Lesiones musculares deportivas: correlación entre anatomía y estudio por imágenes / Muscle injuries in sports: imaging study

Un gran segmento de la población participa en actividades deportivas. Las lesiones musculares corresponden a aproximadamente un tercio de las lesiones deportivas. Las demandas recreacionales y profesionales de la sociedad moderna exigen un diagnóstico precoz y preciso, para un adecuado tratamiento y seguimiento, dadas las implicancias económicas y mediáticas, especialmente en deportistas de elite. La imagenología tiene un rol fundamental en la evaluación de estas lesiones. Permite evaluar localización, extensión, severidad y estimar pronóstico, así como también el seguimiento para determinar el retorno deportivo. En este artículo se revisa la anatomía microscópica y macroscópica muscular, la fisiología, los tipos de lesiones y su representación en imágenes, tanto en ultrasonido (US), como en resonancia magnética (RM). Se mencionan distintas clasificaciones descritas en la literatura y se propone una nueva nomenclatura y descripción, basada principalmente en la anatomía muscular, la localización y cuantificación de las lesiones.

A large segment of the population participates in sporting activities. Muscle injuries account for approximately one-third of the injuries. The recreational and professional demands of modern society require an early and precise diagnosis of these, for an adequate treatment and follow-up, given the economic and media implications, especially in elite athletes1. Imaging plays a fundamental role in the evaluation of these lesions. It allows evaluation location, extent, severity and estimations of prognosis, as well as the follow-up to determine the return to sport. This article reviews the microscopic and macroscopic muscle anatomy, the physiology, types of lesions and their representation in images, both in ultrasound (US) and magnetic resonance (MRI). Different classifications described in the literature are mentioned and a nomenclature and description is proposed, based mainly on the muscle anatomy, localization and type of injury.

Isokinetic performance of ankle evertor and invertor muscles in adolescent female volleyball athletes

This study aimed to analyze the muscular performance of evertor and invertor ankle muscles of adolescent volleyball athletes. Methods: The information provided by database concerning the isokinetic evaluation of ankle muscles from 20 female volleyball players between the ages of 14-17 years old were analyzed. The isokinetic dynamometer was used in a concentric-concentric mode for the ankle evertor and invertor muscles at angular velocities of 60°/s, and 180°/s. Results: Seven athletes had suffered ankle sprains (6 affected the non-dominant limb and all were lateral ankle sprain) in the one year prior to the isokinetic evaluation. The isokinetic results demonstrated that the mean peak torque values for eversion of the non-dominant limb were significantly lower in comparison to the dominant limb at 60°/s. Moreover, although no difference was observed in the average values of the evertor/invertor ratio between the limbs, the ratios were below the values suggested by the literature. Conclusion: We believe that although the athletes reported no ankle injury and no pain in the previous assessment month, the isokinetic results of the non-dominant limb seemed to be directly related to previous ankle sprains injuries in inversion of this limb. The athletes had similar results to those of subjects clinically diagnosed with ankle joint instabilities despite their being active in sports at the moment of the assessment.(AU)

Prevention of shoulder injuries in overhead athletes: a science-based approach

The shoulder is at high risk for injury during overhead sports, in particular in throwing or hitting activities, such as baseball, tennis, handball, and volleyball. In order to create a scientific basis for the prevention of recurrent injuries in overhead athletes, four steps need to be undertaken: (1) risk factors for injury and re-injury need to be defined; (2) established risk factors may be used as return-to-play criteria, with cut-off values based on normative databases; (3) these variables need to be measured using reliable, valid assessment tools and procedures; and (4) preventative training programs need to be designed and implemented into the training program of the athlete in order to prevent re-injury. In general, three risk factors have been defined that may form the basis for recommendations for the prevention of recurrent injury and return to play after injury: glenohumeral internal-rotation deficit (GIRD); rotator cuff strength, in particular the strength of the external rotators; and scapular dyskinesis, in particular scapular position and strength.

