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Objective: In 2020, coronavirus disease-2019 (COVID-19) became the cause of a pandemic. In response, the Japan Sports Agency issued warnings about secondary damage to health, such as the threat to physical and mental well-being due to the lack of exercise in this situation. In this study, we report on cross-sectional and longitudinal examinations of standing trunk flexion to evaluate how temporary long-term school closures affected musculoskeletal function in elementary school students.Patients and Methods: All children in one public elementary school in T-city during the school years 2019 and 2020 were included in this study. A digital forward flexion meter was used to measure standing trunk flexion.Results: In this study, 284 (284/289: 98.3%) and 266 (266/274: 97.1%) children in school years 2020 and 2019, respectively, were found to have valid data for cross-sectional analysis. The standing trunk flexion did not show significant differences between grades or sexes. In the longitudinal analysis, the results of the comparison of standing trunk flexion in children for two consecutive years revealed significant differences only between grades 3 and 4 (P<0.05) and between girls in grades 3 and 4 (P<0.01), but no significant differences in other grades or among boys or girls were observed.Conclusion: Initially, we expected that there would be a difference in the results of functional assessment using standing trunk flexion depending on the period of absence from school. However, the results of this study showed no significant changes in standing trunk flexion. Moreover, since children’s musculoskeletal functions may be affected by various factors during the COVID-19 pandemic, they should be carefully monitored in the future.
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Objective: In 2016, Japan started conducting musculoskeletal examinations that included “limb status” of students as an essential item. Our institution implemented a unified musculoskeletal examination for all public elementary and junior high schools in T-city. In this study, we aimed to report the progress in the past 4 years.Patients and Methods: The Tsukuba Childhood Locomotive-Organ Screening Sheet (T-CLOSS), which is a questionnaire that includes some nationwide-recommended questions, was prepared and distributed to students. Results of the questionnaires were analyzed, and the orthopedic surgeon conducted examinations for the extracted items. From these questionnaires, the ratio of each item, rate of advisory for screening, and content of the advisory were investigated.Results: During 2016–2019, musculoskeletal examinations were conducted in every public schools, with nearly 20,000 students in T-city. The consultation advisory rate was 6.7% in 2019. Of the 524 students who received the third screening recommendation, the actual consultation rate was 248 (40.8%). After the third screening, the proportion of students requiring treatment and outpatient visits was 46.7% (n=248), which accounted for 1.2% of all elementary and junior high school students in the city.Conclusion: We reported the results of 4-year musculoskeletal examinations in a city. In our screening, we distributed a uniform questionnaire throughout the city, and orthopedic surgeons performed secondary examinations of identified students in all schools. This appears to be an advanced effort to prevent musculoskeletal impairment in students. We hope to conduct more sophisticated musculoskeletal examinations using our results, aiming at early detection, early treatment, and improvement of musculoskeletal function in elementary and junior high school students.
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Background: In Japan, in 2016, the School Health and Safety Act was revised and examination of extremities in addition to scoliosis became mandatory. Musculoskeletal examinations were subsequently started using a mark sheet-type questionnaire. In the present study, we aimed to analyze the relationship between physical findings and musculoskeletal problems and propose a preventive strategy for musculoskeletal injuries.Methods: In 2017, a total of 4,073 elementary and middle school students underwent direct musculoskeletal examination. In a direct examination, the following elements were included: torticollis; scoliosis; stiffness of the shoulder, elbow, hip, knee, and ankle; flexion and extension in standing position; flat foot; hallux valgus; and alignment of the upper and lower extremities. Of the 4,073 students who underwent direct examination in early 2017, only 3,754 were able to complete the mark sheet-type questionnaires in early 2018. A prospective longitudinal analysis of the data gathered was performed.Results: A total of 396 (11%) students had injuries. The ankle sprain/non-ankle sprain group comprised 119 (3%)/3,635 (97%) students, while the fracture/non-fracture group comprised 105 (2.8%)/3,650 (97.2%) students, respectively. Comparing the sprain group with the non-sprain group, ankle stiffness significantly correlated with ankle sprain in the univariable and multivariable analyses. Injuries occurred more frequently among boys, older students, students with stiff bodies, and students who were involved in sports activities of longer duration.Conclusion: Ankle stiffness was assumed to be a risk factor for ankle sprain. Stretching of the ankle might be effective for preventing ankle sprain. However, further interventional studies are needed to confirm this finding.
