[The athlete's shoulder : overview of the typical clinical presentations]. / L'épaule du sportif : tour d'horizon des tableaux cliniques typiques.

Shoulder injuries are common in athlete population. They can be due to trauma or overuse. Traumatic lesions are roughly the same in the non-athlete population. On the other hand, overuse lesions are specific to the sport, depending on the movements performed by the athlete. The majority of the early literature studied baseball pitchers. Pathophysiological theories have been applied to other overhead sport. In this article, we discuss briefly the main specificities and conditions of the painful athlete's shoulder.

Les blessures de l'épaule sont fréquentes chez le sportif. Elles peuvent être secondaires à un traumatisme ou liées à une surcharge mécanique. Les lésions traumatiques diffèrent peu des lésions que l'on peut retrouver dans la population non sportive. Par contre, concernant les lésions de surcharge, on constate des blessures spécifiques du sportif, en lien avec la gestuelle du sport pratiqué. Une grande partie de la littérature vient des États-Unis à travers l'étude du lanceur au baseball (pitcher). Les concepts physiopathologiques ont largement été appliqués à d'autres sports nécessitant une gestuelle au-dessus des épaules (overhead athlete). Nous parcourons brièvement les principales spécificités et tableaux cliniques de l'épaule douloureuse chez le sportif.

[Covid 19 : return to sport criteria for elite athletes]. / Covid-19 : critères de retour au sport chez les athlètes d'élite.

The SARS-CoV-2 pandemic raised concerns about potential cardiac damage when infected athletes returned to sport. Swiss sports medicine and cardiology quickly published guidelines to manage this risk, proposing appropriate investigations and a gradual return to sport protocol. Although these guidelines have been adapted as new knowledge emerged in 2021 and 2022, they were introduced at a time of overestimation of the rate of cardiac complications in pauci-/asymptomatic elite athletes. Updated guidelines should be issued shortly, in accordance with the current state of research. In the meantime, the investigations and process suggested by Sport & Exercise Medicine Switzerland and Swiss Olympic remain valid and should be applied.

La pandémie de SARS-CoV-2 a suscité des préoccupations sur de potentielles atteintes cardiaques lors du retour au sport chez les athlètes infectés. Des recommandations de la médecine et cardiologie du sport suisses ont rapidement vu le jour pour gérer ce risque en proposant des investigations adaptées et un protocole de retour au sport graduel. Bien que ces recommandations aient été adaptées avec l'avancée des nouvelles connaissances en 2021 et 2022, elles ont été introduites dans une phase de surestimation du taux de complications cardiaques chez les athlètes d'élite pauci/asymptomatiques. Une mise à jour devrait être prochainement établie en accord avec les données actuelles. Dans l'attente, les investigations et le processus suggéré par Sport & Exercise Medicine Switzerland et Swiss Olympic restent valables et devraient être appliquées.

[Avoiding cognitive bias : example of quantified assessment of muscle strength]. / Éviter les biais cognitifs : exemple lors de l'évaluation quantifiée de la force musculaire.

Optimizing treatments requires the prevention of diagnostic errors. The use of shortcuts, cognitive biases, may lead to errors of judgement that can impair clinical reasoning and distort decision-making. Objective, quantifiable and comparable assessment is a safeguard against this, and for instance force quantification is used for this purpose. We will present here the use of hand-held dynamometers with recommendations for best practice as well as simple but essential tools for interpreting the results. Indeed, the use of these easy-to-use dynamometers requires rigour to ensure the quality of measurements and data analysis by/for the clinician. The use of this equipment should be widely promoted and democratized in informed clinical practice.

L'optimisation des traitements passe par la prévention des erreurs de diagnostic. L'utilisation de raccourcis et les biais cognitifs peuvent engendrer des erreurs de jugement nuisant au raisonnement clinique et risquant de pervertir les prises de décision. L'évaluation objective, quantifiable et comparable en est un rempart et la quantification de la force est, par exemple, utilisée à cette fin. Nous présentons ici l'utilisation des dynamomètres à main avec des recommandations de bonne pratique ainsi que des outils d'interprétation des résultats simples mais indispensables. En effet, l'emploi de ces dynamomètres d'utilisation aisée nécessite de la rigueur pour assurer la qualité des mesures et l'analyse des données par/pour le clinicien. Le recours à ce matériel doit être largement promu et démocratisé en pratique clinique éclairée.

Delphi developed syllabus for the medical specialty of sport and exercise medicine: part 2.

