Selected Musculoskeletal Issues in Adolescents.

Musculoskeletal care of the adolescent patient involves unique knowledge of their rapidly changing physical and psychological health. In this article, the importance of preventing early sports specialization is elucidated, and an encouragement of the safety and necessity of resistance training in adolescents is undertaken. It also explores two common conditions, one affecting the immature skeleton (apophysitis), and one affecting the improperly developed muscular system (patellofemoral syndrome), both of which are diagnosed clinically, and require little advanced imaging. Finally, a brief overview of relative energy deficiency in sport is given.

Handgrip strength in cardiac rehabilitation: normative values, interaction with physical function, and response to training.

PURPOSE: To determine normative values for handgrip (HG) strength at entry into cardiac rehabilitation (CR) and to examine the relationship of HG strength with self-reported physical function and the response of HG strength to exercise training. METHODS: HG strength was measured in 1,960 patients with coronary heart disease. Other measures obtained included oxygen consumption/ unit time (peak VO2), body composition, physical function and depression questionnaires, and assessment of comorbid conditions. Subsequently, HG strength and other measures were obtained in 666 participants who completed 36 sessions of CR exercise training. RESULTS: HG strength was significantly greater in men than in women (40.6 +/- 10.1 kg vs 22.6 +/- 6.5 kg, P < .0001), but diminished with age in both men and women from the third to the eight decade. Factors most strongly correlated with HG strength were gender (r = 0.40, P < .0001), height (r = 0.37, P < .0001), peak VO2 (r = 0.32, P < .0001), and age (r = -0.23, P < .0001). Baseline HG strength was correlated with physical function capacity in patients older than 65 years but not in younger patients. Following CR, HG strength increased overall by 4.6% in comparison with baseline values (34.9 +/- 11.4 to 36.5 +/- 11.6 kg, P < .0001). For the entire cohort, the increase in HG strength was associated with an increase in physical function score (P < .05). CONCLUSIONS: In patients with coronary heart disease, HG strength decreases with age and is lower in women, patients with diabetes, and patients with lower peak Vo2. It remains to be determined whether a training protocol that specifically focuses on increasing HG strength would have a greater impact on overall functional status.