Physical therapists' role in prevention and management of patellar tendinopathy injuries in youth, collegiate, and middle-aged indoor volleyball athletes

ABSTRACTPatellar tendinopathy is highly prevalent in all ages and skill levels of volleyball athletes. To illustrate this, we discuss the clinical, biomechanical, and ultrasound imaging presentation and the intervention strategies of three volleyball athletes at different stages of their athletic career: youth, middle-aged, and collegiate. We present our examination strategies and interpret the data collected, including visual movement analysis and dynamics, relating these findings to the probable causes of their pain and dysfunction. Using the framework of the EdUReP concept, incorporating Education, Unloading, Reloading, and Prevention, we propose intervention strategies that target each athlete's specific issues in terms of education, rehabilitation, training, and return to sport. This framework can be generalized to manage patellar tendinopathy in other sports requiring jumping, from youth to middle age, and from recreational to elite competitive levels.

A conceptual framework for a sports knee injury performance profile (SKIPP) and return to activity criteria (RTAC)

ABSTRACTInjuries to the knee, including intra-articular fractures, ligamentous ruptures, and meniscal and articular cartilage lesions, are commonplace within sports. Despite advancements in surgical techniques and enhanced rehabilitation, athletes returning to cutting, pivoting, and jumping sports after a knee injury are at greater risk of sustaining a second injury. The clinical utility of objective criteria presents a decision-making challenge to ensure athletes are fully rehabilitated and safe to return to sport. A system centered on specific indicators that can be used to develop a comprehensive profile to monitor rehabilitation progression and to establish return to activity criteria is recommended to clear athletes to begin a progressive and systematic approach to activities and sports. Integration of a sports knee injury performance profile with return to activity criteria can guide clinicians in facilitating an athlete's safe return to sport, prevention of subsequent injury, and life-long knee joint health.

Critical review of the impact of core stability on upper extremity athletic injury and performance

BACKGROUND: Programs designed to prevent or rehabilitate athletic injuries or improve athletic performance frequently focus on core stability. This approach is based upon the theory that poor core stability increases the risk of poor performance and/or injury. Despite the widespread use of core stability training amongst athletes, the question of whether or not sufficient evidence exists to support this practice remains to be answered.OBJECTIVES: 1) Open a dialogue on the definition and components of core stability. 2) Provide an overview of current science linking core stability to musculoskeletal injuries of the upper extremity. 3) Provide an overview of evidence for the association between core stability and athletic performance.DISCUSSION: Core stability is the ability to control the position and movement of the trunk for optimal production, transfer, and control of forces to and from the upper and lower extremities during functional activities. Muscle capacity and neuromuscular control are critical components of core stability. A limited body of evidence provides some support for a link between core stability and upper extremity injuries amongst athletes who participate in baseball, football, or swimming. Likewise, few studies exist to support a relationship between core stability and athletic performance.CONCLUSIONS: A limited body of evidence exists to support the use of core stability training in injury prevention or performance enhancement programs for athletes. Clearly more research is needed to inform decision making when it comes to inclusion or emphasis of core training when designing injury prevention and rehabilitation programs for athletes.

Análise da flexibilidade segmentar e prevalência de lesões no futebol segundo faixa etária / Analysis of the joint flexibility and prevalence of soccer injuries according to age / Análisis de la flexibilidad segmentaria y prevalencia de lesiones en el fútbol según franja etárea

Retrações musculares têm apresentado relações com má postura e Lesões Desportivas (LD) em jogadores de futebol jovens e adultos. Este estudo teve por objetivo avaliar a flexibilidade articular, extensibilidade muscular e prevalência de LD em praticantes de futebol, relacionando-as com a faixa etária. A casuística integrou 170 participantes do sexo masculino, procedentes das equipes de base profissionalizante e profissional de um clube desportivo de Campo Grande (MS). Os participantes foram distribuídos em três grupos: G1 (infantojuvenil), G2 (adolescentes) e G3 (adultos). Para a tomada de informações sobre lesões, utilizou-se de um inquérito de morbidade referida. Foram realizadas análises para caracterização antropométrica, flexibilidade articular, extensibilidade muscular e alinhamento corporal. Em relação à prevalência de LD, foram registrados 55 LD durante as duas últimas temporadas, sendo que 48 participantes (28,23%) relataram presença de LD. O G3 revelou a maior taxa de prevalência de LD, totalizando 0,68 LD/atleta. A taxa de lesão por atleta lesionado apresentou-se maior no G2, com 1,4 LM/atleta lesionado. O G2 apresentou maior grau de flexibilidade articular do quadril, com alcance de 26,3±8,0 cm no teste de sentar e alcançar. O G3 apresentou os maiores índices de prevalência de retração para flexores de quadril. Ao teste de Schõber, o G2 mostrou a maior prevalência de inflexibilidade lombar. Conclui-se que atletas profissionais têm maior incidência e prevalência de LD. Os índices de inflexibilidade foram particularmente importantes em faixas etárias mais jovens, sugerindo que uma possível interação entre atributos intrínsecos e extrínsecos se associe a distúrbios musculoesqueléticos em jovens atletas...