Training in the medical specialty of sport and exercise medicine (SEM) is available in many, but not all countries. In 2015, an independent Delphi group, the International Syllabus in Sport and Exercise Medicine Group (ISSEMG), was formed to create a basic syllabus for this medical specialty. The group provided the first part of this syllabus, by identifying 11 domains and a total of 80 general learning areas for the specialty, in December 2017. The next step in this process, and the aim of this paper was to determine the specific learning areas for each of the 80 general learning areas. A group of 26 physicians with a range of primary medical specialty qualifications including, Sport and Exercise Medicine, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. SEM, Family Medicine, Internal Medicine, Cardiology, Rheumatology and Anaesthetics were invited to participate in a multiple round online Delphi study to develop specific learning areas for each of the previously published general learning areas. All invitees have extensive clinical experience in the broader sports medicine field, and in one or more components of sports medicine governance at national and/or international level. The hierarchical syllabus developed by the ISSEMG provides a useful resource in the planning, development and delivery of specialist training programmes in the medical specialty of SEM.

Standardised measurement of physical capacity in young and middle-aged active adults with hip-related pain: recommendations from the first International Hip-related Pain Research Network (IHiPRN) meeting, Zurich, 2018.

Hip-related pain can significantly impact quality of life, function, work capacity, physical activity and family life. Standardised measurement methods of physical capacity of relevance to young and middle-aged active adults with hip-related pain are currently not established. The aim of this consensus paper was to provide recommendations for clinical practice and research on standardised measurement methods of physical capacity in young and middle-aged active adults with hip-related pain. Four areas of importance were identified: (1) clinical measures (range of motion, muscle strength, functional impairments), (2) laboratory-based measures (biomechanics and muscle function (muscle activity, size and adiposity)), (3) physical activity, and (4) return to sport/performance. The literature was reviewed, and a summary circulated to the working group to inform discussion at the consensus meeting. The working group developed clinical and research recommendations from the literature review, which were further discussed and modified within the working group at the consensus meeting. These recommendations were then presented to all 38 International Hip-related Pain Research Network (IHiPRN) participants for further discussion, refinement and consensus voting. Therefore, the recommendations voted on were based on a combination of current evidence and expert opinion. The consensus meeting voted on 13 recommendations, six of which were clinically orientated, and seven more research specific. We recommended that clinicians working with young and middle-aged active adults with hip-related pain assess strength using objective methods of measurement, and clinically assess performance of functional tasks, including walking and running. Physical activity should be quantified using both self-reported and objective measures, and patient expectations of recovery should be quantified prior to treatment. It was recommended that return to physical activity (including sport and occupation) be quantified, and sport-specific activities should be assessed prior to return to sport. The IHiPRN participants were uncertain regarding recommendations for range of motion assessment. Research recommendations were that the measurement properties of range of motion, strength and functional performance tests be investigated, reported and improved in both clinical and research settings. Reporting of movement-related parameters (biomechanics and muscle function) should be standardised and the relationship among movement-related parameters, symptoms, function, quality of life, and intra-articular and imaging findings should be investigated. Quantification of return to physical activity (including sport and occupational demands) is required in future research, and the return to sport continuum should be used. Future research is required to determine the best criteria for rehabilitation progression and return to physical activity following hip-related pain management.

Physiotherapist-led treatment for young to middle-aged active adults with hip-related pain: consensus recommendations from the International Hip-related Pain Research Network, Zurich 2018.