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The Star Excursion Balance Test (SEBT) is a dynamic balance test used for the screening of injuries in the fields of sports; however, we do not clearly understand what factors of the SEBT are associated with the occurrence of injury. We hypothesized that the trunk movement would be a key factor related with the maximum reach distance (MRD) of the SEBT. The purpose of this study was to examine the relationship of the MRD during the SEBT with trunk lean angles and ankle flexibility. We recruited 19 healthy male athletes (age: 21±0.8 years, height: 170.2 ± 6.6 cm, weight: 65.2 ± 6.9 kg) and measured the MRD of the SEBT including anterior, posteromedial and posterolateral directions, the trunk lean angles at MRD, and the maximum ankle dorsi-flexion angle (DFA). The trunk lean angles were measured with the Direct Linear Transformation (DLT) method. The DFA was measured by the weight-bearing-lunge-test. We used Pearson’s correlation coefficient. There were positive correlations between the anterior-MRD and DFA; the posteromedial-MRD and the lateral trunk angle; the posterolateral-MRD and the forward trunk angle (r =.58, r =.47, r =.62, p<0.05, respectively). For future study, we need to consider the trunk movement and to focus on other factors such as muscle strength, muscle activities, center of mass, and center of pressure, which contribute to the MRD of the SEBT.
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Background: The use of prophylactic contralateral pinning for slipped capital femoral epiphysis (SCFE) remains controversial. This study evaluated the outcome of SCFE treatment and examined the use of prophylactic pinning.Methods: The study included 44 patients (33 men, 11 women; 54 hips [right, 31; left, 23]), with mean age of 12.9 (7.3–29) years, who underwent treatment between 1986 and 2017, with follow-up for more than 6 months. Patients were divided into 3 groups: group 1 had bilateral SCFE at first presentation, group 2 developed contralateral side SCFE during follow-up, and group 3 had unilateral SCFE until final follow-up. Three patients who received prophylactic pinning were excluded. Univariate and multivariate logistic analyses were performed.Results: Overall, 93% (50/54) of hips underwent positional reduction and in situ fixation and 7.4% (4/54) underwent open reduction. Mean follow-up period was 4.8 (0.5–25) years. Groups 1, 2, and 3 had 7, 3, and 31 cases, respectively. Sex, age, and follow-up period showed no significant differences among the groups. The Rohrer index was significantly higher in group 1, the affected side posterior sloping angle (PSA) was significantly higher in group 3, and the contralateral side PSA and percentage with endocrinopathy were significantly higher in group 2. In multivariate logistic analysis, age, sex, Rohrer index, affected side PSA, and endocrinopathy were significantly correlated with bilateral SCFE.Conclusion: We recommend prophylactic contralateral side pinning in patients with risk factors of obesity, high PSA before slipping, and endocrinopathy. Careful observation until growth plate closure is required in patients without risk factors.
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Objectives: The purpose of this study was to evaluate the relationship between exercise time and musculoskeletal problems and to determine the appropriate amount of exercise for children in both lower- and higher-grade levels of elementary and junior high schools.Materials and Methods: Mark-sheet-type questionnaires were distributed to and collected from all elementary and junior high schools in two cities. We collected 22,494 questionnaires in total. The relationship between exercise time and musculoskeletal problems was analyzed. The χ2 test and multivariate logistic regression analysis were used for statistical analyses.Results: The mean exercise time in school, in addition to physical education time, was 3.1 hours per week. In 56% of the children, the exercise time was less than 2 hours per week, and in 13% of the children, the exercise time was more than 10 hours per week. Although the rate of sports injury increased with an increase in exercise time, the duration of one-leg stand (a test of balance and muscle strength) also increased with an increase in exercise time. The cut-off values for sports injuries in boys/girls were 2.9/2.9 hours, 4.0/2.9 hours, and 7.5/4.2 hours in lower grade elementary school, higher grade elementary school, and junior high school, respectively.Conclusions: Although an appropriate amount of exercise improves one’s physical health and ability, excessive exercise leads to musculoskeletal problems. Approximately 7 hours/week of exercise is recommended for junior high school students. In elementary school, the exercise time should be carefully decided as the musculoskeletal system of the students is still immature.