Muscle shortening has been associated with asymmetrical posture and Sports Injuries (SI) in soccer players in distinct ages. The objective of the present study was to analyze the joint flexibility, muscle extensibility and the SI prevalence in soccer players according to age: young and adults practitioners. Studied subjects integrated 170 male soccer players from amateurs and professional teams of a sports club from Campo Grande (MS), Brazil. Participants were divided into three age groups: G1 (juvenile), G2 (teenagers) and G3 (adults). To obtain information about injuries, was used a morbidity survey. Anthropometry and clinical tests were performed to analyze the joint flexibility (sit and reach test) and muscle extensibility (Thomas test; Schõber test and posture analysis). In relation to SI prevalence, 48 athletes (28.2%) reported SI incidence during two last years, with register of 55 SI; G3 presented 0.68 IS/ athlete, while G2 showed 1.4 IS/injured athlete. Moreover, G2 reported higher degrees of hip flexibility, with range of 26.3±8.0 cm in sit and reach test, and presence of lumbar shortening in response to Schõber test. In addition, G3 exhibited greater indexes of muscle shortening in hip flexors, evidenced in Thomas examination. In conclusion, evidences have been showing that professional athletes have presented higher incidence and prevalence of sports injuries. However, muscle shortening scores were more important results in youth soccer players, suggesting a possible interaction between intrinsic and extrinsic as cause of skeletal muscle disturbances in youth athletes...

Retracciones musculares han presentado relaciones con mala postura y Lesiones Deportivas (LD) en jugadores de fútbol jóvenes y adultos. Este estudio tuvo por objetivo evaluar la flexibilidad articular, extensibilidad muscular y prevalencia de LD en practicantes de fútbol, relacionándolas con la franja etárea. La casuística integró 170 participantes del sexo masculino, procedentes de los equipos de base profesionalizante y profesional de un club deportivo de Campo Grande (MS). Los participantes fueron distribuidos en tres grupos: G1 (infanto-juvenil), G2 (adolescentes) y G3 (adultos). Para la obtención de informaciones sobre lesiones, se utilizó una averiguación de morbilidad referida. Fueron realizados análisis para caracterización antropométrica, flexibilidad articular, extensibilidad muscular y alineamiento corporal. En relación a la prevalencia de LD, fueran registrados 55 LD durante las dos últimas temporadas, siendo que 48 participantes (28,23%) relataron presencia de LD. El G3 reveló la mayor tasa de prevalencia de LD, totalizando 0,68 LD/atleta. La tasa de lesión por atleta se presentó mayor en el G2, con 1,4 LM/atleta lesionado. El G2 presentó mayor grado de flexibilidad articular de la cadera, con alcance de 26,3±8,0 cm en el test de sentarse y alcanzar. El G3 presentó los mayores índices de prevalencia de retracción para flexores de la cadera. Al test de Schõber, el G2 mostró la mayor prevalencia de inflexibilidad lumbar. Se concluye que atletas profesionales tienen mayor incidencia y prevalencia de LD. Los índices de inflexibilidad fueron particularmente importantes en franjas etáreas más jóvenes, sugiriendo que una posible interacción entre atributos intrínsecos y extrínsecos se asocie a trastornos musculoesqueléticos en jóvenes atletas...

