11-week training period were compared using incidence rate ratios (IRR). Data were analysed using the intention-to-treat principle.

Results

Sixty-seven injuries (21.9%) were recorded. The control and intervention group sustained 40 (26.1%) and 27 (17.6%) injuries, respectively (IRR 0.66, 95% CI 0.39 to 1.11, p=0.098). This corresponds to a 34% reduction in risk of developing medial tibial stress syndrome, patellofemoral pain, Achilles tendinopathy or plantar fasciitis/plantar heel for the intervention group compared with the control group. Participants in the prefabricated orthoses group were more likely to report at least one adverse event (20.3% vs 12.4%; relative risk (RR) 1.63, 95% CI 0.96 to 2.76; p=0.068; number needed to harm 13, 95% CI 6 to 253). The most common adverse events were foot blisters (n=20, 6.6%), arch pain (n=10, 3.3%) and shin pain (n=8, 2.6%).

Conclusion

Prefabricated foot orthoses may be beneficial for reducing the incidence of lower limb injury in naval recruits undertaking defence training.

Trial registration number

Australian New Zealand Clinical Trials Registry: ACTRN12615000024549.




Clinical implications from daily physiotherapy examination of 131 acute hamstring injuries and their association with running speed and rehabilitation progression

2018-02-15T08:15:30-08:00

Aim

To investigate the association of daily clinical measures and the progression of rehabilitation and perceived running effort.

Methods

A cohort of 131 athletes with an MRI-confirmed acute hamstring injury underwent a standardised criteria-based rehabilitation protocol. Descriptive and inferential statistics were used to investigate the association between daily clinical subjective and objective measures and both the progression of rehabilitation and perceived running effort. These measures included different strength, palpation, flexibility and functional tests. Inter-rater and intrarater reliability and minimal detectable change were established for the clinical measures of strength and flexibility by examining measures taken on consecutive days for the uninjured leg.

Results

The progression of the daily measures was seen to be non-linear and varied according to the measure. Intra-rater reliability for the strength and flexibility measures were excellent (95% CI ≥0.85 for all measures). Strength (in the outer range position) and flexibility (in maximum hip flexion with active knee extension (MHFAKE) in supine) were best associated with rehabilitation progression and perceived running effort. Additionally, length of pain on palpation was usefully associated with rehabilitation progression. At lower perceived running effort there was a large variation in actual running speed.

Conclusion

Daily physical measures of palpation pain, outer range strength, MHFAKE and reported pain during daily activity are useful to inform the progression of rehabilitation.

Trial registration number

NCT01812564 and NCT02104258.




{beta}-alanine: performance effects, usage and side effects

2018-02-15T08:15:30-08:00

What did I do?

β-alanine supplementation improves high-intensity exercise capacity. I investigated the influence of β-alanine supplementation combined with high intensity training on performance. I also examined the factors that potentially influence an athlete’s decision to use β-alanine including side effects and dosage compliance.

Why did I do it?

The aim was to consider factors that influence how the findings of β-alanine research relate to practice. Others have examined the efficacy of β-alanine1; however, its influence on repeated-sprint performance when combined with a structured training programme was unknown. Also I wanted to know if β-alanine would assist team sport athletes who are required to sprint repeatedly.

The current practices and level of knowledge relating to the benefits of supplementing with β-alanine among elite athletes are unclear. Poor knowledge of the benefits and correct dosages of β-alanine may influence adherence. As multiple daily doses of β-alanine...




Arthroscopic surgery for degenerative knee arthritis and meniscal tears: a clinical practice guideline

2018-02-15T08:15:30-08:00

What you need to know

  • We make a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease, based on linked systematic reviews; further research is unlikely to alter this recommendation

  • This recommendation applies to patients with or without imaging evidence of osteoarthritis, mechanical symptoms, or sudden symptom onset

  • Healthcare administrators and funders may use the number of arthroscopies performed in patients with degenerative knee disease as an indicator of quality care.

  • Knee arthroscopy is the most common orthopaedic procedure in countries with available data

  • This Rapid Recommendation package was triggered by a randomised controlled trial published in The BMJ in June 2016 which found that, among patients with a degenerative medial meniscus tear, knee arthroscopy was no better than exercise therapy

  • What is the role of arthroscopic surgery in degenerative knee disease? An expert panel...




    Interventions to reduce sedentary behaviour in 0-5-year-olds: a systematic review and meta-analysis of randomised controlled trials

    2018-02-15T08:15:30-08:00

    Aim or objective

    To evaluate the effectiveness of behavioural interventions that report sedentary behaviour outcomes during early childhood.