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<p>Non-contact anterior cruciate ligament (ACL) injury is one of the most severe knee problems for female athletes. Several studies have reported that the decreased lower limb control of women such as decrease of hip abductions muscle strength increase the risk of ACL injury. Also ACL Injury often occurs as a result of knee valgus collapse during single leg landing or pivoting in sports activities like basketball. Female basketball players often show an excessive knee valgus and hip adduction during the play. The purpose of this study was to analyze the effect of hip abductions muscle strength on knee alignment during a single leg landing. Thirty healthy female basketball players participated in this study. Mean age, height, body weight and plyer career were 17.3 years old±3.7, 162.7cm±17.2, 56.2kg±10.9, 8.9 years±3.8 respectively. All subjects were obtained written consent from after explanation of the procedure. Significant negative correlations showed that greater hip abductor peak torque (hip flexion 0 and 30degrees) exhibited less motion toward the knee valgus direction during single leg landing. And also, dynamic Trendelenburg test showed that all positive reactions cause knee valgus direction. These results suggest keeping proper knee position safety during single leg landing; female basketball player should improve the hip abductions muscle strength. Hip joint control will be a major issue for prevention of the non-contact ACL injury.</p>
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The purpose of this study was to examine the effects of knee flexion angles during maximum isometric hip extension. Ten healthy men performed maximum isometric hip extension in prone position at 15° and 90° knee flexion. Then, the hip extension torque was measured, and electromyographic (EMG) data were obtained from the biceps femoris long head, semitendinosus, semimembranosus, adductor magnus, and gluteus maximus muscles. The EMG data were full-wave rectified and integrated (IEMG). The IEMG values obtained during the measurement of isometric hip extension were normalized with the values collected at 90° knee flexion (normalized IEMG [NIEMG]). The hip extension torque at 15° knee flexion was significantly greater than that at 90° knee flexion. The NIEMG values from the hamstrings at 15° knee flexion significantly increased compared with those at 90° knee flexion. Meanwhile, the NIEMG values from the gluteus maximus at 90° knee flexion were significantly greater than those at 15° knee flexion. However, the NIEMG values from the adductor magnus did not significantly differ between 15° and 90° knee flexion. These results indicate that the hamstrings effectively generate contracting force during isometric hip extension and at knee extended position because its fiber length was close to the optimal length.
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Strenuous and consecutive exercise results in fatigue symptoms accompanied decrease in salivary secretory immunoglobulin A (sIgA) in athletes. On the other hand, it has been reported that plasma taurine concentration was increased after the high intensity exercise. However, change in salivary taurine concentration after strenuous and consecutive exercise is unknown. The purpose of this study was to investigate the relationship between fatigue symptoms and changes in salivary taurine concentration in collegiate male soccer players. Thirty seven collegiate male soccer players participated in three consecutive days of match program. To detect of fatigued players, we measured awakening heart rate and body weight. As the results of these two measurements, we divided subjects to two groups (non-fatigue group, n=15; fatigue group, n=22). We also measured salivary sIgA and taurine concentrations before and after program. Before the program, there were no significant differences in any parameters between two groups. Salivary flow rate and sIgA secretion rate were significantly decreased after the program in the fatigue group. Furthermore, salivary taurine concentration was significantly increased after the program in the fatigue group. In the non-fatigue group, there were no significant differences in any parameters during program. Our results indicated that salivary taurine concentration increased after consecutive high-intense exercise in the collegiate male soccer players.