The 1st International Hip-related Pain Research Network meeting discussed four prioritised themes concerning hip-related pain in young to middle-aged adults: (1) diagnosis and classification of hip-related pain; (2) patient-reported outcome measures for hip-related pain; (3) measurement of physical capacity for hip-related pain; (4) physiotherapist-led treatment for hip-related pain. Thirty-eight expert researchers and clinicians working in the field of hip-related pain attended the meeting. This manuscript relates to the theme of physiotherapist-led treatments for hip-related pain. A systematic review on the efficacy of physiotherapist-led interventions for hip-related pain (published separately) was conducted and found that strong evidence for physiotherapist-led treatments was lacking. Prior to the meeting, draft consensus recommendations for consideration in the meeting were also developed based on the systematic review. The draft consensus recommendations were presented to all of the meeting participants via email, at least 1 week prior to the meeting. At the meeting, these recommendations were discussed, revised and voted on. Six recommendations for clinical practice and five recommendations for research were included and all gained consensus. Recommendations for clinical practice were that (i) Exercise-based treatments are recommended for people with hip-related pain. (ii) Exercise-based treatment should be at least 3 months duration. (iii) Physiotherapist-led rehabilitation after hip surgery should be undertaken. (iv) Patient-reported outcome measures, measures of physical impairment and measures of psychosocial factors should be used to monitor response to treatment. (v) Physical activity (that may include sport) is recommended for people with hip-related pain. (vi) Clinicians should discuss patient expectations, use shared-decision making and provide education. Recommendations for research were (i) Reporting of exercise programmes: Exercise descriptors such as load magnitude, number of repetitions and sets, duration of whole programme, duration of contractile element of exercise, duration of one repetition, time under tension, rest between repetitions, range of motion through which the exercise is performed, and rest between exercise sessions should be reported. (ii) Research should investigate the optimal frequency, intensity, time, type, volume and progression of exercise therapy. (iii) Research should examine the effect of patient education in people with hip-related pain. (iv) Research should investigate the effect of other treatments used in people with hip-related pain (for example: manual therapy, medications, injections). (v) Research should examine the impact of comorbidities and social determinants on treatment effectiveness in people with hip-related pain. Clinicians and researchers working with young to middle-aged active adults with hip-related pain may use these consensus recommendations to guide, develop, test and implement individualised, evidence-based physiotherapist-led rehabilitation programmes.

Consensus recommendations on the classification, definition and diagnostic criteria of hip-related pain in young and middle-aged active adults from the International Hip-related Pain Research Network, Zurich 2018.

There is no agreement on how to classify, define or diagnose hip-related pain-a common cause of hip and groin pain in young and middle-aged active adults. This complicates the work of clinicians and researchers. The International Hip-related Pain Research Network consensus group met in November 2018 in Zurich aiming to make recommendations on how to classify, define and diagnose hip disease in young and middle-aged active adults with hip-related pain as the main symptom. Prior to the meeting we performed a scoping review of electronic databases in June 2018 to determine the definition, epidemiology and diagnosis of hip conditions in young and middle-aged active adults presenting with hip-related pain. We developed and presented evidence-based statements for these to a panel of 37 experts for discussion and consensus agreement. Both non-musculoskeletal and serious hip pathological conditions (eg, tumours, infections, stress fractures, slipped capital femoral epiphysis), as well as competing musculoskeletal conditions (eg, lumbar spine) should be excluded when diagnosing hip-related pain in young and middle-aged active adults. The most common hip conditions in young and middle-aged active adults presenting with hip-related pain are: (1) femoroacetabular impingement (FAI) syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without a distinct osseous morphology (labral, chondral and/or ligamentum teres conditions), and that these terms are used in research and clinical practice. Clinical examination and diagnostic imaging have limited diagnostic utility; a comprehensive approach is therefore essential. A negative flexion-adduction-internal rotation test helps rule out hip-related pain although its clinical utility is limited. Anteroposterior pelvis and lateral femoral head-neck radiographs are the initial diagnostic imaging of choice-advanced imaging should be performed only when requiring additional detail of bony or soft-tissue morphology (eg, for definitive diagnosis, research setting or when planning surgery). We recommend clear, detailed and consistent methodology of bony morphology outcome measures (definition, measurement and statistical reporting) in research. Future research on conditions with hip-related pain as the main symptom should include high-quality prospective studies on aetiology and prognosis. The most common hip conditions in active adults presenting with hip-related pain are: (1) FAI syndrome, (2) acetabular dysplasia and/or hip instability and (3) other conditions without distinct osseous morphology including labral, chondral and/or ligamentum teres conditions. The last category should not be confused with the incidental imaging findings of labral, chondral and/or ligamentum teres pathology in asymptomatic people. Future research should refine our current recommendations by determining the clinical utility of clinical examination and diagnostic imaging in prospective studies.

Patient-reported outcome measures for hip-related pain: a review of the available evidence and a consensus statement from the International Hip-related Pain Research Network, Zurich 2018.