    Design

    Systematic review and meta-analysis.

    Data sources

    Academic Search Complete, CINAHL Complete, Global Health, MEDLINE Complete, PsycINFO, SPORTDiscus with Full Text and EMBASE electronic databases were searched in March 2016.

    Eligibility criteria for selecting studies

    Inclusion criteria were: (1) published in a peer-reviewed English language journal; (2) sedentary behaviour outcomes reported; (3) randomised controlled trial (RCT) study design; and (4) participants were children with a mean age of ≤5.9 years and not yet attending primary/elementary school at postintervention.

    Results

    31 studies were included in the systematic review and 17 studies in the meta-analysis. The overall mean difference in screen time outcomes between groups was –17.12 (95% CI –28.82 to –5.42) min/day with a significant overall intervention effect (Z=2.87, p=0.004). The overall mean difference in sedentary time between groups was –18.91 (95% CI –33.31 to –4.51) min/day with a significant overall intervention effect (Z=2.57, p=0.01). Subgroup analyses suggest that for screen time, interventions of ≥6 months duration and those conducted in a community-based setting are most effective. For sedentary time, interventions targeting physical activity (and reporting changes in sedentary time) are more effective than those directly targeting sedentary time.

    Summary/conclusions

    Despite heterogeneity in study methods and results, overall interventions to reduce sedentary behaviour in early childhood show significant reductions, suggesting that this may be an opportune time to intervene.

    Trial registration number

    CRD42015017090.




    Foot orthoses for plantar heel pain: a systematic review and meta-analysis

    2018-02-15T08:15:30-08:00

    Objective

    To investigate the effectiveness of foot orthoses for pain and function in adults with plantar heel pain.

    Design

    Systematic review and meta-analysis. The primary outcome was pain or function categorised by duration of follow-up as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks).

    Data sources

    Medline, CINAHL, SPORTDiscus, Embase and the Cochrane Library from inception to June 2017.

    Eligibility criteria for selecting studies

    Studies must have used a randomised parallel-group design and evaluated foot orthoses for plantar heel pain. At least one outcome measure for pain or function must have been reported.

    Results

    A total of 19 trials (1660 participants) were included. In the short term, there was very low-quality evidence that foot orthoses do not reduce pain or improve function. In the medium term, there was moderate-quality evidence that foot orthoses were more effective than sham foot orthoses at reducing pain (standardised mean difference –0.27 (–0.48 to –0.06)). There was no improvement in function in the medium term. In the longer term, there was very low-quality evidence that foot orthoses do not reduce pain or improve function. A comparison of customised and prefabricated foot orthoses showed no difference at any time point.

    Conclusion

    There is moderate-quality evidence that foot orthoses are effective at reducing pain in the medium term, however it is uncertain whether this is a clinically important change.




    Isokinetic strength assessment offers limited predictive validity for detecting risk of future hamstring strain in sport: a systematic review and meta-analysis

    2018-02-15T08:15:30-08:00

    Objective

    To examine the value of isokinetic strength assessment for predicting risk of hamstring strain injury, and to direct future research into hamstring strain injuries.

    Design

    Systematic review.

    Data sources

    Database searches for Medline, CINAHL, Embase, AMED, AUSPORT, SPORTDiscus, PEDro and Cochrane Library from inception to April 2017. Manual reference checks, ahead-of-press and citation tracking.

    Eligibility criteria for selecting studies

    Prospective studies evaluating isokinetic hamstrings, quadriceps and hip extensor strength testing as a risk factor for occurrence of hamstring muscle strain.

    Methods

    Independent search result screening. Risk of bias assessment by independent reviewers using Quality in Prognosis Studies tool. Best evidence synthesis and meta-analyses of standardised mean difference (SMD).

    Results

    Twelve studies were included, capturing 508 hamstring strain injuries in 2912 athletes. Isokinetic knee flexor, knee extensor and hip extensor outputs were examined at angular velocities ranging 30–300°/s, concentric or eccentric, and relative (Nm/kg) or absolute (Nm) measures. Strength ratios ranged between 30°/s and 300°/s. Meta-analyses revealed a small, significant predictive effect for absolute (SMD=–0.16, P=0.04, 95% CI –0.31 to –0.01) and relative (SMD=–0.17, P=0.03, 95% CI –0.33 to –0.014) eccentric knee flexor strength (60°/s). No other testing speed or strength ratio showed statistical association. Best evidence synthesis found over half of all variables had moderate or strong evidence for no association with future hamstring injury.

    Summary/Conclusion

    Despite an isolated finding for eccentric knee flexor strength at slow speeds, the role and application of isokinetic assessment for predicting hamstring strain risk should be reconsidered, particularly given costs and specialised training required.




    Poor overall quality of clinical practice guidelines for musculoskeletal pain: a systematic review

    2018-02-15T08:15:30-08:00

    Objectives

    Undertake a systematic critical appraisal of contemporary clinical practice guidelines (CPGs) for common musculoskeletal (MSK) pain conditions: spinal (lumbar, thoracic and cervical), hip/knee (including osteoarthritis) and shoulder.

    Design

    Systematic review of CPGs (PROSPERO number: CRD42016051653).

    Included CPGs were written in English, developed within the last 5 years, focused on adults and described development processes. Excluded CPGs were for: traumatic MSK pain, single modalities (eg, surgery), traditional healing/medicine, specific disease processes (eg, inflammatory arthropathies) or those that required payment.

    Data sources and method of appraisal

    Four scientific databases (MEDLINE, Embase, CINAHL and Physiotherapy Evidence Database) and four guideline repositories. The Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument was used for critical appraisal.

    Results

    4664 records were identified, and 34 CPGs were included. Most were for osteoarthritis (n=12) or low back pain (n=11), most commonly from the USA (n=12). The mean overall AGREE II score was 45% (SD=19.7). Lowest mean domain scores were for applicability (26%, SD=19.5) and editorial independence (33%, SD=27.5). The highest score was for scope and purpose (72%, SD=14.3). Only 8 of 34 CPGS were high quality: for osteoarthritis (n=4), low back pain (n=2), neck (n=1) and shoulder pain (n=1).




    Preoperative exercise halves the postoperative complication rate in patients with lung cancer: a systematic review of the effect of exercise on complications, length of stay and quality of life in patients with cancer

    2018-02-15T08:15:30-08:00

    Objective

    To investigate the effectiveness of preoperative exercises interventions in patients undergoing oncological surgery, on postoperative complications, length of hospital stay and quality of life.

    Design

    Intervention systematic review with meta-analysis.

    Data sources

    MEDLINE, Embase and PEDro.

    Eligibility criteria for selecting studies

    Trials investigating the effectiveness of preoperative exercise for any oncological patient undergoing surgery were included. The outcomes of interest were postoperative complications, length of hospital stay and quality of life. Relative risks (RRs), mean differences (MDs) and 95% CI were calculated using random-effects models.

    Results

    Seventeen articles (reporting on 13 different trials) involving 806 individual participants and 6 tumour types were included. There was moderate-quality evidence that preoperative exercise significantly reduced postoperative complication rates (RR 0.52, 95% CI 0.36 to 0.74) and length of hospital stay (MD –2.86 days, 95% CI –5.40 to –0.33) in patients undergoing lung resection, compared with control. For patients with oesophageal cancer, preoperative exercise was not effective in reducing length of hospital stay (MD 2.00 days, 95% CI –2.35 to 6.35). Although only assessed in individual studies, preoperative exercise improved postoperative quality of life in patients with oral or prostate cancer. No effect was found in patients with colon and colorectal liver metastases.

    Conclusions

    Preoperative exercise was effective in reducing postoperative complications and length of hospital stay in patients with lung cancer. Whether preoperative exercise reduces complications, length of hospital stay and improves quality of life in other groups of patients undergoing oncological surgery is uncertain as the quality of evidence is low.

    PROSPEROregistration number




    Prize Winning Abstracts from BASEM Congress 2016

    2018-02-15T08:15:30-08:00

    01: Prognostic factors for musculoskeletal injury identified through medical screening and training load monitoring in professional football (soccer): a systematic review

    T Hughes

    JC Sergeant

    M Parkes

    M Callaghan

    1Manchester United Football Club, UK

    2Arthritis Research UK Centre for Epidemiology, Manchester, UK

    3NIHR Manchester Musculoskeletal Biomedical Research Unit, Manchester, UK

    4Department of Health Professions, Manchester Metropolitan University, Manchester, UK

    10.1136/bjsports-2017-097827.1

    Objectives To identify prognostic factors and models for spinal and lower extremity injuries in adult professional/elite football players from medical screening and training load monitoring processes.

    Methods The MEDLINE, AMED, EMBASE, CINAHL Plus, SPORTDiscus electronic bibliographic databases and the Cochrane Database of Systematic Reviews were searched from inception to July 2016. Searches were limited to original research, published in peer reviewed journals of any language. The Quality in Prognostic Studies (QUIPS) tool was used for appraisal and the modified GRADE approach was used for synthesis. Prospective and retrospective...