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To examine risk factors for shoulder injuries with or without history of the injuries using the stratification analysis for collegiate rugby players. 71 elite rugby players from one university rugby club joined in the preseason medical screening related to their shoulder joints, including basic demographics, history of injuries, and physical findings at that time. Subsequently, the occurrence of shoulder injuries was recorded during four playing seasons. Analysis was stratified with or without history of the injuries; player without the past history of injury, 47 players; player with the past history of injury, 24 players. As a result of all players with the past history, 13 players sustained the shoulder injuries. Internal rotational range of motion [IR ROM] (OR, 1.5; 95%CI, 1.13-1.96; p=0.004), external rotational range of motion [ER ROM] (OR, 1.9; 95%CI, 1.21-2.87; p=0.005), horizontal flexion range of motion [HF ROM] (OR, 1.3; 95%CI, 1.03-1.64; p=0.025), IR muscle strength (OR, 0.4; 95%CI, 0.20-0.65; p=0.001) and rugby experience (OR, 1.2; 95%CI, 1.02-1.46; p=0.032) were associated with the shoulder injuries. On the other hand, 10 players sustained injuries of the players without the past history of injury. IR muscle strength (OR, 0.3; 95%CI, 0.11-0.72; p=0.008) and rugby experience (OR, 1.4; 95%CI, 1.11-1.66; p=0.003) were associated with the shoulder injuries. This study clearly showed that IR, ER, HF ROM, IR muscle strength and rugby experience were important initial risk factors for shoulder injuries. Moreover, IR muscle strength and rugby experience were important recurrence risk factors for shoulder injuries.
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The purpose of this study was to evaluate the change of the hardness of the gastrocnemius muscle (GM) and the Achilles tendon (AT) using Real-time Tissue Elastography (RTE) before and after acute exercise. Nine healthy young male without any exercising custom performed a total of 100 reps. of one-leg heel-rise exercise and the hardness of the gastrocnemius muscle and the Achilles tendon before and after the exercise was examined in comparison. The strain ratio (SR) was even measured in comparison to a reference material. The result indicated that the SR of the GM significantly increased immediately, 15min, 30min and 24h after the exercise, whereas the SR of the AT significantly increased just immediately and 15min after the exercise. In summary, the hardness of GM and AT increased after exercise. These findings suggest that RTE is a useful technique for assessing specific hardness of muscles and tendon, More RTE measurements of various parts of the body and the examination of the relationship between injury and RTE are required for the conditioning of muscles and tendons.
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The purpose of this study was to increase knowledge about the landing posture that induces anterior cruciate ligament (ACL) injury. Analysis was done to determine the knee abduction moment during single limb landing using our previously proposed mathematical model. Our model has proven that the criterion of knee abduction occurring is when the acting line of the ground reaction force is directed laterally to the lower leg segment. Based on this, we predicted a medial shift of the knee joint and a lateral leaning of the trunk segment to induce the knee abduction moment. To verify the results of our model prediction, we conducted a motion analysis experiment with a single limb-landing task. Three male and four female subjects participated in the experiment. Subjects were instructed to fall from a 30 cm high box and land on a target which was assigned by PC-controlled laser pointers. Since the landing target was unexpectedly moved during landing, the subjects were perturbed and exhibited various landing postures. The results of the landing experiment showed that trunk leaning laterally towards the landing limb and medially shifted knee alignment induced the knee abduction moment. These results are consistent with the results predicted by our model. In conclusion, appropriate control of both lower limb alignment and trunk motion in the frontal plane in essential for reducing the risk of ACL injury.
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The purpose of this study is to identify the risk factors which affect the consecutive onset of throwing shoulder injury of a collegiate baseball team, and to calculate regression formula which could predict the future onset.Prospective study. The subjects are 69 asymptomatic collegiate baseball players. We executed medical checkups and investigated who got throwing shoulder injury during this year. We did logistic regression analysis with the medical checkup findings and the data of the onset and found out the factors which significantly affected the onset. We also calculated Odds ratio of these factors and regression formula which predict the probability of the onset of throwing shoulder injury and evaluated the validity of regression model.52%(36/69 cases) of the players suffered throwing shoulder injury during this year. Among the medical checkup findings of asymptomatic phase, pitcher and catcher, past history of throwing shoulder injury, abnormality of scapula-humeral rhythm, heel-buttock distance were thought to be the risk factors which were near-related to the onset of throwing shoulder injury. We calculated regression formula using the medical checkup findings of asymptomatic phase and we could predict the onset of throwing shoulder injury with 82.5% accuracy.In order to prevent this injury, the method used in this study could be useful for field players to predict the onset of throwing shoulder injury.
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PURPOSE : To determine the patterns of electromyographic (EMG) responses and torques of upper extremity muscles in overhead throwers during maximal, eccentric muscle action for shoulder flexion (Flex<sub>Ecc</sub>), abduction (Abd<sub>Ecc</sub>) and diagonal activities (Dia<sub>Ecc</sub>) with full glenohumeral internal rotation, at 60, 120, and 180°/s on the dynamometer.METHODS : Seven asymptomatic subjects (7 men, 4 women) who participate in overhead sports at least three days a week volunteered to participate in this study. Subjects were randomly performed with the test procedure which consisted of at least 5 grade maximal-effort repetitions on the three different testing conditions, at 60, 120, and 180°/s on the dynamometer, while we assessed muscle activation of the anterior deltoid (AD), middle deltoid (MD), posterior deltoid (PD), upper trapezius (UT), middle trapezius (MT), lower trapezius (LT), and biceps brachii (BB) muscles by surface electromyography. EMG data was expressed as a percentage of maximum voluntary isometric contraction (%MVIC) that was obtained from the highest root mean square (RMS, 50 ms) of each muscle and was normalized and averaged.RESULT : AD muscle elicited lower muscle activity during Dia<sub>Ecc</sub> than Flex<sub>Ecc</sub> and Abd<sub>Ecc</sub> (P＜0.05) while the MD, PD, UT, MT, and LT muscles elicited overall greater muscle activities during Dia<sub>Ecc</sub>. MD and MT muscle activities were significantly greater for the faster speed than for the slower speed as 60°/s during Abd<sub>Ecc</sub> (P＜0.05). Peak torque generated greater muscle strength for Dia<sub>Ecc</sub> than Flex<sub>Ecc</sub> and Abd<sub>Ecc</sub>, and it was significantly greater for the faster speed than slower speed during Dia<sub>Ecc</sub> (P＜0.05).CONCLUSION : Posterior upper extremity muscle activities and peak torque values were found to be dependent on eccentric muscle action for diagonal shoulder activity at the faster speed. This study provided evidence that isokinetic eccentric muscle strength testing of the posterior upper extremity muscle was effective to develop of a proper program for overhead sports athletes require forceful stability during deceleration phase.
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[Objective]The purpose of this study is to evaluate an effect of electroacupuncture therapy on low back pain of collegiate athletes. <BR>[Methods]Subjects were 28 collegiate athletes with low back pain who gave informed consent. They consulted a medical doctor beforehand. The electroacupuncture therapy was performed as acupuncture. The evaluation items were as follows:Visual Analogue Scale (VAS) which expresses the state of the pain (Pain-VAS), VAS which shows a training state (Training-VAS), five phases of evaluations to show a training state, pain at the time of the trunk movements, Roland-Morris Disability Questionnaire (RDQ), and Japanese Orthopedic Association (JOA) score. The correlation of each item was estimated.<BR>[Results]The chief complaint of 27 people was low back pain, and one person had pain of the low back and the lower extremities. In the diagnosis, 16 people had non-specific low back pain, 5people had lumbar vertebrae discopathy, and 3had a lumber vertebrae herniated disk. As a result of acupuncture, the training-VAS and five phases of evaluations to show the training state and JOA score were significantly improved. However, as for the pain-VAS and pain at the time of trunk movements and RDQ, a significant difference was not accepted. <BR>[Conclusion]Training-VAS is useful for measuring the outcome of an athlete with low back pain. It is important that athletes with low back pain evaluate their training.
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The aim of this study is to examine the potential of the two-dimensional posture evaluation method as a screening tool for detecting the high-risk population for anterior cruciate ligament injury.Eleven healthy adults participated in this study. They jumped from a 31 cm-high box and landed on their dominant leg. Three-dimensional knee flexion/extension, knee valgus/varus and hip adduction/abduction angle during single-legged landing were calculated. At the same time, the Frontal-plane Knee Displacement index (FKD)-the knee joint position relative to the line between the hip and ankle joint-was measured.FKD reflects the time variation of three-dimensional knee valgus and hip adduction angle very well.Our results suggest that FKD has potential as a screening tool particularly for movement occurring primarily in the frontal-plane.
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To determine the effect of taurine on blood glucose concentration during prolonged exercise, fifteen male university students cycled for 120 min at 50%VO<sub>2</sub>max after 7 days with or without taurine supplementation. Exercise tended to reduce the blood glucose concentration, whereas taurine significantly prevented this decline. Exercise significantly increased plasma glucagon concentrations in both groups to a similar degree. Serum insulin concentrations did not differ during exercise under both conditions. Taurine supplementation respectively significantly inhibited and tended to inhibit the plasma noradrenaline and adrenaline concentrations increased by exercise. These results suggest that taurine supplementation can maintain the blood glucose concentration during prolonged exercise through enhanced catecholamine sensitivity.
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<b>Purpose</b> : This study was to investigate the patterns of electromyography (EMG) amplitude responses during maximal, eccentric muscle action with shoulder adduction and diagonal movement, at 6 different positions on the dynamometer.<b>Methods</b> : The participants for this investigation were 9 males and 5 females. Testing consisted of each subject performing eccentric muscle exercise of the dominant shoulder muscle at a velocity of 60°/sec and 180°/sec. Muscle activity values was recorded individually from six different muscles and peak torque values were extracted for each test from torque curves once. EMG data were normalized to the highest root mean square (RMS), and were expressed as a % maximum voluntary isometric contraction (%MVIC).<b>Results</b> : The posterior parts of upper extremity muscle complex generate overall high muscle activity (> 40%MVIC) during all testing for eccentric muscle activity with diagonal shoulder movement. Posterior deltoid (PD), upper trapezius (UT), and middle trapezius (MT) muscles show differences between eccentric muscle action with shoulder adduction and eccentric muscle action with diagonal shoulder movement.<b>Conclusion</b> : The present results show that an improved understanding of muscle activity patterns during different movement may benefit many fields of athletic trainers, coaches, and athletes, in addition to assisting in injury prevention for throwers, and even rehabilitation after injury.
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The purpose of this study is to evaluate physical characteristics of boxing players with/without low back pain (LBP). Materials and methods : 18 college boxing players were divided into two groups ; The first group consisted of eight subjects with LBP (LBP group), the other one consisted of ten subjects without LBP (no LBP group). The evaluation items were as follows : muscular strength of trunk extension/ flexion/ rotation, cross-sectional areas of the muscles of the lumber region, X ray photograph of lumber spine, MRI, general joint laxity test, muscle tightness test, muscle hardness, tenderness and moiré topography. Results : 9 out of 18 subjects showed lumber region abnormalities in their X ray photograph and MRI. The following evaluation items of LBP group read significant differences compared to those of no LBP group ; The trunk rotator peak torque was weaker at the angular velocity of 120 deg/sec, the laterality of SLR was significantly larger, while the finger floor distance value indicated significantly lower. Discussion : In LBP group, it is suggested that the decline of trunk flexion muscle strength possibly preceded the fall of trunk extension muscle strength which, however, was not observed.
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[Objective] To report the activity by the athletic trainer in a collegiate boxing club, focusing on acupuncture for medical treatment.<BR>[Methods] The athletic trainer was Japan a Japan Sports Association certifiedathletic trainer who was a practitioner of acupuncture and moxibustion. Subjects were twenty-seven collegiate boxers who participated for one year from April, 2004 to March, 2005.<BR>[Results] The activity by the athletic trainer was performed for thirty two days. Medical treatment was performed up to 2.2 times a day. Seventy-one people were treated by the athletic trainer. Medical treatments were acupuncture 28 (39.4%), massage 24 (33.8%), taping 4 (5.6%), and partner stretch 3 (4.2%). Thirteen people (48.1%) had acupuncture. In acupuncture, fifteen people (50%) had a chief complaint in the hand.<BR>[Discussion] Acupuncture was requested by the boxers. The continuation of the activity by the athletic trainer was required for boxing.