Hip-related pain is a well-recognised complaint among active young and middle-aged active adults. People experiencing hip-related disorders commonly report pain and reduced functional capacity, including difficulties in executing activities of daily living. Patient-reported outcome measures (PROMs) are essential to accurately examine and compare the effects of different treatments on disability in those with hip pain. In November 2018, 38 researchers and clinicians working in the field of hip-related pain met in Zurich, Switzerland for the first International Hip-related Pain Research Network meeting. Prior to the meeting, evidence summaries were developed relating to four prioritised themes. This paper discusses the available evidence and consensus process from which recommendations were made regarding the appropriate use of PROMs to assess disability in young and middle-aged active adults with hip-related pain. Our process to gain consensus had five steps: (1) systematic review of systematic reviews; (2) preliminary discussion within the working group; (3) update of the more recent high-quality systematic review and examination of the psychometric properties of PROMs according to established guidelines; (4) formulation of the recommendations considering the limitations of the PROMs derived from the examination of their quality; and (5) voting and consensus. Out of 102 articles retrieved, 6 systematic reviews were selected and assessed for quality according to AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews). Two showed moderate quality. We then updated the most recent review. The updated literature search resulted in 10 additional studies that were included in the qualitative synthesis. The recommendations based on evidence summary and PROMs limitations were presented at the consensus meeting. The group makes the following recommendations: (1) the Hip and Groin Outcome Score (HAGOS) and the International Hip Outcome Tool (iHOT) instruments (long and reduced versions) are the most appropriate PROMs to use in young and middle-aged active adults with hip-related pain; (2) more research is needed into the utility of the HAGOS and the iHOT instruments in a non-surgical treatment context; and (3) generic quality of life measures such as the EuroQoL-5 Dimension Questionnaire and the Short Form Health Survey-36 may add value for researchers and clinicians in this field. We conclude that as none of the instruments shows acceptable quality across various psychometric properties, more methods studies are needed to further evaluate the validity of these PROMS-the HAGOS and iHOT-as well as the other (currently not recommended) PROMS.

[Physical activity†: under-used therapeutic option in the treatment of metabolic diseases]. / Activité physique†: une thérapie trop peu utilisée dans la prise en charge des maladies métaboliques.

It is well demonstrated that physical activity can improve the control of diseases such as diabetes, or dyslipidemia. Introduction of regular and frequent physical activity is also part of the useful measures in the management of excess weight. It is therefore surprising that the prescription of physical activity for the treatment of these diseases is still not part of the curriculum of medical studies, and that reimbursement remains very scarce. This article summarizes the state of scientific knowledge in the field and outlines their clinical application.

Il est bien démontré que l'activité physique (AP) peut participer à l'amélioration du contrôle de maladies telles que le diabète ou l'hyperlipidémie. La reprise d'une AP régulière et fréquente fait également partie des mesures reconnues utiles dans la gestion de l'excès de poids. Il est dès lors étonnant que la prescription d'AP dans le cadre du traitement de ces maladies soit peu enseignée, et sa prise en charge très mal remboursée. Cet article fait le point sur les connaissances dans le domaine, et la manière de les appliquer cliniquement.

[From cellulitis to arthrodesis]. / De la dermohypodermite à l'arthrodèse.

Neuropathic arthropathy is a pathology involving both upper and lower limbs. Different neurological diseases can cause this arthropathy. For instance, shoulder Charcot arthropathies are mostly associated to syringomyelia. The initial diagnosis of this arthropathy is difficult and often delayed in the presence of usually non specific symptoms. Since articular destruction is present in this disease, early diagnosis and primary management of the neurological condition is important, as it slows down the destruction of the joint.

L'arthropathie neuropathique est une pathologie touchant les membres supérieurs et inférieurs en lien avec différentes affections neurologiques. Dans le cadre de l'épaule, la syringomyélie est la cause la plus fréquente. La symptomatologie initiale est peu spécifique, peu douloureuse et conduit à la destruction articulaire. Le diagnostic est par conséquent difficile et souvent retardé. Une prise en charge optimale est nécessaire afin de traiter la pathologie neurologique sous-jacente, ce qui permet de ralentir la destruction articulaire.

[What do you know of RED-S†? A field study on adolescent coaches' knowledge]. / Que savez-vous du RED-S ? Une étude de terrain sur les connaissances des entraîneurs sportifs.

RED-S is a clinical concept introduced in 2014 that broadens the understanding of the athlete's triad. It includes nine areas affected by energy deficiency relative to the body's needs for optimal functioning and it is known that both adolescents and athletes are at higher risk of suffering from a RED-S than the general population. We highlight that sports coaches in French-speaking Switzerland do not know of RED-S nor of its health consequences. They desire to learn more but mention several barriers to this training. Since they have a central role in the lives and health of adolescent athletes, they are the key persons to train in order to improve the prevention and detection of adolescent athletes in need of medical attention.

