Bilateral patellar tendon rupture in a weightlifter during an acute high-loading resistance exercise bout: A case study.

Bilateral patellar tendon ruptures are exceedingly uncommon, especially when they occur in individuals without predisposing risk factors or systemic disease. Due to its rarity, many cases are missed on initial presentation resulting in poor patient outcomes. Identifying associated risk factors aids in diagnosis and mitigates this oversight. We report a case of a healthy, recreational weightlifter who sustained bilateral patellar tendon ruptures during an acute high-loading resistance exercise bout. We discuss how a spike in acute workload may have predisposed our patient to this injury. Research into training load and athlete injury risk is currently in vogue, however, no studies have analysed whether poor load management increases the risk of tendon ruptures. This case prompts awareness for clinicians who diagnose and manage this injury and helps to stimulate the formation of educational initiatives for athletes and coaches, aimed at injury prevention.

Presenting features of female collegiate sports-related concussion in South Africa: a descriptive analysis.

Background: Sports-related concussion (SRC) is an injury with important implications, especially in collision and contact sports, and has a high symptom burden. Student athletes face particular psychosocial challenges, especially female students with pre-existing anxiety/depression are at increased risk for SRC, and have a higher symptom burden before and after injury. Objectives: Describing female SRC presenting features at a collegiate campus-based sports medicine service; examining the association of prior concussion history (PCONC) and pre-existing anxiety/depression (PMHDx) with SRC. Methods: A retrospective cohort and statistical analysis (including corrected effect sizes) of Sport Concussion Assessment Tool (versions 3/5) data (Step 1: PCONC and PMHDx history; Step 2: symptom evaluation) of collegiate female athletes with SRC between 2012 and 2018. Results: Forty females with SRC were identified (age 23 ± 3). The five most frequent symptoms were headache (n = 34; 85%), feeling slowed down (n = 33; 83%), pressure in head (n = 33; 83%), don't feel right (n = 32; 80%) and fatigue/low-energy (n = 32; 80%). These five symptoms also had the highest self-rated severity (median (IQR): headache (3 (2-4)), feeling slowed down (3 (1-4)), fatigue/low-energy (3 (1-5)), don't feel right (3 (1-4)) and pressure in head (3 (2-4)). PMHDx (n = 8; 62.9 vs 38.6; p = 0.0192; Hedges' gs = 0.95; large ES), and not PCONC (n = 13; 51.0 vs 39.8; p = 0.2183; Hedges' gs = 0.48; small ES) was associated with increased mean total symptom severity. Conclusion: Headache, feeling slowed down, pressure in head, don't feel right and fatigue/low-energy had the highest symptom burden. Total symptom severity was no different in those with and without PCONC, but significantly higher in those with PMHDx.

Peripheral arterial disease and intermittent claudication: efficacy of short-term upper body strength training, dynamic exercise training, and advice to exercise at home.

OBJECTIVE: To compare the effect of two training programmes and advice to exercise at home on physiological adaptations in patients with peripheral arterial disease (PAD). DESIGN: 30 patients with a typical history of PAD and intermittent claudication were randomised to either an upper body strength training programme (UBST), a dynamic (walking, cycling, circuit) conventional exercise rehabilitation programme (CER), or advice to 'walk as much as possible at home' (CONT). Before and after intervention groups performed a standard graded treadmill exercise test (GTET) and a 6-minute walk test (SMWT) to determine peak physiological parameters and walking distances. Maximal walking distance (MWD), pain-free walking distance (PFWD), peak oxygen uptake (VO2) , heart rate and perceived pain were measured. RESULTS: MWD on the GTET increased significantly in the CER group compared with the CONT and UBST groups (93.9 +/- 79% v. 7.0 +/- 19.8% v. 7.3 +/- 46%; CER v. UBST v. CONT p = 0.003). Similarly, peak VO2 increased with CER compared with the CONT and UBST groups (28.4 +/- 20 v. -6.2 +/- 15 v. -1.0 +/- 21%; CER v. UBST v. CONT p = 0.004). During the SMWT the CER and UBST groups improved in PFWD compared with the CONT group (37 +/- 47% v. 27 +/- 71% v. -30 +/- 29%; CER v. UBST v. CONT p = 0.03), and perceived pain decreased in the CER group compared with the UBST group (-24 +/- 39% v. 27 +/- 48%; CER v. UBST p = 0.01). CONCLUSION: CER improves physiological parameters and walking distances more than UBST does. CER is effective within 6 weeks. Verbal encouragement to exercise is an ineffective form of management.

Factors predicting walking intolerance in patients with peripheral arterial disease and intermittent claudication.

OBJECTIVE: To determine which physiological variables conduce to walking intolerance in patients with peripheral arterial disease (PAD). DESIGN: The physiological response to a graded treadmill exercise test (GTT) in patients with PAD was characterised. SETTING: Patients were recruited from the Department of Vascular Surgery, Groote Schuur Hospital, Cape Town. SUBJECTS: Thirty-one patients diagnosed with PAD were included in the study. OUTCOME MEASURES: During a GTT, peak oxygen consumption (VO(2peak)), peak minute ventilation (VE(peak)), peak heart rate and peak venous lactate concentrations were measured and compared with those from a comparison group. Ankle-brachial index (ABI) was measured at rest and after exercise. During the GTT, maximum walking distance (MWD) and pain-free walking distance (PFWD) were measured to determine walking tolerance. RESULTS: Peak venous lactate concentrations did not correlate significantly with either PFWD (r = -0.08; p = 0.3) or MWD (r = -0.03; p = 0.4). Resting ABI did not correlate with either MWD (r = 0.09; p = 0.64) or PFWD (r = -0.19; p = 0.29). Subjects terminated exercise at significantly (p < 0.05) lower levels of cardiorespiratory effort and venous lactate concentrations than did a sedentary but otherwise healthy comparison group: peak heart rate 156 +/- 11 v. 114 +/- 22 beats per minute (BPM); p = 0.001; and peak venous lactate concentration 9.7 +/- 2.7 mmol/l v. 3.28 +/- 1.39 mmol/1; p = 0.001. CONCLUSION: Perceived discomfort in these patients is not caused by elevated blood lactate concentrations, a low ABI or limiting cardiorespiratory effort but by other factors not measured in this study.

International Olympic Committee consensus statement: molecular basis of connective tissue and muscle injuries in sport.

Tendon and ligament injures cause significant loss of performance in sport and decreased functional capacity in the workplace. Many of these injures remain difficult to treat, and many individuals have long-term pain and discomfort. Animal studies of growth factor and cell-based therapies have shown promising results, but these treatments also can be misused to enhance athletic performance. The International Olympic Committee (IOC) now has high-level scientific advisors who can advise the IOC as to the use and abuse of these technologies.

Evaluation of maximal exercise performance, fatigue, and depression in athletes with acquired chronic training intolerance.

OBJECTIVE: This study compared differences in maximal strength and aerobic capacity and symptoms of fatigue and depression in athletes with acquired training intolerance (ATI) and control athletes (CON) matched for age and current training volume who did not have symptoms of excessive or chronic fatigue associated with their sporting activity. SETTING: University of Cape Town, Sports Science Institute of South Africa. PARTICIPANTS: Twenty ATI and 10 CON athletes participated in the trial. Although the ATI athletes reported symptoms of excessive fatigue during exercise, or symptoms of fatigue that occurred at rest and during activities of daily living, they did not fulfill the criteria for a diagnosis of chronic fatigue syndrome. MAIN OUTCOME MEASURES: A training and comprehensive medical history was recorded from all subjects. The Beck Depression Inventory Short Form (BDI-SF) was used to assess levels of depression in both ATI and control subjects. Maximal force output during a 5-second isometric voluntary knee extensor muscle contraction, and maximal aerobic capacity (VO2max), maximal heart rate (HRmax), and maximal blood lactate concentrations during a treadmill running test were measured in all subjects. RESULTS: There were no differences in maximal isometric force output, peak treadmill running speed, VO2max, HRmax, or blood lactate concentration at rest or after maximal exercise testing between the ATI and CON athletes. However, the BDI-SF scores were higher in the ATI (7.7 +/- 6.6 arbitrary units) than in the CON athletes (1.7 +/- 1.5 arbitrary units; (P = 0.0052). CONCLUSIONS: These findings suggest that the symptoms of excessive fatigue and acquired training intolerance described by these ATI athletes do not affect their maximal isometric and maximal aerobic capacity, and may be associated with psychologic depression in these athletes.