Características das lesões desportivas e fatores associados com lesão em iniciantes de ginástica artística do sexo feminino / Characteristics of sports injuries and factors associated with injury in beginners of female artistic gymnastics / Características de las lesiones deportivas y factores asociados con lesión en iniciantes de gimnasia artística del sexo feminino

A ginástica artística é uma modalidade que combina arte a gestos biomecânicos e tem se destacado entre crianças e adolescentes. Sua prática pode conduzir a lesões desportivas, por isso é importante conhecer os fatores inerentes ao traumatismo para formulação de modelos preventivos. Desse modo, objetivou-se caracterizar as lesões desportivas e verificar os fatores associados com lesão em praticantes de ginástica artística de diferentes níveis de competitividade. Foram entrevistadas 46 ginastas, com média de idade de 10,1±2,0 anos do sexo feminino, classificadas em dois níveis competitivos: iniciação e treinamento. Utilizou-se o inquérito de morbidade referida adaptado com as características da modalidade para reunir dados pessoais, de treinamento e da lesão. Foram observadas 0,3 lesões por atleta e 1,4 lesões por atleta lesionado, em que ginastas da categoria de treinamento apresentaram maior frequência de lesão (83,3%; n=10) do que as de iniciação (10,5%; n=4). Para ambos os níveis, o momento treinamento e a gravidade leve foram os mais relatados. No mecanismo, o sem contato foi mais prevalente na categoria de treinamento (90%; n=9) e o contato direto foi o mais frequente na iniciação (75%; n=3). As variáveis antropométricas e de treinamento foram consideradas fatores associados com lesão para as ginastas. Conclui-se que ginastas da categoria de treinamento possuem maior frequência de lesão. As variáveis antropométricas e de treinamento foram fatores associados com lesão. As características das lesões dependem do nível de competitividade das ginastas...

The artistic gymnastics is a modality that associates arts with biomechanical gestures, and it has been prominent among children and adolescents. Its practice can lead to sports injuries; therefore, it is important to know the factors inherent to trauma for the formulation of preventive models. Thus, the objective of this study was to characterize sports injuries and to verify factors associated with injury in people practicing artistic gymnastics with different levels of competitiveness. Forty-six gymnasts were interviewed with mean age of 10.1±2.0 years for female participants, who were classified in two competitive levels, i.e, initiation and training. We used the morbidity questionnaire adapted to sports characteristics to collect personal, training, and injury data. It was observed that injury risk was 0.3 injuries per athlete and 1.4 injuries per injured athlete, in which the gymnasts of the training category showed a higher frequency of the injury (83.3%; n=10) compared with the ones in the initiation category (10.5%; n=4). For both levels of competitiveness, training moment and light severity were the most reported variables. In the mechanism, contactless was more prevalent in the training category (90%; n=9) and the direct contact was more common at initiation category (75%; n=3). Anthropometric and training variables were considered as factors associated with injury to the gymnasts. It is concluded that gymnasts of the training category have higher injury frequency. Anthropometric and training variables were factors associated with injury. Characteristics of the injuries depend on the competitiveness level of the ­gymnasts...

La gimnasia artística es una modalidad que combina arte y gestos biomecánicos, y es destacada entre niños y adolescentes. Su práctica puede conducir a lesiones deportivas, por eso es importante conocer los factores inherentes al traumatismo para la formulación de modelos preventivos. De ese modo, el objetivo de este estudio es caracterizar las lesiones deportivas y verificar los factores asociados con lesión en practicantes de gimnasia artística de diferentes niveles de competitividad. Fueron entrevistadas 46 gimnastas, con edad media de 10,1±2,0 años de sexo femenino, clasificadas en dos niveles competitivos: iniciación y entrenamiento. Se utilizó la encuesta de morbilidad adaptada a las características de este deporte para recabar datos personales, de entrenamiento y de lesión. Fueron observadas 0,3 lesiones por atleta y 1,4 lesiones por atleta lesionado, en que gimnastas de la categoría de entrenamiento presentaron mayor frecuencia de lesión (83,3%; n=10) comparadas con las de iniciación (10,5%, n=4). Para ambos niveles, el momento de entrenamiento y la gravedad leve fueron los más relatados. En cuanto al mecanismo, el sin contacto fue el más prevalente en la categoría de entrenamiento (90%; n=9) y de contacto directo fue el más frecuente en la iniciación (75%; n=3). Las variables antropométricas y de entrenamiento fueron consideradas factores asociados con lesión para las gimnastas. Se concluye que las gimnastas de la categoría de entrenamiento poseen mayor frecuencia de lesión. Las variables antropométricas y de entrenamiento fueron factores asociados con lesión. Las características de las lesiones dependen del nivel de competitividad de las gimnastas...