Le RED-S (Relative Energy Deficiency in Sports) est un concept clinique qui élargit la compréhension de la triade de l'athlète. Il comprend neuf domaines affectés par un déficit énergétique et survient lorsque les apports sont insuffisants pour les besoins de fonctionnement optimal. Les adolescents et les athlètes sont à risque de souffrir d'un RED-S en raison de leurs besoins énergétiques augmentés. Notre étude met en évidence un besoin de formation des entraîneurs sportifs, car ils ne connaissent ni le RED-S ni ses conséquences sur la santé. Ils sont en revanche désireux de se former, mais mentionnent des barrières d'accès à la formation. Leur rôle central dans la vie et la santé des athlètes adolescents en fait les acteurs-clés pour améliorer la prévention et la détection du RED-S et l'orientation vers une prise en charge médicale.

[Health for performance†: a concept that must prevail in sports]. / Health for Performance†: un concept à ancrer dans le sport.

Competitive sports demand numerous sacrifices from young adolescent athletes to reach early performance. This comes at a high price: many injuries, sometimes serious, recurrent fatigue, or undue pressure, bordering on abuse definitions. We present a new concept, which seems quite obvious: health for performance. In the presence of complete biopsychosocial health, adolescent athletes can thrive and meet their athletic, social and academic goals. A conducive sports environment, one which integrates interdisciplinarity with healthcare stakeholders, can allow for a complete harmonious positive development, one which is aligned with Public Health goals. Healthy adolescents may become performing athletes, but they will most definitely contribute positively to their wellbeing, as well as society in general.

Le sport de compétition exige des jeunes adolescents de nombreux sacrifices pour la performance dès le plus jeune âge. Ceci n'est pas sans conséquences, comme en témoignent les blessures parfois graves, la fatigue fréquente et les pressions subies, proches des définitions de la maltraitance. Nous présentons ici un concept nouveau, pourtant si évident : la santé pour la performance. En présence d'une santé bio-psycho-sociale complète, les jeunes athlètes se développent harmonieusement et peuvent atteindre leurs objectifs. Un environnement sportif favorable, fonctionnant en interdisciplinarité avec les acteurs de la santé, permet un apprentissage physique complet et favorise un développement positif des adolescents, en accord avec les objectifs de santé publique. Ainsi ils contribueront tant à leur bien-être qu'à celui de la société.

[Fatigue in the adolescent athlète]. / La fatigue chez l'athlète adolescent.

Adolescent athletes frequently complain of fatigue. Acute fatigue after intense training is physiological and necessary in order to develop capacity and increase performance. However, healthcare practitioners must question persistant fatigue, which causes are multiple, sometimes clear, though mostly multifactorial. A comprehensive and holistic approach is especially required in adolescents, with a complete somatic, psychosocial and athletic history. The role of healthcare professionals is to quickly identify specific signs and complex diagnoses, which can lead to physical and psychological consequences in the long term (overtraining, burnout, abuse, eating disorders). Finally, in a time where overweight and inactivity is rampant in the youth, we must imperatively avoid adolescents dropping out of sports and activity.

La fatigue est un motif de consultation fréquent chez l'athlète adolescent. Une fatigue aiguë après un effort intensif est physiologique, voire même recherchée dans le but d'améliorer les performances. Une fatigue qui s'installe doit interpeller. Les causes sont multiples, parfois bien précises, mais souvent multifactorielles. Une approche holistique est indispensable, surtout chez l'adolescent, avec une anamnèse somatique, psychosociale et sportive détaillée. Le rôle du professionnel de la santé est de détecter au plus vite les premiers signes, certains diagnostics difficiles à poser pouvant avoir de lourdes conséquences physiques et psychiques à long terme (surentraînement, burnout, abus, trouble du comportement alimentaire). En cette ère d'épidémie de surpoids chez les jeunes, l'abandon du sport est à éviter absolument.

[Abuse and non-accidental violence in the adolescent athlete†: how to detect and assess†?] / Maltraitance du jeune sportif†: la détecter et l'évaluer.

Youth sports participation is often perceived as a positive contributor to physical and psychological development. However, we must acknowledge that sometimes the sports environment can be plagued by events of abuse and non-accidental violence of different types. A global and systemic approach will allow the limitation of these catastrophic events in young athletes' lives. Healthcare professionals must be able and knowledgeable to identify abuse correctly and in a timely fashion, to report it and to manage applying interdisciplinary principles. Their role is paramount in the education of all stakeholders, helping to raise awareness around abuse in adolescent athletes. Sporting organizations must apply existing recommendations from health and sporting authorities to guarantee the welfare of the adolescents they welcome in their world.