Aetiology of skeletal muscle 'cramps' during exercise: a novel hypothesis.

The aetiology of exercise-associated muscle cramps (EAMC), defined as 'painful, spasmodic, involuntary contractions of skeletal muscle during or immediately after physical exercise', has not been well investigated and is therefore not well understood. This review focuses on the physiological basis for skeletal muscle relaxation, a historical perspective and analysis of the commonly postulated causes of EAMC, and known facts about EAMC from recent clinical studies. Historically, the causes of EAMC have been proposed as (1) inherited abnormalities of substrate metabolism ('metabolic theory') (2) abnormalities of fluid balance ('dehydration theory'), (3) abnormalities of serum electrolyte concentrations ('electrolyte theory') and (4) extreme environmental conditions of heat or cold ('environmental theory'). Detailed analyses of the available scientific literature including data from recent studies do not support these hypothesis for the causes of EAMC. In a recent study, electromyographic (EMG) data obtained from runners during EAMC revealed that baseline activity is increased (between spasms of cramping) and that a reduction in the baseline EMG activity correlates well with clinical recovery. Furthermore, during acute EAMC the EMG activity is high, and passive stretching is effective in reducing EMG activity. This relieves the cramp probably by invoking the inverse stretch reflex. In two animal studies, abnormal reflex activity of the muscle spindle (increased activity) and the Golgi tendon organ (decreased activity) has been observed in fatigued muscle. We hypothesize that EAMC is caused by sustained abnormal spinal reflex activity which appears to be secondary to muscle fatigue. Local muscle fatigue is therefore responsible for increased muscle spindle afferent and decreased Golgi tendon organ afferent activity. Muscles which cross two joints can more easily be placed in shortened positions during exercise and would therefore decrease the Golgi tendon organ afferent activity. In addition, sustained abnormal reflex activity would explain increased baseline EMG activity between acute bouts of cramping. Finally, passive stretching invokes afferent activity from the Golgi tendon organ, thereby relieving the cramp and decreasing EMG activity.

A lumbar body support (KBS 2000) alters lumbar muscle recruitment patterns in patients with acute-upon-chronic lower back pain.

OBJECTIVE: To determine the effects of a locally designed lumbar body support (LBS) on integrated electromyographic (IEMG) activity of the lumbar erector spinae muscles, on heart rate and on ratings of discomfort in patients with low back pain. DESIGN: Non-randomised controlled trial. SETTING: Patients referred from general practitioners and back pain rehabilitation programmes in Cape Town. PATIENTS AND OTHER PARTICIPANTS: Ten patients with low back pain of diverse causes. Values were compared with those in 10 control subjects without low back pain. INTERVENTION: Patients and controls lay supine on (in random order) either a flat conventional mattress or a LBS placed on top of the flat mattress, for a 30-minute period (acute exposure), and every night for 2 weeks (chronic exposure). MAIN OUTCOME MEASURES: IEMG activity of the lumbar erector spinae muscles, heart rate, and perception of comfort. RESULTS: IEMG activity of the lumbar erector spinae muscles did not differ between controls and patients when lying on the LBS on top of the CM after either acute or chronic exposure. However, it was significantly greater (P < 0.05) in patients than in controls when lying on the flat mattress. Subjective ratings of discomfort and heart rates mirrored these changes and were higher in patients only when lying on the flat mattress (P < 0.05). Patients with low back pain also reported that sleeping overnight on the LBS on top of their own mattress significantly reduced discomfort ratings. CONCLUSIONS: When lying on a mattress with a flat surface, patients with chronic low back pain have higher IEMG activity of the erector spinae muscles, higher heart rates and higher subjective ratings of discomfort than do control subjects. These differences disappear when both groups use a specially designed lumbar body support placed on top of the flat surface. These preliminary studies suggest that a lumbar body support should be evaluated in the chronic management of low back pain.