Los desgarros del manguito rotador en atletas / Rotator cuff injuries in athletes

La patología del hombro en deportistas de uso dominante del miembro superior son tan habituales como problemáticas, y las lesiones del manguito rotador, especialmente del supraespinoso son las más frecuentes, abarcando desde tendinopatías, desgarros parciales y desgarros completos. Los factores predisponentes en general son la inadecuada utilización del hombro junto con disbalances musculares sometidos a microtraumas o macrotraumas, y en deportistas de mediana edad se agrega el estado degenerativo del manguito rotador. En este trabajo se abordan estas lesiones para comprender su fisiopatología, cuadro clínico, estudios complementarios, y las opciones de tratamiento.

Traumatismos oculares pediátricos que ameritaron hospitalización / Pediatric ocular traumatism that required hospitalization

Describir los aspectos epidemiológicos, clínicos y terapéuticos de pacientes con traumatismos oculares (TO) que ameritaron hospitalización en el período comprendido. El estudio transversal retrospectivo. Se revisaron las historias de 288 niños que ingresaron a nuestro centro con diagnóstico de TO desde enero 1996 a diciembre 2000, analizando el sexo, edad, circunstancia y localización del TO, conducta terapéutica y días de hospitalización. Se utilizaron técnicas estadísticas descriptivas con medidas porcentuales y frecuencia brutal de los datos. El grupo más afectado fue 7 a 9 años, seguido por el grupo de 4 a 6 años con el 34,3 por ciento, mayormente de sexo masculino 72 por ciento de la población y la circunstancia del TO fue el accidente doméstico en 63 por ciento de los casos y agresiones infantiles en un 15 por ciento. El agente causal más frecuente fueron piedras (30 por ciento) y palos (19 por ciento). La lesión ocular más frecuente fue el hifema (36 por ciento), seguido de perforación ocular con heridas: corneal (32 por ciento), corneoescleral (8 por ciento); el 50 por ciento de los casos ameritó tratamiento quirúrgico, con 4,55 días de hospitalización de promedio (DE=3.72). El no discriminar adecuadamente los factores de riesgo potenciales hacen a los niños mucho más proclives a sufrir TO. Es por ello que se podría sugerir que el status social, cultural y económico aunado a la negligencia de los padres representa factores importantes en los TO oculares en los niños que ocurren en el hogar.

Síndrome do Overtraining / Overtraining syndrome

Os autores fazem uma revisão bibliográfica acerca da etiologia, quadro clínico, critérios diagnósticos e, principalmente, prevenção e tentativas de tratamento da síndrome do overtraining.

In this paper, the authors review the literature regarding to ethiology, clinical presentation, diagnostic criteria and particularly the prevention and the methods of treatment of the overtraining syndrome.

Indice de compresión patelar inverso: un nuevo parámetro radiológico en el pronóstico de las lesiones de la rodilla / Inverse patellar compression index. A new radiological parameter for the prognosis of the kee injuries

Se recopilan datos radiológicos de las rodillas de 40 individuos deportistas sin antecedentes de traumatismos, malformaciones ni datos patológicos importantes en sus rodillas. Se establece un índice matemático con medidas específicas en las rótula y se encuentra una prevalencia de síntomas rótulo-femorales relacionados con el ejercicio y un índice patelar inverso de menos de 2.8, lo cual puede relacionarse como valor pronóstico en atletas

Lesiones más comunes en la rodilla del corredor / The most common injuries in the runner's knee

En un afán de mantenerse en buenas condiciones de salud, el hombre ha extendido la práctica de la carrera a edades cada vez más tempranas y tardías; esto nos ha llevado a observar con más frecuencia afecciones clínicas que hasta hace poco eran relativamente raras. En esta revisión analizaremos estas enfermedades de la rodilla, y comentaremos el tratamiento de cada una de ellas