L'activité sportive contribue au bon développement physique et psychologique des adolescents. Nous devons néanmoins constater que les pratiques y sont parfois néfastes et recèlent des éléments de maltraitance ou de violence non accidentelle. Seule une approche globale et systémique pourra permettre de limiter la survenue de ces événements extrêmement délétères pour la santé des jeunes athlètes. Les professionnels de la santé doivent identifier la maltraitance, la signaler et la prendre en charge en équipe interdisciplinaire. L'éducation et la sensibilisation de tous les acteurs sont les mesures indispensables de départ, puis les organisations sportives doivent de leur côté appliquer les recommandations existantes pour garantir le bien-être des adolescent·e·s qu'ils accueillent.

[Trail running: a challenge for medical support teams]. / Le trail†: un défi pour les intervenants du dispositif sanitaire.

Trail running races are a real challenge for medical and paramedical workers committed to aid station/medical support system, because of their technical and geographical particularities. In this article, we review the different etiologies of collapse, digestive problems, kidney complications, diseases related to the environment and musculoskeletal injuries. Field care and prevention are also examined. Although injuries are often benign, some more serious problems may require rapid and effective intervention. Medical teams must be prepared for each of the different situations discussed in this article.

Les courses de trail présentent, du fait de leurs particularités techniques et géographiques, un réel défi pour les intervenants médicaux et paramédicaux engagés au sein des dispositifs sanitaires. Dans cet article, nous passons en revue les différentes causes de malaise, les problèmes digestifs et les complications rénales, les affections liées à l'environnement, ainsi que les principales lésions musculosquelettiques. La prise en charge sur le terrain et la prévention sont également discutées. Même si les affections rencontrées lors d'un trail sont souvent bénignes, certaines problématiques plus graves peuvent nécessiter l'intervention rapide et efficace des secours qui doivent être préparés aux différentes situations abordées.

Perceptually Regulated Exercise Test Allows Determination of V˙O2max and Ventilatory Threshold But Not Respiratory Compensation Point In Trained Runners.

This study aimed to investigate the differences in maximal oxygen uptake (V̇O2max) and submaximal thresholds between a standard graded exercise test (GXT) and a perceptually regulated graded exercise test (PRGXT) in trained runners. Eleven well-trained middle- to long-distance runners performed both tests in a randomized order. PRGXT used incremental "clamps" of rating of perceived exertion (RPE) over 10×1-min stages on an automated treadmill equipped with a sonar sensor allowing them to change their running speed instantly and in a natural way. GXT used fixed 1 km.h-1 increment every minute. Ventilatory threshold (VT) and respiratory compensation point (RCP) were determined using ventilatory equivalents. No differences were found in V̇O2max (68.0 (5.3) vs. 69.5 (5.9) ml·min-1·kg-1, p=0.243), minute ventilation (V̇E) (159.4 (35.0) vs. 162.4 (33.7) l·min-1, p=0.175), heart rate (HR) (188.4 (6.9) vs. 190.7 (5.2) bpm, p=0.254) and speed (21.0 (1.7) vs. 21.1 (2.3) km·h-1, p=0.761) between GXT and PRGXT. At VT, there were no significant differences between GXT and PRGXT for any outcome variables. For 8 of 11 subjects, it was not possible to determine RCP from ventilatory equivalent in PRGXT. GXT appears more relevant for a comprehensive gas analysis in trained runners.

[Adolescent sport medicine : do simple injuries really exist in youth athletes ?] / Médecine du sport chez les adolescents : qui a parlé de simples blessures ?

Offering an interdisciplinary approach to the athletic adolescent helps to expand the evaluation framework when investigating a medical complaint. It is important to use the opportunity of each consultation to take not only a detailed history of the sporting practice, but also to investigate the social and familial context as well as healthy lifestyle of the young athlete. Considering young athletes within the larger picture of their developmental context of adolescence offers an opportunity to better respect the psychological and physical needs of this life phase. These needs are strongly related to the promotion of a good health among young athletes.

L'approche interdisciplinaire de l'adolescent qui pratique du sport permet d'élargir le cadre d'évaluation lors de l'investigation d'une plainte médicale. Il est important de profiter de chaque opportunité de consultation pour faire non seulement une anamnèse détaillée de la pratique sportive, mais également du contexte social et familial ainsi que de l'hygiène de vie du jeune sportif. Replacer le jeune sportif dans le contexte développemental de l'adolescence offre une possibilité de mieux respecter les besoins fondamentaux psychiques et physiques liés à cette phase de vie, éléments qui sont fortement liés à la promotion d'une bonne santé.

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern.

Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport.